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1.
Am Surg ; 86(2): 95-103, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167059

RESUMEN

Patients undergoing radical pelvic surgery such as proctectomy or radical cystectomy are at risk of experiencing a variety of complications. Frailty renders patients vulnerable to adverse events. We hypothesize that frailty measured preoperatively using a validated scoring system correlates with increased likelihood of experiencing Clavien-Dindo grade IV complications and 30-day mortality and may be used as a predictive model for patients preoperatively. The NSQIP database was queried for patients who underwent proctectomy or radical cystectomy from 2008 to 2012. Preoperative frailty was calculated using the 11-point modified frailty index (MFI). Patients were scored based on the presence of indicators and categorized into two groups (<3 or ≥3). Major postoperative morbidities and mortality were identified and analyzed in each group. 10,048 proctectomy and cystectomy patients were identified. The MFI was found to be predictive of both 30-day mortality (P < 0.0001) and Clavien-Dindo grade IV complications (P < 0.0001). Receiver operating characteristic analysis demonstrated improved discriminative power of the MFI with the addition of American Society of Anesthesiologists class for both prediction of complications and 30-day mortality. An MFI score of ≥3 is predictive of postoperative morbidity and mortality. Providers should be encouraged to calculate frailty preoperatively to predict adverse outcomes.


Asunto(s)
Cistectomía/efectos adversos , Fragilidad/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Proctectomía/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Cistectomía/mortalidad , Cistectomía/estadística & datos numéricos , Bases de Datos Factuales , Femenino , Fragilidad/complicaciones , Fragilidad/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Pelvis/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Proctectomía/mortalidad , Proctectomía/estadística & datos numéricos , Curva ROC , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
2.
Arq Neuropsiquiatr ; 78(1): 2-8, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-32074186

RESUMEN

OBJECTIVE: The association between cognitive impairment and physical frailty has been studied in older adults. The criteria degree of frailty may be keys to associated cognitive impairment. To analyze the association between cognitive impairment and the criteria for frailty. METHODS: We cross-sectionally examined data from 667 older adults (≥60 years of age) from a study entitled 'Variables associated to cognition in elderly caregivers' involving patients in an urban and rural primary healthcare center. We defined cognitive impairment based on different groups of scores on the Mini Mental State Examination, and defined frailty and prefrailty using the criteria by the Cardiovascular Health Study. We performed multinomial regression models to analyze the association between levels of frailty and cognitive impairment. RESULTS: Similar proportions of women (54.8%) and men (45.2%) participated in the study (mean age: 71 years old). We found cognitive impairment, prefrailty and frailty in 34, 54, and 24% of the participants, respectively. Concomitant cognitive impairment and frailty was found in 13% of them. The chances of cognitive impairment increased up to 330% (Odds Ratio [OR]: 4.3; 95% confidence interval [95%CI] 2.4‒7.7; p<0.001) among frail individuals, and 70% (OR: 1.7; 95%CI 1.0‒2.8; p=0.033) among prefrail individuals compared to robust/non-frail individuals. After controlling for age, education, place of residence and functional dependence, slowness and fatigue criteria were significantly associated with cognitive impairment. CONCLUSION: Older adults with frailty have a greater likelihood of concomitant cognitive impairment than prefrail and robust older adults. The prevalence of cognitive impairment and frailty is consistent with data reported in literature. The present findings contribute to the investigation of cognitive frailty.


Asunto(s)
Disfunción Cognitiva/etiología , Anciano Frágil/psicología , Fragilidad/complicaciones , Fragilidad/psicología , Actividades Cotidianas/psicología , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Brasil/epidemiología , Disfunción Cognitiva/epidemiología , Estudios Transversales , Femenino , Fragilidad/epidemiología , Evaluación Geriátrica , Humanos , Vida Independiente , Masculino , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo
3.
Medicine (Baltimore) ; 99(5): e18935, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000408

