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1.
Medicine (Baltimore) ; 100(26): e26492, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190176

RESUMO

ABSTRACT: Researchers have repeatedly examined the relationship between a previous experience of a fall and subsequent fear of falling (FOF); however, few studies have investigated the effects of falling along various timelines among older adults. The objective of this study was to determine whether experiencing a fall in the previous month or the previous year led to FOF among the elderly.The National Health and Aging Trends Study (NHATS) in the U.S. collected information indicative of basic trends in the behavior of individuals aged 65 years and older. In the current study, we applied multiple logistic regression analysis of results from round 7 of the NHATS with the aim of identifying the risk factors associated with FOF among 5559 participants aged 65 years or older.FOF was reported by 48.8% of those who experienced a fall in the previous year and 46.8% experienced a fall in the previous month. The results of regression analysis revealed that after adjusting for sex, age, related chronic disease, activities of daily living, and instrumental activities of daily living, FOF was significantly associated with experiencing a fall during the previous month (OR = 2.29, 95% CI: 1.78-2.95) or during the previous year (OR = 2.60, 95% CI: 2.16-3.14).Our results indicate that experiences of falling during the previous month or the previous year were both significantly associated with a fear of falling, and caregivers should keep this in mind when dealing with community-living elderly individuals.


Assuntos
Acidentes por Quedas/prevenção & controle , Atividades Cotidianas , Envelhecimento , Medo/psicologia , Vida Independente , Acidentes por Quedas/estatística & dados numéricos , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Envelhecimento/psicologia , Feminino , Estado Funcional , Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Vida Independente/psicologia , Vida Independente/normas , Acontecimentos que Mudam a Vida , Masculino , Pesquisa Qualitativa , Fatores de Risco , Taiwan/epidemiologia
2.
Rev. Hosp. Ital. B. Aires (2004) ; 41(2): 52-60, jun. 2021. graf, tab
Artigo em Espanhol | LILACS | ID: biblio-1254374

RESUMO

Introducción: el Índice de Movilidad de De Morton® (en inglés De Morton Mobility Index: DEMMI®) es una escala, válida y fiable para evaluar la movilidad funcional del adulto mayor. Objetivo: validar una versión en español para pacientes hospitalizados en una sala general. Material y métodos: traducción y adaptación transcultural, evaluación de la fiabilidad interobservador y validación de criterio explorando la correlación entre los índices DEMMI y Barthel® al ingreso hospitalario y también entre la percepción subjetiva del cambio en la movilidad por parte del propio paciente y la del puntaje DEMMI, y además evaluando la asociación entre este y el grado de acompañamiento requerido en el egreso hospitalario (n = 87). Su consistencia interna fue evaluada mediante los coeficientes de Kuder y Richardson (KR) y de Cronbach (n = 104). Resultados: la correlación entre los puntajes DEMMI y Barthel fue buena (Spearman's Rho = 0,78: p ≤ 0,0001), mientras que la correlación entre la percepción del paciente respecto del cambio en su movilidad y la variación en el puntaje DEMMI fue moderada (Spearman's Rho = 0,50; p < 0,0001). Quienes fueron dados de alta con alto nivel de acompañamiento habían tenido al ingreso un puntaje DEMMI inferior (28,1; IC 95%, 24,9 a 31,3) al de quienes no lo requirieron (48; 44,4 a 53,0). La consistencia interna fue adecuada (KR = 0,827 y Cronbach = 0,745; Pearson's Rho = 0,7885; p < 0,00001). Conclusión: la consistencia interna y la fiabilidad interobservador de la versión en español del puntaje DEMMI son buenas, mientras que sus cambios tienen buena correlación con los percibidos por los propios pacientes. Consideramos que puede ser usado como un elemento más para estimar al momento del ingreso hospitalario, el grado de acompañamiento que requerirán al ser dados de alta. (AU)


