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The purpose of this retrospective study was to identify factors that could predict the discharge destination of oldest-old patients (patients aged ≥90 years). Information on the nutritional status, activities of daily living (ADL), nursing care needs based on nursing need degree (NND), rehabilitation therapy, and discharge destination was obtained from the medical records of 90 oldest-old patients aged ≥90 years admitted to our hospital, excluding orthopedic inpatients and short-term (≤5 days) inpatients. Of these, 64 were discharged home while 4 died during hospitalization. More than half had moderately low total lymphocyte count (<1200/µL). Home discharge was correlated with living with someone else and little need for assistance during eating and getting/standing-up at admission. The cutoff value for ability for basic movement scale (ABMS) at admission for home discharge was 18 points. Nutritional management and early mobilization are important aspects of clinical management of the oldest-olds.
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OBJECTIVE: Underrepresentation of elderly ovarian cancer patients in clinical trials has led to lack of clarity regarding optimal first-line chemotherapy in this cohort. The Elderly Women with Ovarian Cancer (EWOC)-1 trial demonstrated that 3-weekly carboplatin (3wC) resulted in worse survival and feasibility compared with standard 3-weekly carboplatin-paclitaxel (3wCP) in frail, elderly ovarian cancer patients. Our retrospective study compares feasibility, safety, and efficacy of first-line 3wCP and 3wC in a frail ovarian cancer cohort. METHODS: Clinical data were retrospectively analyzed for newly-diagnosed, International Federation of Gynecology and Obstetrics (FIGO) stage III/IV, ≥70-year-old epithelial ovarian cancer patients, treated by clinician choice with 3wC or 3wCP at two London cancer centers over a 2 year period. Charlson Comorbidity Index (CCI) and Eastern Cooperative Oncology Group (ECOG) performance status provided surrogate markers of frailty. Common Terminology Criteria for Adverse Events v5.0 graded toxicity. RESULTS: A total of 107 patients were treated with 3wC (n=30) and 3wCP (n=77). Age, performance status, and CCI were significantly different between cohorts, with 3wC patients older (84 vs 75 years, p<0.001), with more comorbidities (median CCI 4 vs 3, p<0.001) and worse performance status (47% vs 17% PS ≥2, p=0.015). Surgical outcomes differed significantly between cohorts, with 20 (67%) 3wC patients not undergoing surgery, compared with 22 (29%) 3wCP patients (p<0.001). Median follow-up was 45.8 months (IQR 38.7-56.3 months). While we observed improved progression-free (HR 0.55, 95% CI 0.33 to 0.90, p=0.017) and overall survival (HR 0.44, 95% CI 0.27 to 0.73, p=0.001, log-rank test) in a univariate cox proportional hazards comparison between 3wCP and 3wC, this was not significant on multivariate analysis. Completion of six planned chemotherapy cycles was achieved by the majority, with similar discontinuation rates between groups (13% 3wC vs 8% 3wCP, p>0.05). Overall grade ≥3 hematological toxicity rates were similar between regimens (33% 3wC vs 44% 3wCP, p=0.37) with grade ≥3 neutropenia (p=0.019) and grade ≥3 thrombocytopenia (p=0.006) more common with 3wCP and 3wC, respectively. No treatment-related deaths occurred. CONCLUSION: Our data demonstrates that standard 3wCP is a well-tolerated, feasible first-line treatment for frail, elderly ovarian cancer patients. Improved survival with 3wCP was not significant when corrected for established clinical prognostic factors.