RESUMEN

The effect of frailty on short and long term results of interventional treatment of coronary heart disease is not well defined. The evaluation of frailty may be helpful in appointment of most suitable treatment option and timing of patient follow-up. The frailty syndrome in daily practice of interventional cardiology ward (FRAPICA) study objective is to evaluate prognostic capability of the Fried frailty scale and instrumental activities of daily living scale (IADL) in elderly patients with symptomatic coronary heart disease.This is a single center, prospective, observational study. Patients aged ≥65 years are eligible. The objectives are to report Fried frailty scale and IADL scale dispersion before hospital discharge and to assess predictive impact of both scores. The endpoints are: success of interventional treatment, its complications (procedure related myocardial infarction, dye-induced renal function deterioration, loss of blood), 3-year mortality, either all-cause and cardiovascular, re-infarction, re-intervention, stroke, new-onset heart failure, any hospital readmission, and a combination of all above mentioned. Secondary analyses will focus on distinct clinical patient presentations, sub-classifications of frailty for modeling of long-term risk.FRAPICA trial will improve understanding of the associations between frailty syndrome, cardiovascular system diseases, their invasive treatment, and short and long-term outcomes. It will allow for more individualized assessment of risk and will identify new goals for interventions. (ClinicalTrials.gov Identifier NCT03209414).


Asunto(s)
Enfermedad Coronaria/diagnóstico , Fragilidad/diagnóstico , Estudios Observacionales como Asunto , Actividades Cotidianas , Anciano , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/terapia , Anciano Frágil , Fragilidad/complicaciones , Fragilidad/mortalidad , Fragilidad/terapia , Evaluación Geriátrica , Humanos , Selección de Paciente
4.
Adv Exp Med Biol ; 1216: 39-50, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894545

RESUMEN

Cardiovascular disease burden increases with the increasing age of populations. Also, with increasing longevity, some individuals are ageing along an unfavourable path developing frailty syndrome. Epidemiologic studies indicate that frailty is overrepresented among the persons with cardiovascular disease. On the other hand, frail subjects tend to be burdened with cardiovascular disease to a greater degree than their biologically better-off peers. Hypertension, diabetes, and obesity, especially abdominal, and at least some other risk factors appear to be shared between frailty and cardiovascular disease. The probable common underlying pathophysiologic feature is inflammation and associated phenomena, possibly having its root in the inflammageing. We discuss these issues based on the results of original studies, comprehensive literature reviews, and metaanalyses, by hundreds of dedicated researchers worldwide.


Asunto(s)
Enfermedades Cardiovasculares , Fragilidad , Anciano , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Anciano Frágil/estadística & datos numéricos , Fragilidad/complicaciones , Fragilidad/epidemiología , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Obesidad Abdominal/complicaciones , Obesidad Abdominal/epidemiología , Factores de Riesgo
5.
Adv Exp Med Biol ; 1216: 51-54, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894546

RESUMEN

The prevalence of frailty seems to be higher in people with cardiovascular disease (CVD) compared to those without, but also the prevalence of CVD is higher in people with frailty compared to robust ones. In longitudinal studies and meta-analyses dealing with the role of frailty as potential risk factor for incident CVD, we have an  increasing literature suggesting that frailty increases the risk of these conditions, particularly of fatal events, and independently from several potential confounding factors. Among the domains usually included in the definition of physical frailty, exhaustion, low physical activity, slow gait speed and weakness are significantly associated with the onset of CVD in older people. However, also CVD can be considered as potential risk factor for incident frailty even if the literature is more limited. In this chapter, I will therefore report and discuss the most recent and relevant findings in this topic, of extreme importance in actual geriatric medicine.


Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Anciano Frágil , Fragilidad/complicaciones , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Anciano Frágil/estadística & datos numéricos , Fragilidad/epidemiología , Evaluación Geriátrica , Humanos , Prevalencia , Factores de Riesgo
6.
Adv Exp Med Biol ; 1216: 55-64, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894547

RESUMEN

Chronic inflammation, which is called "inflamm-aging" , is characterized by an increased level of inflammatory cytokines in response to physiological and environmental stressors, and causes the immune system to function consistently at a low level, even though it is not effective. Possible causes of inflammaging include genetic susceptibility, visceral obesity, changes in gut microbiota and permeability, chronic infections and cellular senescence. Inflammation has a role in the development of many age-related diseases, such as frailty. Low grade chronic inflammation can also increase the risk of atherosclerosis and insulin resistance which are the leading mechanisms in the development of cardiovascular diseases (CVD). As it is well known that the risk of CVD is higher in older people with frailty and the risk of frailty is higher in patients with CVD, there may be relationship between inflammation and the development of CVD and frailty. Therefore, this important issue will be discussed in this chapter.


Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Anciano Frágil , Fragilidad/complicaciones , Inflamación/complicaciones , Anciano , Anciano de 80 o más Años , Envejecimiento/inmunología , Envejecimiento/patología , Enfermedades Cardiovasculares/inmunología , Enfermedades Cardiovasculares/patología , Senescencia Celular , Citocinas/inmunología , Fragilidad/inmunología , Fragilidad/patología , Humanos , Inflamación/inmunología , Inflamación/patología
7.
Adv Exp Med Biol ; 1216: 65-77, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894548

RESUMEN

The aim of this chapter is to review the results of recent studies analyzing the role of oxidative stress and systemic inflammation as potential contributors to frailty and CVD, and to explain a possible pathogenic relationship between the latter two conditions. Available evidence suggests that frail patients have elevated levels of oxidative stress biomarkers and proinflammatory cytokines, as well as with reduced concentrations of endogenous antioxidants. This implies that oxidative stress and systemic inflammation might play a role in the pathogenesis of frailty, but an underlying mechanism of this relationship is still mostly hypothetical. Oxidative stress and systemic inflammation are also involved in the pathogenesis of CVD. Cardiovascular conditions are established risk factor for frailty and in turn, presence of frailty constitutes an unfavorable prognostic factor in cardiac patients. Finally, some cardiovascular risk factors, such as lack of physical activity, smoking, obesity and inappropriate diet, are also involved in the etiology of oxidative stress, chronic inflammation and frailty. This complex interplay between intrinsic and extrinsic elements should be considered during holistic management of older persons with frailty and/or cardiovascular conditions.


Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/metabolismo , Anciano Frágil , Fragilidad/complicaciones , Fragilidad/metabolismo , Inflamación/complicaciones , Inflamación/metabolismo , Estrés Oxidativo , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/patología , Fragilidad/patología , Humanos , Inflamación/patología
8.
Adv Exp Med Biol ; 1216: 79-86, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894549

RESUMEN

Frailty is a complex clinical syndrome, progressively described in the last thirty years, resulting from multiple impairments across many organs and systems and characterized by a reduction in physiological reserves and increased vulnerability to stressors, as well. Cardiovascular diseases (CVDs) are a common health problem in very old populations. Age-related changes occur throughout the body and in all organs, including the cardiovascular system. Cellular senescence links age-related CVDs and frailty by many mechanisms of particular interest in the aging biology and geriatric syndromes. Cellular senescence may represent the pivotal factor with its senescence-associated secretory phenotype (SASP) leading to systemic inflammation. In this context, SASP may represent the key element in the association between aging, frailty and the development of age-related CVDs.


Asunto(s)
Envejecimiento/patología , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/patología , Senescencia Celular , Anciano Frágil , Fragilidad/complicaciones , Fragilidad/patología , Anciano , Humanos , Inflamación/complicaciones , Inflamación/patología
9.
Adv Exp Med Biol ; 1216: 99-113, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894551