Introduction: the De Morton Mobility Index (DEMMI) is a valid and reliable scale to evaluate the functional mobility of the elderly. Aim: validate a Spanish version for hospitalized patients in a general ward. Material and methods: translation and cross-cultural adaptation, evaluation of inter-observer reliability and criterion validation exploring the correlation between DEMMI and Barthel scores at hospital admission and also between the subjective perception of the change in mobility by the patient himself and that of DEMMI score, and also, evaluating the association between DEMMI and the degree of support required at hospital discharge (n = 87). Its internal consistency was evaluated using Kuder-Richardson (KR) and Cronbach (n = 104) coefficients. Results: correlation between DEMMI and Barthel scores was good (Spearman's Rho = 0.78: p < = 0.0001), while correlation between patient's perception of change in mobility and variation in DEMMI score was moderate (Spearman's Rho = 0.50; p < 0.0001). Those discharged with a high level of support had a lower DEMMI score upon admission (28.1; 95% CI 24.9 to 31.3) than those who didn´t require it (48; 44.4 to 53.0). Internal consistency was adequate (KR = 0.827 and Cronbach = 0.745; Pearson's Rho = 0.7885; p < 0.00001). Conclusion: internal consistency and interobserver reliability of the Spanish version of DEMMI score are good, while its changes correlate well with those perceived by the patients themselves. We consider that it can be used as another element to estimate at hospital admission, the degree of support they will require upon discharge. (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Avaliação Geriátrica/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Alta do Paciente , Tradução , Atividades Cotidianas , Idoso Fragilizado , Limitação da Mobilidade , Hospitalização
3.
Clin Interv Aging ; 16: 721-729, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33953550

RESUMO

Background: The 30-day mortality rate after hip fracture surgery has been considered as an indirect indicator of the quality of care. This work aims to appraise the Barthel Index, Katz Index, Lawton-Brody Index, and Physical Red Cross Scale registered in the Comprehensive Geriatric Assessment at admission on the of 30-day death probability after hip fracture surgery. Methods: Prospective study including 899 hip fracture patients over 65. Bed-ridden, non-surgically treated patients, and high energy trauma or tumoral etiology fractures were excluded. Variables distribution were assessed by χ2, U-Mann Whitney and we performed binary logistic regression and equal tailed Jeffreys 95% CI for risk assessment. P<0.05 was considered statistically significant. Results: We noted a 30-day mortality rate of 5.9%. We related Barthel Index (OR=0.986 [0.975-0.996], p=0.010), Katz Index (OR=1.254 [1.089-1.444], p=0.002), Lawton-Brody Index (OR=0.885 [0.788-0.992], p=0.037), and Physical Red Cross Scale (OR=1.483 [1.094-2.011], p=0.011) with the 30-day mortality of patients after hip fracture surgery. We also validated the Barthel Index inflection point (0-55) (ORBI(0-55)=2.428 [1.379-4.275], p=0.002) and Katz Index inflection point (A-B) (ORKI(A-B)=0.493 [0.273-0.891], p=0.019) for the assessment of the highest risked patients. Conclusion: The geriatric functional status scores would be useful multifunctional and standalone tools in the assessment of hip fracture patients as singly predictors of 30-day mortality.


Assuntos
Estado Funcional , Avaliação Geriátrica/métodos , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Modelos Logísticos , Masculino , Estudos Prospectivos , Medição de Risco
4.
Nutrients ; 13(4)2021 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-33801694

RESUMO

Identifying factors that affect mortality requires a robust statistical approach. This study's objective is to assess an optimal set of variables that are independently associated with the mortality risk of 433 older comorbid adults that have been discharged from the geriatric ward. We used both the stepwise backward variable selection and the iterative Bayesian model averaging (BMA) approaches to the Cox proportional hazards models. Potential predictors of the mortality rate were based on a broad range of clinical data; functional and laboratory tests, including geriatric nutritional risk index (GNRI); lymphocyte count; vitamin D, and the age-weighted Charlson comorbidity index. The results of the multivariable analysis identified seven explanatory variables that are independently associated with the length of survival. The mortality rate was higher in males than in females; it increased with the comorbidity level and C-reactive proteins plasma level but was negatively affected by a person's mobility, GNRI and lymphocyte count, as well as the vitamin D plasma level.


