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1.
J Oral Rehabil ; 47(1): 61-66, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31332828

RESUMEN

No report has yet examined the impact of oral hypofunction on physical frailty in relation to intra-relationships of physical frailty assessment items. The purpose of this study was to verify the potential of a clinical cascade between oral hypofunction and physical frailty, and especially to support the hypothesis that the influence of oral hypofunction on physical frailty is greater than the intra-relationships among elements of physical frailty and that sex differences significantly affect these relationships. The participants were 272 older adults (101 men and 171 women; mean age 75.1 ± 7.5 years). Maximum occlusal force (MOF) and oral dryness (OD), as indicators of oral hypofunction, and grip strength (GS) and walking speed (WS), as indicators of physical frailty, were measured. Mutual relationship of four variables was verified using covariance structure analysis. In men, three paths from MOF to WS and GS and from WS to GS were confirmed, and those from MOF to WS and from WS to GS were found to be significant (P < .01). In women, three paths from MOF to WS and GS and from WS to GS were also confirmed, as with the men, and those from MOF to WS and from MOF to GS were found to be significant (P < .01). Model adaptability was shown to be good for both men and women. The results suggest our hypothesis was verified, and it is expected that the early detection of oral hypofunction, that is MOF, may be important for assessing physical frailty, especially in women.


Asunto(s)
Fragilidad , Anciano , Anciano de 80 o más Años , Fuerza de la Mordida , Estudios Transversales , Femenino , Anciano Frágil , Evaluación Geriátrica , Humanos , Masculino
2.
Enferm. clín. (Ed. impr.) ; 29(6): 381-384, nov.-dic. 2019.
Artículo en Español | IBECS | ID: ibc-184660

RESUMEN

El envejecimiento unido a la multimorbilidad, la polimedicación y a diversos factores sociales se conforma como uno de los determinantes que conducen a aumentar la complejidad de la atención en las personas mayores y a dificultar, por tanto, el aportar respuestas eficaces desde los sistemas sanitarios a sus necesidades. Para afrontar este nuevo y creciente escenario del cuidado a la persona mayor, es necesario que los sistemas formales de atención, sanitario y social, definan puestos de trabajo específicos para que las especialistas en enfermería geriátrica, formadas para abordar las necesidades de las personas mayores desde una perspectiva de la atención integral, tanto en el envejecimiento saludable como en los diferentes problemas de salud de este grupo poblacional, caracterizado por las propias consecuencias del envejecimiento y la cronicidad hacia la dependencia, desarrollen las competencias que la ley establece en el marco de un equipo interdisciplinar, para las que han sido formadas y acreditadas, sumando así valor en la respuesta que los sistemas sanitario y social han de aportar a este creciente problema de la tríada «envejecimiento-cronicidad-dependencia»


Aging together with multimorbidity, polymedication and various social factors are some of the determinants that lead to increasing complexity of care in the elderly, thus making it difficult for health systems to meet their needs. To approach this new and growing scenario of care for the elderly, the formal health and social care systems must define specific jobs for geriatric nursing specialists trained to address the needs of older people from a perspective of comprehensive care, both for healthy aging, and for the different health problems of this population group, characterized by the consequences of aging and chronicity, towards dependence, and develop the powers established by law in the framework of an interdisciplinary team, for those who have been trained and accredited, thus adding value to the response that health systems have to provide for this growing problem of the 'aging-chronicity-dependence' triad


Asunto(s)
Humanos , Enfermería Geriátrica/métodos , Rol de la Enfermera , Servicios de Salud para Ancianos , Enfermería Geriátrica/organización & administración , Anciano Frágil
3.
Ned Tijdschr Tandheelkd ; 126(12): 637-645, 2019 Dec.
Artículo en Holandés | MEDLINE | ID: mdl-31840674

RESUMEN

Oral care for older people is an underexposed topic in dentistry as well as in general healthcare, while oral care professionals are increasingly confronted with frail and multimorbid older people with complex care needs. The research agenda 'Oral care for the elderly' was developed to encourage the collaboration of researchers in the Netherlands and Flanders (Belgium) to do more research in this area and in this way, to achieve an expansion and implementation of knowledge. This will make possible the provision of a socially responsible and robust basis for sustainable oral care for frail older people. The focus of the agenda is on 3 themes, namely oral health and oral function for older people; multi/interdisciplinary collaboration within primary care and the costs, benefits and long-term effect(s) of oral care throughout the entire course of life. This article provides an overview of this research agenda and the way in which it has been established.


