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1.
Artigo em Inglês | MEDLINE | ID: mdl-33780527

RESUMO

Frailty has been related to inflammaging and certain immune parameters. In previous analyses of participants >80 years of age in the longitudinal BELFRAIL cohort study the main focus was on T-cell phenotypes and the association with CMV-serostatus and survival, finding that a CD4:CD8 ratio >5 was associated with frailty, impaired activities of daily living (ADL), and mortality (but only in women). Here, we phenotyped peripheral blood immune cells via multicolor flow cytometry and correlated these with the dynamics of changes in ADL, geriatric depression score, mini-mental state examination, and short physical performance battery from baseline values over 18 months´ follow-up. We found that higher frequencies of B-cells and late-differentiated CD8+ T-cells at 18 months from baseline were associated with ADL impairment that had worsened over the preceding 18 months. There were no significant associations with monocyte, dendritic cell or NK-cell phenotypes. No associations with the Geriatric Depression Scale GDS, the mini-mental state examination, MMSE or the short physical performance battery SPPB were found. Thus, while these results do not establish causality, they suggest that certain adaptive immune, but not innate immune, parameters are associated with a worsened ADL in the very old.

2.
Chron Respir Dis ; 17: 1479973120928103, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32666810

RESUMO

Sleep-disordered breathing (SDB) is a chronic condition characterized by repeated breathing pauses during sleep. The reported prevalence of SDB in the general population has increased over time. Furthermore, in the literature, a distinction is made between SDB, obstructive sleep apnea (OSA), and "OSA syndrome" (OSAS). Patients with SDB are at increased risk of comorbid cardiovascular diseases (CVDs). The aim of the ARKHsleep study was to assess the prevalence of SDB in general and of OSA and OSAS in particular. A total of 1050 participants aged 30-70 years, who were randomly selected from a population register, were evaluated for the probability of SDB using the Epworth Sleepiness Scale score and body mass index. Sleep was recorded for one night via home sleep apnea testing (Somnolter®). Medical conditions were determined from medical records. Additional data included background characteristics, anthropometric variables, blood pressure, and scores from four questionnaires. The survey sample consisted of 41.2% males and had a mean age of 53.1 ± 11.3 years. The prevalence of mild-to-severe, moderate-to-severe, and severe SDB was 48.9% [45.8-51.9], 18.1% [15.9-20.6], and 4.5% [3.2-5.8], respectively. Individuals reporting snoring or breathing pauses had a higher severity of SDB than individuals free of symptoms. The ARKHsleep study revealed a high burden of both SDB and CVD; however, more large-scale cohort studies and intervention studies are needed to better understand whether the early recognition and treatment of mild SDB with or without symptoms will improve cardiovascular prognosis and/or quality of life.

3.
J Palliat Med ; 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32679002

RESUMO

Objective: To assess the face and content validity, acceptability and feasibility of a French version of the Children's Palliative Outcome Scale (CPOS). Background: Instruments in French used to measure outcomes in pediatric palliative care are lacking. Methods: After forward-backward translation of the 12-item English CPOS to French, we conducted a qualitative pilot study. During semi structured interviews among children and parents, we used the CPOS, the Schedule for the Evaluation of Individual Quality of Life interview guide (SEIQoL) and the Quality of Life in Life-threatening Illness-Family Carer questionnaire (QOLLTI-F), in addition to three expert meetings with PLTs. Results: Fourteen children and adolescents (8-18 years) with life-limiting or life-threatening conditions cared for at home, in hospital or in respite care services, 19 parents, and 9 members of 4 pediatric liaison teams (PLTs) providing palliative care in a Belgian francophone region were included in the study. No families refused to participate. All children with verbal capacities chose to be interviewed in the presence of their parents and a PLT member. The children valued being given the opportunity to share their experiences. New QOL dimensions pertaining to social, emotional, and administrative health-care related issues were added to the original version of the 12-item CPOS, leading to a 22-item CPOS-2. Discussion: The CPOS-2 was perceived as relevant and easy to use by the principal stakeholders. Our study paves the way for a large-scale field study assessing its psychometric characteristics and its implementation in routine clinical care.

