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El Assar M, Rodríguez-Sánchez I, Álvarez-Bustos A, Rodríguez-Mañas L. Biomarkers of frailty. Mol Aspects Med 2024; 97:101271. [PMID: 38631189 DOI: 10.1016/j.mam.2024.101271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
Several biomarkers have been proposed to identify frailty, a multisystemic age-related syndrome. However, the complex pathophysiology and the absence of a consensus on a comprehensive and universal definition make it challenging to pinpoint a singular biomarker or set of biomarkers that conclusively characterize frailty. This review delves into the main laboratory biomarkers, placing special emphasis on those associated with various pathways closely tied to the frailty condition, such as inflammation, oxidative stress, mitochondrial dysfunction, metabolic and endocrine alterations and microRNA. Additionally, we provide a summary of different clinical biomarkers encompassing different tools that have been proposed to assess frailty. We further address various imaging biomarkers such as Dual Energy X-ray Absorptiometry, Bioelectrical Impedance analysis, Computed Tomography and Magnetic Resonance Imaging, Ultrasound and D3 Creatine dilution. Intervention to treat frailty, including non-pharmacological ones, especially those involving physical exercise and nutrition, and pharmacological interventions, that include those targeting specific mechanisms such as myostatin inhibitors, insulin sensitizer metformin and with special relevance for hormonal treatments are mentioned. We further address the levels of different biomarkers in monitoring the potential positive effects of some of these interventions. Despite the availability of numerous biomarkers, their performance and usefulness in the clinical arena are far from being satisfactory. Considering the multicausality of frailty, there is an increasing need to assess the role of sets of biomarkers and the combination between laboratory, clinical and image biomarkers, in terms of sensitivity, specificity and predictive values for the diagnosis and prognosis of the different outcomes of frailty to improve detection and monitoring of older people with frailty or at risk of developing it, being this a need in the everyday clinical practice.
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Affiliation(s)
- Mariam El Assar
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Alejandro Álvarez-Bustos
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, Spain.
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El Assar M, Carnicero JA, Angulo J, Cámara-Hernández V, García-García FJ, Rodríguez-Mañas L. Fat Mass Accounts for Insulin Resistance Impact on Functional Decline and Mortality in Nondiabetic Older Adults. J Am Med Dir Assoc 2024; 25:448-453. [PMID: 37898163 DOI: 10.1016/j.jamda.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To assess the potential role of body composition in the association of insulin resistance (IR) with functional decline and mortality in nondiabetic older persons. DESIGN Longitudinal population-based cohort of community-dwelling people from Toledo, Spain, aged 65 years or older. SETTING AND PARTICIPANTS A total of 1114 nondiabetic persons from the Toledo Study of Healthy Aging cohort (mean age: 74.5, 56.10% female) with complete data at baseline were included. Only 914 participants had fully assessment of functional evaluation during the follow-up period. METHODS IR was determined by the homeostasis model assessment index (HOMA-IR) at baseline while frailty was assessed by the Frailty Trait Scale-5 (FTS-5) at baseline and after 2.99 years' median follow-up period. A total of 319 participants experienced functional decline (2.5-point reduction in the FTS-5 score). A total of 143 deaths were recorded (6.31 years median follow-up) from the Spanish National Death Index. Body compositions were determined using dual-energy x-ray absorptiometry. Multivariate regression models analyzed the effect of HOMA-IR on outcomes, with age, sex, Charlson index, and number of medications included in the basic adjustment model. RESULTS A 1-logaritmic unit increment in HOMA-IR increased the risk of functional decline after basic adjustment [odds ratio (95% confidence interval): 1.41 (1.09-1.83), P = .009]. This significant association was lost when further adjusted for total fat mass [1.14 (0.86-1.50)] and trunk fat mass [1.03 (0.77-1.37)], which accounted for 62.92% and 91.49% of the association. HOMA-IR was inversely associated with mortality risk [hazard ratio 0.66 (0.49-0.87), P = .0037], an association lost after adjustment for total fat mass [0.74 (0.55-1.01)] and trunk fat mass [0.80 (0.58-1.09)], accounting for 29.05% and 45.78% of the association. Adjustment by lean mass did not modify any of the associations. CONCLUSIONS AND IMPLICATIONS Body fat mass, especially in the trunk region, mediates the association of IR with functional decline and to a lesser extent with reduced risk of mortality in nondiabetic older subjects.
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Affiliation(s)
- Mariam El Assar
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - José Antonio Carnicero
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Angulo
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Histología-Investigación, Unidad de Investigación Traslacional en Cardiología (IRYCIS-UFV), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Francisco José García-García
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Leocadio Rodríguez-Mañas
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Spain.
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O'Brien MW, Kimmerly DS, Theou O. Impact of age and sex on the relationship between carotid intima-media thickness and frailty level in the Canadian Longitudinal Study of Aging. J Cardiol 2023; 82:140-145. [PMID: 36682711 DOI: 10.1016/j.jjcc.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/02/2022] [Accepted: 12/17/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Carotid intima-media thickness (cIMT) provides an index of arterial injury. Frailty is an indicator of vulnerability to adverse health outcomes. It is unclear whether cIMT is associated with the multi-dimensional frailty index and/or if this relationship is age- or sex-specific. The aim was to determine the impact of age and sex on the relationship between cIMT and frailty level in middle-aged and older adults. METHODS Frailty and cIMT data were extracted from the Canadian Longitudinal Study of Aging baseline comprehensive cohort of middle-aged (45-64 years) and older adults (>65 years) (n = 10,209). cIMT was assessed via high-resolution ultrasound. Frailty was determined using a 52-item index. Covariate-adjusted ordinary least squares regressions were conducted separately for middle-aged males (n = 3178), middle-aged females (n = 3125), older males (n = 2031), and older females (n = 1875). RESULTS Average cIMTs were larger in older versus middle-aged adults and in males versus females (all, p < 0.001). Average cIMT was positively associated with frailty level in adjusted linear regression models in middle-aged males [adj. R2 = 0.09; β = 0.015 (95 % CI: 0.005-0.026), p = 0.004], middle-aged females [adj. R2 = 0.11; β = 0.040 (95 % CI: 0.025-0.054), p < 0.001], older males [adj. R2 = 0.12; β = 0.019 (95 % CI: 0.004-0.034), p = 0.01], and older females [adj. R2 = 0.11; β = 0.020 (95 % CI: 0.002-0.039), p = 0.03]. CONCLUSION cIMT was an independent contributor to frailty level regardless of age group (middle-aged/older adults) or sex, with the strongest effect observed in middle-aged females. Our cross-sectional study documents the independent relationship between a marker of cardiovascular function and an increased vulnerability to adverse health outcomes in middle-aged and older males and females.
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Affiliation(s)
- Myles W O'Brien
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada; School of Physiotherapy (Faculty of Health) and Division of Geriatric Medicine (Faculty of Medicine), Dalhousie University, Halifax, Nova Scotia, Canada; Geriatric Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Derek S Kimmerly
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Theou
- School of Physiotherapy (Faculty of Health) and Division of Geriatric Medicine (Faculty of Medicine), Dalhousie University, Halifax, Nova Scotia, Canada; Geriatric Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia, Canada.
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Xi L, Xuemei Z, Ling Y, Changchun C, Zhuo H, Jinyang Q, Xin W. Correlation between frailty and cardiac structure and function in echocardiography in elderly patients with normal ejection fraction. Aging Clin Exp Res 2023; 35:775-784. [PMID: 36871112 DOI: 10.1007/s40520-023-02363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/03/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE This study aims to accurately evaluate the cardiac structure and function of the frail population in elderly patients with normal ejection fraction (EF) using the 3D volume quantification and speckle tracking of echocardiography, to explore the correlation between frailty and cardiac structure and function. METHODS A total of 350 elderly aged 65 and above in-patients, excluding those with congenital heart disease, cardiomyopathy, and severe valvular heart disease, were included in the study. Patients were divided into non-frail, pre-frail, and frail group. Echocardiography techniques including speckle tracking and 3D volume quantification, were used to analyze the cardiac structure and function of the study subjects. Comparative analysis was statistically significant if P < 0.05. RESULTS The cardiac structure of the frail group was different compared with non-frail patients, the frail group demonstrated increased left ventricular myocardial mass index (LVMI), but decreased stroke volume. Cardiac function was also impaired in the frail group: reservoir strain and conduit strain of left atrium, strain of right ventricular (RV) free wall, strain of RV septum, 3D EF of RV, and global longitudinal strain of LV were significantly decreased. Frailty was significantly and independently associated with LV hypertrophy (OR 1.889; 95% CI 1.240,2.880; P = 0.003), LV diastolic dysfunction (OR 1.496; 95% CI 1.016,2.203; P = 0.041), left ventricular global longitudinal strain (LVGLS) reduction (OR 1.697; 95% CI 1.192, 2.416; P = 0.003), and reduced RV systolic function (OR 2.200; 95% CI 1.017, 4.759; P = 0.045). CONCLUSION Frailty is closely associated with several heart structural and functional alterations, which not only manifested as LV hypertrophy and reduced LV systolic function, but also decreased LV diastolic function, RV systolic function, and left atrial systolic function. Frailty is an independent risk factor for LV hypertrophy, LV diastolic dysfunction, LVGLS reduction, and reduced RV systolic function. TRIAL REGISTRATION NUMBER ChiCTR2000033419. Date of registration: May 31, 2020.