Asunto(s)
Prestación de Atención de Salud , Atención Primaria de Salud , Anciano , Anciano de 80 o más Años , Bélgica , Anciano Frágil , Humanos , Países Bajos , Salud Bucal
4.
Ned Tijdschr Tandheelkd ; 126(12): 647-652, 2019 Dec.
Artículo en Holandés | MEDLINE | ID: mdl-31840675

RESUMEN

The Netherlands, like other Western countries, shows an obvious demography of aging, which is associated with many challenges. People age differently, after all. Some remain vital until very old age, while others become frail and disabled much earlier in life. Because of the indicated demographic trend, morbidity is expected to increase and with it, the number of older people needing care. 'Aging in place' has become a central phenomenon in healthcare policies. This means that older people should be empowered to lead a meaningful life in their own living environment as long as possible, even when they are frail and care dependent. Therefore, in the future, most care for older people will actually occur at home. This article aims to present a meaningful care model for the older people. Starting from the 'definition discussion' about frailty and a revaluation of the concept of' resilience, a basis will be provided for a sustainable, proactive and personalised elderly care, close to the living environment of older people, in which dentists and other oral health professionals play an important role as well.


Asunto(s)
Personas con Discapacidad , Anciano Frágil , Anciano , Anciano de 80 o más Años , Odontólogos , Personal de Salud , Humanos , Países Bajos
5.
Ned Tijdschr Tandheelkd ; 126(12): 653-656, 2019 Dec.
Artículo en Holandés | MEDLINE | ID: mdl-31840676

RESUMEN

Scientific literature demonstrates relationships to exist between oral health and general health in a number of areas. A healthy oral cavity contributes to general wellbeing, but poor oral health can increase the risk of physical disorders, such as aspiration pneumonia, cardiovascular disorders, diabetes mellitus, and other disorders. Given the risks of these systemic diseases for frail older people, adequate and high-quality oral care is of great importance for this patient group.


Asunto(s)
Diabetes Mellitus , Neumonía por Aspiración , Anciano , Anciano de 80 o más Años , Anciano Frágil , Estado de Salud , Humanos , Boca , Salud Bucal
6.
Ned Tijdschr Tandheelkd ; 126(12): 673-678, 2019 Dec.
Artículo en Holandés | MEDLINE | ID: mdl-31840679

RESUMEN

Oral health in frail older people is often poor. There are a number of reasons for this, such as increased morbity and decreased motivation for (self) care. Good oral health is, however, very important. Studies have revealed poor oral health to cause or aggravate several medical and psychological problems. Illness and medication can, in turn, damage oral health. Oral health among the elderly should therefore be carefully monitored and maintained. This requires multidisciplinary and interprofessional collaboration on the part of healthcare professionals and others involved. Such collaboration is now still very limited; hardly anything has been written about how such collaboration in the area of oral care for frail older people should or could be organised. This article provides an overview of the possibilities and the relevant factors in the area of oral care for the elderly in promoting collaboration among healthcare professionals and others involved. All of this is under the banner of 'united we stand'.