Assuntos
Avaliação Geriátrica/métodos , Mortalidade , Avaliação Nutricional , Estado Nutricional , Idoso , Idoso de 80 Anos ou mais , Teorema de Bayes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores Sociais
5.
Clin Interv Aging ; 16: 687-696, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33911857

RESUMO

Background: Hemoglobin concentration differs by sex, possibly affecting any association between hemoglobin and frailty. This study aimed to evaluate the potential interaction effect of hemoglobin and sex on frailty in Chinese older inpatients. Methods: A cross-sectional study was conducted between February 2015 and November 2017 in a tertiary hospital. Frailty was defined by the Fried phenotype. Hemoglobin concentration was measured with a standard procedure. Covariates included demographics, clinical characteristics, and serum biomarkers. Logistic regression was applied to examine the association between hemoglobin concentration and frailty. The relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were used to evaluate the additive interaction. Results: A total of 619 older inpatients [mean age 69.26±7.44 years; 334 men, 285 women] were included. The mean hemoglobin concentration was significantly lower in the elderly who were frail (11.9 g/L in frail versus 13.1g/L in non-frail; p<0.001). In the multivariable regression models, lower hemoglobin in patients was significantly associated with frailty (adjusted odds ratio (OR) = 2.51, 95% CI:1.37, 4.60). The stratified analyses indicated that lower hemoglobin was associated with frailty among older inpatients with different characteristics. Female inpatients with lower hemoglobin had the highest risk of frailty (adjusted OR=6.43, 95%: 2.38, 17.3); there were interactions between hemoglobin and sex on the development of frailty (RERI=4.30, 95% CI=-1.41, 10.01; AP=0.67, 95% CI=0.37, 0.97;SI=4.80, 95% CI=1.22, 18.84). Conclusions and Implications: Our study provided evidence that sex and lower hemoglobin have an interaction effect on frailty; it is suggested that clinicians may consider sex-specific strategies for the elderly to conform the concept of precision medicine.


Assuntos
Idoso Fragilizado , Hemoglobinas/fisiologia , Pacientes Internados , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , China , Estudos Transversais , Feminino , Avaliação Geriátrica/métodos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
6.
Nutrients ; 13(5)2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33925037

RESUMO

Health and longevity in humans are influenced by numerous factors, including lifestyle and nutrition. However, the direct relationship between lifetime eating habits and functional capacity of the elderly is poorly understood. This study investigated the dietary changes across nutrition transition (NT) in the early 1960s, in a population located in the Sardinia island known for its longevity, dubbed as "Longevity Blue Zone" (LBZ), as well as the relationship between the dietary patterns and a panel of health indicators. A total of 150 oldest-old participants (89 women and 61 men, age range 90-101 years) living in the LBZ were recruited. Participants were interviewed using validated questionnaires to assess the consumption frequency of common food items, as well as the correlation with self-rated health, comorbidity, affective and cognitive level, physical mobility, disability and anthropometric parameters. Differences between subgroups were evaluated using the Mann-Whitney U test for independent samples or the Wilcoxon signed-rank test for paired samples. Correlation analysis was performed by calculating the Spearman correlation coefficient, separately in males and females. Compared to the pre-NT epoch, the consumption of meat, olive oil and fresh fruit slightly increased, while the consumption of lard, legumes and vegetables decreased. A significant association was found between increased olive oil intake across NT and self-rated health (ρ = 0.519), mobility (ρ = 0.502), improved vision (ρ = -0.227) and hearing (ρ = -0.314); increased chicken meat intake and performance in activities of daily living (basic activities of daily living: ρ = 0.351; instrumental activities of daily living: ρ = 0.333). Instead, vegetable consumption showed low correlation with health indicators. A mild increase in meat intake, mostly pastured poultry, is associated with better physical performance in the Sardinian LBZ elders, suggesting that a supply of protein may have been crucial to maintaining adequate functional capacity.


Assuntos
Dieta/métodos , Nível de Saúde , Atividades Cotidianas , Afeto , Idoso de 80 Anos ou mais , Cognição , Pessoas com Deficiência , Feminino , Frutas , Avaliação Geriátrica/métodos , Humanos , Itália , Longevidade , Masculino , Carne , Estado Nutricional , Azeite de Oliva/administração & dosagem , Fatores Sexuais
7.
Clin Interv Aging ; 16: 611-619, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33883888