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Affiliation(s)
- Li Xi
- Department of Cardiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Sichuan, China
| | - Zhong Xuemei
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Ling
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Chen Changchun
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Hou Zhuo
- Department of Cardiology, West China Tianfu Hospital of Sichuan University, Chengdu, China
| | - Qin Jinyang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Xin
- Department of Cardiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Sichuan, China.
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Almahmoud QF, Alhaidar SM, Alkhenizan AH, Basudan LK, Shafiq M. Association Between Lipid Profile Measurements and Mortality Outcomes Among Older Adults in a Primary Care Setting: A Retrospective Cohort Study. Cureus 2023; 15:e35087. [PMID: 36938202 PMCID: PMC10022913 DOI: 10.7759/cureus.35087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
Background Lipid profile components play a role in predicting the development of cardiovascular disease and hence mortality, but recent studies have shown mixed results in the older population. The aim of our study was to investigate the association between levels of lipid profile components with all-cause mortality and cardiovascular outcomes among older adults in a primary care setting in Riyadh, Saudi Arabia. Methods A retrospective cohort study was performed among 485 individuals aged 60 years and older who visited the family medicine clinics linked to a tertiary care hospital during the first six months of 2010. The electronic charts of the participants were reviewed up to April 2022 to gather relevant data. Each lipid profile component, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs), was categorized into four quartiles. LDL was calculated using the Friedewald formula. Cardiovascular outcomes included ischemic heart disease (IHD), heart failure (HF), and stroke. Results The mean follow-up period was 12 years. The elderly participants with the lowest HDL-C quartile (<1.1 mmol/L) were at higher risk of all-cause mortality (adjusted hazard ratio of 2.023 (95% CI 1.21-3.38)) and IHD (adjusted hazard ratio 3.2 (95% CI 1.6-6.2)). High TC (≥5.7 mmol/L) was associated with an increased risk of HF (adjusted hazard ratio 2.1 (95% CI 1.1-4.0)). Conclusion In patients aged 60 years and older, low HDL-C (<1.1 mmol/L) was associated with a higher risk for all-cause mortality and IHD, and high TC was associated with an increased risk of having HF. No significant association was found for LDL-C, TC, and TGs with all-cause mortality.
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Affiliation(s)
- Qusay F Almahmoud
- Family Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Saud M Alhaidar
- Family Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | - Loay K Basudan
- Family Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Mohammed Shafiq
- Family Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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Huang YN, Yan FH, Wang XY, Chen XL, Chong HY, Su WL, Chen YR, Han L, Ma YX. Prevalence and Risk Factors of Frailty in Stroke Patients: A Meta-Analysis and Systematic Review. J Nutr Health Aging 2023; 27:96-102. [PMID: 36806864 DOI: 10.1007/s12603-023-1879-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Summarize the existing evidence regarding the prevalence and risk factors of frailty in stroke patients. DESIGN A meta-analysis and systematic review. PARTICIPANTS Stroke patients in hospitals or communities. METHODS We undertook a systematic review and meta-analysis using articles available in 8 databases, including PubMed, The Cochrane Library, Web of Science, Embase, Chinese Biomedical Database (CBM), China National Knowledge Infrastructure Database (CNKI), Wanfang Database, and Weipu Database (VIP) from January 1990 to April 2022. Studies were quality rated using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality tool. RESULTS A total of 24 studies involving 30,423 participants were identified. The prevalence of frailty and pre-frailty in stroke patients was 27% (95%CI: 0.23-0.31) and 47.9% (95%CI: 0.43-0.53). Female gender (OR = 1.76, 95%CI: 1.63-1.91), advanced age (MD = 6.73, 95%CI: 3.55-9.91), diabetes (OR = 1.34, 95%CI: 1.06-1.69), hyperlipidemia (OR = 1.46, 95%CI: 1.04-2.04), atrial fibrillation (OR = 1.36, 95%CI: 1.01-1.82), National Institutes of Stroke Scale (NIHSS) admission scores (MD = 2.27, 95%CI: 1.72-2.81) were risk factors of frailty in stroke patients. CONCLUSIONS Frailty was more prevalent in stroke patients. Female gender, advanced age, diabetes, hyperlipidemia, atrial fibrillation, and National Institutes of Stroke Scale (NIHSS) admission scores were identified as risk factors for frailty in stroke patients. In the future, medical staff should pay attention to the early screening of frailty in high-risk groups and provide information on its prevention.
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Affiliation(s)
- Y N Huang
- Yuxia Ma, Lin Han, Lanzhou University, China ,
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McKechnie DGJ, Patel M, Papacosta AO, Lennon LT, Ellins EA, Halcox JPJ, Ramsay SE, Whincup PH, Wannamethee SG. Associations between inflammation, coagulation, cardiac strain and injury, and subclinical vascular disease with frailty in older men: a cross-sectional study. BMC Geriatr 2022; 22:405. [PMID: 35527242 PMCID: PMC9082861 DOI: 10.1186/s12877-022-03106-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 04/27/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Inflammation, coagulation activation, endothelial dysfunction and subclinical vascular disease are cross-sectionally associated with frailty. Cardiac-specific biomarkers are less-well characterised. We assessed associations between these and frailty, in men with, and without, cardiovascular disease (CVD). METHODS Cross-sectional analysis of 1096 men without, and 303 with, CVD, aged 71-92, from the British Regional Heart Study. Multinominal logistic regression was performed to examine the associations between frailty status (robust/pre-frail/frail) and, separately, C-reactive protein (CRP), interleukin-6 (IL-6), tissue plasminogen activator (tPA), D-dimer, von Willebrand factor (vWF), high-sensitivity cardiac troponin-T (hs-cTnT), N-terminal pro B-type natriuretic peptide (NT-proBNP) (all natural log-transformed), and, in men without CVD, carotid intima-media thickness (CIMT), carotid-femoral pulse wave velocity (cfPWV), carotid distensibility coefficient (DC), and ankle-brachial pressure index (ABPI), adjusted for age, renal function, BMI, social class, smoking, polypharmacy, cognition, multimorbidity and systolic blood pressure. Explanatory variables with p < 0.05 were carried forward into mutually-adjusted analysis. RESULTS In men without CVD, higher CRP, IL-6, vWF, tPA, hs-cTnT, NT-proBNP, cfPWV, and lower DC were significantly associated with frailty; mutually-adjusted, log IL-6 (OR for frailty = 2.02, 95%CI 1.38-2.95), log hs-cTnT (OR = 1.95, 95%CI 1.24-3.05) and DC (OR = 0.92, 95%CI 0.86-0.99) retained associations. In men with CVD, higher CRP, IL-6, and hs-cTnT, but not vWF, tPA, NT-proBNP or D-dimer, were significantly associated with frailty; mutually-adjusted, log hs-cTnT (OR 3.82, 95%CI 1.84-7.95) retained a significant association. CONCLUSIONS In older men, biomarkers of myocardial injury are associated with frailty. Inflammation is associated with frailty in men without CVD. Carotid artery stiffness is associated with frailty in men without CVD, independently of these biomarkers.
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Affiliation(s)
- Douglas G J McKechnie
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK.
| | - Meera Patel
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK
| | - A Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK
| | | | | | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK
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Xu Y, Wang M, Chen D, Jiang X, Xiong Z. Inflammatory biomarkers in older adults with frailty: a systematic review and meta-analysis of cross-sectional studies. Aging Clin Exp Res 2022; 34:971-987. [PMID: 34981430 DOI: 10.1007/s40520-021-02022-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/05/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Systemic chronic inflammation has been proposed as an essential mediating factor in frailty, and several studies tested its relationship with frailty. However, the issue is still controversial. OBJECTIVES We identified observational studies and pooled their results to assess whether abnormal expression of inflammatory biomarkers is present in the blood of older adults with frailty. METHODS We conducted a systematic search on the Medline, Embase, and Web of Science database from inception to 1st September 2021. The quality of included studies was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies (JBI-MAStARI). Study heterogeneity was assessed with the Cochran Q test and I2 statistic. Pooled estimates were obtained through random-effect models. Sensitivity analyses were conducted by excluding one of the studies. Egger's regression test and observation of funnel plots were used to detect small-study effects and publication bias. PROSPERO registration: CRD42020172853. RESULT A total of 53 cross-sectional studies corresponding to 56 independent study populations were included in this analysis. There were 31 study populations with three frailty categories (3144 frailty, 14,023 pre-frailty, 10,989 robust) and 25 study populations with two frailty categories (2576 frailty, 8368 non-frailty). This meta-analysis performed pooled analyses for the inflammatory biomarker leukocyte, lymphocytes, CRP, IL-6, IL-10, and TNF-α. Older adults with frailty had lower lymphocytes and higher interleukin-6 (IL-6), C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) levels compared with the control group. However, there was no significant difference in leukocyte and IL-10 levels in the two groups. CONCLUSIONS These findings suggest that peripheral inflammatory biomarkers lymphocytes, IL-6, CRP, and TNF-α are related to frailty status. Our findings are not conclusive regarding the causal relationship between chronic inflammation and frailty, so the development of further longitudinal and well-designed studies focused on this is necessary.