Asunto(s)
Anciano Frágil , Salud Bucal , Anciano , Anciano de 80 o más Años , Personal de Salud , Humanos , Autocuidado
7.
Ned Tijdschr Tandheelkd ; 126(12): 679-686, 2019 Dec.
Artículo en Holandés | MEDLINE | ID: mdl-31840680

RESUMEN

Globally, oral health diseases are a major problem that can have serious consequences at both the individual and social level. Despite sufficient knowledge about the prevention of oral health diseases, putting it into practice does not seem obvious, particularly not in a target group of frail older people. Inequality of health, partly increased by society becoming more multicultural and the ageing of the population, must be tackled. Diversity in the provision of care tailored to the care needs of different target groups is necessary. Another challenge lies in removing the barriers that (oral) healthcare providers experience when offering oral healthcare to frail older people. In order to provide a solution to the issues mentioned above, reorientation of oral healthcare services is needed. A more prevention-orientated approach to care, with methods of financing that support this, should be the goal. In addition, health literacy must be improved through health education and promotion. A model has been developed for interprofessional collaboration to optimise (oral) healthcare. This approach would lead to an increase in patient-centred care and in this way takes important steps forwards towards a healthier society.


Asunto(s)
Prestación de Atención de Salud , Anciano Frágil , Anciano , Anciano de 80 o más Años , Humanos , Salud Bucal
8.
Ned Tijdschr Tandheelkd ; 126(12): 687-695, 2019 Dec.
Artículo en Holandés | MEDLINE | ID: mdl-31840681

RESUMEN

Vurnerable older people often need intensive preventive and curative oral health care. However, their physical and cognitive decline does not always allow for lege artis implementation of dental treatments. This causes practical problems often with related moral issues. Including these moral issues in planning and implementation will make oral healthcare more effective and will also alleviate moral pressure on oral healthcare providers. Mostly the moral issues relate to every day ethics, which can be solved by all persons involved collectively, in open consultation and with an ethics of care approach. This means aiming at 'doing the right thing in the right way', including all the relevant aspects of the person of the patient and his/her environment. To achieve this, oral health care should be embedded in the overall care process for the elderly and care providers should feel involved with the older person and have reflective skills.


Asunto(s)
Toma de Decisiones , Anciano Frágil , Anciano , Anciano de 80 o más Años , Atención Odontológica , Femenino , Humanos , Masculino , Principios Morales , Salud Bucal
9.
Ned Tijdschr Tandheelkd ; 126(11): 599-606, 2019 Nov.
Artículo en Holandés | MEDLINE | ID: mdl-31730137

RESUMEN

To improve oral health for frail and care-dependent older people, both intra- and extramurally, in the Euregio Rhine-Waal area in the Netherlands and Germany, we inventoried barriers to oral care for the target group according to the literature, the organisation of oral care in both countries and the implications of this organisation for daily and professional (oral) healthcare and oral care. Results show most identified barriers are common to both countries, but the organisation of oral healthcare differs in both countries. The main differences lie in the financing and organisation of oral care in the intramural situation. In the Netherlands, this is to a large degree regulated and organised on the basis of the Chronic Care Act (Wlz), using the Verenso Oral Care Directive for care-dependent clients as a base for enforcement. In Germany, on the other hand, the provision of oral care in the home situation is more effectively facilitated. In both countries, various initiatives have recently been employed to improve, among other things, information supply, education and financing of oral healthcare.


Asunto(s)
Prestación de Atención de Salud , Cuidado Dental para Ancianos , Salud Bucal , Anciano , Anciano de 80 o más Años , Anciano Frágil , Alemania , Humanos , Países Bajos
10.
Zhonghua Yi Xue Za Zhi ; 99(40): 3126-3131, 2019 Oct 29.
Artículo en Chino | MEDLINE | ID: mdl-31694102