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OBJECTIVE: To explore the experiences of healthcare and social services professionals and their perceptions of using Certificate for self-care with support (CSS) for preventive self-care for older adults with home care, including the CSS process and collaborations between primary healthcare and social services. DESIGN: An inductive qualitative study including seven focus group interviews analyzed with reflexive thematic analysis. SETTING AND SUBJECTS: The study was conducted in the Stockholm Region 2022/23. In total, 23 informants were recruited from four key partners involved in the CSS process: professionals from primary care rehabilitation and primary healthcare, social services officers, and home care staff. RESULT: The analyses resulted in five interconnected themes: 'Guidelines with scope for interpretation,' 'Support for self-care is needed, but complicated in practice,' 'To trust the other professions' competence,' 'There is a transfer of responsibility,' and 'Communication is key.' The overarching theme 'Principles or pragmatism for safe person-centered care,' anchoring the other themes, revealed a common goal of achieving safe and individualized care within available resources, but from two conflicting perspectives: the importance of following the process according to the guidelines or taking a more pragmatic approach. CONCLUSION: This study highlights the need to establish structures facilitating safe self-care among frail groups, such as older persons dependent on home care. Our findings emphasize that the demarcation between, and responsibilities of, organizations need to be discussed and clarified to offer person-centered support. Comprehensible guidelines and functioning communication channels must be established so that all important perspectives can be heard, not least the patient's.
The support of a patient's self-care is an important part of health promotion and preventive efforts.Collaboration between social services and healthcare services is crucial when supporting an older person in performing their self-care.The boundaries and responsibilities of organizations regarding person-centered support for self-care need to be discussed and clarified.Clear guidelines and functioning communication channels must be established to ensure all important perspectives are heard, especially the patient's.
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BACKGROUND: Locally advanced rectal cancer can cause severe symptomatic pelvic morbidity such as pain, haemorrhage or bowel obstruction for frail or metastatic patients, which are often unfit to undergo surgery or intense systemic treatment. The most frequent radiation schedule is 25 Gy/ 5f but the optimal dose is yet to determine. Our aim was to conduct a systematic review on the efficacy and toxicity of the published radiation schedules of palliative rectal cancer. METHODS: Systematic literature of the Medline, Embase and Cochrane library databases were performed throughout the year 2023. Published articles on palliative external beam radiation therapy (EBRT) for locally advanced or metastatic rectal cancer reporting on symptom palliation, overall survival (OS) and quality of life (QOL) were eligible for inclusion. RESULTS: Thirteen studies were included, five of them were prospective studies. There were large variations in radiation schedules, associated chemotherapy and palliative care. Pooled overall symptomatic response rate was 71 %, while response rates were respectively 90 %, 85 %, and 84 % for pain, bleeding, and pelvic symptoms. Acute toxicities were mostly mild genitourinary or gastrointestinal. CONCLUSIONS: Short course palliative radiation for LARC for frail or metastatic patients is efficient for symptom palliation with few adverse effects. A short course EBRT with an integrated IMRT boost on the tumoral volume could be of interest.
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BACKGROUND: The impact of frailty on postoperative outcomes in patients undergoing hepatectomy is still unclear. AIM: To study the influence of frailty on postoperative outcomes, such as mortality, rate of complications, and length of hospitalization, following hepatectomy. METHODS: PubMed, EMBASE, and Scopus databases were searched for observational studies with adult (≥ 18 years) patients after planned/elective hepatectomy. A random-effects model was used for all analyses, and the results are expressed as weighted mean difference (WMD), relative risk (RR), or hazards ratio (HR) with 95% confidence interval (CI). RESULTS: Analysis of the 13 included studies showed a significant association of frailty with elevated risk of in-hospital mortality (RR = 2.76, 95%CI: 2.10-3.64), mortality at 30 d (RR = 4.60, 95%CI: 1.85-11.40), and mortality at 90 d (RR = 2.52, 95%CI: 1.70-3.75) in the postoperative period. Frail patients had a poorer long-term survival (HR = 2.89, 95%CI: 1.84-4.53) and higher incidence of "any" complications (RR = 1.69, 95%CI: 1.40-2.03) and major (grade III or higher on the Clavien-Dindo scale) complications (RR = 2.69, 95%CI: 1.85-3.92). Frailty was correlated with markedly lengthier hospital stay (WMD = 3.65, 95%CI: 1.45-5.85). CONCLUSION: Frailty correlates with elevated risks of mortality, complications, and prolonged hospitalization, which need to be considered in surgical management. Further research is essential to formulate strategies for improved outcomes in this vulnerable cohort.
