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Pan J, Xu G, Zhai Z, Sun J, Wang Q, Huang X, Guo Y, Lu Q, Mo J, Nong Y, Huang J, Lu W. Geriatric nutritional risk index as a predictor for fragility fracture risk in elderly with type 2 diabetes mellitus: A 9-year ambispective longitudinal cohort study. Clin Nutr 2024; 43:1125-1135. [PMID: 38583354 DOI: 10.1016/j.clnu.2024.03.032] [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: 03/06/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND & AIMS The elderly are prone to fragility fractures, especially those suffering from type 2 diabetes mellitus (T2DM) combined with osteoporosis. Although studies have confirmed the association between GNRI and the prevalence of osteoporosis, the relationship between GNRI and fragility fracture risk and the individualized 10-year probability of osteoporotic fragility fractures estimated by FRAX remains unclear. This study aims to delve into the association between the GNRI and a fragility fracture and the 10-year probability of hip fracture (HF) and major osteoporotic fracture (MOF) evaluated by FRAX in elderly with T2DM. METHODS A total of 580 patients with T2DM aged ≥60 were recruited in the study from 2014 to 2023. This research is an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 3.8 years through outpatient services, medical records, and home fixed-line telephone interviews. According to the tertiles of GNRI, all subjects were divided into three groups: low-level (59.72-94.56, n = 194), moderate-level (94.56-100.22, n = 193), and high-level (100.22-116.45, n = 193). The relationship between GNRI and a fragility fracture and the 10-year probability of HF and MOF calculated by FRAX was assessed by receiver operating characteristic (ROC) analysis, Spearman correlation analyses, restricted cubic spline (RCS) analyses, multivariable Cox regression analyses, stratified analyses, and Kaplan-Meier survival analysis. RESULTS Of 580 participants, 102 experienced fragile fracture events (17.59%). ROC analysis demonstrated that the optimal GNRI cut-off value was 98.58 with a sensitivity of 75.49% and a specificity of 47.49%, respectively. Spearman partial correlation analyses revealed that GNRI was positively related to 25-hydroxy vitamin D [25-(OH) D] (r = 0.165, P < 0.001) and bone mineral density (BMD) [lumbar spine (LS), r = 0.088, P = 0.034; femoral neck (FN), r = 0.167, P < 0.001; total hip (TH), r = 0.171, P < 0.001]; negatively correlated with MOF (r = -0.105, P = 0.012) and HF (r = -0.154, P < 0.001). RCS analyses showed that GNRI was inversely S-shaped dose-dependent with a fragility fracture event (P < 0.001) and was Z-shaped with the 10-year MOF (P = 0.03) and HF (P = 0.01) risk assessed by FRAX, respectively. Multivariate Cox regression analysis demonstrated that compared with high-level GNRI, moderate-level [hazard ratio (HR) = 1.950; 95% confidence interval (CI) = 1.076-3.535; P = 0.028] and low-level (HR = 2.538; 95% CI = 1.378-4.672; P = 0.003) had an increased risk of fragility fracture. Stratified analysis exhibited that GNRI was negatively correlated with the risk of fragility fracture, which the stratification factors presented in the forest plot were not confounding factors and did not affect the prediction effect of GNRI on the fragility fracture events in this overall cohort population (P for interaction > 0.05), despite elderly females aged ≥70, with body mass index (BMI) ≥24, hypertension, and with or without anemia (all P < 0.05). Kaplan-Meier survival analysis identified that the lower-level GNRI group had a higher cumulative incidence of fragility fractures (log-rank, all P < 0.001). CONCLUSION This study confirms for the first time that GNRI is negatively related to a fragility fracture and the 10-year probability of osteoporotic fragility fractures assessed by FRAX in an inverse S-shaped and Z-shaped dose-dependent pattern in elderly with T2DM, respectively. GNRI may serve as a valuable predictor for fragility fracture risk in elderly with T2DM. Therefore, in routine clinical practice, paying attention to the nutritional status of the elderly with T2DM and giving appropriate dietary guidance may help prevent a fragility fracture event.
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Affiliation(s)
- Jiangmei Pan
- Youjiang Medical University for Nationalities, Baise, Guangxi, 533000, People's Republic of China; Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Guoling Xu
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Zhenwei Zhai
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Jingxia Sun
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Qiu Wang
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Xiuxian Huang
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Yanli Guo
- Changzhi Medical College, Changzhi, Shanxi, 046000, People's Republic of China
| | - Quan Lu
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Jianming Mo
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Yuechou Nong
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China.
| | - Jianhao Huang
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China.
| | - Wensheng Lu
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China.
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Wu Y, Xiang C, Wang Z, Fang Y. Interpretable prediction models for disability in older adults with hypertension: the Chinese Longitudinal Healthy Longevity and Happy Family Study. Psychogeriatrics 2024; 24:645-654. [PMID: 38514389 DOI: 10.1111/psyg.13112] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/14/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Older adults with hypertension have a high risk of disability, while an accurate risk prediction model is still lacking. This study aimed to construct interpretable disability prediction models for older Chinese with hypertension based on multiple time intervals. METHODS Data were collected from the Chinese Longitudinal Healthy Longevity and Happy Family Study for 2008-2018. A total of 1602, 1108, and 537 older adults were included for the periods of 2008-2012, 2008-2014, and 2008-2018, respectively. Disability was measured by basic activities of daily living. Least absolute shrinkage and selection operator (LASSO) was applied for feature selection. Five machine learning algorithms combined with LASSO set and full-variable set were used to predict 4-, 6-, and 10-year disability risk, respectively. Area under the receiver operating characteristic curve was used as the main metric for selection of the optimal model. SHapley Additive exPlanations (SHAP) was used to explore important predictors of the optimal model. RESULTS Random forest in full-variable set and XGBoost in LASSO set were the optimal models for 4-year prediction. Support vector machine was the optimal model for 6-year prediction on both sets. For 10-year prediction, deep neural network in full variable set and logistic regression in LASSO set were optimal models. Age ranked the most important predictor. Marital status, body mass index, score of Mini-Mental State Examination, and psychological well-being score were also important predictors. CONCLUSIONS Machine learning shows promise in screening out older adults at high risk of disability. Disability prevention strategies should specifically focus on older patients with unfortunate marriage, high BMI, and poor cognitive and psychological conditions.
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Affiliation(s)
- Yafei Wu
- School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, Xiamen, China
| | - Chaoyi Xiang
- School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, Xiamen, China
| | - Zongjie Wang
- School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, Xiamen, China
| | - Ya Fang
- School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
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Silva SLAD, Brito GEGD, Ygnatios NTM, Mambrini JVDM, Lima-Costa MF, Torres JL. [Differences between men and women in the prevalence of frailty and associated factors among older adults: evidence from ELSI-Brazil]. CAD SAUDE PUBLICA 2024; 40:e00144923. [PMID: 38656069 PMCID: PMC11034629 DOI: 10.1590/0102-311xpt144923] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 04/26/2024] Open
Abstract
Based on a national representative sample of the population aged 50 years or older, this study aimed to estimate the prevalence of frailty among men and women, identify associated sociodemographic and health factors, and estimate the population attributable fraction. Data from the second wave (2019-2021) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were used. Frailty was classified based on the number of positive items among unintentional weight loss, exhaustion, low level of physical activity, slow gait, and weakness. The main analyses were based on multinomial logistic regression stratified by sex. The prevalence of frailty was lower in men (8.6%; 95%CI: 6.9; 10.7) than in women (11.9%; 95%CI: 9.6; 14.8), with the most frequent item being the low level of physical activity in both. Age and schooling level were the sociodemographic factors associated with pre-frailty and fragility among men and women. The population attributable fraction was different for frailty between genders. In men, the highest population attributable fraction was due to not having a partner (23.5%; 95%CI: 7.7; 39.2) and low schooling level (18.2%; 95%CI: 6.6; 29,7). In women, higher population attributable fraction values were due to memory deficit (17.1%; 95%CI: 7.6; 26.6), vision deficit (13.4%; 95%CI: 5.1; 21.7), and diabetes mellitus (11.4%; 95%CI: 4.6; 18,1). Similar population attributable fraction levels were observed for heart disease (8.9%; 95%CI: 3.8; 14.1 in women and 8.8%; 95%CI: 2.0; 15.6 in men). Strategies aimed at physical activity have the potential to prevent frailty in both men and women, and the prevention of chronic conditions is more important in women.
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Affiliation(s)
| | | | - Nair Tavares Milhem Ygnatios
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Maria Fernanda Lima-Costa
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Programa de Pós-graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Oquendo B, Nouhaud C, Jarzebowski W, Leger A, Oasi C, Ba M, Lafuente-Lafuente C, Belmin J. Better functional recovery after acute stroke in older patients managed in a new dedicated post-stroke geriatric unit compared to usual management. J Nutr Health Aging 2024; 28:100033. [PMID: 38341964 DOI: 10.1016/j.jnha.2023.100033] [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: 08/11/2023] [Accepted: 12/08/2023] [Indexed: 02/13/2024]
Abstract
OBJECTIVES A Stroke care Pathway dedicated to the ELders (SPEL) for patients with acute stroke was created in 2013 at the hospitals Pitié-Salpêtrière-Charles Foix (Paris, France). It is characterized by a stroke unit dedicated to emergency stroke care, and a post stroke geriatric unit (PSGU) including rehabilitation and management of geriatric syndromes. The aim of the study was to compare the functional recovery of patients transferred to PSGU versus other rehabilitation care in patients over 70 years of age after stroke. DESIGN A cohort observational study over a 4-year period. SETTING Hospitals Pitié-Salpêtrière and Charles Foix (Paris, France). PARTICIPANTS We studied patients over 70 years admitted to the participating stroke unit for acute stroke consecutively hospitalized from January 1, 2013, to January 1, 2017. INTERVENTION Patients transferred in the PSGU were compared to those admitted in other rehabilitation units. MEASUREMENTS The primary outcome was 3-month functional recovery after stroke. The secondary outcomes were the hospital length of stay and the returning home rate. A multivariable logistic regression was applied to adjust for confounding variables (age, sex, NIHSS score and Charlson's comorbidity score). RESULTS Among the 262 patients included in the study, those in the PGSU were significantly older, had a higher Charlson's comorbidity score and a higher initial NIHSS severity score. As compared to the other patients, functional recovery at 3 months was better in the PSGU (Rankin's score decreased by 0.80 points versus 0.41 points, p = 0.01). The average total length of stay was reduced by 16 days in the patients referred to the PSGU (p = 0.002). There was no significant difference in the returning home rate between the two groups (p = 0.88). CONCLUSION The SPEL which includes a post-stroke geriatric unit (PSGU) has been associated with improved recovery and had a positive impact in the management of older post-stroke patients.
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Affiliation(s)
- Bruno Oquendo
- Service de Gériatrie à orientation Cardiologique et Neurologique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France; Sorbonne Université, Paris, France.
| | | | | | - Anne Leger
- Urgences Cérébro-Vasculaires, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Christel Oasi
- Service de Gériatrie à orientation Cardiologique et Neurologique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France
| | - Massamba Ba
- Service de Gériatrie à orientation Cardiologique et Neurologique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France
| | - Carmelo Lafuente-Lafuente
- Service de Gériatrie à orientation Cardiologique et Neurologique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France; Sorbonne Université, Paris, France
| | - Joel Belmin
- Service de Gériatrie à orientation Cardiologique et Neurologique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France; Sorbonne Université, Paris, France
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Kibe LW, Bazargan M, Bosah A, Schrode KM, Kuo Y, Andikrah E, Shaheen M. Diet Quality of Older African Americans: Impact of Knowledge and Perceived Threat of COVID-19. Int J Environ Res Public Health 2023; 20:5274. [PMID: 37047890 PMCID: PMC10094625 DOI: 10.3390/ijerph20075274] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/25/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
Confusing health messages and environmental changes intended to prevent the spread of the COVID-19 virus have affected the dietary behavior of older African Americans. We investigated the impact of COVID-19-related factors on diet quality and the relationship between food access and diet quality. We surveyed 150 African Americans aged 55 years and above during the COVID-19 pandemic. The data obtained included socio-demographic and health information, and COVID-19-related knowledge and perceptions. Dietary intake data was obtained using the Diet History Questionnaire III. Analyses included bivariate and multivariable statistics. Overall, based on United States Department of Agriculture guidelines, the diet quality of older African Americans was poor. Lower knowledge and a lower perceived threat of COVID-19 were significantly associated with poor diet quality. Additionally, older African Americans with chronic diseases and food insecurity had poor diet quality. The COVID-19 pandemic has highlighted the fragility of diet quality. The combined impact of poor knowledge and perceived threat of COVID-19, chronic disease, and food insecurity contribute to poor diet quality in this population. This study adds to the well-known need for strategies to support the right to a healthy diet, particularly during COVID-19 and future pandemics. Proactive interventions to counteract the potential consequences of poor diets are needed.