RESUMEN

Objective: To investigate the characteristics of frailty in the elderly male patients with chronic kidney disease (CKD) and the effects of renal function on the incidence of frailty. Methods: A total of 105 non-dialysis CKD patients aged ≥65 years who were admitted to the Chinese PLA General Hospital between October 1, 2018 and January 30, 2019 were included in this study. Their clinical data and laboratory indicators were collected. Frailty was defined according to Fried frailty criteria. According to the frailty scores, the participants were categorized as non-frail (n=37), intermediately frail (n=37) and frail (n=31). The association of frailty and the level of estimated glomerular filtration rate (eGFR) in the patients was analyzed using the model of multivariate Logistic regression. Results: Among the 105 patients, the mean age was 74 (68, 77) years old. The incidence of frail and intermediate frail was 35.2% (37/105) and 29.5% (31/105), respectively. Multivariate logistic analysis showed statistically significant associations of frailty with age (OR=1.14, 95%CI:1.08-1.20, P<0.001), body mass index (OR=0.87, 95%CI:0.79-0.95, P=0.001) and the level of eGFR (OR=0.98, 95%CI:0.96-0.99, P=0.003) in those patients. The incidence of frail in patients with eGFR<45 ml·min(-1)·(1.73 m(2))(-1) and 45-59 ml·min(-1)·(1.73 m(2))(-1) was 1.02 (OR=2.02, 95%CI: 1.06~3.87) and 0.84 (OR=1.84, 95%CI: 1.05-3.22) times higher than that of eGFR≥60 ml·min(-1)·(1.73 m(2))(-1), respectively. Conclusion: The incidence of frailty in the elderly patients with CKD is affected by many factors, such as age, body mass index and renal function, and increases with decreased renal function.


Asunto(s)
Fragilidad , Insuficiencia Renal Crónica , Anciano , Estudios Transversales , Anciano Frágil , Humanos , Masculino , Factores de Riesgo
11.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(9): 563-570, nov. 2019.
Artículo en Español | IBECS | ID: ibc-184379

RESUMEN

Objetivo: Evaluar en el paciente diabético anciano la probabilidad de mejorar la fragilidad tras realizar ejercicios de fuerza con una banda elástica y ejercicio aeróbico. Métodos: Estudio prospectivo de pacientes diabéticos mayores de 70 años, con Barthel > 80 puntos y Global Deterioration Scale-Functional Assessment Staging < 3 puntos. Se recomendaron ejercicios de fuerza con una banda elástica 3 días a la semana y caminar 30 min al día 5 días a la semana. Se revisó la adherencia a los ejercicios mediante la pregunta de Haynes-Sacket. En el momento basal y a los 6 meses se evaluaron la fragilidad según los criterios de Fried y la capacidad funcional mediante el Short Physical Performance Battery. Resultados: Un total de 44 pacientes completaron los 6 meses de seguimiento. Se produjo falta de adherencia a los ejercicios aeróbicos en el 38,6% de los casos y a los ejercicios con bandas elásticas en el 47,7%. La prevalencia de fragilidad disminuyó del 34,1% inicial al 25% a los 6 meses (p = 0,043), y el porcentaje de sujetos con una limitación funcional moderada-grave se redujo del 26,2 al 21,4% (p = 0,007). La adherencia a los ejercicios aeróbicos (p = 0,034) y la ausencia de cardiopatía isquémica coronaria (p = 0,043) predispusieron a mejorar la fragilidad. Conclusiones: Realizar durante 6 meses ejercicios de fuerza con una banda elástica y ejercicio aeróbico reduce la prevalencia de fragilidad en pacientes diabéticos ancianos. La probabilidad de mejorar la fragilidad disminuye en caso de cardiopatía isquémica coronaria y aumenta con la adherencia a los ejercicios aeróbicos


Aim: To evaluate in the elderly diabetic patient the probability of improving the frailty after performing strength exercises with an elastic band and aerobic exercise. Methods: Prospective study of diabetic patients older than 70 years, with Barthel > 80 points and Global Deterioration Scale -Functional Assessment Staging < 3 points. Strength exercises with an elastic band 3 days a week and walk 30 min a day 5 days a week were recommended. Adherence to the exercises was assessed using the Haynes-Sacket test. Frailty was assessed by the Fried criteria and functional capacity by the Short Physical Performance Battery at baseline and at 6 months. Results: 44 patients completed 6 months of follow-up. There was non-adherence to aerobic exercises in 38.6% of cases and to exercises with elastic bands in 47.7%. The prevalence of frailty decreased from an initial 34.1% to 25% at 6 months (p = 0.043) and the percentage of patients with a moderate-severe functional limitation was reduced from 26.2% to 21.4% (p = 0.007). Adherence to aerobic exercises (p = 0.034) and absence of coronary ischemic heart disease (p = 0.043) predisposed to improve frailty. Conclusions: Performing 6-month strength exercises with an elastic band and aerobic exercise reduces the prevalence of frailty in elderly diabetic patients. The probability of improving frailty decreases in case of coronary ischemic heart disease and increases with adherence to aerobic exercises