4.
Arch Gerontol Geriatr ; 90: 104180, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32688205

RESUMO

BACKGROUND: The relationship of total cholesterol (TC) levels with mortality among older adults without statin therapy has not been fully studied. AIMS: To examine the relationship between TC and all-cause mortality in adults aged 65 years and older in Russia without statin therapy. METHODS: This was a population-based prospective cohort study of community-dwelling people aged 65 years and older in Russia. Data from 379 individuals on cardiovascular risk factors; comorbidities; cognitive, physical and autonomous function; lipid panel; B-type natriuretic peptide; C-reactive protein; and others were collected through interviews, clinical examinations, and laboratory tests. The total follow-up time was 3 years. Cox proportional hazards models for all-cause mortality, C-statistics, internal validation and external validation using the Belgian population from the BELFRAIL study were performed. RESULTS: A U-shaped association between the TC level and all-cause mortality was identified. Older adults without statin therapy and with low/high TC levels were at higher risk for mortality even after adjustment for covariates, with a hazard ratio (HR) of 5.78 (1.96-17.03) for TC < 5.4 mmol/L and an HR of 6.24 (1.69-22.94) for TC levels > 7.2 mmol/L. The association between low TC and all-cause mortality was confirmed in an external population of adults 80 years and older. CONCLUSION: The TC level range associated with the lowest mortality was 5.4-7.2 mmol/L, irrespective of concomitant diseases or health status. The association between low TC levels and a high risk of all-cause mortality was confirmed in a Belgian cohort of adults 80 years and older.

5.
Acta Clin Belg ; : 1-8, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32134709

RESUMO

Objectives: To investigate the prevalence of malnutrition risk and its association with adverse outcomes in a Belgian cohort of community-dwelling adults aged ≥80 years, a worldwide growing age-group.Methods: In the BELFRAIL cohort, malnutrition risk was evaluated with the Mini Nutritional Assessment (MNA total score <24) and prealbumin levels (<20 mg/dl). Agreement between them was assessed with Kohen's kappa coefficient. Association with first unplanned hospitalization (3.0 ± 0.25 years follow-up) and mortality (5.1 ± 0.25 years follow-up) was investigated with survival analysis and Cox multivariate regression.Results: Out of 567 BELFRAIL participants, 556 (98.1%) had MNA and 545 (96.1%) prealbumin levels. Sixty-eight (12.2%) were at risk of malnutrition based on MNA and 69 (12.7%) based on prealbumin, with very poor agreement between them (Kappa = 0.024, 95% CI -0.064, 0.112). For both MNA and prealbumin, participants with malnutrition risk had lower physical and cognitive performance tests' scores. They had no higher risk for first hospitalization compared to those without malnutrition risk, but higher risk for all-cause mortality even after adjustment for multimorbidity, inflammation, physical and mental functioning (HR 1.35 95%CI 0.92-1.97 for MNA; HR 1.46; 95%CI 1.01-2.12 for prealbumin).Conclusion: Malnutrition risk based on MNA or prealbumin was low in a Belgian cohort of community-dwelling adults aged ≥80 years. Physical and cognitive performance was lower in those with malnutrition risk, but malnutrition risk was not independently associated with hospitalization and mortality (except for malnutrition risk by prealbumin). Further research needs to investigate the best tool to assess malnutrition risk in this age group.