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Affiliation(s)
- Lucy W. Kibe
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Mohsen Bazargan
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Adaobi Bosah
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Katrina M. Schrode
- Department of Psychiatry, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Yufu Kuo
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Edward Andikrah
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Magda Shaheen
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
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Chornenki NLJ, Siegal DM, Qamar K, Woolgar S, Rangarajan S, Karampatos S, Leong DP, Hillis CM. Characterizing Frailty In Myeloproliferative Neoplasms: results from the ORCHID study. Leuk Res 2022; 113:106788. [PMID: 35042128 DOI: 10.1016/j.leukres.2022.106788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/08/2022] [Accepted: 01/08/2022] [Indexed: 11/17/2022]
MESH Headings
- Aged
- Canada/epidemiology
- Female
- Frailty/diagnosis
- Frailty/drug therapy
- Frailty/epidemiology
- Geriatric Assessment/methods
- Geriatric Assessment/statistics & numerical data
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Male
- Middle Aged
- Myeloproliferative Disorders/diagnosis
- Myeloproliferative Disorders/drug therapy
- Myeloproliferative Disorders/epidemiology
- Polycythemia Vera/diagnosis
- Polycythemia Vera/drug therapy
- Polycythemia Vera/epidemiology
- Prevalence
- Prospective Studies
- Protein Kinase Inhibitors/therapeutic use
- Surveys and Questionnaires
- Thrombocythemia, Essential/diagnosis
- Thrombocythemia, Essential/drug therapy
- Thrombocythemia, Essential/epidemiology
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Affiliation(s)
| | | | - Kiran Qamar
- Population Health Research Institute, Canada
| | | | | | | | - Darryl P Leong
- Population Health Research Institute, Canada; Department of Medicine, McMaster University, Canada
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Abstract
This study aimed to determine the prevalence and correlates of successful ageing in older community-dwelling adults in India. The cross-sectional sample included 21,343 individuals (≥ 65 years) from the Longitudinal Ageing Study in India (LASI) Wave 1 in 2017-2018. Successful ageing was assessed utilizing a multidimensional concept, including five components: (1) absence of major illness, (2) free of disability, (3) no major depressive disorder, (4) social engagement and (5) life satisfaction. Overall, 27.2% had successful ageing, including 83.3% had no major diseases, 51.0% free from disability, 91.8% had no major depressive disorder, 73.6% were socially engaged and 74.6% had high life satisfaction. In the adjusted logistic regression analysis, male sex (Adjusted Odds Ratio-AOR 1.40, 95% Confidence Interval-CI 1.21-1.26), married (AOR 1.48, 95% CI 1.22-1.79), having formal education (AOR 1.47, 95% CI 1.23-1.74), high subjective socioeconomic status (AOR 1.61, 95% CI 1.29-2.01), urban residence (AOR 1.42, 95% CI 1.19-1.70), Sikhs (AOR 1.76, 95% CI 1.38-2.24), high physical activity (AOR 1.65, 95% CI 1.38-1.97), and daily Yoga practice (AOR 1.34, 95% CI 1.11-1.61) increased the odds of successful ageing, while increasing age (AOR 0.96, 95% CI 0.94-0.79), poor childhood health (AOR: 0.47, 95% CI 0.29-0.75), and underweight (AOR 0.70, 95% CI 0.61-0.81) decreased the odds of successful ageing. Almost one in three older adults in India were successfully ageing. Factors associated with successful ageing included, male sex, married, having formal education, high subjective socioeconomic status, urban residence, Sikhs, physical activity, Yoga practice, younger age, good childhood health, and not having underweight.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
- Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
| | - Karl Peltzer
- Department of Psychology, University of the Free State, Bloemfontein, South Africa.
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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de Oliveira Neto L, Tavares VDDO, Agrícola PMD, de Oliveira LP, Sales MC, de Sena-Evangelista KCM, Gomes IC, Galvão-Coelho NL, Pedrosa LFC, Lima KC. Factors associated with inflamm-aging in institutionalized older people. Sci Rep 2021; 11:18333. [PMID: 34526542 PMCID: PMC8443661 DOI: 10.1038/s41598-021-97225-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/13/2021] [Indexed: 02/08/2023] Open
Abstract
The increase in inflammatory cytokines associated with a reduction in the bioavailability of zinc has been used as a marker for inflammation. Despite the high inflammatory state found in institutionalized older individuals, few studies have proposed verifying the factors associated with this condition in this population. To verify the factors associated with inflamm-aging in institutionalized older people. A total of 178 older people (≥ 60 years old) living in nursing homes in Natal/RN were included in the study. Cluster analysis was used to identify three groups according to their inflammatory state. Analysis anthropometric, biochemical, sociodemographic, and health-related variables was carried out. In sequence, an ordinal logistic regression was performed for a confidence level of 95% in those variables with p < 0.20 in the bivariate analysis. IL-6, TNF-α, zinc, low-density lipids (LDL), high-density lipids (HDL), and triglycerides were associated with inflamm-aging. The increase of 1 unit of measurement of LDL, HDL, and triglycerides increased the chance of inflammation-aging by 1.5%, 4.1%, and 0.9%, respectively, while the oldest old (≥ 80 years old) had an 84.9% chance of presenting inflamm-aging in relation to non-long-lived older people (< 80 years). The association between biochemical markers and inflamm-aging demonstrates a relationship between endothelial injury and the inflammatory state. In addition, the presence of a greater amount of fat in the blood may present a higher relative risk of death.
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Affiliation(s)
- Leônidas de Oliveira Neto
- Department of Arts, Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 3000-Lagoa Nova, Natal, RN, 59078-970, Brazil.
| | | | | | | | - Márcia Cristina Sales
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | | | - Igor Conterato Gomes
- Department of Epidemiology, School of Public Health, University of São Paulo, Brazil, São Paulo, SP, Brazil
| | | | | | - Kenio Costa Lima
- Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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Du YT, Li YW, Zhao BJ, Guo XY, Feng Y, Zuo MZ, Fu C, Zhou WJ, Li HJ, Liu YF, Cheng T, Mu DL, Zeng Y, Liu PF, Li Y, An HY, Zhu SN, Li XY, Li HJ, Wu YF, Wang DX, Sessler DI. Long-term Survival after Combined Epidural-General Anesthesia or General Anesthesia Alone: Follow-up of a Randomized Trial. Anesthesiology 2021; 135:233-245. [PMID: 34195784 DOI: 10.1097/aln.0000000000003835] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Experimental and observational research suggests that combined epidural-general anesthesia may improve long-term survival after cancer surgery by reducing anesthetic and opioid consumption and by blunting surgery-related inflammation. This study therefore tested the primary hypothesis that combined epidural-general anesthesia improves long-term survival in elderly patients. METHODS This article presents a long-term follow-up of patients enrolled in a previous trial conducted at five hospitals. Patients aged 60 to 90 yr and scheduled for major noncardiac thoracic and abdominal surgeries were randomly assigned to either combined epidural-general anesthesia with postoperative epidural analgesia or general anesthesia alone with postoperative intravenous analgesia. The primary outcome was overall postoperative survival. Secondary outcomes included cancer-specific, recurrence-free, and event-free survival. RESULTS Among 1,802 patients who were enrolled and randomized in the underlying trial, 1,712 were included in the long-term analysis; 92% had surgery for cancer. The median follow-up duration was 66 months (interquartile range, 61 to 80). Among patients assigned to combined epidural-general anesthesia, 355 of 853 (42%) died compared with 326 of 859 (38%) deaths in patients assigned to general anesthesia alone: adjusted hazard ratio, 1.07; 95% CI, 0.92 to 1.24; P = 0.408. Cancer-specific survival was similar with combined epidural-general anesthesia (327 of 853 [38%]) and general anesthesia alone (292 of 859 [34%]): adjusted hazard ratio, 1.09; 95% CI, 0.93 to 1.28; P = 0.290. Recurrence-free survival was 401 of 853 [47%] for patients who had combined epidural-general anesthesia versus 389 of 859 [45%] with general anesthesia alone: adjusted hazard ratio, 0.97; 95% CI, 0.84 to 1.12; P = 0.692. Event-free survival was 466 of 853 [55%] in patients who had combined epidural-general anesthesia versus 450 of 859 [52%] for general anesthesia alone: adjusted hazard ratio, 0.99; 95% CI, 0.86 to 1.12; P = 0.815. CONCLUSIONS In elderly patients having major thoracic and abdominal surgery, combined epidural-general anesthesia with epidural analgesia did not improve overall or cancer-specific long-term mortality. Nor did epidural analgesia improve recurrence-free survival. Either approach can therefore reasonably be selected based on patient and clinician preference. EDITOR’S PERSPECTIVE
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Abstract
Researchers have repeatedly examined the relationship between a previous experience of a fall and subsequent fear of falling (FOF); however, few studies have investigated the effects of falling along various timelines among older adults. The objective of this study was to determine whether experiencing a fall in the previous month or the previous year led to FOF among the elderly.The National Health and Aging Trends Study (NHATS) in the U.S. collected information indicative of basic trends in the behavior of individuals aged 65 years and older. In the current study, we applied multiple logistic regression analysis of results from round 7 of the NHATS with the aim of identifying the risk factors associated with FOF among 5559 participants aged 65 years or older.FOF was reported by 48.8% of those who experienced a fall in the previous year and 46.8% experienced a fall in the previous month. The results of regression analysis revealed that after adjusting for sex, age, related chronic disease, activities of daily living, and instrumental activities of daily living, FOF was significantly associated with experiencing a fall during the previous month (OR = 2.29, 95% CI: 1.78-2.95) or during the previous year (OR = 2.60, 95% CI: 2.16-3.14).Our results indicate that experiences of falling during the previous month or the previous year were both significantly associated with a fear of falling, and caregivers should keep this in mind when dealing with community-living elderly individuals.
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Affiliation(s)
- Wei-Cheng Chen
- Taiwan Stipendiary Co., Ltd., Kaohsiung
- Institute of Health Policy and Management, National Taiwan University
| | - Yang-Tzu Li
- Department of Long Term Care, National Taipei University of Nursing and Health Science
| | - Tao-Hsin Tung
- Taiwan Association of Health Industry Management and Development, Taipei, Taiwan
| | - Chieh Chen
- Institute of Medical Sciences, Tzu Chi University, Hualien
| | - Ching-Yao Tsai
- Department of Ophthalmology, Taipei City Hospital
- Institute of Public Health, National Yang-Ming University
- MS Program in Transdisciplinary Long Term Care and Bachelor's Program in Business Management, Fu Jen Catholic University, New Taipei City, Taiwan
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Downer B, Pritchard K, Thomas KS, Ottenbacher K. Improvement in Activities of Daily Living during a Nursing Home Stay and One-Year Mortality among Older Adults with Sepsis. J Am Geriatr Soc 2021; 69:938-945. [PMID: 33155268 PMCID: PMC8049879 DOI: 10.1111/jgs.16915] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVE To describe the recovery of activities of daily living (ADLs) during a skilled nursing facility (SNF) stay and the association with 1-year mortality after SNF discharge among Medicare beneficiaries treated in intensive care for sepsis. DESIGN Retrospective cohort study. SETTING Skilled nursing facilities in the United States. PARTICIPANTS Medicare fee-for-service beneficiaries admitted to an SNF within 3 days of discharge from a hospitalization that included an intensive care unit (ICU) stay for sepsis between January 1, 2013, and September 30, 2015 (N = 59,383). MEASUREMENTS Data from the Minimum Data Set (MDS) were used to calculate a total score for seven ADLs. Improvement was determined by comparing the total ADL scores from the first and last MDS assessments of the SNF stay. Proportional hazard models were used to estimate the association between improvement in ADL function and 1-year mortality after SNF discharge. RESULTS Approximately 58% of SNF residents had any improvement in ADL function. Residents who had improvement in ADL function had 0.72 (95% confidence interval (CI) = 0.69-0.74) lower risk for mortality following SNF discharge than residents who did not improve. Residents who improved 1-3 points (hazard ratio (HR) = 0.82, 95% CI = 0.79-0.84) and four or more points (HR = 0.57, 95% CI = 0.55-0.60) in ADL function had significantly lower mortality risk than residents who did not improve. CONCLUSION Older adults treated in an ICU with sepsis can improve in ADL function during an SNF stay. This improvement is associated with lower 1-year mortality risk after SNF discharge. These findings provide evidence that ADL recovery during an SNF stay is associated with better health outcomes for older adults who have survived an ICU stay for sepsis.
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Affiliation(s)
- Brian Downer
- University of Texas Medical Branch, Division of Rehabilitation Sciences, Galveston, TX, US
- University of Texas Medical Branch, Sealy Center on Aging, Galveston, TX, US
| | - Kevin Pritchard
- University of Texas Medical Branch, Division of Rehabilitation Sciences, Galveston, TX, US
| | - Kali S. Thomas
- Brown University, School of Public Health, Providence, RI, US
- United States Department of Veterans Affairs Medical Center, Providence, RI, US
| | - Kenneth Ottenbacher
- University of Texas Medical Branch, Division of Rehabilitation Sciences, Galveston, TX, US
- University of Texas Medical Branch, Sealy Center on Aging, Galveston, TX, US
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12
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Affiliation(s)
- Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, service de réanimation, Paris, France, Department. of Clinical Medicine, University of Bergen, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway and Research lead Critical Care Directorate St George's Hospital, London, England
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13
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Owodunni OP, Mostales JC, Qin CX, Gabre-Kidan A, Magnuson T, Gearhart SL. Preoperative Frailty Assessment, Operative Severity Score, and Early Postoperative Loss of Independence in Surgical Patients Age 65 Years or Older. J Am Coll Surg 2021; 232:387-395. [PMID: 33385567 PMCID: PMC7771260 DOI: 10.1016/j.jamcollsurg.2020.11.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Preoperative discussions around postoperative discharge planning have been amplified by the COVID pandemic. We wished to determine whether our preoperative frailty screen would predict postoperative loss of independence (LOI). STUDY DESIGN This single-institutional study included demographic, procedural, and outcomes data from patients 65 years or older who underwent frailty screening before a surgical procedure. Frailty was assessed using the Edmonton Frail Scale. The Operative Severity Score was used to categorize procedures. The Hierarchical Condition Category risk-adjustment score, as calculated by the Centers for Medicare and Medicaid Services, was included. LOI was defined as an increase in support outside of the home after discharge. Univariable, multivariable logistic regressions, and adjusted postestimation analyses for predictive probabilities of best fit were performed. RESULTS Five hundred and thirty-five patients met inclusion criteria and LOI was seen in 38 patients (7%). Patients with LOI were older, had a lower BMI, a higher Edmonton Frail Scale score (7 vs 3.0; p < 0.001), and a higher Hierarchical Condition Category score than patients without LOI. Being frail and undergoing a procedure with an Operative Severity Score of 3 or higher was independently associated with an increased risk of LOI. In addition, social dependency, depression, and limited mobility were associated with an increased risk for LOI. On multivariable modeling, frailty status, undergoing an operation with an Operative Severity Score of 3 or higher, and having a Hierarchical Condition Category score ≥1 were the most predictive of LOI (odds ratio 12.72; 95% CI, 12.04 to 13.44; p < 0.001). In addition, self-reported depression, weight loss, and limited mobility were associated with a nearly 11-fold increased risk of postoperative LOI. CONCLUSIONS This study was novel, as it identified clear, generalizable risk factors for LOI. In addition, our findings support the implementation of preoperative assessments to aid in care coordination and provide specific targets for intervention.