RESUMO

Purpose: Many studies have demonstrated that Sarcopenia causes a serious impact on health, including death in older adults. The objective of this study was to determine the association of sarcopenia and pre-sarcopenia with all-cause mortality in older Chileans. Subjects and Methods: Follow-up of 2311 community-dwelling people ≥ 60y from the Alexandros cohort. Anthropometric measurements, handgrip strength, mobility, and physical performance tests were performed. Sarcopenia, pre-sarcopenia, and severe sarcopenia were defined using the 2010 European Working Group on Sarcopenia in Older People (EWGSOP1) algorithm. Muscle mass was estimated using a prediction model with cut-off points validated for the Chilean population. Physical performance was determined by 3 m walking speed or five chair-stands or time up go test (TUG). Mortality data were obtained from death certificates of the National Civil Registry. Life tables for survival data, Kaplan Meier estimations, and Cox regression were calculated. Results: The prevalence of sarcopenia was 20.2% (95% CI:18.6% to 21.9%) and similar in both sexes; pre-sarcopenia was identified in 20.4% (95% CI:18.8% to 22.1%) of the sample. Kaplan Meier survival estimates demonstrated lower survival rates for the people with sarcopenia and pre-sarcopenia (Log rank test for equality of survivor functions: p<0.0001). A dose-response was observed in the survival rates according to the stages of sarcopenia, showing the lowest survival rates for the people with severe sarcopenia, followed by older adults with sarcopenia, pre-sarcopenia, and without sarcopenia (Log rank test for equality of survivor functions: p<0.0001). After adjusting for age, sex, nutritional status, and number of chronic diseases, hazard ratios for death showed higher risk for subjects with sarcopenia (HR=1.47, 95% CI:1.17-1.83) and pre-sarcopenia (HR=1.35, 95% CI:1.03-1.78) in comparison with people without sarcopenia. Conclusion: The results confirm a dose-response increase in the risk of all-cause death in older adults with sarcopenia and pre-sarcopenia compared to non-sarcopenic individuals.


Assuntos
Causas de Morte , Mortalidade/tendências , Sarcopenia/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Chile/epidemiologia , Estudos de Coortes , Feminino , Avaliação Geriátrica/métodos , Força da Mão , Humanos , Vida Independente , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Desempenho Físico Funcional , Prevalência , Modelos de Riscos Proporcionais
8.
Clin Interv Aging ; 16: 537-547, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33790548

RESUMO

Background: Frailty is a major challenge for healthcare systems in ageing societies. This dynamic state of health is a reflection of reduced reserve in various organ systems and enhanced vulnerability to stressors. Research in this area of geriatrics and gerontology is limited in low- and middle-income countries (LMICs) like India. This study is directed at development of a culturally appropriate and validated assessment scale for frailty among older Indians. Methods: After extensive review of the literature on existing scales, a preliminary draft scale was formed. This draft was pre- and pilot-tested to check feasibility and modified accordingly. The final scale was validated on 107 older adults by confirmatory factor analysis and was named the Frailty Assessment and Screening Tool (FAST). The Fried's frailty phenotype was also administered on the same 107 older adults and scores of both were co-related. Suitable cut-off scores were found for frail and pre-frail older adults. Results: The final version of the FAST consisted of 14 questions pertaining to 10 domains. It has good reliability. Cronbach's alpha co-efficient was 0.99; test-retest reliability was 0.97 and validity by confirmatory factor analysis was adequate. The Kaiser-CMeyer-Olkin (KMO) of sampling adequacy was 0.699, and Bartlett's test of sphericity was significant (χ 2 = 353.471, p < 0.001). FAST scores had a cut-off of ≥ 7/14 for frail and ≥ 5/14 for pre-frail elderly. Conclusion: The FAST is a validated tool with good psychometric properties. It is expected that it will be helpful in screening pre-frail and frail older adults in India and other LMICs and guide in clinical decision making for intervention.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Programas de Rastreamento/normas , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Análise Fatorial , Feminino , Humanos , Índia , Masculino , Equilíbrio Postural/fisiologia , Psicometria , Reprodutibilidade dos Testes
9.
Bull Cancer ; 108(5): 513-520, 2021 May.
Artigo em Francês | MEDLINE | ID: mdl-33836861

RESUMO

The older population accounts for almost 60% of new cancers. Their management is a public health problem and is complex. It raises different questions: Is the patient's prognosis linked to cancer or another pathology? The heterogeneity of this population emphasises the importance of the overall condition assessment, in particular to avoid over-treatment (or under-treatment), and to be able to identify frail or vulnerable elderly patients who are at risk of having more treatment toxicities. Through this article, we will recall the importance of geriatric in-depth evaluation (EGA) by detailing the different factors that impact the therapeutic decision, tolerance to treatments… This EGA is however time-consuming and not all patients can be evaluated. In order to identify the subjects covered by this EGA, screening scales have been developed. Finally, we will develop the place of research in oncogeriatric management.