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BACKGROUND: The post-insertion clinical course of esophageal self-expandable metal stents (SEMS) in initially frail patients with esophageal carcinoma (EC) with dysphagia remains unclear. This study aimed to assess dysphagia improvement and evaluate prognosis in initially frail patients with advanced EC following SEMS insertion. METHODS: We retrospectively reviewed EC patients with EC who underwent esophageal SEMS insertion at our institution between January 2014 and March 2023. Inclusion criteria comprised Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥ 3 or ECOG PS 2 for individuals aged ≥ 75 years and recommendation for best supportive care by a multidisciplinary team. RESULTS: Forty-six patients met the inclusion criteria. Among them, 37 patients (80.4%) were ≥ 75 years old, and 21 patients (45.7%) exhibited ECOG PS 3 or 4. Dysphagia score (DS) ≥ 3 was observed in 27 patients (58.7%). All esophageal SEMS insertions were successfully completed. Post-procedure, there were two fatal cases of aspiration pneumonia and one perforation incident. DS improved to ≤ 1 in 25 patients (54.3%), with multivariate analysis indicating DS 3-4 and Glasgow Prognostic Score (GPS) 1-2 as negative predictive factors. The median overall survival was 4.1 months (95% confidence interval 1.8-6.5). CONCLUSIONS: Esophageal SEMS insertion effectively alleviated dysphagia in initially frail EC patients, yet prognosis remained poor, with occurrences of some fatal adverse events. Careful selection of candidates for esophageal SEMS insertions is crucial in this demographic, particularly considering the challenges in improving dysphagia for patients with DS 3-4 and GPS 1-2.
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Trastornos de Deglución , Neoplasias Esofágicas , Cuidados Paliativos , Stents Metálicos Autoexpandibles , Humanos , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/terapia , Anciano , Masculino , Femenino , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Cuidados Paliativos/métodos , Estudios Retrospectivos , Anciano de 80 o más Años , Persona de Mediana Edad , Pronóstico , Anciano Frágil , Fragilidad/complicacionesRESUMEN
BACKGROUND: Although many healthcare settings have since returned to pre-pandemic levels of operation, long-term care (LTC) facilities have experienced extended and significant changes to operations, including unprecedented levels of short staffing and facility closures, that may have a detrimental effect on resident outcomes. This study assessed the pandemic's extended effect on outcomes for LTC residents, comparing outcomes 1 and 2 years after the start of the pandemic to pre-pandemic times, with special focus on residents with frailty and dually enrolled in Medicare and Medicaid. METHODS: Using Medicare claims data from January 1, 2018, through December 31, 2022, we ran over-dispersed Poisson models to compare the monthly adjusted rates of emergency department use, hospitalization, and mortality among LTC residents, comparing residents with and without frailty and dually enrolled and non-dually enrolled residents. RESULTS: Two years after the start of the pandemic, adjusted emergency department (ED) and hospitalization rates were lower and adjusted mortality rates were higher compared with pre-pandemic years for all examined subgroups. For example, compared with 2018-2019, 2022 ED visit rates for dually enrolled residents were 0.89 times lower, hospitalization rates were 0.87 times lower, and mortality rates were 1.17 higher; 2022 ED visit rates for frail residents were 0.85 times lower, hospitalization rates were 0.83 times lower, and mortality rates were 1.21 higher. CONCLUSIONS: In 2022, emergency department and hospital utilization rates among long-term residents were lower than pre-pandemic levels and mortality rates were higher than pre-pandemic levels. These findings suggest that the pandemic has had an extended impact on outcomes for LTC residents.