7.
J Am Med Dir Assoc ; 21(3): 440.e1-440.e8, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31678074

RESUMO

OBJECTIVES: To compare the predictive performance of 3 frailty identification tools for mortality, hospitalization, and functional decline in adults aged ≥80 years using risk reclassification statistics and decision curve analysis. DESIGN: Population-based, prospective cohort. SETTING: BELFRAIL study, Belgium. PARTICIPANTS: 560 community-dwelling adults aged ≥80 years. MEASUREMENTS: Frailty by Cardiovascular Health Study (CHS) phenotype, Longitudinal Aging Study Amsterdam (LASA) markers, and Groeningen Frailty Indicator (GFI); mortality until 5.1 ± 0.25 years from baseline and hospitalization until 3.0 ± 0.25 years; and functional status assessed by activities of daily living at baseline and after 1.7 ± 0.21 years. RESULTS: Frailty prevalence was 7.3% by CHS phenotype, 21.6% by LASA markers, and 22% by GFI. Participants determined to be frail by each tool had a significantly higher risk for all-cause mortality and first hospitalization. For functional decline, only frail by GFI had a higher adjusted odds ratio. Harrell 's C-statistic for mortality and hospitalization and area under receiver operating characteristic curve for functional decline were similar for all tools and <0.70. Reclassification statistics showed improvement only by LASA markers for hospitalization and mortality. In decision curve analysis, all tools had higher net benefit than the 2 default strategies of "treat all" and "treat none" for mortality risk ≥20%, hospitalization risk ≥35%, and functional decline probability ≥10%, but their curves overlapped across all relevant risk thresholds for these outcomes. CONCLUSIONS AND IMPLICATIONS: In a cohort of adults aged ≥80 years, 3 frailty tools based on different conceptualizations and assessment sources had comparable but unsatisfactory discrimination for predicting mortality, hospitalization, and functional decline. All showed clinical utility for predicting these outcomes over relevant risk thresholds, but none was significantly superior. Future research on frailty tools should include a focus on the specific group of adults aged ≥80 years, and the predictive accuracy for adverse outcomes of different tools needs a comprehensive assessment that includes decision curve analysis.

8.
Pediatrics ; 143(1)2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30530504

RESUMO

CONTEXT: Pediatric palliative care (PPC) is intended to promote children's quality of life by using a family-centered approach. However, the measurement of this multidimensional outcome remains challenging. OBJECTIVE: To review the instruments used to assess the impact of PPC interventions. DATA SOURCES: Five databases (Embase, Scopus, The Cochrane Library, PsychInfo, Medline) were searched. STUDY SELECTION: Inclusion criteria were as follows: definition of PPC used; patients aged 0 to 18 years; diseases listed in the directory of life-limiting diseases; results based on empirical data; and combined descriptions of a PPC intervention, its outcomes, and a measurement instrument. DATA EXTRACTION: Full-text articles were assessed and data were extracted by 2 independent researchers, and each discrepancy was resolved through consensus. The quality of the studies was assessed by using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers From a Variety of Fields checklist. RESULTS: Nineteen of 2150 articles met the eligibility criteria. Researchers in 15 used quantitative methods, and 9 were of moderate quality. Multidimensional outcomes included health-related quality of life, spiritual well-being, satisfaction with care and/or communication, perceived social support, and family involvement in treatment or place-of-care preferences. PPC interventions ranged from home-based to hospital and respite care. Only 15 instruments (of 23 reported) revealed some psychometric properties, and only 5 included patient-reported (child) outcome measures. LIMITATIONS: We had no access to the developmental process of the instruments used to present the underlying concepts that were underpinning the constructs. CONCLUSIONS: Data on the psychometric properties of instruments used to assess the impact of PPC interventions were scarce. Children are not systematically involved in reporting outcomes.


Assuntos
Consenso , Assistência à Saúde/normas , Avaliação de Resultados em Cuidados de Saúde/métodos , Cuidados Paliativos/normas , Criança , Humanos , Qualidade de Vida
9.
BMC Geriatr ; 18(1): 291, 2018 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-30477431