Asunto(s)
Humanos , Anciano , Anciano de 80 o más Años , Ejercicio/fisiología , Fuerza Muscular/fisiología , Anciano Frágil , Debilidad Muscular/terapia , Terapia por Ejercicio , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Estudios Prospectivos , Cumplimiento y Adherencia al Tratamiento
12.
Wei Sheng Yan Jiu ; 48(5): 785-792, 2019 Sep.
Artículo en Chino | MEDLINE | ID: mdl-31601319

RESUMEN

OBJECTIVE: To analyze the current situation and correlation between frailty and cognitive dysfunction in the old patients of orthopedic emergency. METHODS: Enrolling 248 elderly people( ≥65 years old) in orthopedic emergency department of Beijing Jishuitan Hospital from September to December 2018, the cognitive function of the subjects was assessed by Mini-mental State Examination( MMSE). The frailty situation was assessed by FRAIL Scale. In addition, ADL, exercise tolerance assessment, gripping power and geriatric nutritional risk index( GNRI) were also tested in this study. RESULTS: In this research, 58( 23. 4%) were the elderly with normal cognitive function, 69( 27. 8%) were MCI, and 86( 34. 7%) were dementia and 35( 14. 1%) were severe dementia. The prevalence of seniors over 76 years old was significantly higher than that of the younger age group( χ~2= 39. 300, P < 0. 001), the prevalence of seniors below primary school was significantly higher than that of junior middle school and above( χ~2= 117. 082, P<0. 001), and the prevalence of dementia in patients with chronic obstructive pulmonary disease( COPD) was higher( χ~2= 11. 685, P = 0. 009). The study subjects were strong elderly, accounting for 69( 27. 8%), 114( 46. 0%) and 65( 26. 2%)were in prefrailty and frailty. The prevalence of prefrailty in 75-85 years old people was significantly higher than that in other groups, and the prevalence of prefrailty and frailty in85 years old people was both higher( χ~2= 45. 247, P<0. 001). In addition, education level( χ~2= 13. 909, P = 0. 008), hypertension( χ~2= 6. 892, P = 0. 032), COPD( χ~2= 8. 411, P =0. 015), cerebral infarction( χ~2= 7. 477, P = 0. 024) and GNRI( χ~2= 22. 942, P = 0. 001)were all the influencing factors of frailty. There were also significant differences in ADL, exercise tolerance and gripping power among the above factors. There were significant differences in cognitive function among subjects with different levels of frailty( χ~2=61. 259, P = 0. 000), ADL( χ~2= 54. 652, P<0. 001), exercise tolerance( χ~2= 77. 001, P =0. 000) and grip strength( χ~2= 54. 778, P < 0. 001). After adjusting for demographic characteristics and chronic diseases such as age, sex, education, BMI, coronary heart disease, hypertension and et al. Logistic regression analysis showed that the OR values of prefrailty, frailty, ADL and exercise tolerance affect cognition are 1. 918( 95% CI 0. 990-3. 716), 2. 732( 95%CI 1. 063-7. 023), 3. 217( 95% CI 1. 421-7. 285), 6. 440( 95% CI1. 803-22. 997). CONCLUSION: Prefrailty and frailty are closely related to cognitive dysfunction in the elderly.