Assuntos
Avaliação Geriátrica/métodos , Neoplasias/diagnóstico , Acidentes por Quedas , Atividades Cotidianas , Idoso , Transtornos Cognitivos , Idoso Fragilizado , Humanos , Estado Nutricional , Desempenho Físico Funcional , Polimedicação , Prognóstico , Fatores Socioeconômicos
10.
Nutrients ; 13(5)2021 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-33923252

RESUMO

Sarcopenia, with risk factors such as poor nutrition and physical inactivity, is becoming prevalent among the older population. The aims of this study were (i) to systematically review the existing data on sarcopenia prevalence in the older Chinese population, (ii) to generate pooled estimates of the sex-specific prevalence among different populations, and (iii) to identify the factors associated with the heterogeneity in the estimates across studies. A search was conducted in seven databases for studies that reported the prevalence of sarcopenia in Chinese older adults, aged 60 years and over, published through April 2020. We then performed a meta-analysis to estimate the pooled prevalence, and investigated the factors associated with the variation in the prevalence across the studies using meta-regression. A total of 58 studies were included in this review. Compared with community-dwelling Chinese older adults (men: 12.9%, 95% CI: 10.7-15.1%; women: 11.2%, 95% CI: 8.9-13.4%), the pooled prevalence of sarcopenia in older adults from hospitals (men: 29.7%, 95% CI:18.4-41.1%; women: 23.0%, 95% CI:17.1-28.8%) and nursing homes (men: 26.3%, 95% CI: 19.1 to 33.4%; women: 33.7%, 95% CI: 27.2 to 40.1%) was higher. The multivariable meta-regression quantified the difference of the prevalence estimates in different populations, muscle mass assessments, and areas. This study yielded pooled estimates of sarcopenia prevalence in Chinese older adults not only from communities, but also from clinical settings and nursing homes. This study added knowledge to the current epidemiology literature about sarcopenia in older Chinese populations, and could provide background information for future preventive strategies, such as nutrition and physical activity interventions, tailored to the growing older population.


Assuntos
Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Sarcopenia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
11.
Nutrients ; 13(4)2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33805185

RESUMO

A simple, short, cheap, and reasonably sensitive and specific screening tool assessing both nutritional and non-nutritional risk factors for sarcopenia is needed. Potentially, such a tool may be the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire, which is available in a seven-item (MSRA-7) and five-item (MSRA-5) version. The study's aim was Polish translation and validation of both MSRA versions in 160 volunteers aged ≥60 years. MSRA was validated against the six sets of international diagnostic criteria for sarcopenia used as the reference standards. PL-MSRA-7 and PL-MSRA-5 both had high sensitivity (≥84.9%), regardless of the reference standard. The PL-MSRA-5 had better specificity (44.7-47.2%) than the PL-MSRA-7 (33.1-34.7%). Both questionnaires had similarly low positive predictive value (PL-MSRA-5: 17.9-29.5%; PL-MSRA-7: 14.4-25.2%). The negative predictive value was generally high for both questionnaires (PL-MSRA-7: 89.8-95.9%; PL-MSRA-5: 92.3-98.5%). PL-MSRA-5 had higher accuracy than the PL-MSRA-7 (50.0-55% vs. 39.4-45%, respectively). Based on the results, the Mini Sarcopenia Risk Assessment questionnaire was successfully adopted to the Polish language and validated in community-dwelling older adults from Poland. When compared with PL-MSRA-7, PL-MSRA-5 is a better tool for sarcopenia risk assessment.


Assuntos
Avaliação Geriátrica/métodos , Sarcopenia/diagnóstico , Inquéritos e Questionários/normas , Idoso , Feminino , Humanos , Masculino , Polônia , Reprodutibilidade dos Testes , Medição de Risco , Traduções
12.
Nutrients ; 13(3)2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33809996

RESUMO

We investigated the effects of oral L-glutamine (Gln) supplementation, associated or not with physical exercises, in control of glycemia, oxidative stress, and strength/power of knee muscles in elderly women. Physically active (n = 21) and sedentary (n = 23) elderly women aged 60 to 80 years were enrolled in the study. Plasma levels of D-fructosamine, insulin, reduced (GSH) and oxidized (GSSG) glutathione, iron, uric acid, and thiobarbituric acid-reactive substances (TBARs) (lipoperoxidation product), as well as knee extensor/flexor muscle torque peak and average power (isokinetic test), were assessed pre- and post-supplementation with Gln or placebo (30 days). Higher plasma D-fructosamine, insulin, and iron levels, and lower strength/power of knee muscles were found pre-supplementation in the NPE group than in the PE group. Post-supplementation, Gln subgroups showed higher levels of GSH, GSSG, and torque peak, besides lower D-fructosamine than pre-supplementation values. Higher muscle average power and plasma uric acid levels were reported in the PE + Gln group, whereas lower insulin levels were found in the NPE + Gln than pre-supplementation values. TBARs levels were diminished post-supplementation in all groups. Gln supplementation, mainly when associated with physical exercises, improves strength and power of knee muscles and glycemia control, besides boosting plasma antioxidant capacity of elderly women.