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Affiliation(s)
- YuShuang Xu
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Geriatric Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - MengMeng Wang
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Geriatric Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Di Chen
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Geriatric Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Jiang
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Geriatric Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ZhiFan Xiong
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Institute of Geriatric Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Guaita A, Brunelli L, Davin A, Poloni TE, Vaccaro R, Gagliardi S, Pansarasa O, Cereda C. Homocysteine, Folic Acid, Cyanocobalamin, and Frailty in Older People: Findings From the “Invece. Ab” Study. Front Physiol 2021; 12:775803. [PMID: 34975530 PMCID: PMC8717775 DOI: 10.3389/fphys.2021.775803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Frailty is an important age-related syndrome associated with several adverse health outcomes. Its biological basis is undefined. Raised plasma homocysteine (HOcy) is an established risk factor for cardiovascular disease, dementia, cognitive impairment, and mortality, but little is known about the possible role of plasma HOcy, cyanocobalamin (B12), and folate (FO levels in the development of frailty. Our first aim was to explore the possible association between frailty and plasma concentrations of HOcy, FO, and B12 in a cohort of community-dwelling older people. The second was to assess the influence of these metabolic factors on six-year incidence of frailty in the 875 individuals eligible for inclusion in this study (those with a full follow-up dataset). This research is based on data from three waves – 2012 (herein taken as baseline), 2014, and 2018 – of a longitudinal study (InveCe.Ab) in which non-frail men and women born between 1935 and 1939 underwent multidimensional assessments. Frailty was estimated using a deficit accumulation-based frailty index (FI). HOcy concentration was significantly positively correlated with FI at all timepoints, while B12 and FO levels were not. Plasma concentration of HOcy emerged as a predictor of six-year cumulative incidence of frailty, independent of age, sex, and education, while B12 and FO levels showed no relationship with frailty incidence. Individuals with plasma HOcy in the top quintile showed five months less frailty-free survival (HR 1.487; 95% CI: 1.063–2.078), regardless of age, sex, and education. These results demonstrate that higher HOcy is a risk factor for frailty onset in older adults.
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Affiliation(s)
- Antonio Guaita
- Epidemiological and Neuropathological Laboratories, Golgi Cenci Foundation, Abbiategrasso, Italy
- *Correspondence: Antonio Guaita,
| | - Laura Brunelli
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Annalisa Davin
- Epidemiological and Neuropathological Laboratories, Golgi Cenci Foundation, Abbiategrasso, Italy
| | - Tino Emanuele Poloni
- Epidemiological and Neuropathological Laboratories, Golgi Cenci Foundation, Abbiategrasso, Italy
| | - Roberta Vaccaro
- Epidemiological and Neuropathological Laboratories, Golgi Cenci Foundation, Abbiategrasso, Italy
| | - Stella Gagliardi
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Orietta Pansarasa
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Cereda
- Epidemiological and Neuropathological Laboratories, Golgi Cenci Foundation, Abbiategrasso, Italy
- Department of Woman, Mother and Newborn, ASST Fatebenefratelli Sacco, “V. Buzzi” Children Hospital, Milan, Italy
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10
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Yuan L, Chang M, Wang J. Abdominal obesity, body mass index and the risk of frailty in community-dwelling older adults: a systematic review and meta-analysis. Age Ageing 2021; 50:1118-1128. [PMID: 33693472 DOI: 10.1093/ageing/afab039] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Indexed: 12/11/2022] Open
Abstract
Obese older people are more likely to be frail than those with a normal body mass index (BMI), but the results of individual studies have been inconsistent. We conducted a systematic review and meta-analysis to clarify the association between obesity and the risk of frailty, and whether there was a relationship between BMI and frailty, in community-dwelling older adults aged ≥60 years. Eight databases (PubMed/MEDLINE, EMBASE, EBSCO, CINAHL, Scopus, Cochrane Library and Web of Science) were systematically searched from inception to August 2020. Relative risks for incident frailty were pooled using a random-effects model. We found a positive association between abdominal obesity and frailty [relative risk (RR) = 1.57, 95% confidence interval (CI) 1.29-1.91, I2 = 48.1%, P = 0.086, six observational studies, 18,764 subjects]. People in the higher category of waist circumference had a pooled 57% higher risk of frailty than those with a normal waist circumference. In addition, a total of 12 observational studies comprising 37,985 older people were included in the meta-analysis on the relationship between BMI and the risk for frailty. Taking the normal BMI as the reference group, the pooled RR of frailty risk ranged from 1.45 (95% CI 1.10-1.90, I2 = 83.3%; P < 0.01) for the underweight group, to 0.93 (95% CI 0.85-1.02, I2 = 34.6%; P = 0.114) for the overweight group and to 1.40 (95% CI 1.17-1.67, I2 = 86.1%; P < 0.01) for the obese group. We have shown that obesity or underweight is associated with an increased risk of frailty in community-dwelling older adults.
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Affiliation(s)
- Linli Yuan
- Medical School, Nanjing University, Nanjing 210093, PR China
| | - Meilian Chang
- Pediatric Outpatient Clinic, Changzheng People's Hospital of Shangqiu City, Shangqiu 476000, PR China
| | - Jing Wang
- Fudan University School of Nursing, Shanghai 200032, PR China
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11
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Sola-Rodríguez S, Vargas-Hitos JA, Gavilán-Carrera B, Rosales-Castillo A, Sabio JM, Hernández-Martínez A, Martínez-Rosales E, Ortego-Centeno N, Soriano-Maldonado A. Relative Handgrip Strength as Marker of Cardiometabolic Risk in Women with Systemic Lupus Erythematosus. Int J Environ Res Public Health 2021; 18:ijerph18094630. [PMID: 33925420 PMCID: PMC8123887 DOI: 10.3390/ijerph18094630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to examine the association of relative handgrip strength (rHGS) with cardiometabolic disease risk factors in women with systemic lupus erythematosus (SLE). Methods: Seventy-seven women with SLE (mean age 43.2, SD 13.8) and clinical stability during the previous six months were included. Handgrip strength was assessed with a digital dynamometer and rHGS was defined as absolute handgrip strength (aHGS) divided by body mass index (BMI). We measured blood pressure, markers of lipid and glucose metabolism, inflammation (high sensitivity C-reactive protein [hs-CRP]), arterial stiffness (pulse wave velocity [PWV]), and renal function. A clustered cardiometabolic risk index (z-score) was computed. Results: Pearson′s bivariate correlations revealed that higher rHGS was associated with lower systolic blood pressure (SBP), triglycerides, hs-CRP, PWV, and lower clustered cardiometabolic risk (rrange = from −0.43 to −0.23; all p < 0.05). Multivariable linear regression analyses adjusted for age, disease activity (SLEDAI), and accrual damage (SDI) confirmed these results (all p < 0.05) except for triglycerides. Conclusions: The findings suggest that higher rHGS is significantly associated with lower cardiometabolic risk in women with SLE.
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Affiliation(s)
- Sergio Sola-Rodríguez
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (A.H.-M.); (E.M.-R.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
- Correspondence: ; Tel.: +34-675-109-317
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.A.V.-H.); (A.R.-C.); (J.M.S.)
| | - Blanca Gavilán-Carrera
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain;
| | - Antonio Rosales-Castillo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.A.V.-H.); (A.R.-C.); (J.M.S.)
| | - José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.A.V.-H.); (A.R.-C.); (J.M.S.)
| | - Alba Hernández-Martínez
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (A.H.-M.); (E.M.-R.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
| | - Elena Martínez-Rosales
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (A.H.-M.); (E.M.-R.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
| | - Norberto Ortego-Centeno
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, “San Cecilio” University Hospital, 18016 Granada, Spain;
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (A.H.-M.); (E.M.-R.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
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12
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Kim JH, Ha MS, Ha SM, Kim DY. Aquatic Exercise Positively Affects Physiological Frailty among Postmenopausal Women: A Randomized Controlled Clinical Trial. Healthcare (Basel) 2021; 9:healthcare9040409. [PMID: 33918160 PMCID: PMC8065774 DOI: 10.3390/healthcare9040409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 12/25/2022] Open
Abstract
Frailty is a risk factor associated with aging. Physical exercise is an important lifestyle factor that can help to avoid risks associated with aging. Therefore, we aimed to determine the effects of aquatic exercise for 12 weeks on body composition, cardiovascular disease risk factors, insulin resistance, and aging-related sex hormones in elderly South Korean women. Twenty-two women aged 70–82 years were randomly assigned to groups that participated or did not participate (controls; n = 10 in aquatic exercise for 60 min, three times per week for 12 weeks (n = 12). Exercise intensity defined as the rating of perceived exertion (RPE), was increased from 12–13 to 13–14, and to 14–15 during weeks 1–4, 5–8, and 9–12, respectively. Body composition (skeletal muscle mass, ratio (%) body fat, and waist circumference), cardiovascular disease risk factors (total, high-density lipoprotein, and low-density lipoprotein cholesterol), insulin resistance (glucose, insulin, and homeostatic model assessment of insulin resistance [HOMA-IR]), and aging-related sex hormone changes (dehydroepiandrosterone-sulfate [DHEA-S]) and sex hormone-binding globulin [SHBG]) were assessed. Aquatic exercise safely improved body composition, reduced insulin resistance, and positively affected the sex hormones DHEA-S and SHBG as well as blood lipid profiles. Our findings suggested that the aquatic exercise program positively altered blood lipids, regulated glucose levels, and sex hormone levels. Therefore, regular, and continuous aquatic exercise is recommended to prevent frailty, decrease cardiovascular risk, and provide older women with an optimal quality of life as they age.