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Wu X, Li X, Xu M, Zhang Z, He L, Li Y. Sarcopenia prevalence and associated factors among older Chinese population: Findings from the China Health and Retirement Longitudinal Study. PLoS One 2021; 16:e0247617. [PMID: 33661964 PMCID: PMC7932529 DOI: 10.1371/journal.pone.0247617] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/09/2021] [Indexed: 12/25/2022] Open
Abstract
Sarcopenia a recognised geriatric syndrome. This study aims to evaluate the prevalence of possible sarcopenia, sarcopenia and severe sarcopenia among older Chinese adults and to identify any associated factors for possible sarcopenia according to the updated diagnostic criteria of the Asian Working Group for Sarcopenia 2019 (AWGS 2019). We used data from the China Health and Retirement Longitudinal Study (CHARLS). The main outcome of this study was possible sarcopenia. Handgrip strength was measured via a dynamometer. The muscle mass was estimated by anthropometric measures. Physical performance was measured by 5-time chair stand test and gait speed test. A multivariate logistic regression model with stepwise method was employed to identify factors associated with possible sarcopenia. A total of 6172 participants aged 60–94 years were included. The prevalence of possible sarcopenia, sarcopenia and severe sarcopenia was 38.5%, 18.6%, and 8.0%, respectively. Age, rural area, falls, higher C-reactive protein (CRP), and chronic diseases (including hypertension, chronic lung diseases, heart disease, psychiatric disease and arthritis) were associated with a higher risk of possible sarcopenia. Conversely, alcohol consumption, higher gait speed and high levels of hemoglobin were associated with decreased risk of possible sarcopenia. However, the associations between possible sarcopenia with alcohol consumption, heart disease, psychiatric disease and hemoglobin were not significant after Bonferroni correction. Our study reported a relatively high prevalence of sarcopenia among older Chinese population, and identified a range of factors associated with sarcopenia. We also found rural elders are more vulnerable to sarcopenia than urban elders. Additionally, we discovered systemic inflammation might be one of the contributing factors between sarcopenia and related comorbidities. We believe the findings of this study would help to identify individuals at high risk of sarcopenia early and therefore implement the prevention and treatment strategies to reduce the disease burden in China.
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Affiliation(s)
- Xin Wu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
- Peking University Research Center on Aging, Beijing Key Laboratory of Protein Posttranslational Modifications and Cell Function, Department of Biochemistry and Molecular Biology, School of Basic Medical Science, Peking University, Beijing, China
| | - Xue Li
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Meihong Xu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Zhaofeng Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Lixia He
- Division of Molecular and Cellular Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Yong Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
- * E-mail:
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15
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Owen RK, Conroy SP, Taub N, Jones W, Bryden D, Pareek M, Faull C, Abrams KR, Davis D, Banerjee J. Comparing associations between frailty and mortality in hospitalised older adults with or without COVID-19 infection: a retrospective observational study using electronic health records. Age Ageing 2021; 50:307-316. [PMID: 32678866 PMCID: PMC7454252 DOI: 10.1093/ageing/afaa167] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The aim of this study was to describe outcomes in hospitalised older people with different levels of frailty and COVID-19 infection. METHODS We undertook a single-centre, retrospective cohort study examining COVID-19-related mortality using electronic health records, for older people (65 and over) with frailty, hospitalised with or without COVID-19 infection. Baseline covariates included demographics, early warning scores, Charlson Comorbidity Indices and frailty (Clinical Frailty Scale, CFS), linked to COVID-19 status. FINDINGS We analysed outcomes on 1,071 patients with COVID-19 test results (285 (27%) were positive for COVID-19). The mean age at ED arrival was 79.7 and 49.4% were female. All-cause mortality (by 30 days) rose from 9 (not frail) to 33% (severely frail) in the COVID-negative cohort but was around 60% for all frailty categories in the COVID-positive cohort. In adjusted analyses, the hazard ratio for death in those with COVID-19 compared to those without COVID-19 was 7.3 (95% CI: 3.00, 18.0) with age, comorbidities and illness severity making small additional contributions. INTERPRETATION In this study, frailty measured using the CFS appeared to make little incremental contribution to the hazard of dying in older people hospitalised with COVID-19 infection; illness severity and comorbidity had a modest association with the overall adjusted hazard of death, whereas confirmed COVID-19 infection dominated, with a sevenfold hazard for death.
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Affiliation(s)
- Rhiannon K Owen
- Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Simon P Conroy
- Department of Health Sciences, Centre for Medicine University of Leicester, University of Leicester School of Medicine, Leicester LE1 7HA, UK
| | - Nicholas Taub
- Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK
| | - Will Jones
- Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniele Bryden
- Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Manish Pareek
- Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Christina Faull
- Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Keith R Abrams
- Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, University College London, London WC1B 5JU, UK
| | - Jay Banerjee
- University Hospitals of Leicester NHS Trust, Leicester, UK
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Abstract
BACKGROUND The key considerations for healthy aging are diversity and inequity. Diversity means that there is no typical older person. Policy should be framed to improve the functional ability of all older people, whether they are robust, care dependent or in between. OBJECTIVE The aim of this article is to describe negative influence of Corona pandemic (COVID-19) for realization of the WHO project about Healthy Aging global strategy proposed in the targets "Health for all". METHODS Authors used descriptive model for this cross-sectional study based on facts in analyzed scientific literature deposited in on-line databases about healthy aging concept of the prevention and treatment of the people who will come or already came to the "third trimester of the life". RESULTS AND DISCUSSION Some 80-year-olds have levels of physical and mental capacity that compare favorably with 30-year-olds. Others of the same age may require extensive care and support for basic activities like dressing and eating. Policy should be framed to improve the functional ability of all older people, whether they are robust, care dependent or in between. Inequity reflects a large proportion (approximately 75%) of the diversity in capacity and circumstance observed in older age is the result of the cumulative impact of advantage and disadvantage across people's lives. Importantly, the relationships we have with our environments are shaped by factors such as the family we were born into, our sex, ethnicity, level of education and financial resources. CONCLUSION COVID-19 pandemic "celebrated" one year of existing in almost all countries in the world with very difficult consequences for whole population. But in the first risk group are old people who have in average 6 to 7 co-morbidities. WHO recommended some measures to improve prevention and treatment this category of population, but COVID-19 pandemic stopped full realization of Decade of Healthy Aging project.
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Affiliation(s)
- Asim Kurjak
- Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
- Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Miro Jakovljevic
- Department of Psychiatry, University Hospital Center Zagreb, Zagreb, Croatia
| | - Izet Masic
- Academy of Medical Sciences of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Milan Stanojevic
- Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
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Ocagli H, Lanera C, Azzolina D, Piras G, Soltanmohammadi R, Gallipoli S, Gafare CE, Cavion M, Roccon D, Vedovelli L, Lorenzoni G, Gregori D. Resting Energy Expenditure in the Elderly: Systematic Review and Comparison of Equations in an Experimental Population. Nutrients 2021; 13:458. [PMID: 33573101 PMCID: PMC7912404 DOI: 10.3390/nu13020458] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022] Open
Abstract
Elderly patients are at risk of malnutrition and need an appropriate assessment of energy requirements. Predictive equations are widely used to estimate resting energy expenditure (REE). In the study, we conducted a systematic review of REE predictive equations in the elderly population and compared them in an experimental population. Studies involving subjects older than 65 years of age that evaluated the performance of a predictive equation vs. a gold standard were included. The retrieved equations were then tested on a sample of 88 elderly subjects enrolled in an Italian nursing home to evaluate the agreement among the estimated REEs. The agreement was assessed using the intraclass correlation coefficient (ICC). A web application, equationer, was developed to calculate all the estimated REEs according to the available variables. The review identified 68 studies (210 different equations). The agreement among the equations in our sample was higher for equations with fewer parameters, especially those that included body weight, ICC = 0.75 (95% CI = 0.69-0.81). There is great heterogeneity among REE estimates. Such differences should be considered and evaluated when estimates are applied to particularly fragile populations since the results have the potential to impact the patient's overall clinical outcome.
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Affiliation(s)
- Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (C.L.); (D.A.); (G.P.); (R.S.); (M.C.); (L.V.); (G.L.)
| | - Corrado Lanera
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (C.L.); (D.A.); (G.P.); (R.S.); (M.C.); (L.V.); (G.L.)
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (C.L.); (D.A.); (G.P.); (R.S.); (M.C.); (L.V.); (G.L.)
- Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy
| | - Gianluca Piras
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (C.L.); (D.A.); (G.P.); (R.S.); (M.C.); (L.V.); (G.L.)
| | - Rozita Soltanmohammadi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (C.L.); (D.A.); (G.P.); (R.S.); (M.C.); (L.V.); (G.L.)
| | - Silvia Gallipoli
- ZETA Research Incorporation, Via A. Caccia 8, 34122 Trieste, Italy;
| | - Claudia Elena Gafare
- Department of Nutrition, University of Buenos Aires and Food and Diet Therapy Service, Acute General Hospital Juan A. Fernandez, Av. Cerviño 3356, Buenos Aires C1425, Argentina;
| | - Monica Cavion
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (C.L.); (D.A.); (G.P.); (R.S.); (M.C.); (L.V.); (G.L.)
| | - Daniele Roccon
- Nursing Home “A. Galvan”, Via Ungheria 340, Pontelongo, 35029 Padova, Italy;
| | - Luca Vedovelli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (C.L.); (D.A.); (G.P.); (R.S.); (M.C.); (L.V.); (G.L.)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (C.L.); (D.A.); (G.P.); (R.S.); (M.C.); (L.V.); (G.L.)
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (C.L.); (D.A.); (G.P.); (R.S.); (M.C.); (L.V.); (G.L.)
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Zipprich HM, Schönenberg A, Teschner U, Prell T. Changes of perceptions and behaviours during the phases of COVID-19 pandemic in German elderly people with neurological disorders: an observational study using telephone interviews. BMJ Open 2021; 11:e045780. [PMID: 33436478 PMCID: PMC7804827 DOI: 10.1136/bmjopen-2020-045780] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Describing perceived limitations in everyday life, psychological burden and approval to easing of measures during the COVID-19 phases in elderly people with neurological disorders. DESIGN Observational, prospective study SETTING: This is a monocentric study conducted at a university hospital in Germany. PARTICIPANTS Overall, 452 elderly people participated in the NeuroGerAdh study (DRKS00016774) and were interviewed by telephone between 18 March and 30 August 2020. RESULTS Overall, 307 (67.9%) patients had relevant limitations in daily life due to the measures. These limitations significantly decreased during the pandemic phases. At the beginning of the pandemic, people complained about restricted social contacts and mobility, which were the most common reasons for perceived limitations in daily life. Later, since June 2020, wearing a mouth-nose mask had become the main reason for perceived limitations. In the elastic net regularisation, model higher perceived limitations in daily life were among others associated with younger age and earlier pandemic phases. Higher psychological burden was mainly associated with early pandemic phase, younger age and depression.The perceived psychological burden decreased as the pandemic phases passed, even though the reasons for psychological burden (anxiety or fear of infection, insecurity and concerns) did not remarkably change during the phases. From 16 June 2020, the patients were asked whether they approve the easing of measures. Sixty-seven of 136 patients (49.3%) approved and 55 (40.4%) did not. The common reasons for disapproval were fear of increased risk of infection and irresponsible behaviour of other people. CONCLUSION While limitations in daily life decreased during the study period, anxiety remains a common psychological burden in elderly sick people, and this needs special attention. Accordingly, most people do not approve easing of measures. Special strategies are needed to cope with changing measures during the COVID-19 pandemic.
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Affiliation(s)
- Hannah M Zipprich
- Department of Neurology, Jena University Hospital, Jena, Thüringen, Germany
| | - Aline Schönenberg
- Department of Neurology, Jena University Hospital, Jena, Thüringen, Germany
| | - Ulrike Teschner
- Department of Neurology, Jena University Hospital, Jena, Thüringen, Germany
| | - Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Thüringen, Germany
- Center for Healthy Aging, Jena University Hospital, Jena, Thüringen, Germany
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19
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Abstract
OBJECTIVES Older adults with frailty are vulnerable to cardiovascular event and subsequent mortality. Frailty and albuminuria share atherosclerotic risk factors. The present study investigated the association of frailty and albuminuria among elderly Chinese inpatients. DESIGN Cross-sectional study. SETTINGS AND PARTICIPANTS A total of 202 patients aged over 60 years from the Center of Gerontology and Geriatric, West China Hospital. MEASUREMENTS Frailty was defined using the five-item FRAIL scale. This included measurements of fatigue, resistance, ambulation, illness, and loss of weight. We further determined the random urine albumin/creatinine ratio (UACR) of all patients. Random UACR ≥30 mg/g was defined as albuminuria, and < 30mg/g as normoalbuminuria. The relationship between albuminuria and frailty was assessed through multiple regression analysis. RESULTS The 202 participants (156 men, 77.2%) had an average age of 78.99±7.60 years, which ranged from 60 to 95. Compared to those without albuminuria, elderly patients with albuminuria were of an older age, had a higher prevalence of diabetes and poorer renal function. The prevalence of frailty, pre-frailty and ambulation (one of the FRAIL components) were higher in the albuminuria group than the normoalbuminuria group (23.9% vs. 12.2%, 47.9% vs.37.4%, 33.8% vs. 16.0%, respectively, P<0.05). Following the adjustment for age, eGFR, hypertension, diabetes and using ACEI/ARB, being frail or pre-frail led to an enhanced risk of albuminuria (OR frail 2.60, 95% CI frail 1.01-6.72; OR pre-frail 2.14, 95% CI pre-frail 1.03-4.44). CONCLUSIONS Frailty is independently associated with albuminuria when adjusted for classic cardiovascular risk factors.