Assuntos
Suplementos Nutricionais , Exercício Físico , Glutamina/farmacologia , Controle Glicêmico/estatística & dados numéricos , Joelho/fisiologia , Músculo Esquelético/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Brasil , Método Duplo-Cego , Feminino , Avaliação Geriátrica/métodos , Humanos , Pessoa de Meia-Idade , Oxirredução/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Torque
13.
Nutrients ; 13(4)2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33806205

RESUMO

Anemia is a significant comorbidity for older adults not fully attributable to iron deficiency. Low-grade inflammation and other micronutrient deficiencies also contribute. This cross-sectional study examined the relationships between nutrient and non-nutrient factors with hemoglobin and anemia in 285 residents (>65 years) of 16 New Zealand aged-care facilities. Blood samples were analyzed for hemoglobin, ferritin, sTfR, hepcidin, zinc, selenium, and interleukin-6 (IL-6), (with ferritin, sTfR, zinc and selenium adjusted for inflammation). Linear regression models examined the relationships between micronutrient biomarkers (iron, zinc, selenium, vitamin B-12 and D), age, sex, and health factors with hemoglobin. Thirty-two percent of participants exhibited anemia, although <2% had either depleted iron stores or iron deficiency. Plasma zinc and selenium deficiencies were present in 72% and 38% of participants, respectively. Plasma zinc and total body iron (TBI) were positively associated (p < 0.05) with hemoglobin, while gastric acid suppressing medications, hepcidin, and interleukin-6 were inversely associated. These relationships were maintained after the application of anemia cut-offs. These findings emphasize the importance of considering multiple micronutrient deficiencies as risk factors for anemia.


Assuntos
Anemia/sangue , Avaliação Geriátrica/métodos , Ferro/sangue , Selênio/sangue , Zinco/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos Transversais , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Masculino , Micronutrientes/sangue , Nova Zelândia , Estado Nutricional
14.
BMC Cancer ; 21(1): 342, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789590

RESUMO

BACKGROUND: The geriatric nutritional risk index (GNRI), originally developed as a nutritional assessment tool to evaluate mortality and morbidity in older hospitalized patients (i.e., those aged ≥65 years), is regarded as a prognostic factor in several cancers. Body composition is also an important consideration when predicting the prognosis of patients with cancer. This study aimed to investigate the relationship between the GNRI and psoas muscle volume (PMV) for survival outcomes in patients with pancreatic cancer. METHODS: This retrospective study evaluated the prognostic significance of the GNRI and PMV in 105 consecutive patients aged ≥65 years who underwent pancreatectomy for histologically confirmed pancreatic cancer. The patients were divided into high (GNRI > 98) and low GNRI groups (GNRI ≤98), and into high (PMV > 61.5 mm3/m3 for men and 44.1 mm3/m3 for women) and low PMV (PMV ≤ 61.5 mm3/m3 for men and 44.1 mm3/m3 for women) groups. RESULTS: Both the 5-year overall survival (OS) and recurrence-free survival (RFS) rates were significantly greater among patients in the high GNRI group than among patients in the low GNRI group. Similarly, both the 5-year OS and RFS rates were significantly greater among patients in the high PMV group than among patients in the low PMV group. Patients were stratified into three groups: those with both high GNRI and high PMV; those with either high GNRI or high PMV (but not both); and those with both low GNRI and low PMV. Patients with both low GNRI and low PMV had a worse 5-year OS rate, compared with patients in other groups (P <  0.001). The C-index of the combination of the GNRI and PMV for predicting 5-year OS was greater than the C-indices of either the GNRI or PMV alone. Multivariate analysis revealed that the combination of the GNRI and PMV was an independent prognostic factor in patients aged ≥65 years with pancreatic cancer (P = 0.003). CONCLUSIONS: The combination of the GNRI and PMV might be useful to predict prognosis in patients aged ≥65 years with pancreatic cancer.