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Affiliation(s)
- Ji-Hyeon Kim
- Department of Liberal Arts, Mokpo National Maritime University, Jeollanam-do 58628, Korea;
| | - Min-Seong Ha
- Department of Sports Culture, College of the Arts, Dongguk University-Seoul, Seoul 04620, Korea;
| | - Soo-Min Ha
- Laboratory of Exercise Physiology, Department of Physical Education, Pusan National University, Busan 46241, Korea;
| | - Do-Yeon Kim
- Laboratory of Exercise Physiology, Department of Physical Education, Pusan National University, Busan 46241, Korea;
- Correspondence: ; Tel.: +82-51-510-2718
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13
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Álvarez-Sánchez N, Álvarez-Ríos AI, Guerrero JM, García-García FJ, Rodríguez-Mañas L, Cruz-Chamorro I, Lardone PJ, Carrillo-Vico A. Homocysteine and C-Reactive Protein Levels Are Associated With Frailty in Older Spaniards: The Toledo Study for Healthy Aging. J Gerontol A Biol Sci Med Sci 2021; 75:1488-1494. [PMID: 31304964 DOI: 10.1093/gerona/glz168] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Indexed: 01/12/2023] Open
Abstract
High-sensitivity C-reactive protein (hsCRP) and homocysteine (Hcy) are inflammation markers but are also related to cardiovascular diseases, disability, or higher risk of death. Although inflammation is considered to be associated with frailty, data regarding the association between hsCRP or Hcy and frailty are controversial or scarce, especially with respect to their association with prefrailty. Thus, our objective was to study the association of hsCRP and Hcy with prefrailty and frailty in 1,211 Spanish men and women aged 65-98 years from the Toledo Study for Healthy Aging (TSHA) cohort, classified according to Fried's criteria. Hcy was independently associated with frailty (odds ratio [OR] = 1.06; 95% confidence interval [CI]: 1.01-1.12), whereas hsCRP was independently associated with both prefrailty (OR = 1.03; 95% CI: 1.01-1.06) and frailty (OR = 1.07; 95% CI: 1.02-1.12). Furthermore, both markers were positively correlated with the number of Fried's criteria that were met and were independently associated with the criteria of exhaustion (Hcy: OR = 1.03, 95% CI: 1.00-1.06), weakness (hsCRP: OR = 1.03, 95% CI: 1.01-1.05), and low physical activity (hsCRP: OR = 1.04, 95% CI: 1.02-1.06). Thus, our results highlight the importance of inflammation in age-related physical decline and, in particular, its association with fatigue, low strength, and decreased physical activity.
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Affiliation(s)
- Nuria Álvarez-Sánchez
- Instituto de Biomedicina de Sevilla, IBiS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Spain
| | | | - Juan Miguel Guerrero
- Instituto de Biomedicina de Sevilla, IBiS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Spain.,Department of Clinical Biochemistry, Virgen del Rocío University Hospital, Sevilla, Spain.,Departamento de Bioquímica Médica y Biología Molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, Spain
| | | | - Leocadio Rodríguez-Mañas
- Servicio de Geriatría y Fundación para la Investigación Biomédica, Hospital Universitario de Getafe Madrid, Spain
| | - Ivan Cruz-Chamorro
- Instituto de Biomedicina de Sevilla, IBiS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Spain.,Departamento de Bioquímica Médica y Biología Molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, Spain
| | - Patricia Judith Lardone
- Instituto de Biomedicina de Sevilla, IBiS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Spain.,Departamento de Bioquímica Médica y Biología Molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, Spain
| | - Antonio Carrillo-Vico
- Instituto de Biomedicina de Sevilla, IBiS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Spain.,Departamento de Bioquímica Médica y Biología Molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, Spain
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14
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Shih AC, Chen LH, Tsai CC, Chen JY. Correlation between Sleep Quality and Frailty Status among Middle-Aged and Older Taiwanese People: A Community-Based, Cross-Sectional Study. Int J Environ Res Public Health 2020; 17:ijerph17249457. [PMID: 33348703 PMCID: PMC7766620 DOI: 10.3390/ijerph17249457] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022]
Abstract
Poor sleep quality and frailty are common problems among aged people. However, the association between sleep quality and frailty in middle-aged and older people is seldom discussed in Asia, especially in Taiwan. This study investigated this association hopefully to provide pertinent knowledge for the prevention of frailty. We conducted a cross-sectional study and enrolled 828 subjects, 237 male and 591 female, aged 50–85 years old, from a community in Northern Taiwan. Poor sleep quality was defined as the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) > 5. Prefrailty and frailty were defined as fulfillment of one or two and three, respectively, of five phenotypic criteria: exhaustion, weakness, slowness, weight loss, and low physical activity. Our univariate analysis showed that the incidence of prefrailty/frailty in the group of poor sleep quality was higher than that in the group of CPSQI ≤ 5 (p < 0.001). Further multiple logistic regression analysis revealed that poor sleep quality was an independent factor for prefrailty and frailty status (odds ratio = 1.95, 95% confidence interval = 1.38–2.77), after adjustment for confounding factors. We concluded that poor sleep quality is independently associated with prefrailty and frailty status in our study population.
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Affiliation(s)
- An-Chen Shih
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
| | - Lee-Hwa Chen
- Department of Athletic Training and Health, National Taiwan Sport University, Taoyuan 333, Taiwan; (L.-H.C.); (C.-C.T.)
| | - Chin-Chueh Tsai
- Department of Athletic Training and Health, National Taiwan Sport University, Taoyuan 333, Taiwan; (L.-H.C.); (C.-C.T.)
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-975362672
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15
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Marcos-Pérez D, Sánchez-Flores M, Proietti S, Bonassi S, Costa S, Teixeira JP, Fernández-Tajes J, Pásaro E, Laffon B, Valdiglesias V. Association of inflammatory mediators with frailty status in older adults: results from a systematic review and meta-analysis. GeroScience 2020; 42:1451-1473. [PMID: 32803650 DOI: 10.1007/s11357-020-00247-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022] Open
Abstract
Frailty is a geriatric syndrome defined as a status of extreme vulnerability to stressors, leading to a higher risk of negative health-related outcomes. "Inflammaging", an age-related state of low-grade chronic inflammation, is characterized by an increased concentration of pro-inflammatory cytokines and acute phase proteins. Inflammaging has been postulated as an underlying mechanism of frailty, and several studies tested the relationship between frailty and concentration of inflammatory mediators. The aim of this systematic review and meta-analysis was to test whether inflammatory mediators are overproduced in frail older adults. Among the 758 articles identified in the literature search, 50 were included in the systematic review, and 39 in the three meta-analyses, i.e., C-reactive protein (CRP), interleukin 6 (IL6), and tumor necrosis factor α. To reduce heterogeneity, meta-analyses were restricted to studies identifying frailty by the Fried et al. [1] [J. Gerontol. A. Biol. Sci. Med. Sci. 56, M146-56] phenotypic criteria. Quantitative analyses measuring the association between frailty and biomarker concentrations showed significant differences when frail subjects were compared to non-frail and pre-frail subjects for CRP and IL6. This work established strong association between inflammatory biomarkers and frailty, confirming the role of age-related chronic inflammation in frailty development.