Asunto(s)
Disfunción Cognitiva , Fragilidad , Evaluación Geriátrica , Anciano , Anciano de 80 o más Años , Anciano Frágil , Humanos , Prevalencia
13.
Lancet ; 394(10206): 1298, 2019 10 12.
Artículo en Inglés | MEDLINE | ID: mdl-31609212
14.
Rev Lat Am Enfermagem ; 27: e3202, 2019.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-31664410

RESUMEN

OBJECTIVE: to synthesize the knowledge about the association of frailty syndrome and cognitive impairment in older adults. METHOD: the Joanna Briggs Institute's systematic review of etiology and risk factors was adopted. The search for the studies was conducted by two independent reviewers in the databases MEDLINE, Embase, CINAHL and LILACS and by manual search was performed by tow reviewers independently. The measures of association Odds Ratio and Relative Risk were used in the meta-analysis. The software R version 3.4.3 and the meta-analysis package Metafor 2.0 were used for figure analysis. RESULTS: three studies identified the association of frailty syndrome and cognitive impairment through Odds Ratio values show that frail older adults are 1.4 times more likely to present cognitive impairment than non-frail older adults. Four studies analyzed the association through the measure of Relative Risk and found no statistical significance, and four studies used mean values. CONCLUSION: despite of the methodological differences of the studies and the lack of definition of an exact proportion in the cause and effect relationship, most studies indicate Frailty Syndrome as a trigger for Cognitive decline.


Asunto(s)
Disfunción Cognitiva/psicología , Fragilidad/psicología , Anciano , Anciano de 80 o más Años , Femenino , Anciano Frágil , Humanos , Masculino
15.
J Frailty Aging ; 8(4): 162-168, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31637400

RESUMEN

BACKGROUND: Physical frailty is a clinical syndrome associated with aging and manifesting as slowness, weakness, reduced physical activity, weight loss, and/or exhaustion. Frail older adults often report that their major problem is "low energy", and there is indirect evidence to support the hypothesis that frailty is a syndrome of dysregulated energetics. We hypothesized that altered cellular energy production underlies compromised response to stressors in the frail. METHODS: We conducted a pilot study to assess muscle energetics in response to a mild isometric exercise challenge in women (n=30) ages 84-93 years. The frailty status was assessed by a validated physical frailty instrument. Localized phosphorus (P31) magnetic resonance spectroscopy with a 1.5T magnet was used to assess the kinetics of Phosphocreatine recovery in the tibialis anterior muscle following maximal isometric contraction for 30 seconds. RESULTS: Phosphocreatine recovery following exertion, age-adjusted, was slowest in the frail group (mean=189 sec; 95%CI: 150,228) compared to pre-frail (mean=152 sec; 95%CI: 107,197) and nonfrail subjects (mean=132 sec; 95%CI: 40,224). The pre-frail and frail groups had 20 sec (95%CI: -49,89) and 57 sec (95%CI: -31,147) slower phosphocreatine recovery, respectively, than the non-frail. This response was paralleled by dysregulation in glucose recovery in response to oral glucose tolerance test in women from the same study population. CONCLUSIONS: Impaired muscle energetics and energy metabolism might be implicated in the physical frailty syndrome.


Asunto(s)
Ejercicio/fisiología , Fragilidad/fisiopatología , Músculos/metabolismo , Fosfocreatina/metabolismo , Anciano de 80 o más Años , Femenino , Anciano Frágil , Humanos , Proyectos Piloto
16.
J Frailty Aging ; 8(4): 169-175, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31637401