RESUMO

BACKGROUND: Among older couples, spouses are first in line to provide care, and they are key elements in the home support of dependent older persons. In this context, ensuring the health of these older spousal caregivers should be an important issue for all of the providers who care for older adults. The aim of this study was to longitudinally assess the health of older spousal caregivers considering frailty, nutrition, cognition, physical performance and mood disorders. METHODS: In this longitudinal, observational cohort study, participants were assessed at home in Wallonia, Belgium. At baseline, 82 community-dwelling spouses of older patients with cognitive deficits or functional impairment were assessed; 78 caregivers were assessed at follow-up (16 months). The clinical instruments used included Frailty Phenotype (Fried), the Mini Nutritional Assessment-short form (MNA-SF), Short Physical Performance Battery (SPPB), Geriatric Depression Scale (GDS-15), clock drawing test, medications, Zarit Burden Index (ZBI), and Caregiver Reaction Assessment (CRA). Biological assessments included plasma interleukin-6 (IL-6), ultrasensitive C-reactive protein (CRP), cortisol, albumin and insulin growth factor-1 (IGF-1). RESULTS: Among caregivers, 54% were women, and the mean age was 80 years. Among care-receivers, 83% had cognitive impairment. Caregivers were more likely to be in a pre-frail stage. In one-third of the caregivers, the frailty status worsened. Transitions were observed between each of the states, except from frail to robust. In contrast to frailty, items including nutrition, cognitive status, SPPB and mood assessments were stable over time, with approximately 70% of the caregivers not experiencing significant change at follow-up. Caregiver experiences assessed with the Zarit Burden Interview and CRA were relatively stable over 16 months. CONCLUSION: Many caregivers of geriatric patients are spouses who are old themselves. A failure in the health of the caregiver may anticipate an undesired care breakdown. Caregiver health and its determinants should be explored in future longitudinal studies that cover a longer time period.


Assuntos
Cuidadores/psicologia , Disfunção Cognitiva/psicologia , Idoso Fragilizado/psicologia , Nível de Saúde , Cônjuges/psicologia , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Cuidadores/tendências , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Avaliação Nutricional , Estado Nutricional/fisiologia
10.
Melanoma Res ; 28(6): 611-617, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30192302

RESUMO

About half of the melanomas are detected by patients but the mean thickness of such melanomas is higher than when diagnosed by physicians. Symptoms and signs described by patients are dynamic changes and pruritus, the appearance of a new lesion having been rarely investigated. These observations are documented for melanomas but not for benign naevi. To the best of our knowledge, this is the first study in which both melanomas and suspected excised naevi were included. The main objectives were to (a) analyse the value of the anamnestic predictors for melanoma versus non-melanoma and (b) calculate the influence of age on the most significant anamnestic predictors. In order to reach these objectives, we prospectively collected data on symptoms (pruritus, anxiety) and signs (de novo appearance, dynamic changes and bleeding) described by patients undergoing the excision of lesions clinically diagnosed as melanocytic and considered as suspicious by 46 Belgian dermatologists. Among 1865 lesions, dynamic changes and de novo appearance were significant predictors for melanoma versus non-melanoma diagnosis in all patients and patients older than 50, respectively. More precisely, dynamic changes and de novo appearance occurred to be strong predictors for melanoma diagnosis in patients greater than 41.5 and greater than 44.5 years, respectively. Pruritus was not significant for melanoma diagnosis. As a conclusion, when mid-age or older patients observe melanocytic lesions as recently changed or newly appeared, such lesions should be considered more carefully than when observed by young patients.


Assuntos
Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia , Adulto Jovem
11.
J Am Med Dir Assoc ; 19(10): 884-890, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30056012

RESUMO

BACKGROUND/OBJECTIVES: Our aim was to describe the prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) in Belgian nursing homes and to identify characteristics of residents, general practitioners (GPs), and nursing homes (NHs) that are associated with the number of PIMs and PPOs. DESIGN: A cross-sectional study. SETTING: and Participants: Nursing home residents (NHRs), aged ≥65 years, not in palliative care were included in 54 Belgian NHs participating in the COME-ON study. MEASURES: Instances of PIMs were detected using a combination of the STOPP v2 and AGS 2015 Beers criteria. Instances of PPOs were detected using START v2. To assess factors associated with the number of PIMs and PPOs, a multivariate binomial negative regression analysis was performed. RESULTS: A total of 1410 residents, with a median age of 87 years, was included. The median number of medications taken was 9. PIMs were detected in 88.3% of NHRs and PPOs in 85.0%. Use of benzodiazepines (46.7%) and omission of vitamin D (51.5%) were the most common PIM and PPO, respectively. The factor most strongly associated with increased PIMs was the use of 5 to 9 drugs or ≥10 drugs [relative risk (RR) (95% confidence interval [CI]: 2.27 (1.89, 2.76) and 4.04 (3.37, 4.89), respectively]. The resident's age was associated with both decreased PIMs and increased PPOs. PIMs and PPOs were also associated with some NH characteristics, but not with GP characteristics. CONCLUSION: Implications: The high prevalence of PIMs and PPOs remains a major challenge for the NH setting. Future interventions should target in priority residents taking at least 10 medications and/or those taking psychotropic drugs. Future studies should explore factors related to organizational and prescribing culture. Moreover, special attention must be paid to the criteria used to measure inappropriate prescribing, including criteria relative to underuse.