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Affiliation(s)
- X Yang
- Ying Li, MD, The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University. 37 Guoxuexiang, Chengdu, Sichuan providence, PR. China, 610041; Tel: 86-028-8542 2321; Fax: 86-028-8542 2321; E-mail:
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Abstract
OBJECTIVES This study aimed to explore the evolutionary stage of the elderly from the normal to the cognitive frailty, and to identify the important factors which influenced the changes of the cognitive frailty stage from the «physiological-psychological-social» perspective. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS A random cluster sampling was used to recruit 4,010 old adults living in community from Shanxi province in China. MEASUREMENTS Data were collected by face-to-face questionnaire survey. Multinomial logistic regression was used to screen the factors contributing to the 6 population groups with various cognitive functions and frailty status. Principal component analysis was used to redefine the evolutionary stages of cognitive frailty, while the orthogonal partial least squares discrimination analysis and binary logistic regression were used to identify the important factors and distinguish different stages and influence directions. RESULTS The factors contributing to the population with various cognitive functions and frailty status were involved in all aspects of «physical-psychological-social». Apart from normal group, other 5 groups were clustered into «stage of frailty change» and « stage of cognitive frailty change». Aging, early onset of chronic diseases, high pain intensity, and poor nutritional status might deteriorate the individual's evolution from "normal stage" to "stage of frailty change", while the increasing social activity might promote the individual's health. Simultaneously, early onset of chronic diseases, high pain intensity and poor nutritional status also played important roles in the evolution of individual from "stage of frailty change" to "stage of cognitive frailty change". CONCLUSION The formation of cognitive frailty might experience the «normal-frailty-cognitive frailty» stages change, and both the prevention and intervention of frailty might delay the occurrence of cognitive frailty. Therefore, the strategies for both prevention and intervention among old adults should be throughout centered on the parts of preventing the premature onset of chronic diseases, carrying out stage-tailored nutrition intervention, and establishing standardized pain management, especially the part of increasing the social activities among older adults.
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Affiliation(s)
- J Lu
- Jiao Lu, Shanxi Medical University, No. 56, Xinjian South Road, Box No. 1042, 030001, Taiyuan, Shanxi, China, Tel: +86 13100096395,
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Saraiva MD, Apolinario D, Avelino-Silva TJ, de Assis Moura Tavares C, Gattás-Vernaglia IF, Marques Fernandes C, Rabelo LM, Tavares Fernandes Yamaguti S, Karnakis T, Kalil-Filho R, Jacob-Filho W, Romero Aliberti MJ. The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults during the COVID-19 Pandemic. J Nutr Health Aging 2021; 25:440-447. [PMID: 33786560 PMCID: PMC7678592 DOI: 10.1007/s12603-020-1532-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to abrupt restrictions of life-space mobility. The impact of shelter-in-place orders on older adults' health and well-being is still unclear. OBJECTIVE To investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic. DESIGN Multicenter prospective cohort study based on structured telephone interviews. SETTING Four geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil. PARTICIPANTS 557 community-dwelling adults aged 60 years and older. MEASUREMENTS The Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of ≥ 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question «How is the COVID-19 pandemic affecting your QoL?», to which participants could respond «not at all», «to some extent», or «to a great extent». We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL. RESULTS Participants were on average 80±8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58). CONCLUSION Older adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.
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Affiliation(s)
- M D Saraiva
- Márlon Juliano Romero Aliberti, Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo. Av. Dr. Eneas de Carvalho Aguiar 155, 8º andar, Clinica Medica, LIM-66, Cerqueira Cesar, Sao Paulo - SP, 05403-000, Brazil. Tel.: +55-11-26618116. E-mail address:
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22
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Ramírez-Vélez R, López Sáez de Asteasu M, Morley JE, Cano-Gutierrez CA, Izquierdo M. Performance of the Short Physical Performance Battery in Identifying the Frailty Phenotype and Predicting Geriatric Syndromes in Community-Dwelling Elderly. J Nutr Health Aging 2021; 25:209-217. [PMID: 33491036 DOI: 10.1007/s12603-020-1484-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 01/06/2023]
Abstract
The early identification of seniors at high risk of geriatric syndromes is fundamental for targeting interventions to those who most need them. To date, the predictive value of the Short Physical Performance Battery (SPPB) for multifactorial clinical conditions has not been clearly established. Thus, the aim of the present study was to determine whether the SPPB could identify frailty and predict geriatric syndromes in community-dwelling older adults. Participants comprised men and women aged 60 years and older who participated in the Health and Well-being and Aging Survey in Colombia 2015 (n=4125, 57.6% women). A structured interview was administered to obtain socio-demographic data which included age, sex, ethnicity, socioeconomic status, and urbanicity. The study included the measurement of body mass, grip strength, SPPB, Lawton´s instrumental ADL scale, specific subjective memory complaints (SSMC), frailty phenotype (Fried and FRAIL Scale), and self-reported falls, geriatric syndromes and/or medical conditions. ROC analysis was used to examine the ability of the SPPB test to predict frailty and geriatric syndromes. The cutoff that maximized both sensitivity and specificity for the frailty phenotype was 8 points or below for men and 7 points or below for women. These cutoff values significantly predicted four geriatric syndromes in descending order: mild dementia (♂ ORajus 3.34, and ♀ ORajus 2.79), low grip strength (♂ ORajus 1.98, and ♀ ORajus 2.45), falls (♂ ORajus 1.39, and ♀ ORajus 1.49), and SSMC (♂ ORajus 1.39). In summary, the main finding of the present study was that SPPB score (i.e., ≤ 8 ♂ and ≤ 7 ♀) seems to be a useful measure for identifying the physical frailty phenotype and predicting geriatric syndromes in community-dwelling older adults.
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Affiliation(s)
- R Ramírez-Vélez
- Robinson Ramirez-Velez, Pública de Navarra (UPNA)-Complejo Hospitalario de Navarra (CHN), Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008, Calle Cataluña, s/n, 31006 Pamplona, Navarra, Spain, E-mail: , Phone: +34-695-526-321
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23
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Abstract
Accidental falls in the elderly and their consequences are one of the leading causes of disability; they significantly reduce the quality of life and lead to loss of independence and impaired social functioning. This study presents selected issues regarding the causes of accidental falls and research tools for determining the risk of falls based on a review of the scientific literature available in English in the PubMed/ MEDLINE, Cochrane Library, Embase, Scopus, PEDro databases and in Polish in the Polish Medical Bibliography and Polish Scien-tific Journals Database of 2015-2020, covering original papers, systematic reviews and meta-analyses. The following keywords were used: public health, risk factors, accidental falls, fall-related injuries, elderly, geriatric assessment. A total of 65 publications were included in the analysis. We believe that the use of at least two different tools in the risk assessment should be encouraged in view of the complexity and multitude of the risk factors. An optimal approach to the problem assumes interdisciplinary collaboration of all medical staff in assessment, rehabilitation, as well as fall prevention strategies, which is the most economical method of treatment.
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Affiliation(s)
- Karolina Gawrońska
- Zakład Usprawniania Leczniczego Centralnego Szpitala Klinicznego MSWiA w Warszawie, Polska / Rehabilitation Center, Central Research Hospital of the Ministry of the Interior and Administration in Warsaw, Poland
| | - Jacek Lorkowski
- Centralny Szpital Kliniczny MSWiA w Warszawie, Polska / Central Research Hospital of the Ministry of the Interior and Administration in Warsaw, Poland Clinical Department of Orthopedics, Traumatology and Sports Medicine
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Liu HT, Wu SC, Tsai CH, Li C, Chou SE, Su WT, Hsu SY, Hsieh CH. Association between Geriatric Nutritional Risk Index and Mortality in Older Trauma Patients in the Intensive Care Unit. Nutrients 2020; 12:nu12123861. [PMID: 33348716 PMCID: PMC7766904 DOI: 10.3390/nu12123861] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 01/04/2023] Open
Abstract
The geriatric nutritional risk index (GNRI) is a simple and efficient tool to assess the nutritional status of patients with malignancies or after surgery. Because trauma patients constitute a specific population that generally acquires accidental and acute injury, this study aimed to identify the association between the GNRI at admission and mortality outcomes of older trauma patients in the intensive care unit (ICU). Methods: The study population included 700 older trauma patients admitted to the ICU between 1 January 2009 and 31 December 2019. The collected data included age, sex, body mass index (BMI), albumin level at admission, preexisting comorbidities, injury severity score (ISS), and in-hospital mortality. Multivariate logistic regression analysis was conducted to identify the independent effects of univariate predictive variables resulting in mortality in our study population. The study population was categorized into four nutritional risk groups: a major-risk group (GNRI < 82; n = 128), moderate-risk group (GNRI 82 to <92; n = 191), low-risk group (GNRI 92–98; n = 136), and no-risk group (GNRI > 98; n = 245). Results: There was no significant difference in sex predominance, age, and BMI between the mortality (n = 125) and survival (n = 575) groups. The GNRI was significantly lower in the mortality group than in the survival group (89.8 ± 12.9 vs. 94.2 ± 12.0, p < 0.001). Multivariate logistic regression analysis showed that the GNRI (odds ratio—OR, 0.97; 95% confidence interval (CI) 0.95–0.99; p = 0.001), preexisting end-stage renal disease (OR, 3.6; 95% CI, 1.70–7.67; p = 0.001), and ISS (OR, 1.1; 95% CI, 1.05–1.10; p < 0.001) were significant independent risk factors for mortality. Compared to the patients in group of GNRI > 98, those patients in group of GNRI < 82 presented a significantly higher mortality rate (26.6% vs. 13.1%; p < 0.001) and length of stay in hospital (26.5 days vs. 20.9 days; p = 0.016). Conclusions: This study demonstrated that GNRI is a significant independent risk factor and a promising simple screening tool to identify the subjects with malnutrition associated with higher risk for mortality in those ICU elderly trauma patients.
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Affiliation(s)
- Hang-Tsung Liu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan; (H.-T.L.); (C.-H.T.); (C.L.); (S.-E.C.); (W.-T.S.); (S.-Y.H.)
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan;
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan; (H.-T.L.); (C.-H.T.); (C.L.); (S.-E.C.); (W.-T.S.); (S.-Y.H.)
| | - Chi Li
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan; (H.-T.L.); (C.-H.T.); (C.L.); (S.-E.C.); (W.-T.S.); (S.-Y.H.)
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan; (H.-T.L.); (C.-H.T.); (C.L.); (S.-E.C.); (W.-T.S.); (S.-Y.H.)
| | - Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan; (H.-T.L.); (C.-H.T.); (C.L.); (S.-E.C.); (W.-T.S.); (S.-Y.H.)
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan; (H.-T.L.); (C.-H.T.); (C.L.); (S.-E.C.); (W.-T.S.); (S.-Y.H.)
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan
- Correspondence: ; Tel.: +886-7-7327476
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Yuan W, Gong S, Han Y. How does rising housing price affect the health of middle-aged and elderly people? The complementary mediators of social status seeking and competitive saving motive. PLoS One 2020; 15:e0243982. [PMID: 33320920 PMCID: PMC7737984 DOI: 10.1371/journal.pone.0243982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/29/2020] [Accepted: 12/02/2020] [Indexed: 11/19/2022] Open
Abstract
Under the backdrop of China's aging population and continuous rising housing price and base on theories pertaining to social status seeking, marriage matching and intergenerational family relationships, use the 2010 and 2014 CFPS national survey micro data, we examine the impact of rising housing price on the health of middle-aged and elderly people and the underlying mechanisms. Rising housing price has a significant negative impact on the health of middle-aged and elderly people, and this effect is also reflected in their physical health, mental acuity and emotional well-being. The internal mechanism is that social status seeking motivation plays a significant mediator role. Through further analysis, we find that competitive saving motive is another intermediate mechanism that causes rising housing price to affect the health of middle-aged and elderly people; it is complementary to the social status seeking motivation. What's more, the mediation effect of the competitive saving motive is notably heterogeneous, as it exists only for middle-aged and elderly people with male or noncollege educated child but does not exist for those with female or college educated child.
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Affiliation(s)
- Wei Yuan
- School of Business Administration, Hubei University of Economics, Wuhan, China
| | - Shuying Gong
- College of Business, Shanghai University of Finance and Economics, Shanghai, China
- * E-mail: (SG); (YH)
| | - Yimin Han
- College of Business, Shanghai University of Finance and Economics, Shanghai, China
- * E-mail: (SG); (YH)
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26
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Mori H, Yamasaki K, Itoh T, Saishoji Y, Torisu Y, Mori T, Izumi Y. Predictors of prolonged mechanical ventilation identified at an emergency visit for elderly people: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e23472. [PMID: 33285748 PMCID: PMC7717806 DOI: 10.1097/md.0000000000023472] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to determine the factors that are associated with prolonged mechanical ventilation in elderly patients.Retrospective cohort studySingle tertiary hospital in JapanWe retrospectively identified 228 patients aged 75 years or older who were admitted to a single tertiary care center in Japan between January 1, 2014 and December 31, 2017 because of endogenous diseases and underwent mechanical ventilation.The primary outcome was extubation difficulty, which was defined as the need for mechanical ventilation for more than 14 days after intubation, reintubation within 72 hours after extubation, tracheotomy or extubation, or death within 14 days after intubation.A multivariate analysis showed that age (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.66-1.38; P = .80), gender (OR = 0.56; 95%CI = 0.27-1.17; P = .13), body mass index (BMI) (OR = 1.05; 95%CI = 0.98-1.14; P = .16), smoking history (OR = 0.64; 95%CI = 0.29-1.41; P = .27), Activities of daily living (ADL) (OR = 0.95; 95%CI = 0.49-1.83; P = .87), and modified acute physiology and chronic health evaluation (APACHE) II score (OR = 1.02; 95%CI = 0.95-1.09; P = .61) were not statistically significantly different. However, there were statistically significant differences in extubation difficulty between patients with diabetes mellitus (OR = 2.3; 95%CI = 1.01-5.12; P = .04) and those with cardiovascular disease diagnosis on admission (OR = 0.31; 95%CI = 0.1-0.97; P = .04).Diabetes mellitus and cardiovascular disease diagnosis on admission were factors that were associated with prolonged mechanical ventilation in the elderly. The results of this study may help to support shared decision making with patients or surrogate decision makers at the start of intensive care in the elderly.