RESUMEN

The number of older people candidates for interventional cardiology, such as PCI but especially for transcatheter aortic valve implantation (TAVI) , would increase in the future. Generically, the surgical risk, the amount of complications in the perioperative period, mortality and severe disability remain significantly higher in the elderly than in younger. For this reason it's important to determine the indication for surgical intervention, using tools able to predict not only the classics outcome (length of stay, mortality), but also those more specifically geriatrics, correlate to frailty: delirium, cognitive deterioration, risk of institutionalization and decline in functional status. The majority of the most used surgical risks scores are often specialist-oriented and many variables are not considered. The need of a multidimensional diagnostic process, focused on detect frailty, in order to program a coordinated and integrated plan for treatment and long term follow up, led to the development of a specific geriatric tool: the Comprehensive Geriatric Assessment (CGA). The CGA has the aim to improve the prognostic ability of the current risk scores to capture short long term mortality and disability, and helping to resolve a crucial issue providing solid clinical indications to help physician in the definition of on interventional approach as futile. This tool will likely optimize the selection of TAVI older candidates could have the maximal benefit from the procedure.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Anciano Frágil , Fragilidad/complicaciones , Fragilidad/cirugía , Evaluación Geriátrica , Anciano , Anciano de 80 o más Años , Humanos , Intervención Coronaria Percutánea , Medición de Riesgo , Reemplazo de la Válvula Aórtica Transcatéter
10.
Adv Exp Med Biol ; 1216: 149-152, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894554

RESUMEN

Frailty is a clinical concept which is gaining increased momentum not only in geriatrics, but in all specialties treating adult patients. In these Future Perspectives, the following roles of frailty in the field of cardiovascular diseases (CVD) will be discussed as a narrative review: (1) Frailty as an adjunct to assess CVD patients in addition to traditional risk scores; (2) bidirectional relationship between frailty and CVD; (3) widening the scope of endpoints in CVD trials-inclusion of frailty; (4) finally, the relationship between geriatrics and cardiology will be shortly discussed.


Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Anciano Frágil , Fragilidad/complicaciones , Anciano , Cardiología , Geriatría , Humanos , Narración
11.
World Neurosurg ; 133: e813-e818, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31605842

RESUMEN

BACKGROUND: Preoperative risk assessment is important, but inexact because physiologic reserves are difficult to measure. When assessing quality of life for patients with brain tumors, having a better predictor of postsurgical outcome would be beneficial in counseling these patients. Frailty is thought to estimate physiologic reserves, and it has been found to predict postoperative complications, length of stay, and discharge to a skilled nursing facility or assisted living facility in patients undergoing various types of surgery. Frailty as an adjunct to preoperative assessment of neurosurgical patients has never been evaluated. This study aimed to determine whether frailty predicts neurosurgical complications in patients with brain tumors and enhances current perioperative risk models. METHODS: Frailty was preoperatively assessed in 260 patients undergoing surgery for brain tumor resection using a validated scale that assessed weakness, weight loss, exhaustion, low physical activity, and slowed walking speed. Patients were classified as nonfrail (score of 0-1), moderately frail (score of 2-3), or frail (score of 4-5). Moderately frail and frail patients were combined for analysis. RESULTS: Preoperative frailty was associated with an increased risk for discharge to a location other than home (10.36; 95% confidence interval, 3.6-30.1), postoperative complications (2.09; 95% confidence interval, 1.09-3.98), and a longer length of stay (1.66; 95% confidence interval, 1.24-2.21). CONCLUSIONS: Frailty independently predicts discharge disposition, postoperative complications, and length of stay in patients undergoing surgery for brain tumor resection. Preoperative assessment of frailty can help neurosurgeons and patients make more informed decisions about pursing surgical treatment.


Asunto(s)
Neoplasias Encefálicas/cirugía , Fragilidad/complicaciones , Procedimientos Neuroquirúrgicos/efectos adversos , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente , Pronóstico , Estudios Prospectivos , Calidad de Vida , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Adulto Joven
12.
J Surg Res ; 246: 464-475, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31635837