Assuntos
Prescrição Inadequada/estatística & dados numéricos , Casas de Saúde , Acidentes por Quedas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Transtornos Cognitivos/epidemiologia , Comorbidade , Estudos Transversais , Demência/epidemiologia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Polimedicação , Prevalência
12.
BMC Palliat Care ; 17(1): 77, 2018 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-29788956

RESUMO

BACKGROUND: Although continuity of care in paediatric palliative care (PPC) is considered to be an essential element of quality of care, it's implementation is challenging. In Belgium, five paediatric liaison teams (PLTs) deliver palliative care. A Royal Decree issued in 2010 provides the legal framework that defines the PLTs' missions, as ensuring continuity of curative and palliative care between the hospital and home for children diagnosed with life-limiting conditions. This national study describes how PLTs ensure continuity of care by describing their activities and the characteristics of the children they cared for from 2010 to 2014. METHODS: Thematic analysis of open-ended questions was performed and descriptive statistics of aggregated data issued from annual reports, collected by the Belgian Ministry of Public Health through the Cancer Plan was used. A review panel of PLT members discussed the results and contributed to their interpretation. RESULTS: Between 2010 and 2014, 3607 children and young adults (0-21 years) were cared for by the 5 Belgian PLTs (mean of 721/per year). Of these children, 50% were diagnosed with an oncological disease, 27% with a neurological or metabolic disease. Four hundred and twenty eight (428) children had died. For 51% of them, death took place at home. PLT activities include coordination; communication; curative and palliative care; education; research and fundraising. Different perceptions of what constitutes a palliative stage, heterogeneity in reporting diagnosis and the current lack of specific valid indicators to report PPC activities were found. CONCLUSION: PLTs are offering highly individualised, flexible and integrated care from diagnosis to bereavement in all care settings. Improvements in data registration and implementation of outcome measures are foreseen.


Assuntos
Relações Interprofissionais , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Pediatria/métodos , Adolescente , Adulto , Bélgica , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Equipe de Assistência ao Paciente , Pesquisa Qualitativa , Adulto Jovem
13.
Clin Epidemiol ; 10: 363-379, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29670402

RESUMO

Background: Previous findings suggest that apathy symptoms independently of depressive symptoms measured using the Geriatric Depression Scale (GDS) are associated with cardiovascular disease (CVD) in older individuals. Aims: To study whether apathy and depressive symptoms in older people are associated with future CVD, stroke, and mortality using individual patient-data meta-analysis. Methods: Medline, Embase, and PsycInfo databases up to September 3, 2013, were systematically searched without language restrictions. We sought prospective studies with older (mean age ≥65 years) community-dwelling populations in which the GDS was employed and subsequent stroke and/or CVD were recorded to provide individual participant data. Apathy symptoms were defined as the three apathy-related subitems of the GDS, with depressive symptoms the remaining items. We used myocardial infarction (MI), stroke, and all-cause mortality as main outcomes. Analyses were adjusted for age, sex, and MI/stroke history. An adaptation of the Newcastle-Ottawa scale was used to evaluate bias. Hazard ratios were calculated using one-stage random-effect Cox regression models. Results: Of the 52 eligible studies, 21 (40.4%) were included, comprising 47,625 older people (mean age [standard deviation] 74 [7.4] years), over a median follow-up of 8.8 years. Participants with apathy symptoms had a 21% higher risk of MI (95% confidence interval [CI] 1.08-1.36), a 37% higher risk of stroke (95% CI 1.18-1.59), and a 47% higher risk of all-cause mortality (95% CI 1.38-1.56). Participants with depressive symptoms had a comparably higher risk of stroke (HR 1.36, 95% CI 1.18-1.56) and all-cause mortality (HR 1.44, 95% CI 1.35-1.53), but not of MI (HR 1.08, 95% CI 0.91-1.29). Associations for isolated apathy and isolated depressive symptoms were comparable. Sensitivity analyses according to risk of bias yielded similar results. Conclusion: Our findings stress the clinical importance of recognizing apathy independently of depressive symptoms, and could help physicians identify persons at increased risk of vascular disease.