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Affiliation(s)
| | | | - Takehiro Itoh
- Nursing Department, National Hospital Organization, Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, Japan
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Brunello A, Galiano A, Finotto S, Monfardini S, Colloca G, Balducci L, Zagonel V. Older cancer patients and COVID-19 outbreak: Practical considerations and recommendations. Cancer Med 2020; 9:9193-9204. [PMID: 33219746 PMCID: PMC7774711 DOI: 10.1002/cam4.3517] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
Since the COVID-19 outbreak started, it has been affecting mainly older individuals. Among the most vulnerable older individuals are those with cancer. Many published guidelines and consensus papers deal with prioritizing cancer care. Given the lack of high-quality evidence for management of cancer in older patients also in normal times, it is even more stringent to provide some resources on how to avoid both undertreatment and overtreatment in this population, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated. We hereby discuss some general recommendations (implement triage procedures; perform geriatric assessment; carefully assess comorbidity; promote early integration of palliative care in oncology; acknowledge the role of caregivers; maintain active take in charge to avoid feeling of abandonment; mandate seasonal flu vaccination) and discuss practical suggestions for specific disease settings (early-stage and advanced-stage disease for solid tumors, and hematological malignancies). The manuscript provides resources on how to avoid both undertreatment and overtreatment in older patients with cancer, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated.
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Affiliation(s)
- Antonella Brunello
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| | - Antonella Galiano
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| | - Silvia Finotto
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| | | | - Giuseppe Colloca
- Dipartimento di Diagnostica per ImmaginiRadioterapia Oncologica ed EmatologiaIstituto di RadiologiaFondazione Policlinico A. Gemelli IRCCS ‐ Università Cattolica Sacro CuoreRomaItaly
| | - Lodovico Balducci
- Moffitt Cancer CenterUniversity of South Florida College of MedicineTampaFloridaUSA
| | - Vittorina Zagonel
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
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Najafi B, Veranyan N, Zulbaran-Rojas A, Park C, Nguyen H, Nakahara QK, Elizondo-Adamchik H, Chung J, Mills JL, Montero-Baker M, Armstrong DG, Rowe V. Association Between Wearable Device-Based Measures of Physical Frailty and Major Adverse Events Following Lower Extremity Revascularization. JAMA Netw Open 2020; 3:e2020161. [PMID: 33211104 PMCID: PMC7677765 DOI: 10.1001/jamanetworkopen.2020.20161] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Physical frailty is a key risk factor associated with higher rates of major adverse events (MAEs) after surgery. Assessing physical frailty is often challenging among patients with chronic limb-threatening ischemia (CLTI) who are often unable to perform gait-based assessments because of the presence of plantar wounds. OBJECTIVE To test a frailty meter (FM) that does not rely on gait to determine the risk of occurrence of MAEs after revascularization for patients with CLTI. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 184 consecutively recruited patients with CLTI at 2 tertiary care centers. After 32 individuals were excluded, 152 participants were included in the study. Data collection was conducted between May 2018 and June 2019. EXPOSURES Physical frailty measurement within 1 week before limb revascularization and incidence of MAEs for as long as 1 month after surgery. MAIN OUTCOMES AND MEASURES The FM works by quantifying weakness, slowness, rigidity, and exhaustion during a 20-second repetitive elbow flexion-extension exercise using a wrist-worn sensor. The FM generates a frailty index (FI) ranging from 0 to 1; higher values indicate progressively greater severity of physical frailty. RESULTS Of 152 eligible participants (mean [SD] age, 67.0 [11.8] years; 59 [38.8%] women), 119 (78.2%) were unable to perform the gait test, while all could perform the FM test. Overall, 53 (34.9%), 58 (38.1%), and 41 (27.0%) were classified as robust (FI <0.20), prefrail (FI ≥0.20 to <0.35), or frail (FI ≥0.35), respectively. Within 30 days after surgery, 24 (15.7%) developed MAEs, either major adverse cardiovascular events (MACE; 8 [5.2%]) or major adverse limb events (MALE; 16 [10.5%]). Baseline demographic characteristics were not significantly different between frailty groups. In contrast, the FI was approximately 30% higher in the group that developed MAEs (mean [SD] score, 0.36 [0.14]) than those who were MAE free (mean [SD] score, 0.26 [0.13]; P = .001), with observed MAE rates of 4 patients (7.5%), 7 patients (12.1%), and 13 patients (31.7%) in the robust, prefrail and frail groups, respectively (P = .004). The FI distinguished individuals who developed MACE and MALE from those who were MAE free (MACE: mean [SD] FI score, 0.38 [0.16]; P = .03; MALE: mean [SD] FI score, 0.35 [0.13]; P = .004) after adjusting by body mass index. CONCLUSIONS AND RELEVANCE In this cohort study, measuring physical frailty using a wrist-worn sensor during a short upper extremity test was a practical method for stratifying the risk of MAEs following revascularization for CLTI when the administration of gait-based tests is often challenging.
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Affiliation(s)
- Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Narek Veranyan
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Alejandro Zulbaran-Rojas
- Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Catherine Park
- Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Hung Nguyen
- Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Hector Elizondo-Adamchik
- Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jayer Chung
- Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Joseph L. Mills
- Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Miguel Montero-Baker
- Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Vincent Rowe
- Keck School of Medicine, University of Southern California, Los Angeles
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Yajima T, Yajima K, Takahashi H. Impact of Annual Change in Geriatric Nutritional Risk Index on Mortality in Patients Undergoing Hemodialysis. Nutrients 2020; 12:nu12113333. [PMID: 33138201 PMCID: PMC7692349 DOI: 10.3390/nu12113333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022] Open
Abstract
Regular nutritional assessment may decrease the mortality rate in patients undergoing hemodialysis. This study aimed to evaluate whether annual change in geriatric nutritional risk index (ΔGNRI) can precisely predict mortality. We retrospectively examined 229 patients undergoing hemodialysis who measured geriatric nutritional risk index (GNRI). Patients were divided into four groups according to the baseline GNRI of 91.2, previously reported cutoff value, and declined or maintained GNRI during the first year (ΔGNRI < 0% vs. ΔGNRI ≥ 0%): Group 1 (G1), GNRI ≥ 91.2 and ΔGNRI ≥ 0%; G2, GNRI ≥ 91.2 and ΔGNRI < 0%; G3, GNRI < 91.2 and ΔGNRI ≥ 0%; and G4, GNRI < 91.2 and ΔGNRI < 0%. They were followed for mortality. During a median follow-up of 3.7 (1.9–6.9) years, 74 patients died, of which 35 had cardiovascular-specific causes. The GNRI significantly decreased from 94.8 ± 6.3 to 94.1 ± 6.7 in the first year (p = 0.035). ΔGNRI was negatively associated with baseline GNRI (ρ = −0.199, p = 0.0051). The baseline GNRI < 91.2 and ΔGNRI < 0% were independently associated with all-cause mortality (adjusted hazard ratio (aHR) 2.59, 95%, confidence interval (CI) 1.54–4.33, and aHR 2.33, 95% CI 1.32–4.32, respectively). The 10-year survival rates were 69.8%, 43.2%, 39.9%, and 19.2% in G1, G2, G3, and G4, respectively (p < 0.0001). The aHR value for G4 vs. G1 was 3.88 (95% CI 1.62–9.48). With regards to model discrimination, adding ΔGNRI to the baseline risk model including the baseline GNRI significantly improved the net reclassification improvement by 0.525 (p = 0.0005). With similar results obtained for cardiovascular mortality. We concluded that the ΔGNRI could not only predict all-cause and cardiovascular mortality but also improve predictability for mortality; therefore, GNRI might be proposed to be serially evaluated.
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Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu 501-6062, Japan
- Correspondence: ; Tel.: +81-58-388-0111
| | - Kumiko Yajima
- Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan;
| | - Hiroshi Takahashi
- Division of Medical Statistics, Fujita Health University School of Medicine, Aichi 470-1192, Japan;
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Lee BO, Yao CT, Pan CF. Effectiveness of board game activities for reducing depression among older adults in adult day care centers of Taiwan: a quasi-experimental study. Soc Work Health Care 2020; 59:725-737. [PMID: 33138738 DOI: 10.1080/00981389.2020.1842576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 10/06/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
Depression is common in older adults and is associated with an increased risk of cognitive impairment. To clarify the possible roles of board game use in psychosomatic health promotion, this study evaluated the effects of board game activities in reducing depression in older adults. This was a quasi-experimental study. Purposive sampling was used to select 150 participants aged 65 years and above with intact mental functions who were currently residing in adult day care centers. Seventy-five participants who participated in 12 sessions of selected board game activities were assigned to the experimental group, and 75 participants who adhered to their ordinary activities were allocated to the control group. Structured questionnaires were used for data collection. The board game activities showed promising effects on the depression levels of the investigated older adults living in adult day care centers. Therefore, one possible beneficial effect of board game activities may be reduced depression in older adults. The results of this study provide support for the mediating role of board game activities in the mental health of long-term care elders. Incorporating board game activities into social work may help to make it more diverse and innovative.
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Affiliation(s)
- Bih-O Lee
- College of Nursing, Kaohsiung Medical University , Kaohsiung, Taiwan
- Faculty of Nursing, Universitas Airlangga , Surabaya, Indonesia
| | - Ching-Teng Yao
- Master Program of Long-Term Care in Aging, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Chao-Fen Pan
- Kaohsiung Medical University , Kaohsiung, Taiwan
- Department of Industrial Engineering and Management, National Kaohsiung University of Science and Technology , Kaohsiung, Taiwan
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Woolford SJ, D'Angelo S, Curtis EM, Parsons CM, Ward KA, Dennison EM, Patel HP, Cooper C, Harvey NC. COVID-19 and associations with frailty and multimorbidity: a prospective analysis of UK Biobank participants. Aging Clin Exp Res 2020; 32:1897-1905. [PMID: 32705587 PMCID: PMC7377312 DOI: 10.1007/s40520-020-01653-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [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: 06/08/2020] [Accepted: 07/07/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Frailty and multimorbidity have been suggested as risk factors for severe COVID-19 disease. AIMS We investigated, in the UK Biobank, whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19. METHODS 502,640 participants aged 40-69 years at baseline (54-79 years at COVID-19 testing) were recruited across UK during 2006-10. A modified assessment of frailty using Fried's classification was generated from baseline data. COVID-19 test results (England) were available for 16/03/2020-01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, after adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups. RESULTS 4510 participants were tested for COVID-19 (positive = 1326, negative = 3184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR = 1.4 [95%CI = 1.1, 1.8]), report slow walking speed (OR = 1.3 [1.1, 1.6]), report two or more falls in the past year (OR = 1.3 [1.0, 1.5]) and be multimorbid (≥ 4 comorbidity groupings vs 0-1: OR = 1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. However, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants. DISCUSSION AND CONCLUSIONS Frailty and multimorbidity do not appear to aid risk stratification, in terms of positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.
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Affiliation(s)
- S J Woolford
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - S D'Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C M Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - H P Patel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Medicine for Older People, University Hospital Southampton, Southampton, UK
- Academic Geriatric Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Abstract
IMPORTANCE Sensory impairments may heighten the risk of premature brain aging. Little is known regarding the association of sensory impairments with cognitive function and depression in China. OBJECTIVE To examine the association of visual and/or hearing impairments with cognitive decline and depression. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the data from 18 038 respondents to the 2015 survey of the China Health and Retirement Longitudinal Study, a nationally representative survey of adults aged 45 years or older and their spouses. EXPOSURES The presence of sensory impairments was identified by self-reported assessment of visual and/or hearing functions. MAIN OUTCOMES AND MEASURES Overall, 3 composite measures were used to assess the respondents' cognitive performance, including episodic memory, mental intactness, and global cognitive function. Depression was examined using the 10-item Center for Epidemiological Studies-Depression scale score. Multiple generalized linear regression models, adjusting for self-reported sociodemographic characteristics, health behaviors, chronic conditions, and participants' overall health, were used. RESULTS Of 18 038 respondents, 9244 (51.2%) were women. The mean (SD) age was 59.9 (9.7) years. Respondents with visual impairment had poorer episodic memory (β = -0.12; 95% CI, -0.19 to -0.05) and global cognition (β = -0.16; 95% CI, -0.31 to -0.02) and a greater risk of depression (odds ratio, 1.78; 95% CI, 1.59 to 1.99) than those without visual impairment. Respondents with hearing impairment had poorer episodic memory (β = -0.24; 95% CI, -0.30 to -0.18), mental intactness (β = -0.19; 95% CI, -0.28 to -0.10), and global cognition (β = -0.43; 95% CI, -0.55 to -0.31) as well as a greater risk of depression (odds ratio, 1.57; 95% CI, 1.44 to 1.70) than those without hearing impairment. People who reported dual sensory impairment performed worse on all of the aforementioned outcome measures (episodic memory: β = -0.23; 95% CI, -0.31 to -0.14; mental intactness: β = -0.13; 95% CI, -0.27 to -0.0003; global cognition: β = -0.37; 95% CI, -0.55 to -0.19; depression: odds ratio, 2.19; 95% CI, 1.90 to 2.52). CONCLUSIONS AND RELEVANCE In this study, visual and hearing impairments were independently and together associated with poorer cognitive and depression outcomes. A more comprehensive and integrated system of care, covering vision, hearing, and cognition, is needed in China's health care system to address age-related sensory impairments.
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Affiliation(s)
- Hongguo Rong
- China Center for Health Development Studies, Peking University, Beijing, China
- Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaozhen Lai
- China Center for Health Development Studies, Peking University, Beijing, China
- Peking University School of Public Health, Beijing, China
| | - Rize Jing
- China Center for Health Development Studies, Peking University, Beijing, China
- Peking University School of Public Health, Beijing, China
| | - Xiao Wang
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, Anding Hospital, Capital Medical University, Beijing, China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
- Peking University Health Science Center, Chinese Center for Disease Control and Prevention Joint Center for Vaccine Economics, Beijing, China
- Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Beijing, China
| | - Elham Mahmoudi
- Department of Family Medicine, University of Michigan, Ann Arbor
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Fart F, Rajan SK, Wall R, Rangel I, Ganda-Mall JP, Tingö L, Brummer RJ, Repsilber D, Schoultz I, Lindqvist CM. Differences in Gut Microbiome Composition between Senior Orienteering Athletes and Community-Dwelling Older Adults. Nutrients 2020; 12:nu12092610. [PMID: 32867153 PMCID: PMC7551621 DOI: 10.3390/nu12092610] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Gastrointestinal (GI) health is an important aspect of general health. Gastrointestinal symptoms are of specific importance for the elderly, an increasing group globally. Hence, promoting the elderly’s health and especially gastrointestinal health is important. Gut microbiota can influence gastrointestinal health by modulation of the immune system and the gut–brain axis. Diverse gut microbiota have been shown to be beneficial; however, for the elderly, the gut microbiota is often less diverse. Nutrition and physical activity, in particular, are two components that have been suggested to influence composition or diversity. Materials and Methods: In this study, we compared gut microbiota between two groups of elderly individuals: community-dwelling older adults and physically active senior orienteering athletes, where the latter group has less gastrointestinal symptoms and a reported better well-being. With this approach, we explored if certain gut microbiota were related to healthy ageing. The participant data and faecal samples were collected from these two groups and the microbiota was whole-genome sequenced and taxonomically classified with MetaPhlAn. Results: The physically active senior orienteers had a more homogeneous microbiota within the group and a higher abundance of Faecalibacterium prausnitzii compared to the community-dwelling older adults. Faecalibacterium prausnitzii has previously shown to have beneficial properties. Senior orienteers also had a lower abundance of Parasutterella excrementihominis and Bilophila unclassified, which have been associated with impaired GI health. We could not observe any difference between the groups in terms of Shannon diversity index. Interestingly, a subgroup of community-dwelling older adults showed an atypical microbiota profile as well as the parameters for gastrointestinal symptoms and well-being closer to senior orienteers. Conclusions: Our results suggest specific composition characteristics of healthy microbiota in the elderly, and show that certain components of nutrition as well as psychological distress are not as tightly connected with composition or diversity variation in faecal microbiota samples.