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Affiliation(s)
- Diego Marcos-Pérez
- Universidade da Coruña, Grupo DICOMOSA, Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología, Facultad de Ciencias de la Educación, Campus Elviña s/n, 15071, A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), AE CICA-INIBIC, Oza, 15071, A Coruña, Spain
| | - María Sánchez-Flores
- Universidade da Coruña, Grupo DICOMOSA, Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología, Facultad de Ciencias de la Educación, Campus Elviña s/n, 15071, A Coruña, Spain.,Environmental Health Department, National Health Institute, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal.,EPIUnit -Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal
| | - Stefania Proietti
- Scientific Direction, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166, Rome, Italy
| | - Stefano Bonassi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166, Rome, Italy.,Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Via di Val Cannuta, 247, 00166, Rome, Italy
| | - Solange Costa
- Environmental Health Department, National Health Institute, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal.,EPIUnit -Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal
| | - Joao Paulo Teixeira
- Environmental Health Department, National Health Institute, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal.,EPIUnit -Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal
| | - Juan Fernández-Tajes
- Wellcome Centre for Human Genetics, McCarthy's group, University of Oxford, Roosevelt Drive, Headington, Oxford, OX3 7BN, UK.,Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, CRC, SUS Malmö, Jan Waldenströms gata 35, House 91:12, SE-214 28, Malmö, Sweden
| | - Eduardo Pásaro
- Universidade da Coruña, Grupo DICOMOSA, Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología, Facultad de Ciencias de la Educación, Campus Elviña s/n, 15071, A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), AE CICA-INIBIC, Oza, 15071, A Coruña, Spain
| | - Blanca Laffon
- Universidade da Coruña, Grupo DICOMOSA, Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología, Facultad de Ciencias de la Educación, Campus Elviña s/n, 15071, A Coruña, Spain. .,Instituto de Investigación Biomédica de A Coruña (INIBIC), AE CICA-INIBIC, Oza, 15071, A Coruña, Spain.
| | - Vanessa Valdiglesias
- Instituto de Investigación Biomédica de A Coruña (INIBIC), AE CICA-INIBIC, Oza, 15071, A Coruña, Spain.,EPIUnit -Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal.,Universidade da Coruña, Grupo DICOMOSA, Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Biología, Facultad de Ciencias, Campus A Zapateira s/n, 15071, A Coruña, Spain
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16
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Mailliez A, Guilbaud A, Puisieux F, Dauchet L, Boulanger É. Circulating biomarkers characterizing physical frailty: CRP, hemoglobin, albumin, 25OHD and free testosterone as best biomarkers. Results of a meta-analysis. Exp Gerontol 2020; 139:111014. [PMID: 32599147 DOI: 10.1016/j.exger.2020.111014] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/03/2020] [Accepted: 06/20/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION During aging, individuals can be classified as being in one of 3 different states: robust, frail or dependent. Frailty is described as reversible, so early detection offers the potential of returning the subject to a robust status. There are multiple clinical frailty scales but no gold standard and frailty is not systematically assessed in clinicians' daily practice. Reliable biomarkers of frailty are lacking, however, while their identification and systematic use would make this simple scale a useful clinical tool. OBJECTIVE To conduct a review of the literature concerning the biomarkers associated with frailty and to compare in a meta-analysis the plasmatic values of each biomarker in the frail with the robust group. RESULTS 503 articles were identified on PubMed, 467 on Scopus and 369 on Web Of Science. 67 articles were included, collecting a total of 32,934 robust subjects and 6864 frail subjects. C-reactive protein (CRP) (Standardized Mean Difference (SMD): 0.49 CI 95% [0.37-0.61]) was significantly higher in the frail group whereas hemoglobin (SMD: -0.67[-0.90; -0.44]), albumin (SMD: -0.62[-0.84; -0.41]), 25-hydroxyvitamin D (25OHD) (SMD: -0.43 [-0.64; -0.21]) and, in men, free testosterone (SMD: -0.77 [-1.05; -0.49]) were significantly lower in the frail group. CONCLUSION We found 5 biomarkers that were associated with frailty (CRP, hemoglobin, albumin, 25OHD and free testosterone in men) belonging to multiple physiological systems. Further cohort studies are needed to verify their ability to screen for frailty.
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Affiliation(s)
- Aurélie Mailliez
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France; Geriatrics Department, CHU Lille, Lille, France
| | - Axel Guilbaud
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France
| | | | - Luc Dauchet
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France
| | - Éric Boulanger
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France; Geriatrics Department, CHU Lille, Lille, France; Special Interest Group on Aging Biology of European Geriatric Medicine Society, France.
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17
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Corina A, Abrudan MB, Nikolic D, Cӑtoi AF, Chianetta R, Castellino G, Citarrella R, Stoian AP, Pérez-Martínez P, Rizzo M. Effects of Aging and Diet on Cardioprotection and Cardiometabolic Risk Markers. Curr Pharm Des 2020; 25:3704-3714. [PMID: 31692432 DOI: 10.2174/1381612825666191105111232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022]
Abstract
The prevalence of several diseases increases by age, including cardiovascular diseases, which are the leading cause of morbidity and mortality worldwide. Aging, as a complex process characterized by senescence, triggers various pathways, such as oxidative stress, systemic inflammation, metabolism dysfunction, telomere shortening, mitochondrial dysfunction and deregulated autophagy. A better understanding of the mechanisms underlying senescence may lead to the development of new therapeutic targets and strategies for age-related pathologies and extend the healthy lifespan. Modulating lifestyle risk factors and adopting healthy dietary patterns remain significant tools in delaying the aging process, decreasing age-associated comorbidities and mortality, increasing life expectancy and consequently, preventing the development of cardiovascular disease. Furthermore, such a strategy represents the most cost-effective approach, and the quality of life of the subjects may be significantly improved. An integrated, personalized approach targeting cardiometabolic aging and frailty is suggested in daily clinical practice. However, it should be initiated from an early age. Moreover, there is a need for further well designed and controlled studies in order to elucidate a link between the time of feeding, longevity and cardiovascular prevention. In the future, it is expected that the pharmacological treatment in cardioprotective management will be necessary, accompanied by equally important lifestyle interventions and adjunctive exercise.
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Affiliation(s)
- Andreea Corina
- Lipids and Atherosclerosis Research Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Maria B Abrudan
- Department of Pharmaceutical Technology and Biopharmaceutics, "Iuliu Hațieganu", University of Medicine and Pharmacy, Faculty of Pharmacy, Cluj-Napoca, Romania
| | - Dragana Nikolic
- PROMISE Department, University of Palermo, Palermo, Italy.,Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Adriana F Cӑtoi
- Pathophysiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roberta Chianetta
- PROMISE Department, University of Palermo, Palermo, Italy.,Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Giuseppa Castellino
- PROMISE Department, University of Palermo, Palermo, Italy.,Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | | | - Anca P Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Pablo Pérez-Martínez
- Lipids and Atherosclerosis Research Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Manfredi Rizzo
- PROMISE Department, University of Palermo, Palermo, Italy
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Lee WJ, Peng LN, Loh CH, Chen LK. Sex-different associations between serum homocysteine, high-sensitivity C-reactive protein and sarcopenia: Results from I-Lan Longitudinal Aging Study. Exp Gerontol 2020; 132:110832. [DOI: 10.1016/j.exger.2020.110832] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/24/2019] [Accepted: 01/03/2020] [Indexed: 01/05/2023]
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Chen CH, Liu LK, Chen MJ, Lee WJ, Lin MH, Peng LN, Chen LK. Associations between vitamin D deficiency, musculoskeletal health, and cardiometabolic risk among community-living people in Taiwan: Age and sex-specific relationship. Medicine (Baltimore) 2018; 97:e13886. [PMID: 30593197 PMCID: PMC6314705 DOI: 10.1097/md.0000000000013886] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The role of serum vitamin D (Vit D) in cardiometabolic and muscle health remains unclear. The study aimed to evaluate associations of Vit D and factors of healthy aging among community-living middle-aged and older people in Taiwan. Analytic data on 1839 community-living older adults were excerpted from I-Lan Longitudinal Aging Study. All participants were collected demographic characteristics, serum Vit D, functional assessment, and cardiometabolic risk factors. The prevalence of Vit D insufficiency and deficiency in this study was 50.5% and 33.6%, respectively. Among 617 participants with Vit D deficiency, 72.3% of them were women. In multivariate logistic regression, the independent risk factors of Vit D deficiency were male gender (odds ratio [OR]: 0.266; 95% confidence interval [CI]: 0.213-0.333; P < 0.001), higher BMI (OR: 1.036; 95% CI: 1.005-1.067; P = 0.022), high total cholesterol (OR: 1.437; 95% CI: 1.160-1.779; P = 0.001), and high triglyceride (OR: 1.865; 95% CI: 1.446-2.404; p < 0.001). In multinomial logistic regression for 3-level Vit D status analysis, similar trend was found among participants with Vit D insufficiency. Insulin resistance increased in 2.31 and 1.71-folds in Vit D deficiency and insufficiency groups. Besides, association between Vit D deficiency and osteopenia was found only in women. In conclusion, Vit D deficiency was more common in women, and associated with poorer musculoskeletal health and higher cardiovascular and metabolic risk, including higher BMI, DBP, insulin resistance, total cholesterol, and triglyceride.