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BACKGROUND: Frailty has become a key concern in an aging population. A comprehensive geriatric assessment (CGA) service framework was developed and evaluated aiming to target and connect frail older adults who are at high risk of requiring long-term care services. METHODS: A community-based pilot study was conducted in fiscal year 2016 and 2017 in Kure city, Hiroshima, Japan. Participants aged 65 and over living in Kure city, and 393 persons were extracted from the Kihon Check List (KCL) responses. Among the eligible individuals, 101 consented to participate and received CGA and referred to services based on individual health needs. The efficacy was evaluated by referral rate of services, continuity of the service usage, evaluation of participant's health condition and the quality of life (QoL) after the 6-month follow-up. RESULTS: Ninety-nine (98.0%) participants needed support for the instrumental activity of daily living, 97 (96.0%) were categorized as locomotive syndrome, and 64 (63.4%) had a depressive tendency. Afterward, 60 participants (59.4%) subsequently accepted the referral services, however, 34 (33.7%) used the services and the remaining 26 (25.7%) did not use the services. The health condition improvements in the service-uses group were statistically significant (p < 0.001), however, QoL score did not change between the baseline and 6th -month. CONCLUSION: KCL extracted high-risks older people, and CGA revealed related diseases and health conditions. However, the high refusal rate of referral services indicates a necessity to modify the service framework such as by collaborating with community general support centers, which could increase the efficacy of service framework.
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Anciano Frágil , Evaluación Geriátrica , Cuidados a Largo Plazo , Humanos , Anciano , Proyectos Piloto , Masculino , Femenino , Evaluación Geriátrica/métodos , Japón/epidemiología , Anciano de 80 o más Años , Cuidados a Largo Plazo/métodos , Calidad de Vida , Actividades Cotidianas , Derivación y ConsultaRESUMEN
Case presentation: A 100-year-old male presented with an episode of profound bradycardia. The patient's carer alerted the emergency department and they withdrew the bisoprolol and controlled the bradycardia. Once the problem was resolved, we were asked if any of his medications could be related to the bradycardia. Assessment and evaluation: On reviewing all the patient's treatment, which is very complex, we cannot establish a clear relationship between any of his 19 drugs and the bradycardia, except for the bisoprolol already withdrawn, but we found 6 other problems that we tried to solve. Results: Of the 6 proposed changes, 3 are accepted. Final comment: The review of a complex treatment will probably allow us to detect some aspects that could be improved.
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Background: Patients with frailty are more prone to have perioperative adverse events, and enhanced recovery after surgery (ERAS) has been widely adopted to improve perioperative outcomes. The purpose of this study was to assess the impact of improved compliance with ERAS on perioperative outcomes in frail patients. Methods: Geriatric patients (over 65 years) who underwent multi-level lumbar fusion surgery between June 2017 and June 2022 were included. The patients were divided into two groups according to their degree of compliance with the ERAS. Stepwise nearest-neighbor propensity score matching 1:1 cohorts for age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classfication and Charlson Comorbidity Index (CCI) was performed between groups, namely frail-compliant (FC), frail-noncompliant (FN). Further length of stay (LOS), complications and clinical efficacy were compared between groups. Results: There were 83 pairs of well-balanced patients with comparable clinical baseline data. It was worth noting that patients in FC group has significant lower overall complications (20.5% in the FC group vs 39.8% in the FN group, P = 0.007), major complications (7.2% in the FC group vs 19.3% in the FN group, P = 0.022) and shorter LOS (11.18 ± 5.32 in the FC group vs 14.45 ± 4.68 in the FN group, P < 0.001) than patients in FN group. In addition, the initial occurrence of ambulation (2.14 ± 1.21 in FC group vs 3.18 ± 1.73 in FN group, P = 0.012) and bowel movement (3.68 ± 1.24 in FC group vs 4.17 ± 1.32 in FN group, P = 0.031) were earlier for patients in FC group than patients in FN group. With regard to clinical efficacy, there were no significant difference between FC and FN group in terms of patients who meet minimal clinical important difference (MCID) for Oswestry Disability Index (ODI) at postoperative day (POD) 30, Visual Analog Scale (VAS) for back at POD 30-90 and VAS for legs at POD 30, 90, and 180 follow-up intervals. However, there were significant more patients meeting MCID for ODI at POD 90 and180, and VAS for back at POD 180 between FC and FN group. Conclusions: In this retrospective cohort study, we found that frail patients with higher ERAS adherence group had a lower incidence of overall complication, mjor complications, and a shorter LOS than their lower ERAS adherence counterparts. In addition, frail patients with higher ERAS adherence had earlier ambulatioin and bowel movement. More importantly, we found there were significant more patients meeting MCID for ODI at POD 90 and180, and VAS for back at POD 180 in higher ERAS adherence than their lower counterparts.