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Affiliation(s)
- Frida Fart
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden; (F.F.); (S.K.R.); (R.W.); (I.R.); (J.P.G.-M.); (L.T.); (R.J.B.); (D.R.); (I.S.)
| | - Sukithar Kochappi Rajan
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden; (F.F.); (S.K.R.); (R.W.); (I.R.); (J.P.G.-M.); (L.T.); (R.J.B.); (D.R.); (I.S.)
| | - Rebecca Wall
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden; (F.F.); (S.K.R.); (R.W.); (I.R.); (J.P.G.-M.); (L.T.); (R.J.B.); (D.R.); (I.S.)
| | - Ignacio Rangel
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden; (F.F.); (S.K.R.); (R.W.); (I.R.); (J.P.G.-M.); (L.T.); (R.J.B.); (D.R.); (I.S.)
| | - John Peter Ganda-Mall
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden; (F.F.); (S.K.R.); (R.W.); (I.R.); (J.P.G.-M.); (L.T.); (R.J.B.); (D.R.); (I.S.)
- Laboratory of Translational Mucosal Immunology, Digestive Diseases Research Unit, Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
| | - Lina Tingö
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden; (F.F.); (S.K.R.); (R.W.); (I.R.); (J.P.G.-M.); (L.T.); (R.J.B.); (D.R.); (I.S.)
| | - Robert J. Brummer
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden; (F.F.); (S.K.R.); (R.W.); (I.R.); (J.P.G.-M.); (L.T.); (R.J.B.); (D.R.); (I.S.)
| | - Dirk Repsilber
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden; (F.F.); (S.K.R.); (R.W.); (I.R.); (J.P.G.-M.); (L.T.); (R.J.B.); (D.R.); (I.S.)
| | - Ida Schoultz
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden; (F.F.); (S.K.R.); (R.W.); (I.R.); (J.P.G.-M.); (L.T.); (R.J.B.); (D.R.); (I.S.)
| | - Carl Mårten Lindqvist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden; (F.F.); (S.K.R.); (R.W.); (I.R.); (J.P.G.-M.); (L.T.); (R.J.B.); (D.R.); (I.S.)
- Correspondence:
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Zhao L, Han C, Zheng Z, Xiu SL, Chan P. Risk of mini-mental state examination (MMSE) decline in the elderly with type 2 diabetes: a Chinese community-based cohort study. BMC Endocr Disord 2020; 20:129. [PMID: 32843019 PMCID: PMC7448427 DOI: 10.1186/s12902-020-00606-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/11/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We aimed to investigate the correlation of factors involved in the change of Mini-Mental State Examination (MMSE) and type 2 diabetes in the elderly. METHODS This study was a secondary analysis of a prospective cohort study. Type 2 diabetes patients aged > 55 years were recruited and assigned into three groups based on their glycated hemoglobin (HbA1c) levels: HbA1c < 7, 7% ≤ HbA1c < 8% and HbA1c ≥8%. MMSE decline was considered the endpoint. Factors related to MMSE decline were identified by univariate and multivariate regression analyses. RESULTS Altogether, 1519 subjects were included, 883 in the Low group, 333 in the Median group, and 303 in the High group. Age ≥ 75 years, education below elementary school level, not participating in seminars or consultation on healthcare, physical activity less than 30 min/day, cerebrovascular disease history, MMSE score at baseline, and HBA1c ≥8% were associated with cognitive decline by univariate and multivariate analysis. When the other factors were adjusted for, HBA1c ≥8% was independently associated with the severity of cognitive decline (β = 0.58, 95%CI:0.06-1.11, P = 0.029) and the occurrence of cognitive decline (odds ratio (OR) = 1.55, 95%CI:1.13-2.12, P = 0.007). CONCLUSIONS In elderly patients with type 2 diabetes, HbA1c ≥8% is an independent factor for cognitive decline and is also associated with the severity of the cognitive decline.
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Affiliation(s)
- Lei Zhao
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Chao Han
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, 45 Changchun Road, Xicheng District, Beijing, China
| | - Zheng Zheng
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, 45 Changchun Road, Xicheng District, Beijing, China
| | - Shuang Ling Xiu
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Piu Chan
- Department of Neurobiology, Geriatrics, and Neurology, Xuanwu Hospital, No. 45 Changchun St., Xicheng District, Beijing, China.
- Department of Neurology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China.
- Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing, 100053, China.
- Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing, 100053, China.
- Beijing Key Laboratory for Parkinson's Disease, Beijing, 100053, China.
- National Clinical Research Center for Geriatric Disorders, Beijing, 100053, China.
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Ida S, Kaneko R, Imataka K, Okubo K, Shirakura Y, Azuma K, Fujiwara R, Takahashi H, Murata K. Frequency of Social Isolation and Homeboundness and Their Relationships with High-Level Functional Capacity in Elderly Diabetic Patients. Clin Interv Aging 2020; 15:1439-1447. [PMID: 32904527 PMCID: PMC7457396 DOI: 10.2147/cia.s244529] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the frequency of social isolation (hereinafter, isolation) and homeboundness in elderly diabetic patients and to investigate their relationships with high-level functional capacity. PATIENTS AND METHODS Subjects were diabetic outpatients aged 65 years and older who were visiting the Japanese Red Cross Ise Hospital. Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to evaluate high-level functional capacity. Isolation was defined as having less than one interaction per week with someone other than co-habiting family members. Homeboundness was defined as leaving the house less than once a day. Multiple regression analysis was performed with the TMIG-IC score as the dependent variable and isolation and homeboundness as independent variables. RESULTS Four hundred fifty-one patients were included in the analysis. The frequency of isolation and homeboundness affected 37% and 13.3% of men and 28.9% and 20.6% of women, respectively. The adjusted partial regression coefficient of the TMIG-IC scores of isolated, homebound, and isolated+homebound men was -0.94 [95% confidence interval (CI), -1.68 to -0.21; P = 0.012], -0.27 (95% CI, -1.93 to 1.39; P = 0.746), and -4.03 (95% CI, -5.37 to -2.68; P < 0.001) in relation to that of the non-isolated and non-homebound group as reference. In women, the respective coefficients to the reference were -1.33 (95% CI, -2.93 to 0.25; P = 0.099), -0.65 (95% CI, -2.56 to 1.26; P = 0.501), and -3.01 (95% CI, -4.92 to -1.1; P = 0.002), respectively. CONCLUSION The frequency of isolation was high in both female and male elderly diabetic patients. In men, there was a significant relationship between isolation and decline in high-level functional capacity. In both men and women, there was a significant relationship between isolation+homeboundness and decline in high-level functional capacity.
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Affiliation(s)
- Satoshi Ida
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Ryutaro Kaneko
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Kanako Imataka
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Kaoru Okubo
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Yoshitaka Shirakura
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Kentaro Azuma
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Ryoko Fujiwara
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Hiroka Takahashi
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Kazuya Murata
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
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Kotwal AA, Lee SJ, Dale W, Boscardin WJ, Waite LJ, Smith AK. Integration of an Objective Cognitive Assessment Into a Prognostic Index for 5-Year Mortality Prediction. J Am Geriatr Soc 2020; 68:1796-1802. [PMID: 32356919 PMCID: PMC8189656 DOI: 10.1111/jgs.16451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES Prognostic indices rarely include cognition. We determined if a comprehensive cognitive screen or brief individual items were associated with improved mortality predictions of a widely used prognostic index. DESIGN, SETTING, AND PARTICIPANTS The National Social Life Health and Aging Project Wave 2, a nationally representative, cross-sectional, in-home survey conducted in 2010 to 2011 on 3,199 community-dwelling adults aged 60 to 99 years. MEASUREMENTS Cognition was measured using a Survey-Adapted Montreal Cognitive Assessment (MoCA-SA) grouped into three screened categories: screen normal (≥24 points), screen positive for mild cognitive impairment (18-23 points), and screen positive for dementia (<18 points). Single-item cognitive measures included clock-draw and five-word delayed recall. We constructed a modified Lee Prognostic Index (range = 0-18 points) based on age, behavior, function, and comorbidities shown to predict long-term mortality. We used logistic regression and the fraction of new information provided to determine if each cognitive measure improved the Lee index's 5-year mortality prediction. RESULTS The sample was 54% female and had a mean age of 72 years, MoCA-SA score of 22 (SD = 4.5), and Lee index of 7 (SD = 3). Regression analysis indicated the MoCA-SA modestly improved the Lee index's mortality prediction (P < .001; fraction of new information provided = 0.06); for low Lee index scores (<4 points), the absolute mortality rate difference was 7% by cognitive status; and for higher Lee index scores (4-7 points or 8-12 points), the absolute mortality rate difference was 15% by cognitive status. The clock-draw and delayed-recall items added similar value to mortality predictions as the longer MoCA-SA. Cognition had the third highest fraction of new information of all 13 Lee index items. CONCLUSION Incorporating a brief measure of cognition into a modified Lee index, even with single items, resulted in more accurate 5-year mortality risk predictions. Cognition should be included in prognostic calculators in older adults given its independent association with mortality risk. J Am Geriatr Soc 68:1796-1802, 2020.
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Affiliation(s)
- Ashwin A. Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
| | - Sei J. Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
| | - William Dale
- Department of Supportive Care Medicine, City of Hope National Medical Center
| | - W. John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
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Pourhassan M, Daubert D, Wirth R. Measured and Predicted Resting Energy Expenditure in Malnourished Older Hospitalized Patients: A Cross-Sectional and Longitudinal Comparison. Nutrients 2020; 12:nu12082240. [PMID: 32727100 PMCID: PMC7468721 DOI: 10.3390/nu12082240] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022] Open
Abstract
A number of equations have been proposed to predict resting energy expenditure (REE). The role of nutritional status in the accuracy and validity of the REE predicted in older patients has been paid less attention. We aimed to compare REE measured by indirect calorimetry (IC) and REE predicted by the Harris–Benedict formula in malnourished older hospitalized patients. Twenty-three malnourished older patients (age range 67–93 years, 65% women) participated in this prospective longitudinal observational study. Malnutrition was defined as Mini Nutritional Assessment Long Form (MNA-SF) score of less than 17. REE was measured (REEmeasured) and predicted (REEpredicted) on admission and at discharge. REEpredicted within ±10% of the REEmeasured was considered as accuracy. Nutritional support was provided to all malnourished patients during hospitalization. All patients were malnourished with a median MNA-LF score of 14. REEmeasured and REEpredicted increased significantly during 2-week nutritional therapy (+212.6 kcal and +19.5 kcal, respectively). Mean REEpredicted (1190.4 kcal) was significantly higher than REEmeasured (967.5 kcal) on admission (p < 0.001). This difference disappeared at discharge (p = 0.713). The average REEpredicted exceeded the REEmeasured on admission and at discharge by 29% and 11%, respectively. The magnitude of difference between REEmeasured and REEpredicted increased along with the degree of malnutrition (r = 0.42, p = 0.042) as deviations ranged from −582 to +310 kcal/day in severe to mildly malnourished patients, respectively. REEpredicted by the Harris–Benedict formula is not accurate in malnourished older hospitalized patients. REE measured by IC is considered precise, but it may not represent the true energy requirements to recover from malnutrition. Therefore, the effect of malnutrition on measured REE must be taken into account when estimating energy needs in these patients.
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Affiliation(s)
- Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham
| | | | - Mackenzie E Fowler
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Yue Zhang
- Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Richard E Kennedy
- Department of Medicine, University of Alabama at Birmingham, Birmingham
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Jiang C, Zou M, Chen M, Jiang Y, Chang P, Cui Y, Jiang L. Reliability and validity of the Mandarin version of the Continuity Assessment Record and Evaluation for older people who are transferred between hospitals and nursing homes in China. Health Soc Care Community 2020; 28:1180-1189. [PMID: 32048425 DOI: 10.1111/hsc.12951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 06/10/2023]
Abstract
To date, assessment tools for older people are different between hospitals and nursing homes in China. The difference between assessment tools can lead to poor communication of information between hospitals and nursing homes, which causes discontinuity of care and adverse outcomes when older people are transferred between these different settings. Continuity Assessment Record and Evaluation (CARE) is a comprehensive geriatric assessment tool developed in the United States of America. This study aimed to evaluate the reliability and validity of the Mandarin Version of CARE for older people who are transferred between hospitals and nursing homes. Using a convenience sampling method, 120 older people in hospitals and 120 older people in nursing homes in Shanghai were selected to test the internal consistency, interrater reliability and criterion-related validity of CARE from May to November 2017. When used among hospital, 70.0% (7/10) of the subscales had a Cronbach's alpha coefficients of greater than 0.7, 94.3% (50/53) of the items had an intraclass correlation coefficient (ICC) of greater than 0.75. When used in nursing homes, 90.0% (9/10) of the subscales had a Cronbach's alpha coefficients of greater than 0.7, 94.3% (50/53) of the items had an ICC of greater than 0.75. For both settings, the correlation coefficients of the subscales with their corresponding instruments for criterion-related validity were all greater than 0.8 (p < .01). The Mandarin version of CARE exhibits good reliability and validity. It can be used as an assessment tool for transition between hospitals and nursing homes.