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Affiliation(s)
- Chia-Hung Chen
- Department of Family Medicine, Heping-Fuyou Branch, Taipei City Hospital
- Center for Geriatrics and Gerontology, Taipei Veteran General Hospital
| | - Li-Kuo Liu
- Center for Geriatrics and Gerontology, Taipei Veteran General Hospital
- Aging and Health Research Center, National Yang-Ming University
- Department of Geriatric Medicine, National Yang Ming University School of Medicine
| | - Mei-Ju Chen
- Department of Family Medicine, Heping-Fuyou Branch, Taipei City Hospital
- College of Healthcare Administration and Management, National Taipei University of Nursing and Health Science, Taipei
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang-Ming University
- Department of Geriatric Medicine, National Yang Ming University School of Medicine
- Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yilan, Taiwan
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veteran General Hospital
- Aging and Health Research Center, National Yang-Ming University
- Department of Geriatric Medicine, National Yang Ming University School of Medicine
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veteran General Hospital
- Aging and Health Research Center, National Yang-Ming University
- Department of Geriatric Medicine, National Yang Ming University School of Medicine
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veteran General Hospital
- Aging and Health Research Center, National Yang-Ming University
- Department of Geriatric Medicine, National Yang Ming University School of Medicine
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Peng LN, Chou MY, Liang CK, Lee WJ, Kojima T, Lin MH, Loh CH, Chen LK. Association between serum activin A and metabolic syndrome in older adults: Potential of activin A as a biomarker of cardiometabolic disease. Exp Gerontol 2018; 111:197-202. [PMID: 30071284 DOI: 10.1016/j.exger.2018.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/18/2018] [Accepted: 07/28/2018] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease imposes substantial burdens of morbidity and mortality that increase with population aging. Estimating cardiometabolic risk accurately and expediently is challenging, and no single biomarker is satisfactory; hence, we investigated the potential of serum activin A for this purpose. Study data were collected from 433 community-dwelling adults age ≥53 years from Yilan County, Taiwan. Data included: demographics and medical history; physical measurements (blood pressure, body mass index, waist circumference); comprehensive functional assessments (frailty, cognitive function, depressive symptoms, nutritional status); fasting blood biochemistry (glucose, high-density lipoprotein cholesterol, triglycerides, high-sensitivity C-reactive protein, insulin-like growth factor-1, activin A, stratified into high, medium and low tertiles, and others); and dual-energy X-ray absorptiometry. Metabolic syndrome was considered a proxy for overall cardiometabolic risk. Subjects mean age was 69.3 ± 9.2 years, 48.3% were males. Compared to women, men had higher systolic blood pressure, education levels, relative appendicular skeletal muscle mass, waist circumference, physical activity, walking speed, free androgen index, and levels of serum uric acid, alanine aminotransferase, and dehydroepiandrosterone sulfate. High activin A was significantly associated with age, relative appendicular skeletal muscle mass in both gender, waist circumference in women, current alcohol drinking, hypertension, and Charlson Comorbidity Index. There were dose-dependent relationships (low to high) between serum activin A and frailty, cognitive impairment, malnutrition, metabolic syndrome, uric acid, and high-sensitivity C-reactive protein. Logistic regression analyses showed older age, serum uric acid, and metabolic syndrome were significantly associated with medium and high activin-A status, whereas, skeletal muscle mass, insulin-like growth factor-1 and dehydroepiandrosterone sulphate were associated with high, but not medium, serum activin A. This discovery of a dose-dependent association between serum activin A levels, age, and metabolic syndrome, suggests activin A may be a biomarker of overall cardiometabolic risk; however, further studies are needed to evaluate its potential applications in assessing and managing cardiometabolic risk.
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Affiliation(s)
- Li-Ning Peng
- Department of Geriatric Medicine, National Yang Ming University School of Medicine, 115, Sec. 2, Linong St., Taipei 11221, Taiwan; Aging and Health Research Center, National Yang Ming University, 155, Sec. 2, Linong St., Taipei 11221, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Rd., Taipei 11217, Taiwan
| | - Ming-Yueh Chou
- Department of Geriatric Medicine, National Yang Ming University School of Medicine, 115, Sec. 2, Linong St., Taipei 11221, Taiwan; Aging and Health Research Center, National Yang Ming University, 155, Sec. 2, Linong St., Taipei 11221, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386 Ta-Chun 1st Rd., Kaohsiung 81362, Taiwan
| | - Chih-Kuang Liang
- Department of Geriatric Medicine, National Yang Ming University School of Medicine, 115, Sec. 2, Linong St., Taipei 11221, Taiwan; Aging and Health Research Center, National Yang Ming University, 155, Sec. 2, Linong St., Taipei 11221, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386 Ta-Chun 1st Rd., Kaohsiung 81362, Taiwan
| | - Wei-Ju Lee
- Department of Geriatric Medicine, National Yang Ming University School of Medicine, 115, Sec. 2, Linong St., Taipei 11221, Taiwan; Aging and Health Research Center, National Yang Ming University, 155, Sec. 2, Linong St., Taipei 11221, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, 386 Rongguang Rd., Yuanshan Township, YiLan County 264, Taiwan
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate Institute of Medicine, The University of Tokyo, 7-3-1 Jongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ming-Hsien Lin
- Department of Geriatric Medicine, National Yang Ming University School of Medicine, 115, Sec. 2, Linong St., Taipei 11221, Taiwan; Aging and Health Research Center, National Yang Ming University, 155, Sec. 2, Linong St., Taipei 11221, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Rd., Taipei 11217, Taiwan
| | - Ching-Hui Loh
- Department of Geriatric Medicine, National Yang Ming University School of Medicine, 115, Sec. 2, Linong St., Taipei 11221, Taiwan; Aging and Health Research Center, National Yang Ming University, 155, Sec. 2, Linong St., Taipei 11221, Taiwan; Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec. 3, Chung Yang Rd., Hualien 970, Taiwan
| | - Liang-Kung Chen
- Department of Geriatric Medicine, National Yang Ming University School of Medicine, 115, Sec. 2, Linong St., Taipei 11221, Taiwan; Aging and Health Research Center, National Yang Ming University, 155, Sec. 2, Linong St., Taipei 11221, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Rd., Taipei 11217, Taiwan.
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Lee WJ, Peng LN, Liang CK, Loh CH, Chen LK. Cognitive frailty predicting all-cause mortality among community-living older adults in Taiwan: A 4-year nationwide population-based cohort study. PLoS One 2018; 13:e0200447. [PMID: 30001354 PMCID: PMC6042743 DOI: 10.1371/journal.pone.0200447] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cognitive frailty (CF) featured as frailty plus cognitive impairment was deemed to be a novel target for dementia and disable prevention. The study was intended to investigate the epidemiology of CF and the association between CF and all-cause mortality. METHODS The national representative cohort study was comprised of 1,103 community-living middle-aged and older adults. CF was defined as the co-existence of dynapenia (weakness and/or slowness) and cognitive impairment (1.5 standard deviations below the age-, sex- and education-matched norms in cognitive tests) without known neurodegenerative diseases. Dynapenia was defined by the Asian Working Group for Sarcopenia and cognitive function was assessed by the Short Portable Mental Status Questionnaire. RESULTS The prevalence of CF was 8.6% in this study. Subjects with CF were older, more likely to be women, having less regular exercise, fewer educational years, more depressive symptoms and greater multimorbidity. Compared to robust individuals, CF was significantly associated with all-cause mortality (HR: 3.1, 95% CI:1.3-7.7, p = 0.012). CONCLUSION Dynapenia and cognitive impairment synergistically contribute to the mortality risk for the participants in this study. Further study is needed to explore the underlying pathophysiology and the reversibility of CF.