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The current fallback position for the elderly frail nearing the end of life (less than 12 months to live) is hospitalisation. There is a reluctance to use the term 'terminally ill' for this population, resulting in overtreatment, overdiagnosis and management that is not consistent with the wishes of people. This is the major contributor to the so-called hospital crisis, including decreased capacity of hospitals, reduced ability to conduct elective surgery, increased attendances at emergency departments and ambulance ramping. The authors recently conducted the largest randomised study, to their knowledge, attempting to inform specialist hospital medical teams about the terminally ill status of their admitted patients. This information did not influence their clinical decisions in any way. The authors discuss the reasons why this may have occurred, such as the current avoidance of discussing death and dying by society and the concentration of healthcare workers on actively managing the acute presenting problem and ignoring the underlying prognosis in the elderly frail. The authors discuss ways of improving the management of the elderly nearing the end of life, such as more detailed goals of care discussions using the concept of shared decision-making rather than simply completing Advanced Care Decision documents. Empowering people in this way could become the most important driver of people's health care.
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Cuidado Terminal , Humanos , Cuidado Terminal/psicología , Anciano , Anciano Frágil , Hospitalización , Toma de Decisiones Conjunta , Enfermo Terminal/psicología , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Overdiagnosis of urinary tract infections (UTIs) is one of the most common reasons for the unnecessary use of antibiotics in nursing homes, increasing the risk of missing serious conditions. Various decision tools and algorithms aim to aid in UTI diagnosis and the initiation of antibiotic therapy for residents. However, due to the lack of a clear gold standard, these tools vary widely and can be complex, with some requiring urine testing. As part of the European-funded IMAGINE project, aimed at improving antibiotic use for UTIs in nursing home residents, we have reviewed the recommendations. OBJECTIVES: This review provides a comprehensive summary of the more relevant tools and algorithms aimed at identifying true UTIs among residents living in nursing homes and discusses the challenges in using these algorithms based on updated research. SOURCES: The discussion is based on a relevant medical literature search and synthesis of the findings and published tools to provide an overview of the current state of improving the diagnosis of UTIs in nursing homes. CONTENT: The following topics are covered: prevalence of asymptomatic bacteriuria, diagnostic challenges, clinical criteria, urinary testing, and algorithms to be implemented in nursing home facilities. IMPLICATIONS: Diagnosing UTIs in residents is challenging due to the high prevalence of asymptomatic bacteriuria and non-specific urinary tract signs and symptoms among those with suspected UTIs. The fear of missing a UTI and the perceived antibiotic demands from residents and relatives might lead to overdiagnosis of this common condition. Despite their widespread use, urine dipsticks should not be recommended for geriatric patients. Patients who do not meet the minimum diagnostic criteria for UTIs should be evaluated for alternative conditions. Adherence to a simple algorithm can prevent unnecessary antibiotic courses without compromising resident safety.
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OBJECTIVE: The surgical population is ageing and often frail. Frailty increases the risk for poor post-operative outcomes such as delirium, which carries significant morbidity, mortality and cost. Frailty is often measured in a binary manner, limiting pre-operative counselling. The goal of this study was to determine the relationship between categorical frailty severity level and post-operative delirium. METHODS: We performed an analysis of a retrospective cohort of older adults from 12 January 2018 to 3 January 2020 admitted to a tertiary medical center for elective surgery. All participants underwent frailty screening prior to inpatient elective surgery with at least two post-operative delirium assessments. Planned ICU admissions were excluded. Procedures were risk-stratified by the Operative Stress Score (OSS). Categorical frailty severity level (Not Frail, Mild, Moderate, and Severe Frailty) was measured using the Edmonton Frail Scale. Delirium was determined using the 4 A's Test and Confusion Assessment Method-Intensive Care Unit. RESULTS: In sum, 324 patients were included. The overall post-operative delirium incidence was 4.6% (15 individuals), which increased significantly as the categorical frailty severity level increased (2% not frail, 6% mild frailty, 23% moderate frailty; P < 0.001) corresponding to increasing odds of delirium (OR 2.57 [0.62, 10.66] mild vs. not frail; OR 12.10 [3.57, 40.99] moderate vs. not frail). CONCLUSIONS: Incidence of post-operative delirium increases as categorical frailty severity level increases. This suggests that frailty severity should be considered when counselling older adults about their risk for post-operative delirium prior to surgery.
