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1.
Med Clin North Am ; 104(2): 327-343, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32035572

RESUMEN

Aging-associated anatomic and physiologic decline begins during the fourth decade of life and progresses over the ensuing decades sometimes to a state of frailty, with the decline amplified when there is deconditioning. Aging-related gait and balance disorders leading to an increased risk of falling can be compensated for with the use of exercise interventions, durable medical equipment, and environmental modifications. Caregiver training is an essential component of geriatric rehabilitation.


Asunto(s)
Accidentes por Caídas/prevención & control , Evaluación Geriátrica/métodos , Enfermedad de Parkinson , Velocidad al Caminar , Anciano , Cuidadores/educación , Humanos , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/rehabilitación
2.
Isr Med Assoc J ; 22(2): 94-99, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32043326

RESUMEN

BACKGROUND: Internal thoracic impedance (ITI) measurement is a sensitive method for detecting preclinical pulmonary edema and pleural effusion. OBJECTIVES: To investigate the efficacy of this non-invasive method for detecting early pleural effusion among geriatric patients and to monitor increased ITI during its resolution. METHODS: This prospective, controlled study was conducted between July 2012 and August 2015. The study comprised 70 patients aged 65 to 94 years; and 39 of the patients had pleural effusion. ITI was measured continuously with a RS-207 monitor. The predictive value of ITI monitoring was determined based on a total of eight measurements taken at 12-hour intervals over 84 hours. RESULTS: As a result of medical treatment, the median ITI of the study group increased from 31 (interquartile range [IQR] 28-33 ohms) to 41 ohms (IQR 38-41 ohms; P < 0.001) compared to non-significant changes in the control group. Average respiratory rate (per minute) in the study group decreased from 29 (IQR 28-34) to 19 (IQR 18-20). CONCLUSIONS: ITI monitoring is efficient for diagnosis and for ongoing clinical evaluation of the treatment of elderly patients with pleural effusion. Timely treatment may prevent serious complications of effusions avoiding extended hospitalization.


Asunto(s)
Pletismografía de Impedancia/métodos , Derrame Pleural , Anciano , Diagnóstico Precoz , Femenino , Evaluación Geriátrica/métodos , Humanos , Israel , Masculino , Monitoreo Fisiológico/métodos , Derrame Pleural/diagnóstico , Derrame Pleural/etiología , Derrame Pleural/fisiopatología , Pruebas en el Punto de Atención , Recurrencia , Reproducibilidad de los Resultados
3.
Br J Anaesth ; 124(2): 146-153, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31862160

RESUMEN

BACKGROUND: Near-infrared spectroscopy non-invasively measures regional cerebral oxygen saturation. Intraoperative cerebral desaturations have been associated with worse neurological outcomes. We investigated whether perioperative cerebral desaturations are associated with postoperative delirium in older patients after cardiac surgery. METHODS: Patients aged 70 yr and older scheduled for on-pump cardiac surgery were included between 2015 and 2017 in a single-centre, prospective, observational study. Baseline cerebral oxygen saturation was measured 1 day before surgery. Throughout surgery and after ICU admission, cerebral oxygen saturation was monitored continuously up to 72 h after operation. The presence of delirium was assessed using the confusion assessment method for the ICU. Association with delirium was evaluated with unadjusted analyses and multivariable logistic regression. RESULTS: Ninety-six of 103 patients were included, and 29 (30%) became delirious. Intraoperative cerebral oxygen saturation was not significantly associated with postoperative delirium. The lowest postoperative cerebral oxygen saturation was lower in patients who became delirious (P=0.001). The absolute and relative postoperative cerebral oxygen saturation decreases were more marked in patients with delirium (13 [6]% and 19 [9]%, respectively) compared with patients without delirium (9 [4]% and 14 [5]%; P=0.002 and P=0.001, respectively). These differences in cerebral oxygen saturation were no longer present after excluding cerebral oxygen saturation values after patients became delirious. Older age, previous stroke, higher EuroSCORE II, lower preoperative Mini-Mental Status Examination, and more substantial absolute postoperative cerebral oxygen saturation decreases were independently associated with postoperative delirium incidence. CONCLUSIONS: Postoperative delirium in older patients undergoing cardiac surgery is associated with absolute decreases in postoperative cerebral oxygen saturation. These differences appear most detectable after the onset of delirium. CLINICAL TRIAL REGISTRATION: NCT02532530.