Assuntos
Avaliação Geriátrica/métodos , Avaliação Nutricional , Neoplasias Pancreáticas/fisiopatologia , Músculos Psoas/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Neoplasias Pancreáticas/mortalidade , Prognóstico , Fatores de Risco , Taxa de Sobrevida
15.
J Nutr Health Aging ; 25(4): 416-418, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33786556

RESUMO

OBJECTIVES: To explore the association between inflammatory cytokines and intrinsic capacity in older adults. METHOD: Data were retrieved from the Cardiovascular Health, Cognition and Aging Study. A total of 130 participants aged 60-99 years (mean age 73.11±9.02 years) were recruited. Intrinsic capacity was assessed by the five domains recommended by the World Health Organization: locomotion, cognition, vitality, sensory and psychological domains. Circulating interleukin-6, tumor necrosis factor receptor 1 (TNFR1), insulin-like growth factor-1, and vaspin levels were measured. Logistic regression was conducted for factors associated with intrinsic capacity decline. RESULTS: Intrinsic capacity decline was associated with older age, kidney diseases, olfactory disturbances and lower grip strength. Logistic regression showed that circulating TNFR1 was independently associated with intrinsic capacity decline after adjustments for age, sex, education, chronic diseases, grip strength, and physical activity. CONCLUSION: Elevated circulating TNFR1 levels are independently associated with declined intrinsic capacity, suggesting that chronic inflammation may underlie intrinsic capacity decline.


Assuntos
Envelhecimento/sangue , Citocinas/metabolismo , Avaliação Geriátrica/métodos , Receptores Tipo I de Fatores de Necrose Tumoral/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
J Nutr Health Aging ; 25(4): 419-424, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33786557

RESUMO

OBJECTIVES: To compare the ability of Frailty Phenotype (FP), FRAIL and Frailty Index (FI) to predict adverse outcomes. DESIGN: A prospective cohort study. SETTING: A senior community in Beijing, China. PARTICIPANTS: A total of 188 older adults aged 65 years or older (mean age 84.0 ± 4.4 years, 58.5% female). MEASUREMENTS: Frailty was evaluated by FP, FRAIL and FI. The agreement between scales was assessed by Cohen kappa coefficient. The predictive value of the three scales for adverse outcomes during one-year follow-up period were analyzed using decision curve analysis(DCA) and receiver operating characteristic curve (ROC) analysis. RESULTS: Frailty ranged from 25% (FRAIL) to 42.6% (FI). The agreement between scales was moderate to good (Cohen's kappa coefficient 0.44~0.61). DCA showed though the curves of the scales overlapped across all relevant risk thresholds, clinical treating had a higher net benefit than "treat all" and "treat none" when risk of unplanned hospital visits ≥30%, risk of functional decline or falls ≥15%. The three scales had similar predictive value for unplanned hospital visits (area under ROC, AUC 0.63, 0.64 and 0.69). FRAIL and FI had similar predictive value for functional decline (AUC 0.63,0.65). FI had predictive value for falls (AUC 0.65). CONCLUSIONS: All three scales showed clinical utility but FRAIL may be best in practice because it is simple. Multidimensional measures of frailty are better than unidimensional for prediction of adverse outcomes among older adults.


Assuntos
Rotas de Resultados Adversos/normas , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/complicações , Avaliação Geriátrica/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Prospectivos
17.
J Nutr Health Aging ; 25(4): 479-483, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33786565

RESUMO

Although geriatric research in general has increased in recent years, there is no effective treatment for frailty. Among older adults, those with frailty have an increased risk of falls, disability, and death. The population of older adults has increased rapidly in China, and resulting in an increased demand for medical care services for older adults, including those with frailty. However, much of the research on frailty has been conducted in Europe and the United States, and European and American standards for frailty are not always applicable to Chinese individuals. Clinicians and researchers in China have shown increasing interest in frailty in recent years. Here, we reviewed the current state of frailty research in China.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Avaliação Geriátrica/métodos , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Humanos , Masculino
18.
J Nutr Health Aging ; 25(4): 484-491, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33786566