RESUMEN

BACKGROUND: Screening patients for frailty is traditionally done at the bedside. However, recent electronic medical record (EMR)-based, comorbidity-focused frailty assessments have been developed. Our objective was to determine how a common bedside frailty assessment, the trauma and emergency surgery (TEGS) frailty index (FI), compares to an EMR-based frailty assessment in predicting geriatric TEGS outcomes. MATERIALS AND METHODS: We retrospectively reviewed our quality improvement project database consisting of TEGS patients ≥ 65 y old. Patients were screened with the TEGS FI, a 15-question bedside assessment, including comorbidities, physical activity, emotional health, and nutrition. Six of 15 items were retrievable from the enterprise data warehouse (EDW), storing all EMR data from Northwestern Memorial Hospital, and use to calculate the EDW frailty score. Patient characteristics and outcomes were compared between different groups. RESULTS: Two hundred thirty-six geriatric TEGS patients were included, of which 75 (31.8%) were TEGS FI frail and 60 (25.4%) were EDW frail. TEGS FI frail patients had increased length of stay (LOS), loss of independence (LOI), and complications compared to TEGS FI nonfrail patients. EDW frail patients had higher LOS and complications than EDW nonfrail patients but similar LOI. TEGS FI and EDW frail patients had similar outcomes except TEGS FI-only patients more often have LOI. CONCLUSIONS: Bedside frailty assessments and EMR-based assessments are both effective in identifying geriatric TEGS patients at risk for increased LOS and complications. However, bedside frailty screening was better at identifying patients who have LOI and may be a more appropriate choice when screening for frailty.


Asunto(s)
Tratamiento de Urgencia/efectos adversos , Fragilidad/diagnóstico , Evaluación Geriátrica/métodos , Complicaciones Posoperatorias/epidemiología , Heridas y Traumatismos/cirugía , Anciano , Anciano de 80 o más Años , Comorbilidad , Registros Electrónicos de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Fragilidad/complicaciones , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo
13.
J Surg Res ; 246: 403-410, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31630882

RESUMEN

BACKGROUND: Available methods for determining outcomes in vascular surgery patients are often subjective or not applicable in nonambulatory patients. The purpose of the present study was to assess the association between vascular surgery outcomes and a previously validated upper-extremity function (UEF) method, which incorporates wearable motion sensors for the physical frailty assessment. MATERIALS AND METHODS: Patients (≥50 y old) undergoing vascular surgery were recruited. Participants performed the 20-s UEF test, which involved rapid elbow flexion. This technology quantifies physical frailty features including slowness, weakness, exhaustion, and flexibility, which allows grouping individuals into nonfrail, prefrail, and frail categories. Surgical outcomes included length of hospital stay, discharged disposition, and 30-d mortality, complications, readmission, and reintervention(s). Associations between outcomes and frailty were assessed using nominal logistic regression models, adjusted for age, gender, body mass index, and wound classification. RESULTS: Thirty-seven participants were recruited: eight nonfrail (age = 62.0 ± 10.6); 22 prefrail (age = 65.6 ± 11.6); and seven frail (age = 68.0 ± 8.0). Significant associations were observed between frailty and length of hospital stay (three times longer among frail participants, P = 0.03), mortality after surgery (two incidents among frail participants, P < 0.01), and adverse discharge disposition (all nonfrail patients were discharged home, whereas only 43% of frail patients discharged home, P = 0.01). CONCLUSIONS: This is the first study to validate the utility of UEF among patients undergoing any vascular surgery. Findings suggest that UEF may provide an objective and simple approach for assessing frailty to predict adverse events after vascular surgery, especially for nonambulatory patients.


Asunto(s)
Codo/fisiopatología , Fragilidad/diagnóstico , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Vasculares/efectos adversos , Dispositivos Electrónicos Vestibles , Anciano , Femenino , Fragilidad/complicaciones , Fragilidad/fisiopatología , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Reoperación/estadística & datos numéricos , Medición de Riesgo/métodos , Factores de Riesgo , Factores de Tiempo
15.
J Shoulder Elbow Surg ; 29(1): e22-e28, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31466891