Asunto(s)
Encéfalo/metabolismo , Procedimientos Quirúrgicos Cardíacos , Delirio/etiología , Evaluación Geriátrica/métodos , Oxígeno/metabolismo , Complicaciones Posoperatorias/etiología , Anciano , Anciano de 80 o más Años , Bélgica , Delirio/metabolismo , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/metabolismo , Estudios Prospectivos , Espectroscopía Infrarroja Corta
4.
Isr Med Assoc J ; 12(21): 779-784, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31814339

RESUMEN

BACKGROUND: Older age is an independent predictor of worse outcome from traumatic brain injury (TBI). No clear guidelines exist for the management of TBI in elderly patients. OBJECTIVES: To describe the outcomes of elderly patients presenting with TBI and intracranial bleeding (ICB), comparing a very elderly population (≥ 80 years of age) to a younger one (70-79). METHODS: Retrospective analysis of the outcomes of elderly patients presenting with TBI with ICB admitted to a level I trauma center. RESULTS: The authors analyzed 100 consecutive patients aged 70-79 and 100 patients aged 80 and older. In-hospital mortality rates were 9% and 21% for groups 70-79 and ≥ 80 years old, respectively (P = 0.017). Patients 70-79 years old showed a 12-month survival rate of 73% and a median survival of 47 months. In patients ≥ 80 years old, 12-month survival was 63% and median survival was 27 months (P = NS). In patients presenting with a Glasgow Coma Scale score of ≥ 8, the in-hospital mortality rates were 41% (n=5/12) and 100% (n=8/8). Among patients ≥ 80 years old undergoing emergent surgical decompression, in-hospital mortality was 66% (n=12/18). Survivors presented with a severe drop in their functional score. Survival was dismal in patients ≥ 80 years old who were treated conservatively despite recommended operative guidelines. CONCLUSIONS: There is a lack of reliable means to evaluate the outcome in patients with poor functional status at baseline. The negative prognostic impact of severe TBI is profound, regardless of treatment choices.


Asunto(s)
Lesiones Traumáticas del Encéfalo , Tratamiento Conservador , Craniectomía Descompresiva , Hemorragias Intracraneales , Factores de Edad , Anciano , Anciano de 80 o más Años , Lesiones Traumáticas del Encéfalo/diagnóstico , Lesiones Traumáticas del Encéfalo/mortalidad , Tratamiento Conservador/métodos , Tratamiento Conservador/mortalidad , Craniectomía Descompresiva/métodos , Craniectomía Descompresiva/estadística & datos numéricos , Femenino , Evaluación Geriátrica/métodos , Escala de Coma de Glasgow , Humanos , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/mortalidad , Israel/epidemiología , Masculino , Pronóstico , Recuperación de la Función , Tasa de Supervivencia
5.
Isr Med Assoc J ; 12(21): 796-800, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31814342

RESUMEN

BACKGROUND: The use of graphic depictions (pictorials) to represent medical conditions is an accepted method that can complement standard methodology of comprehensive geriatric assessment. OBJECTIVES: To use the clinical pathway method to develop a comprehensive geriatric genogram assessment tool (CGGAT), which could supplement the written summary letter and recommendations. METHODS: We used the critical paths method to develop a tool to facilitate implementation of the comprehensive geriatric assessment recommendations. A multidisciplinary group of clinicians used the critical pathways method to develop a CGGAT. RESULTS: We used the CGGAT to depict the physical and functional status of patients and to complement the textual historical information, family dynamics, and current patient issues. CGGAT is a simple instrument that provides a visual structure and it can facilitate the sharing of information among team members, encourage interdisciplinary dialogue, enhance understanding and adherence on the part of patients and professionals, and reduce the burden on the clinicians who conduct the initial comprehensive geriatric assessment. CONCLUSIONS: We showed the benefits and obstacles related to the adaptation of this new tool and provide recommendations for further development.