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Affiliation(s)
- Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Department of Geriatrics, National Yang Ming University School of Medicine, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Land, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Department of Geriatrics, National Yang Ming University School of Medicine, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Kuang Liang
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Department of Geriatrics, National Yang Ming University School of Medicine, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ching-Hui Loh
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Department of Geriatrics, National Yang Ming University School of Medicine, Taipei, Taiwan
- Center of Health and Aging, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- * E-mail: (CHL); (LKC)
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Department of Geriatrics, National Yang Ming University School of Medicine, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (CHL); (LKC)
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Hwang AC, Liu LK, Lee WJ, Peng LN, Chen LK. Calf Circumference as a Screening Instrument for Appendicular Muscle Mass Measurement. J Am Med Dir Assoc 2018; 19:182-184. [DOI: 10.1016/j.jamda.2017.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 01/06/2023]
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Liang Y, Vetrano DL, Qiu C. Serum total cholesterol and risk of cardiovascular and non-cardiovascular mortality in old age: a population-based study. BMC Geriatr 2017; 17:294. [PMID: 29281976 PMCID: PMC5745647 DOI: 10.1186/s12877-017-0685-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 12/12/2017] [Indexed: 11/16/2022] Open
Abstract
Background Whether the suggested inverse association between total cholesterol and mortality in old age varies according to cause of death and use of cholesterol medications remains to be elucidated. The aim of this study was to assess the associations of total cholesterol with cardiovascular and non-cardiovascular mortality in old age, and to explore whether their associations vary by use of cholesterol-lowering medications. Methods The study participants included 3090 older adults (age ≥ 60 years, 63.7% women) from a population-based cohort study, i.e., the Swedish National study on Aging and Care in Kungsholmen, Stockholm. At baseline (2001–2004), data on demographic factors, lifestyles, cardiovascular risk factors, use of medications, global cognitive function, mobility limitation, and apolipoprotein E genotype were collected through interviews, clinical examinations, laboratory tests as well as from the Swedish national patient register. Vital statistics data (e.g., date and causes of death) till December 31, 2011 for all participants were derived from Swedish cause of death register. Data were analyzed using Cox proportional hazards model for all-cause mortality and Fine-Gray competing risks regression model for cause-specific mortality controlling for multiple potential confounders. Results During 23,196 person-years of follow-up (median per person, 7.5 years), 1059 (34.3%) participants died. Compared to normal total cholesterol (<5.18 mmol/l), borderline-high (5.18–6.21 mmol/l) and high (≥6.22 mmol/l) total cholesterol were associated with a decreased risk of all-cause mortality, with the multiple-adjusted hazard ratio (95% confidence interval, CI) of 0.71 (0.61–0.83) and 0.68 (0.57–0.80), respectively (P for trend <0.001). The competing risk regression models revealed that the reduced all-cause mortality associated with high total cholesterol (≥6.22 mmol/l)) was mainly due to the reduced risk of non-cardiovascular mortality (hazard ratio = 0.67, 95% CI = 0.51–0.88). These associations were statistically evident only among individuals without use of cholesterol-lowering medications. Conclusions The inverse association between high total cholesterol and reduced all-cause mortality in older adults is primarily due to non-cardiovascular mortality, especially among those who are not treated with cholesterol-lowering medications.
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Affiliation(s)
- Yajun Liang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden. .,Department of Public Health Sciences, Karolinska Institutet, Widerströmska huset, 171 77, Stockholm, Sweden.
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Department of Geriatrics, Catholic University of Rome, Rome, Italy
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden. .,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
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Nadruz W, Kitzman D, Windham BG, Kucharska-Newton A, Butler K, Palta P, Griswold ME, Wagenknecht LE, Heiss G, Solomon SD, Skali H, Shah AM. Cardiovascular Dysfunction and Frailty Among Older Adults in the Community: The ARIC Study. J Gerontol A Biol Sci Med Sci 2017; 72:958-964. [PMID: 27733425 DOI: 10.1093/gerona/glw199] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/18/2016] [Indexed: 01/30/2023] Open
Abstract
Background The contribution of cardiovascular dysfunction to frailty in older adults is uncertain. This study aimed to define the relationship between frailty and cardiovascular structure and function, and determine whether these associations are independent of coexisting abnormalities in other organ systems. Methods We studied 3,991 older adults (mean age 75.6±5.0 years; 59% female) from the Atherosclerosis Risk in Communities (ARIC) Study in whom the following six organ systems were uniformly assessed: cardiac (by echocardiography), vascular (by ankle-brachial-index and pulse-wave-velocity), pulmonary (by spirometry), renal (by estimated glomerular filtration rate), hematologic (by hemoglobin), and adipose (by body mass index and bioimpedance). Frailty was defined by the presence of ≥3 of the following: low strength, low energy, slowed motor performance, low physical activity, or unintentional weight loss. Results Two hundred eleven (5.3%) participants were frail. In multivariable analyses adjusted for demographics, diabetes, hypertension, and measures of other organ system function, frailty was independently and additively associated with left ventricular hypertrophy (odds ratio [OR] = 1.72; 95% confidence interval [CI] = 1.30-2.40), reduced global longitudinal strain (reflecting systolic function; OR = 1.68; 95% CI = 1.16-2.44), and greater left atrial volume index (reflecting diastolic function; OR = 1.60; 95% CI = 1.13-2.27), which together demonstrated the greatest association with frailty (OR = 2.10; 95% CI = 1.57-2.82) of the systems studied. Lower magnitude associations were observed for vascular and pulmonary abnormalities, anemia, and impaired renal function. Cardiovascular abnormalities remained associated with frailty after excluding participants with prevalent cardiovascular disease. Conclusions Abnormalities of cardiac structure and function are independently associated with frailty, and together show the greatest association with frailty among the organ systems studied.
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Affiliation(s)
- Wilson Nadruz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Internal Medicine, University of Campinas, Campinas, Brazil
| | - Dalane Kitzman
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Beverly Gwen Windham
- Department of Medicine, Geriatrics University of Mississippi Medical Center, Jackson
| | | | - Kenneth Butler
- Department of Medicine, Geriatrics University of Mississippi Medical Center, Jackson
| | - Priya Palta
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Michael E Griswold
- Department of Medicine, Geriatrics University of Mississippi Medical Center, Jackson
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Hwa Hsu C, Tung HH, Clinciu DL, Chen LK, Yin WH, Iqbal U, Wang TJ. Physical activity: A primary health quality determinant among community-dwelling geriatric women in Taiwan. Int J Qual Health Care 2017; 29:792-796. [DOI: 10.1093/intqhc/mzx101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 08/03/2017] [Indexed: 01/10/2023] Open
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Fuentes F, Palomo I, Fuentes E. Platelet oxidative stress as a novel target of cardiovascular risk in frail older people. Vascul Pharmacol 2017; 93-95:14-19. [PMID: 28705733 DOI: 10.1016/j.vph.2017.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/18/2017] [Accepted: 07/10/2017] [Indexed: 12/13/2022]
Abstract
The average lifespan of humans and the percentage of people entering the 65 and older age group are growing rapidly. Within this age group, cardiovascular diseases (CVD) increase steeply and are the most common cause of death. During aging, experimental and clinical studies support the pivotal role played by reactive oxidant species in the mechanism of platelet activation. Frailty has been implicated as a causative and prognostic factor in patients with CVD. Oxidative stress is increased in frail older people, and may lead to accelerated aging and higher incidence of oxidative diseases such as CVD. The present article aims to highlight the relative contribution of platelet oxidative stress as a key target of frailty in elderly people with CVD.
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Affiliation(s)
- Francisco Fuentes
- Becario Obstetricia y Ginecología Universidad Católica del Maule, Talca, Chile
| | - Iván Palomo
- Platelet Research Center, Department of Clinical Biochemistry and Immunohaematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Universidad de Talca, Talca, Chile.
| | - Eduardo Fuentes
- Platelet Research Center, Department of Clinical Biochemistry and Immunohaematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Universidad de Talca, Talca, Chile; Núcleo Científico Multidisciplinario, Universidad de Talca, Talca, Chile.
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28
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Velissaris D, Pantzaris N, Koniari I, Koutsogiannis N, Karamouzos V, Kotroni I, Skroumpelou A, Ellul J. C-Reactive Protein and Frailty in the Elderly: A Literature Review. J Clin Med Res 2017; 9:461-465. [PMID: 28496545 PMCID: PMC5412518 DOI: 10.14740/jocmr2959w] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 12/15/2022] Open
Abstract
Chronic inflammation is a well-established background process in many age-related diseases. Many recent studies investigate the use of various inflammatory biomarkers such as C-reactive protein (CRP), interleukin-6, and interleukin-1 as predictors of physical and cognitive performance among elders. The phenotype of frailty has also been associated with underlying inflammatory mechanisms. The aim of this article was to review the literature referring to the correlation of CRP serum levels and frailty in older individuals. We tried to identify all relevant publications regarding the relation of CRP as an index of frailty in the elderly and its potential use. Although many studies in the recent medical literature positively associate serum CRP levels and frailty in older individuals, some do not, and some raise some interesting questions and set the basis for future studies. The association of CRP and frailty in elder patients should be considered when clinicians interpret inflammatory biomarkers in various clinical settings in such patients. Well-designed, prospective clinical trials are warranted to better assess the role and pathophysiology of frailty in the elderly and its mechanisms as also the exact role of CRP as an inflammatory marker and as a prognostic index in this syndrome.