RESUMEN

BACKGROUND: Frailty and the metabolic Syndrome (MetS) are frequently found in old subjects and have been associated with increased risk of functional decline and dependency. Moreover, central characteristics of the MetS like inflammation, obesity and insulin resistance have been associated with the frailty syndrome. However, the relationship between MetS and frailty has not yet been studied in detail. Aim of the current analysis within the Berlin Aging Study II (BASE-II) was to explore associations between MetS and frailty taking important co-variables such as nutrition (total energy intake, dietary vitamin D intake), physical activity and vitamin D-status into account. METHODS: Complete cross-sectional data of 1,486 old participants (50.2% women, 68.7 (65.8-71.3) years) of BASE-II were analyzed. MetS was defined following the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity in 2009. Frailty was defined according to the Fried criteria. Limitations in physical performance were assessed via questionnaire, muscle mass was measured using dual energy X-ray absorptiometry (DXA) and grip strength using a Smedley dynamometer. Adjusted regression models were calculated to assess the association between MetS and Frailty. RESULTS: MetS was prevalent in 37.6% of the study population and 31.9% were frail or prefrail according to the here calculated frailty index. In adjusted models the odds of being frail/prefrail were increased about 50% with presence of the MetS (OR1.5; 95% CI 1.2,1.9; p= 0.002). Moreover the odds of being prefrail/frail were significantly increased with low HDL-C (OR: 1.5 (95%CI: 1.0-2.3); p = 0.037); and elevated waist circumference (OR: 1.65 (95%CI: 1.1-2.3); p = 0.008). CONCLUSION: The current analysis supports an association between MetS and frailty. There are various metabolic, immune and endocrine alterations in MetS that also play a role in mechanisms underlying the frailty syndrome. To what extent cytokine alterations, inflammatory processes, vitamin D supply and hormonal changes in age and in special metabolic states as MetS influence the development of frailty should be subject of further research.


Asunto(s)
Fragilidad/epidemiología , Síndrome Metabólico/epidemiología , Anciano , Berlin/epidemiología , Estudios Transversales , Femenino , Anciano Frágil , Humanos , Masculino
17.
J Frailty Aging ; 8(4): 180-185, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31637403

RESUMEN

BACKGROUND: Due to differences in the definition of frailty, many different screening instruments have been developed. However, the predictive validity of these instruments among community-dwelling older people remains uncertain. OBJECTIVE: To investigate whether combined (i.e. sequential or parallel) use of available frailty instruments improves the predictive power of dependency in (instrumental) activities of daily living ((I)ADL), mortality and hospitalization. DESIGN, SETTING AND PARTICIPANTS: A prospective cohort study with two-year follow-up was conducted among pre-frail and frail community-dwelling older people in the Netherlands. MEASUREMENTS: Four combinations of two highly specific frailty instruments (Frailty Phenotype, Frailty Index) and two highly sensitive instruments (Tilburg Frailty Indicator, Groningen Frailty Indicator) were investigated. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for all single instruments as well as for the four combinations, sequential and parallel. RESULTS: 2,420 individuals participated (mean age 76.3 ± 6.6 years, 60.5% female) in our study. Sequential use increased the levels of specificity, as expected, whereas the PPV hardly increased. Parallel use increased the levels of sensitivity, although the NPV hardly increased. CONCLUSIONS: Applying two frailty instruments sequential or parallel might not be a solution for achieving better predictions of frailty in community-dwelling older people. Our results show that the combination of different screening instruments does not improve predictive validity. However, as this is one of the first studies to investigate the combined use of screening instruments, we recommend further exploration of other combinations of instruments among other study populations.


Asunto(s)
Actividades Cotidianas , Evaluación Geriátrica/métodos , Hospitalización , Mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Anciano Frágil , Humanos , Masculino , Países Bajos/epidemiología , Valor Predictivo de las Pruebas , Estudios Prospectivos
18.
J Frailty Aging ; 8(4): 186-191, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31637404

RESUMEN

BACKGROUND: With increasing interest in addressing quality of life of older individuals, tests such as the Functional Independence Measure (FIM) are widely used measures of infirmity and burden of care. However, these scales are largely qualitative and especially problematic when assessing movement-based tasks. While effective, reliable analysis of human movement is technically complicated and expensive; an infrared depth sensor is potentially a low-cost, portable devise which may provide a quantitative aspect to clinical testing. OBJECTIVE: to assess the utility of the KinectTM sensor in providing an objective evaluation of human movement using an oft measured ADL (chair stand). DESIGN: Cross-sectional study. SETTING: Community, geriatric day-care center in Japan. PARTICIPANTS: Men (n=136) and women (n=266) between 50 and 93 years of age, consisting of healthy (HE; n=312) and physically frail (FR; n= 90) individuals. MEASUREMENTS: Subjects completed two trials of the chair stand, conducted without assistance. Trials were timed and recorded with KinectTM v2. Coronal plane angle (CPA) was determined by a line transecting the shoulder-center and waist relative to the vertical axis and was used to assess quality of the chair stand movement pattern. RESULTS: Age, height, and body mass were not different between groups. CPA was significantly greater in FR (29.3 ± 8.3°) than HE (19.5 ± 6.5°). CPA and age were significantly related (r=0.148, p<0.01). An optimal threshold for CPA identifying frailty was determined by a receiver-operator characteristic curve with a CPA of 23.1° providing the greatest combination of sensitivity (79%) and specificity (73%). CONCLUSION: During the chair stand, frail older adults adopted a forward lean position (increased CPA) compared to healthy older adults. This compensatory posture appears to facilitate torso rotation while reducing lower-limb muscular effort during standing. As such, CPA serves as an indicator of reduced lower-body function in older, frail adults.