Asunto(s)
Atención Integral de Salud/métodos , Gráficos por Computador , Vías Clínicas , Evaluación Geriátrica/métodos , Anciano , Ambiente , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Evaluación Nutricional , Grupo de Atención al Paciente/organización & administración , Pruebas Psicológicas
6.
Medicine (Baltimore) ; 98(45): e17882, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31702661

RESUMEN

The asymmetry in lower extremity strength is known to be related to the functional mobility in older adults living in the community. However, little is known about the association between lower extremity lean mass asymmetry and functional mobility in this patient group. Hence, this study aimed to determine whether asymmetry in lower extremity muscle mass has a significant relationship with functional mobility in older adults living in the community.This cross-sectional study analyzed the pre-existing data from the Korean Frailty and Aging Cohort Study. A total of 435 older people (aged 70-84 years) were divided into the following groups according to their Limb Asymmetry Index (LAsI): low, intermediate, and high asymmetric groups. LAsI is calculated using lower extremity lean mass, and comparisons between groups were conducted. The participants were also further divided into better and worse mobility groups based on their physical performance test results (Timed Up and Go and Short Physical Performance Battery), and comparisons between groups were conducted. Comparisons between fallers and non-fallers were also conducted. In addition, this study investigated the factors that had a significant effect on gait speed and fall experience within the past year among older adults living in the community.The LAsI was significantly associated with gait speed in older adults living in the community. Older adults in the highest tertile of the LAsI had a slower gait speed than those in the lowest tertile of the LAsI. However, no significant difference was observed in the LAsI between the better mobility group and worse mobility group. Moreover, the LAsI was not a significant predictor of falls.Asymmetry in lower extremity lean mass was significantly associated with gait speed in older adults living in the community.


Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Composición Corporal , Extremidad Inferior/patología , Fuerza Muscular , Rendimiento Físico Funcional , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Fragilidad/complicaciones , Fragilidad/fisiopatología , Evaluación Geriátrica/métodos , Humanos , Masculino , República de Corea , Encuestas y Cuestionarios , Velocidad al Caminar/fisiología
7.
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
8.
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
9.
J Frailty Aging ; 8(4): 215-221, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31637409

RESUMEN

Multiple myeloma is a malignant plasma cell disease, which typically affects older patients, with a median age at diagnosis of 70 years. The challenge in treating older patients is to accurately identify 'fit' patients that can tolerate more intensive treatment to maximize disease control, while simultaneously identifying vulnerable or 'frail' patients who may develop toxicity with significant morbidity and mortality, requiring different treatment options or dose modification. Multiple frailty scores have been devised for multiple myeloma over the years in newly-diagnosed patients. This paper gives an overview of the three common frailty measurements: the International Myeloma Working Group Frailty Score, Mayo Clinic Frailty Score and the Revised Myeloma Co-Morbidity Index. We will summarize the derivation, validation, usability and applicability of these scores in different clinical settings, emphasizing the main strengths and limitations for each index score. We will also highlight future directions in the operationalization of frailty in multiple myeloma.


Asunto(s)
Fragilidad/diagnóstico , Evaluación Geriátrica/métodos , Mieloma Múltiple/epidemiología , Anciano , Anciano Frágil , Humanos , Reproducibilidad de los Resultados
10.
Mayo Clin Proc ; 94(10): 1994-2003, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31585582

RESUMEN

OBJECTIVE: To determine whether a low Braden skin score (BSS), reflecting increased risk for skin pressure injury, would predict lower survival in cardiac intensive care unit (CICU) patients after adjustment for illness severity and comorbidities. PATIENTS AND METHODS: This retrospective cohort study included consecutive unique adult patients admitted to a single tertiary care referral hospital CICU from January 1, 2007, through December 31, 2015, who had a BSS documented on CICU admission. The primary outcome was all-cause hospital mortality, using elastic net penalized logistic regression to determine predictors of hospital mortality. The secondary outcome was all-cause post-discharge mortality, using Cox proportional hazards models to determine predictors of post-discharge mortality. RESULTS: The study included 9552 patients with a mean age of 67.4±15.2 years (3589 [37.6%] were females) and a hospital mortality rate of 8.3%. Admission BSS was inversely associated with hospital mortality (unadjusted odds ratio, 0.70; 95% CI, 0.68-0.72; P<.001; area under the receiver operator curve, 0.80; 95% CI, 0.78-0.82), with increased short-term mortality as a function of decreasing admission BSS. After adjustment for illness severity and comorbidities using multivariable analysis, admission BSS remained inversely associated with hospital mortality (adjusted odds ratio, 0.88; 95% CI, 0.85-0.92; P<.001). Among hospital survivors, admission BSS was inversely associated with post-discharge mortality after adjustment for illness severity and comorbidities (adjusted hazard ratio, 0.89; 95% CI, 0.88-0. 90; P<.001). CONCLUSION: The admission BSS, a simple inexpensive bedside nursing assessment potentially reflecting frailty and overall illness acuity, was independently associated with hospital and post-discharge mortality when added to established multiparametric illness severity scores among contemporary CICU patients.


