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1.
Rev Esp Salud Publica ; 952021 Mar 26.
Artigo em Espanhol | MEDLINE | ID: mdl-33767129

RESUMO

OBJECTIVE: Older people have been severely affected by the COVID-19 pandemic. The aim of this study was to describe the main epidemiological findings of a COVID-19 outbreak occurred in March 2020 at a nursing home for elderly in Granada. Risk factors associated with the spread of the virus in the center were investigated. METHODS: A retrospective cohort study was conducted, collecting the most relevant clinical and epidemiological findings, occurred during the outbreak follow-up period (from 03/13/2020 to 06/20/2020). The association between the residents' health conditions (underlying diseases, level of physical dependence, level of cognitive impairment) and the risk of infection was estimated using multivariate Cox regression. RESULTS: 52 PCR-confirmed COVID-19 cases were identified among the residents and 50 cases among the employees of the nursing home. The epidemic curve was characteristic of a person to person transmission. Among residents with a higher level of physical dependence, according to the Barthel index score, a higher incidence of infection was detected, adjusting for age, sex and health conditions. At 55 days of exposure, moderately (RR 2.82), severely (RR 4.71) and completely (RR 3.49) dependent residents had between 2-4 times greater risk of infection than the minimally dependent residents (p<0.05). CONCLUSIONS: The epidemic curve supports the hypothesis of a cross-transmission of infections between residents and staff members of the nursing home. In the context of sustained transmission of the virus, physical dependence of the residents increases the risk of exposure to the virus, facilitating its spreading.


Assuntos
/complicações , Idoso Fragilizado , Fragilidade/complicações , Casas de Saúde , Idoso , Idoso de 80 Anos ou mais , Surtos de Doenças , Feminino , Humanos , Incidência , Masculino , Pandemias , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Risco , Fatores de Risco , Espanha/epidemiologia
2.
J Thorac Cardiovasc Surg ; 161(3): 822-832.e6, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33451846

RESUMO

OBJECTIVES: To (1) measure 4 physiologic metrics before esophagectomy, (2) use these in an index to predict composite postoperative outcome after esophagectomy, and (3) compare predictive accuracy of this index to that of the Fried Frailty Index and Modified Frailty Index. METHODS: Grip strength (kilograms), 30-second chair sit-stands (number), 6-minute walk distance (meters), and normalized psoas muscle area (cm2/m) were measured for 77 consenting patients from January 1, 2018, to April 1, 2019. Imbalanced random forest classification estimated probability of a composite postoperative outcome, which included mortality, respiratory complications, anastomotic leak, delirium, length of stay ≥14 days, discharge to nursing facility, and readmission. G-mean error was used to compare predictive accuracy among indexes. RESULTS: Median grip strength was 38 kg (25th-75th percentiles, 31-44), number of sit-stands 11 (10-14), psoas muscle area to height ratio 6.9 cm2/m (6.0-8.2), and 6-minute walk distance 407 m (368-451). There was generally weak correlation between these metrics, with the highest between 30-second sit-stands and 6-minute walk distance (r = 0.57). Age, degree of patient-reported exhaustion, and the 4 objective metrics comprised the Esophageal Vitality Index, which had a lower G-mean error of 32% (31-33) than the Fried Frailty Index, 37% (37-38), and the Modified Frailty Index, 48% (47-48). CONCLUSIONS: The Esophageal Vitality Index, an objective, simple assessment consisting of grip strength, 30-second chair sit-stands, 6-minute walk, and psoas muscle area to height ratio outperformed commonly used frailty indexes in predicting postesophagectomy mortality and morbidity. The index provides a robust picture of patients' fitness for surgery beyond the qualitative "eyeball" test.


