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2.
J Frailty Aging ; 9(1): 4-8, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150207

RESUMO

Biomarkers of frailty and sarcopenia are essential to advance the understanding of these conditions of aging and develop new diagnostic tools and effective treatments. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force - a group of academic and industry scientists from around the world -- met in February 2019 to discuss the current state of biomarker development for frailty and sarcopenia. The D3Cr dilution method, which assesses creatinine excretion as a biochemical measure of muscle mass, was suggested as a more accurate measure of functional muscle mass than assessment by dual energy x-ray absorptiometry (DXA). Proposed biomarkers of frailty include markers of inflammation, the hypothalamic-pituitary-adrenal (HPA) axis response to stress, altered glucose insulin dynamics, endocrine dysregulation, aging, and others, acknowledging the complex multisystem etiology that contributes to frailty. Lack of clarity regarding a regulatory pathway for biomarker development has hindered progress; however, there are currently several international efforts to develop such biomarkers as tools to improve the treatment of individuals presenting these conditions.


Assuntos
Fragilidade , Sarcopenia , Comitês Consultivos , Biomarcadores , Congressos como Assunto , Humanos
3.
J Frailty Aging ; 9(1): 9-13, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150208

RESUMO

For clinical studies of sarcopenia and frailty, clinically meaningful outcome measures are needed to monitor disease progression, evaluate efficacy of interventions, and plan clinical trials. Physical performance measures including measures of gait speed and other aspects of mobility and strength have been used in many studies, although a definition of clinically meaningful change in performance has remained unclear. The International Conference on Frailty and Sarcopenia Research Task Force (ICFSR-TF), a group of academic and industry scientists investigating frailty and sarcopenia, met in Miami Beach, Florida, USA in February 2019 to explore approaches for establishing clinical meaningfulness in a manner aligned with regulatory authorities. They concluded that clinical meaningful change is contextually dependent, and that both anchor- based and distribution-based methods of quantifying physical function are informative and should be evaluated relative to patient-reported outcomes. In addition, they identified additional research needed to enable setting criteria for clinical meaningful change in trials.


Assuntos
Fragilidade/fisiopatologia , Desempenho Físico Funcional , Sarcopenia/fisiopatologia , Comitês Consultivos , Congressos como Assunto , Humanos
4.
J Frailty Aging ; 9(1): 14-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150209

RESUMO

With aging populations around the world, frailty is becoming more prevalent increasing the need for health systems and social systems to deliver optimal evidence based care. However, in spite of the growing number of frailty publications, high-quality evidence for decision making is often lacking. Inadequate descriptions of the populations enrolled including frailty severity and frailty conceptualization, lack of use of validated frailty assessment tools, utilization of different frailty instruments between studies, and variation in reported outcomes impairs the ability to interpret, generalize and implement the research findings. The utilization of common data elements (CDEs) and core outcome measures (COMs) in clinical trials is increasingly being adopted to address such concerns. To catalyze the development and use of CDEs and COMs for future frailty studies, the Canadian Frailty Network (www.cfn-nce.ca; CFN), a not-for-profit pan-Canadian nationally-funded research network, convened an international group of experts to examine the issue and plan the path forward. The meeting was structured to allow for an examination of current frailty evidence, ability to learn from other COMs and CDEs initiatives, discussions about specific considerations for frailty COMs and CDEs and finally the identification of the necessary steps for a COMs and CDEs consensus initiative going forward. It was agreed at the onset of the meeting that a statement based on the meeting would be published and herein we report the statement.


Assuntos
Pesquisa Biomédica/organização & administração , Fragilidade , Canadá , Elementos de Dados Comuns , Consenso , Humanos
5.
Am Surg ; 86(2): 95-103, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167059

RESUMO

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.


Assuntos
Cistectomia/efeitos adversos , Fragilidade/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Protectomia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Cistectomia/mortalidade , Cistectomia/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Fragilidade/complicações , Fragilidade/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Período Pós-Operatório , Valor Preditivo dos Testes , Protectomia/mortalidade , Protectomia/estatística & dados numéricos , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
Medicine (Baltimore) ; 99(5): e18935, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000408

RESUMO

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).


Assuntos
Doença das Coronárias/diagnóstico , Fragilidade/diagnóstico , Estudos Observacionais como Assunto , Atividades Cotidianas , Idoso , Doença das Coronárias/complicações , Doença das Coronárias/mortalidade , Doença das Coronárias/terapia , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/mortalidade , Fragilidade/terapia , Avaliação Geriátrica , Humanos , Seleção de Pacientes
10.
Adv Exp Med Biol ; 1216: 1-7, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894541

RESUMO

Over the past decades, a progressive and exponential aging of the population has been observed. In particular, an absolute e relative increase of old and very old persons is also projected for the next 30 years. This demographic phenomenon is substantially responsible for the growing prevalence of frailty in our societies. Frailty is a clinical condition characterized by an excessive vulnerability of the individual to endogenous and exogenous stressors. This status generates a high risk of developing negative health-related events. Shifting to a construct as frailty to biologically define the perimeter of action for geriatric medicine will probably concur at modernizing the old way of practicing medicine. In this chapter the concept of frailty, its impact on the evolving healthcare systems, the controversies associated with its assessment and, ultimately, the role it plays in the management of older persons are discussed.