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Affiliation(s)
- Caixia Jiang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Min Zou
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | | | - Yijun Jiang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Polun Chang
- Institute of bioMedical Informatics, National Yang-Ming University, Taipei City, Taiwan
| | - Yanyan Cui
- Institute of bioMedical Informatics, National Yang-Ming University, Taipei City, Taiwan
| | - Liping Jiang
- Department of Nursing, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Duflos C, Troude P, Strainchamps D, Ségouin C, Logeart D, Mercier G. Hospitalization for acute heart failure: the in-hospital care pathway predicts one-year readmission. Sci Rep 2020; 10:10644. [PMID: 32606326 PMCID: PMC7327074 DOI: 10.1038/s41598-020-66788-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 05/06/2020] [Indexed: 11/18/2022] Open
Abstract
In patients with heart failure, some organizational and modifiable factors could be prognostic factors. We aimed to assess the association between the in-hospital care pathways during hospitalization for acute heart failure and the risk of readmission. This retrospective study included all elderly patients who were hospitalized for acute heart failure at the Universitary Hospital Lariboisière (Paris) during 2013. We collected the wards attended, length of stay, admission and discharge types, diagnostic procedures, and heart failure discharge treatment. The clinical factors were the specific medical conditions, left ventricular ejection fraction, type of heart failure syndrome, sex, smoking status, and age. Consistent groups of in-hospital care pathways were built using an ascending hierarchical clustering method based on a primary components analysis. The association between the groups and the risk of readmission at 1 month and 1 year (for heart failure or for any cause) were measured via a count data model that was adjusted for clinical factors. This study included 223 patients. Associations between the in-hospital care pathway and the 1 year-readmission status were studied in 207 patients. Five consistent groups were defined: 3 described expected in-hospital care pathways in intensive care units, cardiology and gerontology wards, 1 described deceased patients, and 1 described chaotic pathways. The chaotic pathway strongly increased the risk (p = 0.0054) of 1 year readmission for acute heart failure. The chaotic in-hospital care pathway, occurring in specialized wards, was associated with the risk of readmission. This could promote specific quality improvement actions in these wards. Follow-up research projects should aim to describe the processes causing the generation of chaotic pathways and their consequences.
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Affiliation(s)
- Claire Duflos
- Department of Medical Information, CHU, University of Montpellier, Montpellier, France.
- PhyMedExp, U1046, INSERM, Montpellier, France.
| | - Pénélope Troude
- Public Health Department, Universitary Hospital Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, Paris, France
| | - David Strainchamps
- Department of Medical Information, CHU, University of Montpellier, Montpellier, France
| | - Christophe Ségouin
- Public Health Department, Universitary Hospital Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, Paris, France
| | - Damien Logeart
- Cardiology Department, Universitary Hospital Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, Paris, France
| | - Grégoire Mercier
- Department of Medical Information, CHU, University of Montpellier, Montpellier, France
- CEPEL, University of Montpellier, Montpellier, France
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Hilal S, Perna S, Gasparri C, Alalwan TA, Vecchio V, Fossari F, Peroni G, Riva A, Petrangolini G, Rondanelli M. Comparison between Appendicular Skeletal Muscle Index DXA Defined by EWGSOP1 and 2 versus BIA Tengvall Criteria among Older People Admitted to the Post-Acute Geriatric Care Unit in Italy. Nutrients 2020; 12:E1818. [PMID: 32570825 PMCID: PMC7353304 DOI: 10.3390/nu12061818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/24/2020] [Accepted: 06/12/2020] [Indexed: 11/25/2022] Open
Abstract
This study aims to assess the agreement between the appendicular skeletal muscle index (ASMI) and dual-energy X-ray absorptiometry (DXA) using a single frequency bioelectrical impedance analysis (BIA) to assess criteria. Moreover, we used the European working group on sarcopenia in older people 1 (EWGSOP1), EWGSOP2, and the Tengvall equation to estimate a low prevalence in ASMI (under the cutoff criteria). We examined a sample of 765 elderly individuals (27.8% male and 72.2% female, aged 82 ± 8.2 years). Based on the cutoff identified by Tengvall, EWGSOP1, and EWGSOP2, the results showed that the prevalence of low ASMI in females was 10.1%, 11.4%, and 9.2%, respectively, and 98.1%, 30.5%, and 23.5% in males, respectively. Moreover, low ASMI prevalence under each diagnostic criterion and body mass index (BMI) was calculated. For BMI < 25 kg/m2, the ASMI prevalence was 39.9%, 25.9%, and 20.6%, as determined using Tengvall, EWGSOP1, and EWGSOP2, respectively, and for BMI > 25 kg/m2, the ASMI prevalence was 29.0%, 6.6%, and 5.2%. The percentage of agreement and Cohen's Kappa with the corresponding p-value between Tengvall and EWGSOP1 was 70.1% (p < 0.001). Between Tengvall and EWGSOP2, it was 69.4% (p < 0.001). Between EWGSOP1 and EWGSOP2, it was 96.5% (p < 0.001). Regarding gender, low ASMI prevalence in males was higher than in females. Moreover, in females, the prevalence was comparable among the three diagnostic criteria, while in males, it was significantly higher under Tengvall than the other two criteria. The application of the Tengvall formula with a single frequency BIA should be revised in terms of application for assessing low ASMI in elderly patients.
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Affiliation(s)
- Sawsan Hilal
- Department of Mathematics, College of Science, University of Bahrain, Sakhir Campus, P.O. Box 32038 Zallaq, Bahrain;
| | - Simone Perna
- Department of Biology, College of Science, University of Bahrain, Sakhir Campus, P.O. Box 32038 Zallaq, Bahrain; (S.P.); (T.A.A.)
| | - Clara Gasparri
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ‘‘Istituto Santa Margherita’’, University of Pavia, 27100 Pavia, Italy; (V.V.); (F.F.); (G.P.)
| | - Tariq A. Alalwan
- Department of Biology, College of Science, University of Bahrain, Sakhir Campus, P.O. Box 32038 Zallaq, Bahrain; (S.P.); (T.A.A.)
| | - Viviana Vecchio
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ‘‘Istituto Santa Margherita’’, University of Pavia, 27100 Pavia, Italy; (V.V.); (F.F.); (G.P.)
| | - Federica Fossari
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ‘‘Istituto Santa Margherita’’, University of Pavia, 27100 Pavia, Italy; (V.V.); (F.F.); (G.P.)
| | - Gabriella Peroni
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ‘‘Istituto Santa Margherita’’, University of Pavia, 27100 Pavia, Italy; (V.V.); (F.F.); (G.P.)
| | - Antonella Riva
- Research and Development Unit, Indena, 20139 Milan, Italy; (A.R.); (G.P.)
| | | | - Mariangela Rondanelli
- IRCCS Mondino Foundation, 27100 Pavia, Italy;
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
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Li Y, Yang Z, Ai T, Wu S, Xia L. Association of "initial CT" findings with mortality in older patients with coronavirus disease 2019 (COVID-19). Eur Radiol 2020; 30:6186-6193. [PMID: 32524220 PMCID: PMC7283986 DOI: 10.1007/s00330-020-06969-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023]
Abstract
Objectives To investigate the association of chest CT findings with mortality in clinical management of older patients. Methods From January 21 to February 14, 2020, 98 older patients (≥ 60 years) who had undergone chest CT scans (“initial CT”) on admission were enrolled. Manifestation and CT score were compared between the death group and the survival group. In each group, patients were sub-grouped based on the time interval between symptom onset and the “initial CT” scan: subgroup1 (interval ≤ 5 days), subgroup2 (interval between 6 and 10 days), and subgroup3 (interval > 10 days). Adjusted ROC curve after adjustment for age and gender was applied. Results Consolidations on CT images were more common in the death group (n = 46) than in the survival group (n = 52) (53.2% vs 32.0%, p < 0.001). For subgroup1 and subgroup2, a higher mean CT score was found for the death group (33.0 ± 17.1 vs 12.9 ± 8.7, p < 0.001; 38.8 ± 12.3 vs 24.3 ± 11.9, p = 0.002, respectively) and no significant difference of CT score was identified with respect to subgroup3 (p = 0.144). In subgroup1, CT score of 14.5 with a sensitivity of 83.3% and a specificity of 77.3% for the prediction of mortality was an optimal cutoff value, with an adjusted AUC of 0.881. In subgroup2, CT score of 27.5 with a sensitivity of 87.5% and a specificity of 70.6% for the prediction of mortality was an optimal cutoff value, with an adjusted AUC of 0.895. Conclusions “Initial CT” scores may be useful to speculate prognosis and stratify patients. Severe manifestation on CT at an early stage may indicate poor prognosis for older patients with COVID-19. Key Points • Severe manifestation on CT at an early stage may indicate poor prognosis for older patients with COVID-19. • Radiologists should pay attention to the time interval between symptom onsets and CT scans of patients with COVID-19. • Consolidations on CT images were more common in death patients than in survival patients.
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Affiliation(s)
- Yan Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Zhenlu Yang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Tao Ai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Shandong Wu
- Department of Radiology, Department of Biomedical Informatics, Department of Bioengineering, Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Sanford AM, Morley JE, Berg-Weger M, Lundy J, Little MO, Leonard K, Malmstrom TK. High prevalence of geriatric syndromes in older adults. PLoS One 2020; 15:e0233857. [PMID: 32502177 PMCID: PMC7274399 DOI: 10.1371/journal.pone.0233857] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [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: 02/26/2020] [Accepted: 05/13/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The geriatric syndromes of frailty, sarcopenia, weight loss, and dementia are highly prevalent in elderly individuals across all care continuums. Despite their deleterious impact on quality of life, disability, and mortality in older adults, they are frequently under-recognized. At Saint Louis University, the Rapid Geriatric Assessment (RGA) was developed as a brief screening tool to identify these four geriatric syndromes. MATERIALS AND METHODS From 2015-2019, the RGA, comprised of the FRAIL, SARC-F, Simplified Nutritional Appetite Questionnaire (SNAQ), and Rapid Cognitive Screen (RCS) tools and a question on Advance Directives, was administered to 11,344 individuals ≥ 65 years of age across Missouri in community, office-based, hospital, Programs of All-Inclusive Care for the Elderly (PACE), and nursing home care settings. Standard statistical methods were used to calculate the prevalence of frailty, sarcopenia, weight loss, and dementia across the sample. RESULTS Among the 11,344 individuals screened by the RGA, 41.0% and 30.4% met the screening criteria for pre-frailty and frailty respectively, 42.9% met the screening criteria for sarcopenia, 29.3% were anorectic and at risk for weight loss, and 28.1% screened positive for dementia. The prevalence of frailty, risk for weight loss, sarcopenia, and dementia increased with age and decreased when hospitalized patients and those in the PACE program or nursing home were excluded. CONCLUSIONS Using the RGA as a valid screening tool, the prevalence of one or more of the geriatric syndromes of frailty, sarcopenia, weight loss, and dementia in older adults across all care continuums is quite high. Management approaches exist for each of these syndromes that can improve outcomes. It is suggested that the brief RGA screening tool be administered to persons 65 and older yearly as part of the Medicare Annual Wellness Visit.
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Affiliation(s)
- Angela M. Sanford
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
| | - John E. Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
| | - Marla Berg-Weger
- School of Social Work, Saint Louis University, St. Louis, MO, United States of America
| | - Janice Lundy
- Department of Social Work and Geriatric Care Management, Perry County Memorial Hospital, Perryville, MO, United States of America
| | - Milta O. Little
- Division of Geriatric Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Kathleen Leonard
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
| | - Theodore K. Malmstrom
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, United States of America
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R Van Domelen D, Bandeen-Roche K. A Note on Proposed Estimation Procedures for Claims-Based Frailty Indexes. Am J Epidemiol 2020; 189:369-371. [PMID: 31673711 DOI: 10.1093/aje/kwz247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/25/2019] [Accepted: 09/12/2019] [Indexed: 01/18/2023] Open
Abstract
Two groups (Segal et al. Med Care. 2017;55(7):716-722; Segal et al. Am J Epidemiol. 2017;186(6):745-747; and Kim et al. J Gerontol A Biol Sci Med Sci. 2018;73(7):980-987) recently proposed methods for modeling frailty in studies where a reference standard frailty measure is not directly observed, but Medicare claims data are available. The groups use competing frailty measures, but the premise is similar: In a validation data set, model the frailty measure versus claims variables; in the primary data set, impute frailty status from claims variables, and conduct inference with those imputed values in place of the unobserved frailty measure. Potential use cases include risk prediction, confounding control, and prevalence estimation. In this commentary, we describe validity issues underlying these approaches, focusing mainly on risk prediction. Our main concern is that these approaches do not permit valid estimation of associations between the reference standard frailty measure (i.e., "frailty") and health outcomes. We argue that Segal's approach is akin to multiple imputation but with the outcome variable omitted from the imputation model, while Kim's is akin to regression calibration but with many variables improperly treated as surrogates. We discuss alternatives for risk prediction, including a secondary approach previously considered by Kim et al., and briefly comment on other use cases.
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Moreno X, Lera L, Albala C. Disability-free life expectancy and life expectancy in good self-rated health in Chile: Gender differences and compression of morbidity between 2009 and 2016. PLoS One 2020; 15:e0232445. [PMID: 32353089 PMCID: PMC7192428 DOI: 10.1371/journal.pone.0232445] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/29/2019] [Accepted: 04/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background Chile has one of the highest life expectancies at 60 years in South America. This study was aimed to determine healthy life expectancies among Chilean older people, according to self-rated health and disability, and to explore gender differences. Methods Data from the National Survey of Health (2009 and 2016) were used to estimate prevalence of less than good self-rated health and disability among people aged 60 years and above. Health expectancies were calculated with the Sullivan method. Results In both years, women expected to live a lower proportion of their life expectancy in good self-rated health (54.5% [95% CI 50.0–58.8] for men and 37.6% [95% CI 34.3–40.8] for women in 2009; 46.1% [95% CI 42.6–49.7] for men and 38.5% [95% CI 35.6–41.4] for women in 2016). Life expectancy in less than good self-rated health increased for men (9.4 years [95% CI 8.4–10.3] in 2009; 11.5 years [95% CI 10.7–12.2]). Women expected to live a lower proportion of their remaining life without disabilities (65.3% [95% CI 61.2–69.4] for men and 44.9% [95% CI 41.9–47.9] for women in 2009; 71.9% [95% CI 68.7–75.0] for men and 61.1% [95% CI 58.5–63.8] for women in 2016). In 2016, disability-free life expectancy increased among women, but they still had a higher life expectancy with mild disability (2.8 years [95% CI 2.3–3.4] for men and 6.0 years [95% CI 5.4–6.7] for women). Conclusions Women expected to spend more years in less than good self-rated health and disabled. There was an expansion of life expectancy in less than good SRH among men and a compression of disability in both sexes. The high proportion of years expected to be lived in less than good self-rated health and gender differences in disability-free life expectancy of older adults should be addressed by public health policies in Chile.