Asunto(s)
Fragilidad/diagnóstico , Fragilidad/mortalidad , Evaluación Geriátrica/métodos , Mortalidad Hospitalaria , Úlcera por Presión/diagnóstico , Anciano , Anciano de 80 o más Años , Causas de Muerte , Estudios de Cohortes , Unidades de Cuidados Coronarios , Femenino , Fragilidad/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Admisión del Paciente , Valor Predictivo de las Pruebas , Úlcera por Presión/complicaciones , Pronóstico , Estudios Retrospectivos
11.
Br J Anaesth ; 123(6): 808-817, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31587833

RESUMEN

BACKGROUND: Preclinical studies suggest that exposure to general anaesthesia (GA) could cause neurodegeneration consistent with Alzheimer's disease (AD) pathology. Brain magnetic resonance imaging (MRI) is useful to study structural brain changes. We tested the hypothesis that exposure to surgery with GA (surgery/GA) is associated with greater cortical thinning and increased frequency of white matter lesions. METHODS: This is a cross-sectional analysis of 70-91-yr-old participants enrolled in the Mayo Clinic Study of Aging who had baseline MRI. The thickness of selected cortical regions, the volume of white matter hyperintensities, and the frequency of cortical infarctions were compared in participants who were and were not exposed to surgery/GA within 20 yr before the first MRI obtained after enrolment. RESULTS: Of 1410 participants with MRI scans, 932 were exposed to surgery/GA before scanning. In adjusted analyses, cortical thickness in regions vulnerable to AD was significantly less in those exposed to surgery/GA in the prior 20 yr (difference -0.023 mm, [95% confidence interval (CI) -0.041 to -0.005], P=0.014). Those with surgery in the prior 20 yr were more likely to have 'abnormal thickness' compared with those without surgery (odds ratio=1.45, [95% CI 1.10-1.90], P=0.009). Exposure was not associated with white matter hyperintensities or the presence of brain infarcts. CONCLUSIONS: This study suggests that exposure of older adults to surgical anaesthesia is associated with thinning in cortical regions implicated in AD. The pathogenesis and mechanisms driving these neurodegenerative changes, and the potential clinical significance of these findings, require further study.


Asunto(s)
Anestesia General/efectos adversos , Encéfalo/efectos de los fármacos , Encéfalo/diagnóstico por imagen , Evaluación Geriátrica/métodos , Imagen por Resonancia Magnética/métodos , Anciano , Anciano de 80 o más Años , Encéfalo/fisiopatología , Estudios Transversales , Femenino , Humanos , Masculino
12.
BMC Med ; 17(1): 185, 2019 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-31575376

RESUMEN

BACKGROUND: The identification of individuals at increased risk of poor health-related outcomes is a priority. Geriatric research has proposed several indicators shown to be associated with these outcomes, but a head-to-head comparison of their predictive accuracy is still lacking. We therefore aimed to compare the accuracy of five geriatric health indicators in predicting different outcomes among older persons: frailty index (FI), frailty phenotype (FP), walking speed (WS), multimorbidity, and a summary score including clinical diagnoses, functioning, and disability (the Health Assessment Tool; HAT). METHODS: Data were retrieved from the Swedish National Study on Aging and Care in Kungsholmen, an ongoing longitudinal study including 3363 people aged 60+. To inspect the accuracy of geriatric health indicators, we employed areas under the receiver operating characteristic curve (AUC) for the prediction of 3-year and 5-year mortality, 1-year and 3-year unplanned hospitalizations (1+), and contacts with healthcare providers in the 6 months before and after baseline evaluation (2+). RESULTS: FI, WS, and HAT showed the best accuracy in the prediction of mortality [AUC(95%CI) for 3-year mortality 0.84 (0.82-0.86), 0.85 (0.83-0.87), 0.87 (0.85-0.88) and AUC(95%CI) for 5-year mortality 0.84 (0.82-0.86), 0.85 (0.83-0.86), 0.86 (0.85-0.88), respectively]. Unplanned hospitalizations were better predicted by the FI [AUC(95%CI) 1-year 0.73 (0.71-0.76); 3-year 0.72 (0.70-0.73)] and HAT [AUC(95%CI) 1-year 0.73 (0.71-0.75); 3-year 0.71 (0.69-0.73)]. The most accurate predictor of multiple contacts with healthcare providers was multimorbidity [AUC(95%CI) 0.67 (0.65-0.68)]. Predictions were generally less accurate among younger individuals (< 78 years old). CONCLUSION: Specific geriatric health indicators predict clinical outcomes with different accuracy. Comprehensive indicators (HAT, FI, WS) perform better in predicting mortality and hospitalization. Multimorbidity exhibits the best accuracy in the prediction of multiple contacts with providers.