Asunto(s)
Evaluación Geriátrica/métodos , Rendimiento Físico Funcional , Balance Postural , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Anciano Frágil , Humanos , Japón , Masculino , Persona de Mediana Edad
19.
J Frailty Aging ; 8(4): 192-197, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31637405

RESUMEN

INTRODUCTION: Physical frailty (PF) appears to be associated with low cognitive performance and mild cognitive impairment (MCI). This review evaluated and synthesized the evidence of studies investigating the association between PF and MCI, the prevalence of both conditions and the rate of conversion of healthy older adult to one of them during the follow-up. METHODS: A systematic review was performed according to the PRISMA recommendations in the Pubmed, SciELO and LILACS databases. Five studies were eligible according to inclusion and exclusion criteria. RESULTS: Regarding the study design, cross-sectional studies prevailed. Most studies showed a positive association between PF and MCI. Moreover, PF seems to predict a worse cognitive trajectory among participants with MCI and it is associated to a higher risk of developing MCI. CONCLUSION: Our findings suggest a significant association between PF and MCI. Further longitudinal studies are needed to better explore causality.


Asunto(s)
Disfunción Cognitiva/epidemiología , Fragilidad/epidemiología , Anciano , Estudios Transversales , Anciano Frágil , Humanos , Prevalencia
20.
J Frailty Aging ; 8(4): 198-204, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31637406

RESUMEN

OBJECTIVES: Eating alone is related to depression, nutritional risk, and mortality. These effects are also influenced by living status. However, little is known about the relationship between eating alone despite living with family and frailty. This study explores the relationship of eating alone and living status with frailty in community-dwelling older adults. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Kashiwa city, Chiba prefecture, Japan; randomly selected community-dwelling older adults (aged 65 years and over). MEASUREMENTS: Eating status was assessed by the question, "Do you eat meals with anyone, at least once a day: yes or no?" Frailty was defined by Kihon Checklist (KCL) score 8 or over. Domains of frailty were divided into instrumental activities of daily living (IADL), physical strength, nutrition, eating, socialization, memory, and mood, based on KCL categories. Binary logistic regression analysis was used, adjusting for age, years of education, chronic diseases, number of teeth and cognitive function. RESULTS: Among the total of 1,914 participants, 49.8% were male, and the overall mean age was 72.9 ± 5.5 years. Of all participants, 56 (5.9%) of men and 112 (11.7%) of women were frail. Older adults who ate alone despite living with others were more likely to be frail (OR 2.49, 95%CI 1.1-5.5 for men and OR 2.16, 95%CI 1.0-4.5 for women). Of particular note, eating and living status were associated with lower physical strength and mood in men, whereas in women these statuses were associated with lower scores for IADL, socialization, memory, and mood. CONCLUSIONS: Eating alone despite living with others was associated with high frailty in both genders; however, the pathways were different between genders. These results might help yield a simple, fundamental intervention approach to multifaceted frailty, reflecting gender and associated high-risk domains.


Asunto(s)
Conducta Alimentaria , Fragilidad/epidemiología , Características de la Residencia/estadística & datos numéricos , Anciano , Estudios Transversales , Femenino , Anciano Frágil , Humanos , Vida Independiente , Japón/epidemiología , Masculino
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