RESUMEN

BACKGROUND: A proximal humeral fracture is well established as a fracture of fragility in elderly patients. However, this injury does not receive the same emphasis on post-injury management as a femoral neck fracture. The objectives of this study were to establish the influence of sustaining a proximal humeral fracture on mortality and to identify the variables predictive of 5-year mortality. METHODS: Between January 2007 and January 2011, 288 consecutive patients who were admitted after sustaining a proximal humeral fracture were identified from the clinical coding department. Data were retrospectively collected and included patient demographic characteristics, comorbidities, anemia, physical and social independence, length of inpatient stay, management, and mortality. RESULTS: Of the patients, 13 (4.5%) had died at 1 month; 28 (9.7%), at 3 months; 46 (16.0%), at 1 year; and 117 (40.6%), at 5 years. A Cox proportional hazards regression identified male sex, comorbidities, unemployment or retirement, and nonoperative management as independent predictors of 5-year mortality. CONCLUSIONS: Elderly patients who require admission after sustaining a proximal humeral fracture are frail and subject to a greater-than-average risk of mortality for their age. The risk of mortality is greater for those of male sex who have comorbidities and a loss of physical and social independence.


Asunto(s)
Hospitalización , Fracturas del Hombro/mortalidad , Fracturas del Hombro/terapia , Anciano , Anciano de 80 o más Años , Comorbilidad , Tratamiento Conservador/estadística & datos numéricos , Femenino , Fragilidad/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Jubilación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Fracturas del Hombro/complicaciones , Desempleo/estadística & datos numéricos
16.
Medicine (Baltimore) ; 98(48): e18113, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31770235

RESUMEN

The impact of vitamin D deficiency on the recovery of patients with malnutrition remains undefined. Our aim was to study the prevalence of vitamin D deficiency in a well-characterized cohort of patients with malnutrition and its association with outcomes.Within this secondary analysis of a randomized controlled trial, we examined the association of vitamin D deficiency and adverse clinical outcomes over a follow-up of 180 days in hospitalized patients at risk for malnutrition. We measured 25-hydroxyvitamin D levels upon admission and defined Vitamin D deficiency when levels were <50nmol/l. The primary endpoint was 180-day mortality.The prevalence of vitamin D deficiency in our cohort of 828 patients was 58.2% (n = 482). Patients with vitamin D deficiency had increased 180-day mortality rates from 23.1% to 29.9% (odds ratio 1.42, 95% confidence interval [CI] 1.03-1.94, P = .03). When adjusting the analysis for demographics, comorbidities, and randomization, this association remained significant for the subgroup of patients not receiving vitamin D treatment (adjusted odds ratio 1.63, 95% CI 1.01-2.62, P = .04). There was no significantly lower risk for mortality in the subgroup of vitamin D deficient patients receiving vitamin D treatment compared to not receiving treatment (adjusted odds ratio 0.74, 95% CI 0.48-1.13, P = .15).Vitamin D deficiency is highly prevalent in the population of malnourished inpatients and is negatively associated with long-term mortality particularly when patients are not receiving vitamin D treatment. Our findings suggest that malnourished patients might benefit from vitamin D screening and treatment in case of deficiency.


Asunto(s)
Anciano Frágil/estadística & datos numéricos , Fragilidad/mortalidad , Desnutrición/mortalidad , Deficiencia de Vitamina D/mortalidad , Deficiencia de Vitamina D/terapia , Anciano , Anciano de 80 o más Años , Suplementos Dietéticos , Femenino , Fragilidad/sangre , Fragilidad/complicaciones , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Desnutrición/sangre , Desnutrición/complicaciones , Prevalencia , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento , Vitamina D/análogos & derivados , Vitamina D/sangre , Vitamina D/uso terapéutico , Deficiencia de Vitamina D/complicaciones , Vitaminas/uso terapéutico
17.
Int Heart J ; 60(6): 1366-1372, 2019 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-31735775