14.
Artigo em Inglês | MEDLINE | ID: mdl-29693637

RESUMO

Evidence suggests that nutritional status during fetal development and early life leaves an imprint on the genome, which leads to health outcomes not only on a person as an adult but also on his offspring. The purpose of this study is to bring forth an overview of the relevant parameters that need to be collected to assess the long-term and transgenerational health outcomes of famine. A literature search was conducted for the most pertinent articles on the epigenetic effects of famine. The results were compiled, synthesized and discussed with an expert in genetics for critical input and validation. Prenatal and early life exposure to famine was associated with metabolic, cardiovascular, respiratory, reproductive, neuropsychiatric and oncologic diseases. We propose a set of parameters to be collected in disaster settings to assess the long-term outcomes of famine: PALTEM (parameters to assess long-term effects of malnutrition).


Assuntos
Desastres , Epigenômica/organização & administração , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Inanição/complicações , Inanição/fisiopatologia , Adulto , Feminino , Desenvolvimento Fetal/fisiologia , Nível de Saúde , Humanos , Masculino , Estado Nutricional , Gravidez
15.
Aging Clin Exp Res ; 30(5): 507-516, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28653254

RESUMO

BACKGROUND: Forced expiratory volume in 1 s over height cubed (FEV1/Ht3) is an FEV1 expression that uses no reference values and is independently associated with adverse outcomes in older adults. No studies have reported on the prognostic value of its decline over time in adults aged 80 and over. AIM: To investigate the prognostic value of FEV1/Ht3 decline for adverse outcomes in a cohort of adults aged 80 and over. METHODS: 328 community-dwelling adults aged 80 and over of the BELFRAIL prospective cohort had two valid FEV1 measurements as part of their comprehensive geriatric assessment at baseline and follow-up (after 1.7 ± 0.21 years). Kaplan-Meier survival curves, Cox and logistic multivariable regression, assessed association of excessive decline of FEV1/Ht3 (lowest quintile of percentage change) with all-cause mortality (3 years after follow-up assessment), time to first hospitalization (1 year), and new/ worsened disability in activities of daily living (ADL) at the follow-up assessment. RESULTS: Participants with excessive FEV1/Ht3 decline had increased adjusted hazard ratio for all-cause death 1.61 (95% CI 1.01-2.55) and first hospitalization 1.71 (1.08-2.71) and increased odds ratio for new/worsened ADL disability at follow-up 2.02 (1.10-3.68) compared to the rest of the study population. CONCLUSIONS: Excessive, short-term decline in FEV1/Ht3 was independently associated with all-cause mortality, time to first, unplanned hospitalization, and ADL disability in a cohort of adults aged 80 and over. This FEV1 expression should be further investigated in studies of longitudinal FEV1 change in older adults.


Assuntos
Atividades Cotidianas , Envelhecimento/fisiologia , Volume Expiratório Forçado/fisiologia , Avaliação Geriátrica , Idoso de 80 Anos ou mais , Estatura , Feminino , Humanos , Vida Independente , Estimativa de Kaplan-Meier , Masculino , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Espirometria/métodos
16.
Aging Clin Exp Res ; 30(2): 119-132, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28474314