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Affiliation(s)
- Ximena Moreno
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
- * E-mail:
| | - Lydia Lera
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Cecilia Albala
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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François E, Mineur L, Deplanque G, Laplaige P, Smith D, Gourgou S, Tanang A, Ionescu-Goga M, Veerabudun K, Lelarge Y, Kim S, Rollot F. Efficacy and Safety of Bevacizumab Combined With First-Line Chemotherapy in Elderly (≥75 Years) Patients With Metastatic Colorectal Cancer: A Real-World Study. Clin Colorectal Cancer 2020; 19:e100-e109. [PMID: 32299778 DOI: 10.1016/j.clcc.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/26/2019] [Revised: 01/12/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although elderly patients are the first concerned by colorectal cancer (CRC), they are underrepresented in clinical trials. The real-world CASSIOPEE study was thus conducted in elderly patients treated for metastatic CRC (mCRC). METHODS This French prospective, multicenter, noninterventional study aimed to estimate 1-year progression-free survival (PFS) and overall survival (OS), and describe treatments, patient autonomy (Instrumental Activities of Daily Living; Balducci scale), and safety over 24 months, in patients older than 75 with mCRC, starting first-line bevacizumab plus chemotherapy (NCT01555762). RESULTS From 2012 to 2014, 402 patients were included (safety population: n = 383, efficacy population: n = 358). Patient characteristics were as follows: mean age, 81 ± 4 years (<80 years, 46%; 80-85 years, 44%; >85 years, 10%); men, 52%; colon primary tumor, 80%; main metastatic site, liver 66%; Eastern Cooperative Oncology Group performance 0-1, 81%. Median PFS was 9.1 months (95% confidence interval [CI]: 8.3-10.2). It was superior for patients ≤85 years (<80 years: 9.3 months; 80-85 years: 9.5 months) compared with patients >85 years (8.3 months). Median OS was 19.0 months (95% CI, 16.5-21.5) and decreased in the 2 oldest groups (20.6, 17.8, and 13.0 months). Autonomy assessments decreased over time leading to nonconclusive results. Twenty-six percent of patients experienced serious adverse events (SAEs): 7% bevacizumab-related SAEs, and 6% bevacizumab-targeted SAEs. Two fatal bevacizumab-related adverse events were reported (hemorrhagic stroke and intestinal ischemia). CONCLUSIONS This large French real-world study showed that medically fit older patients with mCRC could have a benefit/risk balance similar to that of younger patients when treated with first-line bevacizumab plus chemotherapy. Improvements in geriatric assessments are needed to better define this population.
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Affiliation(s)
- Eric François
- Oncologie médicale, Centre Antoine Lacassagne, Nice, France.
| | - Laurent Mineur
- Radiation Oncology, Gastro-Intestinal and Liver Cancer Unit, Institut Sainte-Catherine, Avignon, France
| | - Gaël Deplanque
- Oncologie médicale, Groupe hospitalier Paris Saint Joseph, Paris, France
| | - Philippe Laplaige
- Oncologie et chimiothérapie ambulatoire, Polyclinique de Blois, La Chaussée St Victor, France
| | - Denis Smith
- Hépato-gastro-entérologie, Hôpital Saint André, Bordeaux, France
| | - Sophie Gourgou
- Unité de Biométrie, Institut du Cancer de Montpellier, Montpellier, France
| | - Alexandre Tanang
- Medical Department, Oncology, Roche SAS, Boulogne Billancourt, France
| | | | | | - Yoann Lelarge
- Medical Department, Oncology, Roche SAS, Boulogne Billancourt, France
| | - Stefano Kim
- Oncologie médicale, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Florence Rollot
- Soins de support en oncologie/onco-gériatrie, Institut Curie, Paris, France
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van der Zwaard BC, Stein CE, Bootsma JEM, van Geffen HJAA, Douw CM, Keijsers CJPW. Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture. Arch Orthop Trauma Surg 2020; 140:487-492. [PMID: 31664575 DOI: 10.1007/s00402-019-03294-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 05/06/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Geriatricians have been increasingly involved in the pre-operative process in frail elderly patients with a hip fracture which can benefit re-hospitalization, post-operative functional performance, and mortality. The objective of this study was to compare the number of older patients with hip fractures who opted for non-surgical management after the addition of pre-operative comprehensive geriatric assessment (CGA) with shared decision making by a geriatrician to usual care. Secondary objectives were: reasons for non-surgical management, duration of life, and location of death. MATERIALS AND METHODS A single-center, with a level 2 trauma center, retrospective study comparing care before and after introducing pre-operative CGA with shared decision making in September 2014. Patients ≥ 70 years with a hip fracture, admitted from January 2014 to September 2015, were included. The percentages of patients elected for non-surgical management and palliative care without or with CGA were compared. Differences in secondary objectives (age, sex, medical history, medication use, functional, and social status) were compared descriptively and qualitatively. RESULTS With pre-operative CGA significantly more patients (or representatives) elected the non-surgical management option after hip fracture (respectively, 9.1% vs 2.7%, p = 0.008). Patient characteristics were comparable. Reported reasons not to undergo surgery include aversion to be more dependent on others, and severe dementia. CONCLUSION The geriatrician can have an important role in decisions for non-surgical management by shared decision making in the pre-operative period in patients ≥ 70 years with a hip fracture in the emergency room.
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Affiliation(s)
- Babette C van der Zwaard
- Department of Orthopedic Surgery, Jeroen Bosch Hospital, PO Box 90153, 5200 ME, 's-Hertogenbosch, The Netherlands.
| | - Charlotte E Stein
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Janet E M Bootsma
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Conny M Douw
- Department of Orthopedic Surgery, Jeroen Bosch Hospital, PO Box 90153, 5200 ME, 's-Hertogenbosch, The Netherlands
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Kessler M, Thumé E, Scholes S, Marmot M, Facchini LA, Nunes BP, Machado KP, Soares MU, de Oliveira C. Modifiable risk factors for 9-year mortality in older English and Brazilian adults: The ELSA and SIGa-Bagé ageing cohorts. Sci Rep 2020; 10:4375. [PMID: 32152345 PMCID: PMC7062886 DOI: 10.1038/s41598-020-61127-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/14/2020] [Indexed: 12/19/2022] Open
Abstract
To quantify and compare 9-year all-cause mortality risk attributable to modifiable risk factors among older English and Brazilian adults. We used data for participants aged 60 years and older from the English Longitudinal Study of Ageing (ELSA) and the Bagé Cohort Study of Ageing (SIGa-Bagé). The five modifiable risk factors assessed at baseline were smoking, hypertension, diabetes, obesity and physical inactivity. Deaths were identified through linkage to mortality registers. For each risk factor, estimated all-cause mortality hazard ratios (HR) and population attributable fractions (PAF) were adjusted by age, sex, all other risk factors and socioeconomic position (wealth) using Cox proportional hazards modelling. We also quantified the risk factor adjusted wealth gradients in mortality, by age and sex. Among the participants, 659 (ELSA) and 638 (SIGa-Bagé) died during the 9-year follow-up. Mortality rates were higher in SIGa-Bagé. HRs and PAFs showed more similarities than differences, with physical inactivity (PAF 16.5% ELSA; 16.7% SIGa-Bagé) and current smoking (PAF 4.9% for both cohorts) having the strongest association. A clear graded relationship existed between the number of risk factors and subsequent mortality. Wealth gradients in mortality were apparent in both cohorts after full adjustment, especially among men aged 60-74 in ELSA. A different pattern was found among older women, especially in SIGa-Bagé. These findings call attention for the challenge to health systems to prevent and modify the major risk factors related to non-communicable diseases, especially physical inactivity and smoking. Furthermore, wealth inequalities in mortality persist among older adults.
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Affiliation(s)
- Marciane Kessler
- Department of Postgraduate Program in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil.
- Department of Epidemiology & Public Health, University College London (UCL), London, United Kingdom.
| | - Elaine Thumé
- Department of Postgraduate Program in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Shaun Scholes
- Department of Epidemiology & Public Health, University College London (UCL), London, United Kingdom
| | - Michael Marmot
- Department of Epidemiology & Public Health, University College London (UCL), London, United Kingdom
| | - Luiz Augusto Facchini
- Department of Postgraduate Program in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
- Department of Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Bruno Pereira Nunes
- Department of Postgraduate Program in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Karla Pereira Machado
- Department of Postgraduate Program in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Mariangela Uhlmann Soares
- Department of Postgraduate Program in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London (UCL), London, United Kingdom
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Coelho-Júnior HJ, Calvani R, Picca A, Gonçalves IO, Landi F, Bernabei R, Cesari M, Uchida MC, Marzetti E. Protein-Related Dietary Parameters and Frailty Status in Older Community-Dwellers across Different Frailty Instruments. Nutrients 2020; 12:nu12020508. [PMID: 32079345 PMCID: PMC7071300 DOI: 10.3390/nu12020508] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 12/22/2022] Open
Abstract
The present study investigated the associations between frailty status and (a) daily protein intake, (b) daily body weight-adjusted protein intake, (c) branched-chain amino acid (BCAA) consumption, (d) evenness of protein distribution across main meals, (e) number of daily meals providing at least 30 g of protein, and (f) number of daily meals providing at least 0.4 g protein/kg of body weight in community-dwelling older adults. The relationship between frailty status and protein-related dietary parameters was explored across different frailty assessment tools. Two hundred older adults were enrolled in the study. Participant frailty status was determined according to a modified Fried’s frailty phenotype (mFP), the FRAIL scale, and the Study of Osteoporotic Fracture (SOF) index. Diet was assessed by 24-h dietary recall, while diet composition was estimated using a nutritional software. A frailty instrument-dependent relationship was observed between frailty status and protein-related dietary parameters. Protein consumption was associated with frailty status only in participants identified as frail according to the mFP. In addition, protein and BCAA intake was found to be greater in robust and pre-frail participants relative to their frail counterparts. Our findings suggest that the association between frailty and protein-related dietary parameters is tool dependent. Specifically, protein and BCAA consumption appears to be lower only in older adults identified as frail by the mFP.
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Affiliation(s)
- Hélio J. Coelho-Júnior
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (F.L.)
- Applied Kinesiology Laboratory-LCA, School of Physical Education, University of Campinas, 083-851 Campinas-SP, Brazil;
- Mãe Mariana Nursing Home, Rehabilitation unit, 08562-460 Poá-SP, Brazil
- Correspondence: (H.J.C.-J.); (E.M.); Tel.: +39-06-3015-5559 (H.J.C.-J.)
| | - Riccardo Calvani
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (F.L.)
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Anna Picca
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (F.L.)
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Ivan O. Gonçalves
- Center of Health Sciences, University of Mogi das Cruzes, 08780-911 Mogi das Cruzes, Brazil;
| | - Francesco Landi
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (F.L.)
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Roberto Bernabei
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (F.L.)
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, Università di Milano, 20133 Milan, Italy
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Marco C. Uchida
- Applied Kinesiology Laboratory-LCA, School of Physical Education, University of Campinas, 083-851 Campinas-SP, Brazil;
| | - Emanuele Marzetti
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (F.L.)
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
- Correspondence: (H.J.C.-J.); (E.M.); Tel.: +39-06-3015-5559 (H.J.C.-J.)
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Chase JAD, Russell D, Huang L, Hanlon A, O'Connor M, Bowles KH. Relationships Between Race/Ethnicity and Health Care Utilization Among Older Post-Acute Home Health Care Patients. J Appl Gerontol 2020; 39:201-213. [PMID: 29457521 PMCID: PMC6344331 DOI: 10.1177/0733464818758453] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Few studies have explored racial/ethnic differences in health care outcomes among patients receiving home health care (HHC), despite known differences in other care settings. We conducted a retrospective cohort study examining racial/ethnic disparities in rehospitalization and emergency room (ER) use among post-acute patients served by a large northeastern HHC agency between 2013 and 2014 (N = 22,722). We used multivariable binomial logistic regression to describe the relationship between race/ethnicity and health care utilization outcomes, adjusting for individual-level factors that are conceptually related to health service use. Overall rates of rehospitalization and ER visits were 10% and 13%, respectively. African American and Hispanic patients experienced higher odds of ER visits or rehospitalization during their HHC episode. Racial/ethnic differences in utilization were mediated by enabling factors, such as caregiver availability, and illness-level factors, such as illness severity, functional status, and symptoms. Intervention targets may include early risk assessment, proactive management of clinical conditions, rehabilitative therapy, and caregiver training.
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Affiliation(s)
- Jo-Ana D. Chase
- University of Pennsylvania, 338G School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, Assistant Professor, University of Missouri – Columbia,
| | - David Russell
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, 1250 Broadway, 7th Floor, New York, NY 10001,
| | - Liming Huang
- 418 Curie Blvd, Suite 479L, Claire M. Fagin Hall, School of Nursing, University of Pennsylvania,
| | - Alexandra Hanlon
- 418 Curie Blvd, Suite 479L, Claire M. Fagin Hall, School of Nursing, University of Pennsylvania,
| | - Melissa O'Connor
- National Hartford Center for Gerontological Nursing Excellence, Assistant Professor, College of Nursing, Villanova University, Driscoll Hall, Office #316, 800 Lancaster Avenue, Villanova, PA 19085,
| | - Kathryn H. Bowles
- University of Pennsylvania, 418 Curie Boulevard Room 340, Philadelphia, PA 19104; Director of the Center for Home Care Policy and Research, Visiting Nurse Service of New York,
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