Assuntos
Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Assistência à Saúde , Avaliação Geriátrica , Humanos
11.
Adv Exp Med Biol ; 1216: 9-19, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894542

RESUMO

The general notion of frailty is widely understood to be a state of increased vulnerability to stressors, following age-related declines in function and reserves across multiple physiological systems. Frailty is clinically characterised by slower and/or incomplete recovery from stressors such as infection, injury, surgery or psychosocial distress. There is however no consensus on a single operational definition. Numerous assessment tools and scores are promoted to detect or measure frailty but two have widest research background and acceptance, the Frailty Phenotype and the deficit based Frailty Index. We describe these and other approaches in the context of a description of the psychometric properties, types of scaling, uses and misuses of assessment tools. We advocate the choice of an appropriate measurement tool be based on the population characteristics and the purpose for which it is to be used and illustrate how an understanding of the properties of different tools helps to inform this choice.


Assuntos
Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Humanos , Fenótipo , Psicometria
12.
Adv Exp Med Biol ; 1216: 21-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894543

RESUMO

Frailty is a complex of symptoms that is characterized by impaired stress tolerance due to a decline in the functionality of different organs. Due to its multifactorial aetiology, several definitions and assessments of this symptom complex have been developed, of which the Fried Frailty Score (Phenotype Score) and the broader Frailty Index (Deficit Accumulation Index) are the most commonly used. The prevalence of frailty increases with age independently of the assessment instrument and ranges between 4 and 59% in community-dwelling elderly populations and is higher in women than in men. The actual prevalence rate in a population depends on the prevalence of chronic diseases including depression, nutritional status, and inherently socio-economic background and education. Frailty is, however, not a steady state and progression, but also reversion is common. Although numerous studies on the prevalence of frailty have been conducted, systematic assessments in different populations are rare, which reduces the comparability of results. Similarly heterogeneous, but less frequent are studies on the incidence and on trajectories and transitions of frailty, calling for further, more systematic studies on this topic.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Avaliação Geriátrica , Humanos , Vida Independente , Estado Nutricional , Prevalência
13.
Adv Exp Med Biol ; 1216: 39-50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894545

RESUMO

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.


Assuntos
Doenças Cardiovasculares , Fragilidade , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/complicações , Fragilidade/epidemiologia , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Obesidade Abdominal/complicações , Obesidade Abdominal/epidemiologia , Fatores de Risco
14.
Adv Exp Med Biol ; 1216: 51-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894546

RESUMO

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.


Assuntos
Doenças Cardiovasculares/complicações , Idoso Fragilizado , Fragilidade/complicações , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Prevalência , Fatores de Risco
15.
Adv Exp Med Biol ; 1216: 55-64, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894547

RESUMO

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.


Assuntos
Doenças Cardiovasculares/complicações , Idoso Fragilizado , Fragilidade/complicações , Inflamação/complicações , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/imunologia , Envelhecimento/patologia , Doenças Cardiovasculares/imunologia , Doenças Cardiovasculares/patologia , Senescência Celular , Citocinas/imunologia , Fragilidade/imunologia , Fragilidade/patologia , Humanos , Inflamação/imunologia , Inflamação/patologia
16.
Adv Exp Med Biol ; 1216: 65-77, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894548

RESUMO

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.


Assuntos
Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/metabolismo , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/metabolismo , Inflamação/complicações , Inflamação/metabolismo , Estresse Oxidativo , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/patologia , Fragilidade/patologia , Humanos , Inflamação/patologia
17.
Adv Exp Med Biol ; 1216: 79-86, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894549

RESUMO

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.


Assuntos
Envelhecimento/patologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/patologia , Senescência Celular , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/patologia , Idoso , Humanos , Inflamação/complicações , Inflamação/patologia
18.
Adv Exp Med Biol ; 1216: 99-113, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894551

RESUMO

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.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/cirurgia , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Humanos , Intervenção Coronária Percutânea , Medição de Risco , Substituição da Valva Aórtica Transcateter
19.
Adv Exp Med Biol ; 1216: 115-129, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894552

RESUMO

Cardiovascular diseases (CVD) and frailty syndrome are major problems for successful aging. These conditions share many biological aspects, symptoms and adverse effects. Aerobic capacity and muscle strength, that are important characteristics for independence in daily activity, are markedly reduced in older adults with CVD and frailty. There are evidence and recommendations of physical activity and exercises to prevent, treat and manage these conditions. However, the exact dose-response (type, intensity and duration) of exercises is still uncertain for these population. A good physical exercise program should consider the aging physiologic alterations, the vulnerability of the frail syndrome, and the functional-structural changes of CVD. Therefore, a multicomponent program with aerobic and strength training is desirable to improve these conditions. For long term results it is important to older adults with these conditions to change lifestyle and be more active during daily living to reduce sedentary behavior. Being frail with CVD it is not a contraindication for older adults to be engaged in physical activities.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Terapia por Exercício , Exercício/fisiologia , Idoso Fragilizado , Fragilidade/prevenção & controle , Idoso , Humanos
20.
Adv Exp Med Biol ; 1216: 149-152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894554

RESUMO

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.


Assuntos
Doenças Cardiovasculares/complicações , Idoso Fragilizado , Fragilidade/complicações , Idoso , Cardiologia , Geriatria , Humanos , Narração
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