RESUMO

INTRODUCTION: Evidence suggests that providing care for an older loved one may present a risk to the health of the caregiver. To understand the link between the psychosocial stress of caregiving and damage to the health of caregivers, numerous studies have assessed the presence of inflammatory biomarkers among caregivers. These biomarkers are measured to understand the relationships between the social stress of caregiving and the health of caregivers. OBJECTIVE: To provide a complete summary of the current literature regarding the most clinically relevant pro-inflammatory biomarkers associated with caregiving. METHODS: We searched articles in MEDLINE and EMBASE from January 1980 to 30 April 2016 for all studies that assessed biomarkers (cortisol, interleukin-6 and c-reactive protein) among caregivers of community-dwelling older persons. The quality of the selected studies was assessed by two reviewers using the STROBE or CONSORT checklist. RESULTS: Twenty-four studies were included. Most of the studies were cross-sectional and focused on dementia caregiving. Increases in biomarkers were associated with problems such as disturbed sleep, burden or pain and caregiving characteristics, including daily stressors and the duration of caregiving. Cognitive-behavioural therapy and participation in leisure activities were associated with significantly lower levels of cortisol and IL-6, respectively. DISCUSSION: We found little evidence concerning the association between caregiving status and biomarkers of stress and inflammation. We discuss potential sources of bias and suggest some directions for further research. This stress model can be expanded by taking into account the positive aspects of caregiving and the potential resources of caregivers.


Assuntos
Cuidadores/psicologia , Demência/enfermagem , Estresse Psicológico/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos Transversais , Demência/psicologia , Feminino , Humanos , Hidrocortisona/sangue , Interleucina-6/sangue , Masculino
17.
Arch Gerontol Geriatr ; 75: 76-82, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29197259

RESUMO

OBJECTIVES: Caregiving is often associated with burden and chronic stress. Sense of coherence (SOC) may help the caregivers in coping with their stress and was identified as a positive factor for health outcomes and quality of life. We aimed to study the links between SOC, burden, depression and positive affects among caregivers of frail older patients. METHODS: Seventy-nine spousal caregivers were recruited via the geriatric outpatient clinic. DATA COLLECTED: Zarit Burden Inventory, SOC-13, Geriatric Depression Scale, Caregiver Reaction Assessment (CRA), sleep, time of supervision, Katz Index, Global Deterioration Scale and Neuropsychiatric Inventory. ANALYSES: Caregiver's characteristics were analyzed by burden severity and SOC level. Multivariable logistic regressions were used in order to identify the variable that best predict caregiver burden and high SOC. RESULTS: The mean age was 79.4±5.3; 53% were women. Among care-recipient, 82% had cognitive impairment and the median Katz Index was 3. Caregivers with a high SOC and an older age reported a lower burden (Odds Ratio (OR) 0.18, 95% confidence interval (CI) 0.04-0.65 and OR 0.87, 95% CI 0.76-0.98, respectively). A higher burden was associated with patient functional limitations (OR 8.69, 95% CI 2.28-40.46). DISCUSSION: Having a high sense of coherence seems to be a protective factor against the burden. To support caregivers, health providers should recognize the expertise of the caregivers and the meaningfulness of this care situation.


Assuntos
Adaptação Psicológica , Cuidadores/psicologia , Depressão/psicologia , Senso de Coerência , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Depressão/prevenção & controle , Feminino , Seguimentos , Humanos , Masculino , Razão de Chances , Qualidade de Vida , Estudos Retrospectivos
18.
NPJ Prim Care Respir Med ; 27(1): 62, 2017 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-29138407

RESUMO

A hallmark of the diagnosis of chronic obstructive pulmonary disease (COPD) is the measurement of post-bronchodilator (post-BD) airflow obstruction (AO) by spirometry, but spirometry is not enough for the provision of a clinical diagnosis. In the majority of previous epidemiological studies, COPD diagnosis has been based on spirometry and a few clinical characteristics. The aim of our study was to identify outcomes in patients newly diagnosed with airflow obstruction (AO) based on a diagnostic work-up conducted as part of a population-based cross-sectional study in North-Western Russia. Spirometry was performed before (pre-BD) and after BD administration, and AO was defined using the FEV1/FVC <0.70 and FEV1/FVC

Assuntos
Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria , Broncodilatadores/uso terapêutico , Estudos Transversais , Feminino , Seguimentos , Volume Expiratório Forçado/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Federação Russa/epidemiologia , Capacidade Vital/efeitos dos fármacos
19.
Age Ageing ; 46(6): 994-1000, 2017 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-28633384