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Delirio , Fragilidad , Complicaciones Posoperatorias , Humanos , Masculino , Anciano , Femenino , Estudios Retrospectivos , Delirio/epidemiología , Delirio/diagnóstico , Incidencia , Fragilidad/diagnóstico , Fragilidad/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Anciano de 80 o más Años , Evaluación Geriátrica/métodos , Anciano Frágil/estadística & datos numéricos , Factores de Riesgo , Procedimientos Quirúrgicos Electivos/efectos adversos , Índice de Severidad de la Enfermedad , Medición de RiesgoRESUMEN
Older spousal caregivers bear the dual burden of managing health changes and caring for their partners. This study aimed to investigate the association between spousal caregiving and frailty in older adults. A retrospective cohort study with a 4-year follow-up was conducted using seven waves of data from the Health and Retirement Study (2006-2018). The mean age of participants was 65.1 years. A significant correlation was found between spousal caregiving and frailty increase. Multilevel analysis demonstrated a significant difference in the changes in frailty index over 12 years between caregivers and non-caregivers. This study uncovered a significant association between spousal caregiving and frailty in older adults, suggesting that becoming a spousal caregiver is not only linked to higher levels of frailty but also accelerates its progression. Healthcare providers can tailor support services to assist caregivers in managing challenges and promoting healthy aging.
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Background: The effect of sarcopenia on depressive mood during geriatric rehabilitation remains unclear. This study investigated the potential influence of sarcopenia on depressive mood among geriatric patients in a rehabilitation setting. Methods: This observational cohort study enrolled 204 patients aged ≥65 years (mean: 78.8±7.6 years, 45.1% women) admitted to a rehabilitation unit between April 2020 and July 2021. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment (AWGS2019) criteria, which include low handgrip strength and muscle mass. Depressive mood was defined as a 15-item Geriatric Depression Scale score of ≥6 points. We applied logistic regression models to examine the influence of sarcopenia on depressive mood at discharge. Results: We observed sarcopenia in 58.3% of patients. The logistic regression model showed that sarcopenia negatively influenced depressive mood at discharge (odds ratio, 5.460; 95% confidence interval, 2.344-13.415). Of the 68 patients without depressive mood at admission, those with sarcopenia (n=31) had a significantly higher incidence of depressive mood at discharge compared with patients without sarcopenia (n=37) (41.9% vs. 16.2%, p=0.037). Conclusion: Sarcopenia at admission negatively affected depressive mood at discharge from geriatric rehabilitation. Thus, early and routine assessment of sarcopenia is vital for patients undergoing geriatric rehabilitation.
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The aim of this study was to analyze the incidence and anamnestic characteristics of frail patients with stable coronary artery disease (CAD) and to evaluate the role of frailty in the development of complications and adverse outcomes in the perioperative period and early survival period after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: The study included 387 patients admitted to the clinic for a scheduled primary CABG. A seven-item questionnaire, "PRISMA-7", was used to identify frail elderly patients before the procedure. We divided the study sample into two groups, taking into account the results of the survey: patients without frailty, n0 = 300 (77.5%), and patients with frailty, n1 = 87 (22.5%). The anamnestic and laboratory data, outcome of the surgical intervention, perioperative and early complications, and adverse outcomes were analyzed. RESULTS: We detected frailty in 22.5% of the patients with CAD before the procedure. According to the anamnestic data and paraclinical and intraoperative findings, the groups of patients with and without frailty were comparable. The differences were revealed in the intraoperative and early postoperative periods of CABG. Thus, postoperative rhythm disturbances (19.5% vs. 10.5%, p = 0.025, V = 0.115, respectively) and transient ischemic attacks/stroke (5.7% vs. 1.3%, p = 0.031, V = 0.122, respectively) occurred significantly more often among the frail patients. There were no significant differences between the groups in the frequency of other intraoperative and early postoperative complications. In the group of frail patients, four fatal outcomes due to early postoperative ischemia were recorded, and among patients without frailty, one fatal outcome was recorded (4.5% vs. 0.3%, p = 0.010, V = 0.156, respectively). At the 1-year follow-up visit, the presence of frailty in history served as a predictor of mortality (11.5% vs. 0.6%, p Ë 0.001, V = 0.290, respectively). CONCLUSION: The presence of frailty can be used as an independent predictor of an unfavorable prognosis in patients with CAD, both in the perioperative and early survival period after CABG. It should be taken into account during surgical risk assessment.