Asunto(s)
Evaluación Geriátrica/métodos , Indicadores de Salud , Anciano , Anciano de 80 o más Años , Personas con Discapacidad/estadística & datos numéricos , Femenino , Anciano Frágil , Fragilidad/diagnóstico , Fragilidad/epidemiología , Fragilidad/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Mortalidad , Valor Predictivo de las Pruebas , Pronóstico , Suecia/epidemiología
13.
Wiad Lek ; 72(9 cz 1): 1697-1702, 2019.
Artículo en Polaco | MEDLINE | ID: mdl-31586986

RESUMEN

Physical activity is one of the most important element of a healthy lifestyle and determinant of the physical and mental health. According to the WHO, limited physical activity is the fourth most common premature deaths risk factor in the world. Regular sport and active recreation is very important for our health. Physical exercise is the most effective method used by physiotherapists to prevent and slow down the aging process of the body, and consequently, diseases of elderly, such as: osteoporosis, injuries caused by falls, diabetes or hypertension. Physical activity has a positive effect on the quality of life and cognitive functions of elderly. People over 65 years constitute about 40-50% of people who require specialist medical care in the world. Therefore, health and medical professionals dealing with preventive healthcare and treatment of elderly people should have basic knowledge in geriatric rehabilitation, as well as to be able to plan suitable physiotherapy program adequate to the needs of older people. To assess the functional status of the patient, as well as the effectiveness of the training, various types of functional tests are used, specially designed for the elderly. These tests are based on the Comprehensive Geriatric Assessment (COG) considering the state of health, physical and mental fitness as well as socio-environmental conditions. The physiotherapeutic program should be based on functional training involving the entire human body, i.e. nervous, muscular, skeletal, sensory and balance systems.


Asunto(s)
Ejercicio , Evaluación Geriátrica/métodos , Rendimiento Físico Funcional , Anciano , Anciano de 80 o más Años , Humanos , Salud Mental , Calidad de Vida
14.
Clin Interv Aging ; 14: 1671-1680, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31631988

RESUMEN

Purpose: The co-occurrence of frailty and depression in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality have rarely been investigated. We aimed to examine the co-occurrence of frailty and depressive symptoms in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality using all the information from a longitudinal study. Patients and methods: We used the Taiwan Longitudinal Study of Aging (TLSA) for this study. TLSA was initiated in 1989 and followed periodically. We included participants from 1989 to 2007, who had data on frailty and depressive symptoms. Frailty was assessed by accumulation of functional deficits in 6 dimensions including disease status, sensory dysfunction, balance, functional limitations, health risk behaviors, and life satisfaction. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). A multistate model with interval censoring was used to examine the transition between states of frailty with or without depressive symptoms, and finally to death. A mixed model was used to examine the relationships between frailty and depressive symptoms. Results: The coexistence of frailty and depressive symptoms was associated with higher mortality. Individuals with depressive symptom had a lower probability of reversal to a better state. Previous depression score predicted current frailty, but the coefficient was smaller than that of previous frailty. Previous frailty predicted current depression score, and the coefficient was stronger than that of previous depression. Conclusion: Depressive symptoms increased the mortality and decreased the probability of reversal in the frail older adults.