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Affiliation(s)
| | | | - Ioanna Koniari
- Department of Cardiology, University Hospital of Patras, Greece
| | | | | | - Ioanna Kotroni
- Coronary Care Unit, University Hospital of Patras, Greece
| | | | - John Ellul
- Department of Neurology, University Hospital of Patras, Greece
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Lee WJ, Peng LN, Chiou ST, Chen LK. Physical Health Indicators Improve Prediction of Cardiovascular and All-cause Mortality among Middle-Aged and Older People: a National Population-based Study. Sci Rep 2017; 7:40427. [PMID: 28079182 DOI: 10.1038/srep40427] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 12/05/2016] [Indexed: 11/08/2022] Open
Abstract
The effectiveness of established methods for stratifying cardiovascular risk, for example, the Framingham risk score (FRS), may be improved by adding extra variables. This study evaluated the potential benefits of adding physical health indicators (handgrip strength, walking speed, and peak expiratory flow) to the FRS in predicting cardiovascular and all-cause mortality by using a nationwide population-based cohort study data. During median follow-up of 4.1 years, 67 of 911 study subjects had died. In Cox regression analysis, all additional physical health indicators, except walking speed, significantly predicted cardiovascular and all-cause mortality (P < 0.05). Compared with the conventional FRS, c statistics were significantly increased when dominant handgrip strength or relative handgrip strength (handgrip strength adjusted for body mass index), or combination with walking speed or peak expiratory flow were incorporated into the FRS prediction model, both in the whole cohort and also in participants who did not have prevalent cardiovascular diseases at baseline. In conclusion, dominant or relative handgrip strength are simple and inexpensive physical health indicators that substantially improve the accuracy of the FRS in predicting cardiovascular and all-cause mortality among middle-aged and older people.
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Buta B, Choudhury PP, Xue QL, Chaves P, Bandeen-Roche K, Shardell M, Semba RD, Walston J, Michos ED, Appel LJ, McAdams-DeMarco M, Gross A, Yasar S, Ferrucci L, Fried LP, Kalyani RR. The Association of Vitamin D Deficiency and Incident Frailty in Older Women: The Role of Cardiometabolic Diseases. J Am Geriatr Soc 2016; 65:619-624. [PMID: 28008596 DOI: 10.1111/jgs.14677] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Evidence suggests vitamin D deficiency is associated with developing frailty. However, cardiometabolic factors are related to both conditions and may confound and/or mediate the vitamin D-frailty association. We aimed to determine the association of vitamin D concentration with incidence of frailty, and the role of cardiometabolic diseases (cardiovascular disease, diabetes, hyperlipidemia, hypertension) in this relationship. DESIGN Prospective longitudinal cohort study (7 visits from 1994-2008). SETTING Baltimore, Maryland. PARTICIPANTS Three hundred sixty-nine women from the Women's Health and Aging Study II aged 70-79 years, free of frailty at baseline. MEASUREMENTS Serum circulating 25-hydroxyvitamin D (25[OH]D) concentration was assessed at baseline and categorized as: <10; 10-19.9; 20-29.9; and ≥30 ng/mL. Frailty incidence was determined based on presence of three or more criteria: weight loss, low physical activity, exhaustion, weakness, and slowness. Cardiometabolic diseases were ascertained at baseline. Analyses included Cox regression models adjusted for key covariates. RESULTS Incidence rate of frailty was 32.2 per 1,000 person-years in participants with 25(OH)D < 10 ng/mL, compared to 12.9 per 1,000 person-years in those with 25(OH)D ≥ 30 ng/mL (mean follow-up = 8.5 ± 3.7 years). In cumulative incidence analyses, those with lower 25(OH)D exhibited higher frailty incidence, though differences were non-significant (P = .057). In regression models adjusted for demographics, smoking, and season, 25(OH)D < 10 ng/mL (vs ≥30 ng/mL) was associated with nearly three-times greater frailty incidence (hazard ratio (HR) = 2.77, 95% CI = 1.14, 6.71, P = .02). After adjusting for BMI, the relationship of 25(OH)D < 10 ng/mL (vs ≥30 ng/mL) with incident frailty persisted, but was attenuated after further accounting for cardiometabolic diseases (HR = 2.29, 95% CI = 0.92, 5.69, P = .07). CONCLUSION Low serum vitamin D concentration is associated with incident frailty in older women; interestingly, the relationship is no longer significant after accounting for the presence of cardiometabolic diseases. Future studies should explore mechanisms to explain this relationship.
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Affiliation(s)
- Brian Buta
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Qian-Li Xue
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Paulo Chaves
- Benjamin Leon Center for Geriatric Research and Education and Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Karen Bandeen-Roche
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.,Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland
| | - Michelle Shardell
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Richard D Semba
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeremy Walston
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Erin D Michos
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Mara McAdams-DeMarco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alden Gross
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Linda P Fried
- Mailman School of Public Health, Columbia University, New York, New York
| | - Rita Rastogi Kalyani
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Soysal P, Stubbs B, Lucato P, Luchini C, Solmi M, Peluso R, Sergi G, Isik AT, Manzato E, Maggi S, Maggio M, Prina AM, Cosco TD, Wu YT, Veronese N. Inflammation and frailty in the elderly: A systematic review and meta-analysis. Ageing Res Rev 2016; 31:1-8. [PMID: 27592340 DOI: 10.1016/j.arr.2016.08.006] [Citation(s) in RCA: 578] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/08/2016] [Accepted: 08/24/2016] [Indexed: 01/05/2023]
Abstract
The pathogenesis of frailty and the role of inflammation is poorly understood. We examined the evidence considering the relationship between inflammation and frailty through a systematic review and meta-analysis. A systematic literature search of papers providing data on inflammatory biomarkers and frailty was carried out in major electronic databases from inception until May 2016. From 1856 initial hits, 35 studies (32 cross-sectional studies n=3232 frail, n=11,483 pre-frail and n=8522 robust, and 563 pre-frail+robust; 3 longitudinal studies n=3402 participants without frailty at baseline) were meta-analyzed. Cross-sectional studies reported that compared to 6757 robust participants, both 1698 frail (SMD=1.00, 95%CI: 0.40-1.61) and 8568 pre-frail (SMD=0.33, 95%CI: 0.04-0.62) participants had significantly higher levels of C-reactive protein (CRP). Frailty (n=1057; SMD=1.12, 95%CI: 0.27-2.13) and pre-frailty (n=4467; SMD=0.56, 95%CI: 0.00-1.11) were associated with higher serum levels of interleukin-6 compared to people who were robust (n=2392). Frailty and pre-frailty were also significantly associated with elevated white blood cell and fibrinogen levels. In three longitudinal studies, higher serum CRP (OR=1.06, 95%CI: 0.78-1.44,) and IL-6 (OR=1.19, 95%CI: 0.87-1.62) were not associated with frailty. In conclusion, frailty and pre-frailty are associated with higher inflammatory parameters and in particular CRP and IL-6. Further longitudinal studies are needed.
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32
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Van Epps P, Oswald D, Higgins PA, Hornick TR, Aung H, Banks RE, Wilson BM, Burant C, Graventstein S, Canaday DH. Frailty has a stronger association with inflammation than age in older veterans. Immun Ageing 2016; 13:27. [PMID: 27777599 PMCID: PMC5069820 DOI: 10.1186/s12979-016-0082-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/10/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Upregulation of pro-inflammatory cytokines has not only been associated with increased morbidity and mortality in older adults but also has been linked to frailty. In the current study we aimed to compare the relative relationship of age and frailty on inflammation and thrombosis in older veterans. RESULTS We analyzed 117 subjects (age range 62-95 years; median 81) divided into 3 cohorts: non-frail, pre-frail and frail based on the Fried phenotype of frailty. Serum inflammatory markers were determined using commercially available ELISA kits. Frail and pre-frail (PF) subjects had higher levels than non-frail (NF) subjects of IL-6 (NF vs. PF: p = 0.002; NF vs. F: p < 0.001), TNFR1 (NF vs. F: p = 0.012), TNFRII (NF vs. F: 0.002; NF vs. PF: p = 0.005) and inflammatory index: = 0.333*log(IL-6) + 0.666*log(sTNFR1) (NF vs. F: p = 0.009; NF vs. PF: p < 0.001). Frailty status explained a greater percent of variability in markers of inflammation than age: IL-6 (12 % vs. 0.3 %), TNFR1 (5 % vs. 4 %), TNFR2 (11 % vs. 6 %), inflammatory index (16 % vs. 8 %). Aging was significantly associated with higher fibrinogen (p = 0.04) and D-dimer levels (p = 0.01) but only among NF subjects. CONCLUSION In conclusion, these data suggest that among older veterans, frailty status has a stronger association with inflammation and the inflammatory index than age does. Larger studies, in more diverse populations are needed to confirm these findings.
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Affiliation(s)
- P. Van Epps
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH USA
- Division of Infectious Disease, Case Western Reserve University, Cleveland, OH USA
| | - D. Oswald
- Division of Infectious Disease, Case Western Reserve University, Cleveland, OH USA
| | - P. A. Higgins
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH USA
- School of Nursing, Case Western Reserve University, Cleveland, OH USA
| | - T. R. Hornick
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH USA
- Division of Geriatrics, Department of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - H. Aung
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH USA
- Division of Infectious Disease, Case Western Reserve University, Cleveland, OH USA
| | - R. E. Banks
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH USA
| | - B. M. Wilson
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH USA
| | - C. Burant
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH USA
- School of Nursing, Case Western Reserve University, Cleveland, OH USA
| | - S. Graventstein
- Division of Geriatrics, Department of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - D. H. Canaday
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH USA
- Division of Infectious Disease, Case Western Reserve University, Cleveland, OH USA
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