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OBJECTIVES: Frailty is a prevalent geriatric condition that significantly impacts the health of older adults. This study aimed to examine the prevalence of frailty among older Chinese adults aged ≥ 65 years and to assess its association with adverse geriatric outcomes. METHOD: This study included 20,724 older adults aged ≥ 65 years in Jiangsu Province, China, utilizing a random, stratified, multistage cluster sampling approach. Frailty was assessed using the 5-item FRAIL scale. Geriatric outcomes, such as independence in activities of daily living (ADL), cognitive impairment, and frequent fall events (occurring four or more times in the preceding year), were evaluated. Logistic regression models were employed to evaluate the association between frailty and geriatric outcomes, with results presented as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The mean age of the participants was 73.4 ± 6.4 years. The standardized prevalence of prefrailty and frailty was 35.2% and 10.3%, respectively. Individuals identified as prefrail or frail tended to live in rural areas, have lower educational levels, be widowed, have lower incomes, and engage in less physical activity. Prefrailty and frailty were associated with an increased risk of limitations in BADL (OR: 9.62, 95% CI: 7.43-12.46; and OR: 29.25, 95% CI: 22.42-38.17, respectively) and IADL (OR: 2.54, 95% CI 2.35-2.74; and OR: 5.19, 95% CI 4.66-5.78, respectively), positive cognitive impairment screening (OR: 1.23, 95% CI: 1.16-1.31; and OR: 1.72, 95% CI: 1.56-1.91, respectively), and frequent falls (occurring four or more times in the preceding year) (OR: 3.38, 95% CI: 2.50-4.56; and OR: 8.37, 95% CI: 6.01-11.65). The association between frailty and both limitations in BADL and falls was notably more pronounced among the younger age groups (p for interaction < 0.001). CONCLUSIONS: According to the 5-item FRAIL scale, frailty was associated with limitations in BADLs and IADLs, positive cognitive impairment screening, and recent falls among older adults living in the community. Screening for frailty in younger age groups has the potential to prevent declines in physical function and falls.
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Accidentes por Caídas , Actividades Cotidianas , Disfunción Cognitiva , Anciano Frágil , Fragilidad , Evaluación Geriátrica , Vida Independiente , Humanos , Anciano , Masculino , Femenino , China/epidemiología , Accidentes por Caídas/prevención & control , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/diagnóstico , Vida Independiente/tendencias , Anciano de 80 o más Años , Fragilidad/epidemiología , Fragilidad/diagnóstico , Anciano Frágil/psicología , Evaluación Geriátrica/métodos , Tamizaje Masivo/métodos , Prevalencia , Estudios TransversalesRESUMEN
AIMS: This study aims to assess the concordance between in-person clinical and virtual oral examinations among hospitalized older adults. METHODS: A single examiner performed an in-person clinical examination, recorded systemic health history and oral health indices, clinically documented the Bedside Oral Exam (BOE), and captured photographs for subsequent analysis during a virtual examination. Following a 90-day washout period, a virtual examination was repeated by the same examiner and by a second examiner. Descriptive analysis and a Kappa test were used to compare proportions and evaluate the agreement between results. RESULTS: Intra-examiners presented high percentage of agreement in all domains of BOE (80%-86%), with an exception for gingiva (78%). Kappa's intra-examiners presented moderate scores in saliva, mucous membrane, gingiva and teeth/dentures domains and a strong score in the tongue domain (0.839). Inter examiners presented moderate agreement in lips and gingiva, saliva, mucous membrane, and teeth/dentures domains. Inter examiners Kappa scores were weak for lips (0.395) and gingiva (0.498) domains; moderate for saliva (0.703), mucous membrane (0.769) and teeth/dentures (0.714) domains and strong for the tongue domain (0.872). CONCLUSION: In this study, a moderate level of agreement was observed between clinical and virtual oral examinations among older hospitalized patients. These findings are encouraging and warrant further investigation about how teledentistry can be used to enhance oral health access to this vulnerable population.