Asunto(s)
Depresión/epidemiología , Anciano Frágil/estadística & datos numéricos , Fragilidad/epidemiología , Anciano , Anciano de 80 o más Años , Comorbilidad , Depresión/psicología , Trastorno Depresivo/epidemiología , Femenino , Anciano Frágil/psicología , Fragilidad/psicología , Evaluación Geriátrica/métodos , Humanos , Estudios Longitudinales , Masculino , Factores de Riesgo , Taiwán/epidemiología
15.
Braz J Med Biol Res ; 52(9): e8204, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31482974

RESUMEN

Sarcopenia remains poorly managed in clinical practice due to the lack of simple and accurate screening tools. This study aimed to identify the cutoff values of the SARC-F questionnaire and Ishii's score using the variables age, grip strength, and calf circumference in older inpatients in China to compare the accuracy of the two methods and to explore their predictive ability for adverse outcomes (rehospitalization, falls, fracture, and death). Hospitalized patients (n=138) aged ≥60 years were included. The accuracy of the two tools was evaluated using the reference diagnosis recommended by the Asian Working Group on Sarcopenia (assessing patients with measurements of muscle mass, handgrip strength, and usual gait speed). Follow-up data were obtained by telephone and clinical visits combined with the inpatient medical record system after discharge for at least one year. The results showed that the SARC-F score reached the highest Youden's index when a score of 3 was set as the cutoff value. Ishii's score presented a higher accuracy than SARC-F (area under the receiver operating curve: 0.78 vs 0.64, P=0.01). The Kaplan-Meier survival analysis demonstrated a higher cumulative incidence of rehospitalization in sarcopenic individuals compared to non-sarcopenic individuals according to SARC-F (log-rank test, P<0.001). Cox analysis revealed that SARC-F was an independent risk factor for rehospitalization (adjusted hazard ratio: 4.23, 95%CI: 2.12-9.79, P<0.001). The SARC-F and Ishii's scores might facilitate the early detection of sarcopenia and help identify older adults at risk for adverse outcomes in clinical practice.


Asunto(s)
Índice de Masa Corporal , Evaluación Geriátrica/métodos , Fuerza de la Mano/fisiología , Sarcopenia/diagnóstico , Encuestas y Cuestionarios , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Pacientes Internos , Estimación de Kaplan-Meier , Masculino , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Sarcopenia/fisiopatología
16.
Aging Clin Exp Res ; 31(12): 1843-1846, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31486995

RESUMEN

The aim of this study was to develop a simple visualized approach to classify persons into meaningful gait speed categories. Footprints of 310 instrumented gait analyses of 190 geriatric persons (mean age 79.1 years, 74 women) were used in a retrospective analysis to classify persons´ footprints into a left/right step overlapping, an intermediate or a long stepping pattern. The association between gait speed and step length was r = 0.91. More than 75% of the measurements classified as overlapping stepping pattern had a gait speed of below 0.5 m/s. All participants of the long stepping pattern group had a gait speed of faster than 1 m/s. The positive predictive values for classifying gait speed correctly were 71-100%. The proposed screening tool can be used in outpatient settings or home visits and is likely to be applicable if instrumented gait speed assessment is not available.


Asunto(s)
Evaluación Geriátrica/métodos , Velocidad al Caminar , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos
17.
BMC Infect Dis ; 19(1): 761, 2019 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-31477059

RESUMEN

BACKGROUND: Aspiration pneumonia is a serious problem among elderly patients; it is caused by many risk factors including dysphagia, poor oral hygiene, malnutrition, and sedative medications. The aim of this study was to define a convenient procedure to objectively evaluate the risk of aspiration pneumonia in the clinical setting. METHODS: This prospective study included an aspiration pneumonia (AP) group, a community-acquired pneumonia (CAP) group, and a control (Con) group (patients hospitalized for lung cancer chemotherapy). We used the Oral Health Assessment Tool (OHAT), which assesses oral hygiene, and evaluated performance status, body mass index, serum albumin levels, substance P values in plasma, and oral bacterial counts. RESULTS: The oral health as assessed by the OHAT of the aspiration pneumonia group was significantly impaired compared with that of the CAP group and the control (5.13 ± 0.18, 4.40 ± 0.26, 3.90 ± 0.22, respectively; p < 0.05). The oral bacterial count in the aspiration pneumonia group (7.20 ± 0.11) was significantly higher than that in the CAP group (6.89 ± 0.12), consistent with the OHAT scores. Oral bacterial count was significantly reduced by oral care. CONCLUSIONS: OHAT and oral bacterial counts can be a tool to assess the requirement of taking oral care and other preventive procedures in patients at high risk of aspiration pneumonia.