RESUMO

INTRODUCTION: Although many studies associate a poor state of oral health with the risk of undernutrition in both the autonomous and dependent elderly, very few of them consider the frail elderly person. However, the identification of the frail elderly is one of major issues of modern geriatrics. It is at this stage that preventive strategies are the most effective against the risks of dependency. The main objective of our study is to explore the nature of the association between oral health and undernutrition in the frail elderly patient, and to identify the associated factors. MATERIALS AND METHODS: We have used the data of an observational transversal monocentric study, conducted among a population of patients hospitalized for frailty assessment at the Geriatric Frailty Clinic (G.F.C.) for Assessment of Frailty and Prevention of Disability. The enrolment site is the Cité de la Santé, at Toulouse University Hospital. Data were collected from January 25, 2016 February 2, 2018. The data collected sociodemographic characteristics, oral health (Oral Health Assessment Tool), nutritional status (Mini Nutritional Assessment), Body Mass Index, and weight loss according to Fried), frailty (Fried criteria), functional status (Mini Mental State Examination, Activity of Daily Living, Instrumental Activity of Daily Living, Geriatric Depression Scale-15), and behavior (tobacco and alcohol). RESULTS: We included 1,155 subjects with an average age of 81.9 years, including 65% women. Bivariate analysis indicated a statistically significant association (p<0.05) between a pathological state of oral health and undernutrition, particularly with regard to decay of natural teeth, pathologies of the tongue, gums and tissues, dry mouth, lack of oral cleanliness and presence of dental pain. Multivariate analysis adjusted for socio-demographic, behavioral and functional data confirmed some of these associations, notably between the item gum/mucous membrane and the decrease of the score (p<0.01); this same item and weight loss according to Fried (p<0.01), and the item tongue and weight loss (p<0.05). A statistically significant association appeared between the state of oral health and frailty (item tongue (p<0.01)). DISCUSSION: Our study shows a statistically significant association between a pathological state of oral health and nutrition disorders in the frail elderly person. This result confirms the hypothesis postulating that a poor state of oral health would be associated with nutritional disorders among the frail elderly. Our analysis also shows a statistically significant association between a deteriorated state of oral health and frailty. Tongue diseases here increase the risk of frailty for the patient. Our results are, however, limited and do not allow for an analysis of causal effect. It would be useful to complete our study by more refined analyses of risk factors, conducted on a larger sample, and with a follow-up patients over time. CONCLUSION: We show here the importance of targeting the frail population in order to screen for oral disease and refer patients for dental care. Ensuring oral health care of frail patients seems indispensable if they are to maintain not only a healthy nutritional state, but also a satisfactory general state of health, thus allowing for successful aging.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/complicações , Desnutrição/etiologia , Avaliação Nutricional , Estado Nutricional/fisiologia , Saúde Bucal/normas , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica/métodos , Humanos , Masculino , Desnutrição/fisiopatologia
19.
Clin Interv Aging ; 16: 335-343, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33654390

RESUMO

Purpose: The Timed Up and Go (TUG) test is used to assess a person's mobility and balance. We aimed to provide updated reference values for TUG performance for the community-dwelling older population according to age and sex, and according to the presence of arthritis and non-communicable diseases (NCDs). Participants and Methods: Cross-sectional data from the seventh wave (2015-2016) of the population-based Norwegian Tromsø Study counting 5400 community-dwelling people (53% women), aged 60-84 years were used. Reference values were presented as percentiles and means for men and women by age at five-year intervals. Results: Median TUG score was stable during age 60-65 years, and after age 65 years median TUG score increased significantly with age (increase by 0.14 sec per 1 year higher age in both men and women, p<0.001). At the youngest ages (<65 years), in both men and women, there were no differences in TUG performance for those with NCD or arthritis compared to those without these diseases. After age 65 however, those without these diseases performed significantly better (p<0.05) in both men and women. Conclusion: The present study provided percentile reference values for TUG performance in community-dwelling older adults in Norway by age and sex, and in subgroups of those having arthritis and NCDs. TUG scores increased with age, and performance was significantly poorer among participants with arthritis or NCDs after age 65 years. The findings may guide clinical interventions for individuals with mobility and balance disabilities.


Assuntos
Artrite , Vida Independente/estatística & dados numéricos , Desempenho Físico Funcional , Equilíbrio Postural , Idoso , Artrite/diagnóstico , Artrite/epidemiologia , Artrite/fisiopatologia , Estudos Transversais , Feminino , Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Masculino , Doenças não Transmissíveis/epidemiologia , Noruega/epidemiologia , Valores de Referência
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