RESUMO

Background: adults aged 80 and over, a fast growing age-group, with increased co-morbidity and frailty have not been the focus of previous research on dyspnoea. We investigate the correlates of dyspnoea and its association with adverse outcomes in a cohort of adults aged 80 and over. Methods: about 565 community-dwelling adults aged 80 and over of the BELFRAIL prospective cohort had assessment of Medical Research Council dyspnoea scale (MRC), forced expiratory volume in 1 s (FEV1), N-terminal pro-brain natriuretic peptide (NT-proBNP), physical performance tests, grip strength, 15 items geriatric depression scale, activities of daily living (ADL), body mass index (BMI) and demographics data. Kaplan-Meier survival curves, Cox and logistic multivariable regression, classification and regression tree (CART) analysis assessed association of dyspnoea (MRC 3-5) with time-to-cardiovascular and all-cause death (5 years), time to first hospitalisation (3 years), new/worsened ADL disability (2 years), and its correlates. Results: participants with dyspnoea MRC 3-5 (29.9%) had increased hazard ratios for cardiovascular mortality 2.85 (95% confidence interval 1.93-4.20), all-cause mortality 2.04 (1.58-2.64), first hospitalisation 1.72 (1.35-2.19); and increased odds ratio for new/worsened disability 2.49 (1.54-4.04), independent of age, sex and smoking status. Only FEV1, physical performance, BMI and NT-proBNP (in order of importance) were selected in the tree-based classification model for dyspnoea. Conclusions: in a cohort of adults aged 80 and over, dyspnoea was common and an independent predictor of adverse outcomes, with cardio-respiratory and physical performance impairments as key independent correlates. Its routine and comprehensive evaluation in primary care could be very valuable in caring for this age-group.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Dispneia/fisiopatologia , Pulmão/fisiopatologia , Fatores Etários , Idoso de 80 Anos ou mais , Envelhecimento , Bélgica/epidemiologia , Biomarcadores/sangue , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Avaliação da Deficiência , Progressão da Doença , Dispneia/diagnóstico , Dispneia/mortalidade , Dispneia/terapia , Feminino , Volume Expiratório Forçado , Avaliação Geriátrica , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Análise Multivariada , Peptídeo Natriurético Encefálico/sangue , Razão de Chances , Fragmentos de Peptídeos/sangue , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo
20.
Arch Gerontol Geriatr ; 71: 105-114, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28415034

RESUMO

BACKGROUND: Prediction models help to make decisions about further management in clinical practice. This study aims to develop a mortality risk score based on previously identified risk predictors and to perform internal and external validations. METHODS: In a population-based prospective cohort study of 611 community-dwelling individuals aged 65+ in St. Petersburg (Russia), all-cause mortality risks over 2.5 years follow-up were determined based on the results obtained from anthropometry, medical history, physical performance tests, spirometry and laboratory tests. C-statistic, risk reclassification analysis, integrated discrimination improvement analysis, decision curves analysis, internal validation and external validation were performed. RESULTS: Older adults were at higher risk for mortality [HR (95%CI)=4.54 (3.73-5.52)] when two or more of the following components were present: poor physical performance, low muscle mass, poor lung function, and anemia. If anemia was combined with high C-reactive protein (CRP) and high B-type natriuretic peptide (BNP) was added the HR (95%CI) was slightly higher (5.81 (4.73-7.14)) even after adjusting for age, sex and comorbidities. Our models were validated in an external population of adults 80+. The extended model had a better predictive capacity for cardiovascular mortality [HR (95%CI)=5.05 (2.23-11.44)] compared to the baseline model [HR (95%CI)=2.17 (1.18-4.00)] in the external population. CONCLUSION: We developed and validated a new risk prediction score that may be used to identify older adults at higher risk for mortality in Russia. Additional studies need to determine which targeted interventions improve the outcomes of these at-risk individuals.


Assuntos
Mortalidade , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/análise , Feminino , Humanos , Masculino , Peptídeo Natriurético Encefálico/sangue , Estudos Prospectivos , Risco , Federação Russa
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