Asunto(s)
Bacterias/aislamiento & purificación , Biomarcadores/sangre , Evaluación Geriátrica/métodos , Mucosa Bucal/microbiología , Neumonía por Aspiración/diagnóstico , Anciano , Anciano de 80 o más Años , Biomarcadores/análisis , Estudios de Casos y Controles , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Humanos , Masculino , Microbiota/fisiología , Persona de Mediana Edad , Higiene Bucal , Proyectos Piloto , Neumonía por Aspiración/sangre , Neumonía por Aspiración/microbiología , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo
19.
Clin Interv Aging ; 14: 1265-1276, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31371932

RESUMEN

Background: Gait measures such as gait speed, stride length, step width, and stance duration change with advanced age and are associated with adverse health outcomes among older adults. The stride-to-stride variabilities of gait measures are also related to falls and cognitive decline in older adults; however, reference values of these gait parameters in older Japanese adults do not exist. This study aimed to determine the reference values of gait parameters as measured by a plantar pressure platform in community-dwelling older Japanese adults. Methods: Community-dwelling adults (N=1,212) who were independent in basic activities of daily living and aged 70-96 years (491 men, 721 women) completed the gait performance measurement in a geriatric health assessment. We assessed 10 gait performance measures with a plantar pressure platform system (P-WALK, BTS Bioengineering) and calculated means and coefficient of variations (CVs) of the gait measures as well as quintiles for those gait parameters per age group among men and women. Results: Mean (SDs) of gait speed, stride length, step width, and stance durations were 1.26 (0.24) meters per second (m/s), 121.9 (19.8) cm, 24.0 (3.2) cm, and 552.4 (60.4) milliseconds (ms), respectively, in men, and 1.27 (0.21) m/s, 115.7 (16.3) cm, 17.9 (2.8) cm, and 517.6 (59.8) ms, respectively, in women. Mean of CVs (SD) of stride length, step width, and single-stance duration were 2.76 (1.35), 12.06 (3.98), and 5.74 (2.66), respectively, in men and 2.69 (1.24), 15.65 (4.53), and 5.77 (2.40), respectively, in women. Gait parameters (except CVs of step width) declined significantly with age regardless of gender (P< 0.01 for trends). Conclusion: This study determined age group dependent gait parameter reference values, presented as means with quintile ranges, in community-dwelling older Japanese adults. These reference values may be useful metrics for gait assessment in the elderly.


Asunto(s)
Actividades Cotidianas , Vida Independiente , Actividad Motora/fisiología , Velocidad al Caminar/fisiología , Accidentes por Caídas/prevención & control , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/diagnóstico , Femenino , Evaluación Geriátrica/métodos , Humanos , Japón , Masculino , Valores de Referencia , Características de la Residencia
20.
Geriatr Psychol Neuropsychiatr Vieil ; 17(3): 279-289, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31449046

RESUMEN

The objective of this study was to compare in general practice, patients aged 65 years and over: the MMSE, screening tools for cognitive disorder recommended by the HAS and the Codex. METHOD: 53 patients were included between June and October 2017 at La Charmille general practice in Limpiville in rural areas during an observational study. Patients over 65 years of age were included following a consultation with their general practitioner. The MMSE and the Codex were compared on their results, intrinsic variables, the time of handover. Geriatric comorbidity factors are compared between groups of patients "with" and "without" cognitive disorders detected. RESULTS: Of the 53 patients, 94% CI 95% [4.10; 20.25] had cognitive impairment, at an average age of 74.15 years. The predominance is female with 30 patients (57%). The passage time of the Codex is on average 1min 43s, significantly faster (p = 4,29*10-26) than the time of passing the MMSE 4min 51s on average. There is a better satisfaction of the Codex compared to the MMSE (p = 1.675*10-6) with an average digital scale score of 7.3 against 6.3 respectively. There is no significant difference between population with cognitive and non-cognitive impairment and geriatric comorbidity factor due to selection bias. CONCLUSION: Codex appears to be a rapid, reliable, reproducible cognitive impairment screening tool adapted to the general practice consultation format. An important axis to work, awareness, education of doctors at the university and continuing education on the screening and management of dementia syndromes and fragility.


Asunto(s)
Disfunción Cognitiva/diagnóstico , Evaluación Geriátrica/métodos , Pruebas de Estado Mental y Demencia , Pruebas Neuropsicológicas , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/psicología , Comorbilidad , Femenino , Francia/epidemiología , Humanos , Masculino , Tamizaje Masivo , Estudios Prospectivos , Reproducibilidad de los Resultados , Población Rural , Sensibilidad y Especificidad
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