RESUMEN

The Kihon Checklist (KCL) is a reliable tool for determining frailty status in the elderly. However, there is no information in the literature about the relationship between frailty status and exercise capacity. Here, we examined the associations between cardiopulmonary exercise testing parameters and frailty status in elderly patients with stable heart failure (HF).Ninety-two elderly patients with stable HF were evaluated using cardiopulmonary exercise testing and the KCL. A KCL score of 0-3 was classified as robust, 4-7 as pre-frail, and ≥ 8 as frail.Mean age, peak VO2, and KCL score were 81.7 years, 13.2 mL/kg/minute, and 10.7, respectively. KCL score was significantly correlated with peak VO2 (r = -0.527, P < 0.001) and peak work rate (r = -0.632, P < 0.001). In patients with frailty (n = 63), the peak work rate (WR) was significantly lower than it was in patients without frailty (n = 29; 39.9 versus 69.5 W, respectively; P < 0.001). Multivariate analysis revealed that peak WR and peak systolic blood pressure were significant, independent predictors of frailty (ß = -0.108 and -0.045, respectively). In a diagnostic performance plot analysis, a cutoff value for peak WR of 51.9 W was the best predictor of frailty.Frailty status was significantly associated with peak WR and peak systolic blood pressure in elderly patients with stable HF. Therefore, cardiopulmonary exercise testing may be useful for assessing frailty status in this patient population.


Asunto(s)
Tolerancia al Ejercicio/fisiología , Ejercicio Físico/fisiología , Fragilidad/diagnóstico , Fragilidad/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Anciano , Anciano de 80 o más Años , Presión Sanguínea/fisiología , Lista de Verificación , Prueba de Esfuerzo , Femenino , Fragilidad/complicaciones , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Consumo de Oxígeno/fisiología , Valor Predictivo de las Pruebas
18.
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
19.
Clin Interv Aging ; 14: 1783-1795, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31695348

RESUMEN

Objective: To explore variation in medication regimen complexity in residential aged care facilities (RACFs) according to resident age, length of stay, comorbidity, dementia severity, frailty, and dependence in activities of daily living (ADLs), and compare number of daily administration times and Medication Regimen Complexity Index (MRCI) as measures of regimen complexity. Methods: This study was a cross-sectional analysis of baseline data from the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial. The SIMPLER study recruited 242 residents with at least one medication charted for regular administration from 8 RACFs in South Australia. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Dementia severity was assessed using the Dementia Severity Rating Scale. Frailty was assessed using the FRAIL-NH scale. Dependence in ADLs was assessed using the Katz ADL scale. Results: The median age of participants was 87 years (interquartile range 81-92). Over one-third of participants (n=86, 36%) had 5 or more daily medication administration times. The number of daily administration times and MRCI scores were positively correlated with resident length of stay (rs=0.19; 0.27), FRAIL-NH score (rs=0.23; 0.34) and dependence in ADLs (rs=-0.21; -0.33) (all p<0.01). MRCI was weakly negatively correlated with CCI score (rs=-0.16; p=0.013). Neither number of daily administration times nor MRCI score were correlated with age or dementia severity. In multivariate analysis, frailty was associated with number of daily administration times (OR: 1.13, 95% CI: 1.03-1.24) and MRCI score (OR: 1.26, 95% CI: 1.13-1.41). Dementia severity was inversely associated with both multiple medication administration times (OR: 0.97, 95% CI: 0.94-0.99) and high MRCI score (OR: 0.95, 95% CI: 0.92-0.98). Conclusion: Residents with longer lengths of stay, more dependent in ADLs and most frail had the most complex medication regimens and, therefore, may benefit from targeted strategies to reduce medication regimen complexity.


Asunto(s)
Demencia , Fragilidad , Preparaciones Farmacéuticas , Actividades Cotidianas , Factores de Edad , Anciano de 80 o más Años , Instituciones de Vida Asistida , Comorbilidad , Estudios Transversales , Demencia/complicaciones , Femenino , Fragilidad/complicaciones , Humanos , Tiempo de Internación , Cuidados a Largo Plazo , Masculino , Sistemas de Medicación , Preparaciones Farmacéuticas/administración & dosificación , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Australia del Sur
20.
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
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