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BACKGROUND: There is a need to identify vascular and geroscience-relevant markers and mediators that can physiologically link ageing to vascular disease. There is evidence of specific T cell subsets, all influenced by age, that exert positive and negative effects on vascular health. CD31+, termed angiogenic T cells, have been linked to vascular repair whereas CD28null, termed senescent T cells, display pro-inflammatory and cytotoxic effector functions. OBJECTIVE: This study sought to determine the combined influence of increasing age and frailty status on these circulating CD31+ and CD28null T cell subsets. METHODS: This cross-sectional study recruited four different cohorts of men and women; young (20-30 years, n=22), older (65-75 years, n=17), robust non-frail (76+ years, n=17), and frail (76+ years, n=15) adults. Frailty was determined using the Fried Frailty method. T cell subsets were determined by whole blood flow cytometry based on the expression of CD3, CD4, CD8, CD31 and CD28. Cognitive impairment (CI) was measured via the Montreal Cognitive Assessment test. RESULTS: Whether expressed as circulating counts or as a % of total T cells, there was a progressive decrease (p<0.05) in CD31+ T cells with increasing age but paradoxically higher values (p<0.05) in the frail compared to the robust non-frail group. These changes were similar in the CD4+ and CD8+ fractions. CD28null T cells were considerably higher (p<0.05) in the frail compared to the robust non-frail group, including in the CD8+ (47% vs 29%, p<0.05) and CD4+ (4% vs 1%, p<0.05) fractions. CD28null T cell percentage was also higher (p<0.05) in those with moderate CI compared to mild CI and normal function. CONCLUSION: CD8+CD28null T cells are considerably elevated in frailty and with cognitive impairment and may serve as a useful target for intervention. Currently, the utility of CD31+ T cells as an ageing biomarker may be confined to healthy ageing cohorts.
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Envejecimiento , Fragilidad , Humanos , Masculino , Femenino , Anciano , Fragilidad/sangre , Fragilidad/inmunología , Estudios Transversales , Envejecimiento/fisiología , Envejecimiento/inmunología , Envejecimiento/sangre , Adulto , Antígenos CD28/sangre , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/sangre , Senescencia Celular , Subgrupos de Linfocitos T/inmunología , Adulto Joven , Anciano de 80 o más Años , Anciano Frágil , Biomarcadores/sangre , Disfunción Cognitiva/sangre , Disfunción Cognitiva/inmunología , Linfocitos T/inmunologíaRESUMEN
Being commonly diagnosed in elderly women and associated with comorbidities as well as ageing-related cardio-vascular changes, heart failure with preserved ejection fraction (HFpEF) has been recently considered as a distinct cardiogeriatric syndrome. Frailty is another frequent geriatric syndrome. HFpEF and frailty share common underlying mechanisms, often co-exist, and represent each other's risk factors. A threshold of 65 years old is usually used to screen patients for both frailty and HFpEF in research and clinical settings. However, both HFpEF and frailty are very heterogenous conditions that may develop at younger ages. In this review we aim to provide a broader overview on the coexistence of HFpEF and frailty throughout the lifetime. We hypothesize that HFpEF and frailty patients' profiles (young, elderly, superaged) represent a continuum of the common ageing process modified by cumulative exposure to risk factors resulting to a presentation of HFpEF and frailty at different ages. We believe, that suggested approach might stimulate assessment of frailty in HFpEF assessment and vice versa regardless of age and early implementation of targeted interventions. Future studies of pathophysiology, clinical features, and outcomes of frailty in HFpEF by age are needed.