Assuntos
Técnicas de Apoio para a Decisão , Esofagectomia , Fragilidade/diagnóstico , Indicadores Básicos de Saúde , Idoso , Composição Corporal , Tomada de Decisão Clínica , Esofagectomia/efeitos adversos , Esofagectomia/mortalidade , Tolerância ao Exercício , Feminino , Fragilidade/complicações , Fragilidade/fisiopatologia , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/fisiopatologia , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Teste de Caminhada , Caminhada
3.
J Surg Res ; 257: 252-259, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32862053

RESUMO

BACKGROUND: Emergency laparotomy (EL) is an increasingly common procedure in the elderly. Factors associated with mortality in the subpopulation of frail patients have not been thoroughly investigated. Sarcopenia has been investigated as a surrogate for frailty and poor prognosis. Our primary aim was to evaluate the association between easily measured sarcopenia parameters and 30-day postoperative mortality in elderly patients undergoing EL. Length of stay (LOS) and admission to an intensive care unit were secondary end points. METHODS: We conducted a retrospective cohort study, over a 5-year period, of patients aged 65 y and older who underwent EL at a tertiary university hospital. Sarcopenia was evaluated on admission computed tomography scan by two methods, first by psoas muscle attenuation and second by the product of perpendicular cross-sectional diameters (PCSDs). The lowest quartile of PCSDs and attenuation were defined as sarcopenic and compared with the rest of the cohort. Attenuation was stratified for the use of contrast enhancement. Multivariant logistic regression was performed to determine independent risk factors. RESULTS: During the study period, 403 patients, older than 65 y, underwent EL. Of these, 283 fit the inclusion criteria and 65 (23%) patients died within 30 d of surgery. On bivariate analysis, psoas muscle attenuation, but not PCSDs, was found to be associated with 30-day mortality (OR = 2.43, 95% CI = 1.34-4.38, P = 0.003) and longer LOS (35.7 d versus 22.2 d, Δd 13.5, 95% CI = 6.4-20.7, P < 0.001). In a multivariate analysis, psoas muscle attenuation, but not PCSDs, was an independent risk factor for 30-day postoperative mortality (OR = 2.35, 95% CI = 1.16-4.76, P = 0.017) and longer LOS (Δd = 14.4, 95% CI = 7.7-21.0, P < 0.001). Neither of the sarcopenia parameters was associated with increased admission to an intensive care unit. DISCUSSION: Psoas muscle attenuation is an independent risk factor for 30-day postoperative mortality and LOS after EL in the elderly population. This measurement can inform clinicians about the operative risk and hospital resource utilization.


Assuntos
Tratamento de Emergência/efeitos adversos , Fragilidade/diagnóstico , Laparotomia/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Músculos Psoas/diagnóstico por imagem , Sarcopenia/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Estudos de Viabilidade , Feminino , Fragilidade/complicações , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Sarcopenia/complicações , Tomografia Computadorizada por Raios X
4.
J Frailty Aging ; 10(1): 63-69, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33331624

RESUMO

BACKGROUND: Sarcopenia is associated with adverse outcomes in cancer, chemotherapy, solid organ transplants, intensive care and medical patients. It has also been proven to increase perioperative mortality, hospital length of stay and complications in patients of various age groups. However, a limited number of studies have examined the association of post-surgical outcomes and sarcopenia inclusively in patients aged 65 years and older. OBJECTIVE: This scoping review aimed to examine the relationship between adverse post-surgical outcomes and sarcopenia in patients aged 65 years and older. METHODOLOGY: EMBASE and Medline databases were searched for sarcopenia, perioperative period and post-surgical outcomes. The articles were screened based on exclusion and inclusion criteria and were reviewed systematically as per the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. RESULTS: After duplicates removal and application of the inclusion and exclusion criteria, eight articles were included for this study from a total of nine hundred initially identified articles. All studies defined sarcopenia as low muscle mass but did not include physical function or muscle strength as the parameter of sarcopenia. Low muscle mass was associated with higher mortality in emergency surgeries, reduced long term survival in open elective surgeries, and increased length of hospital stay in endoscopic surgeries. CONCLUSION: The current review suggests that low muscle mass is associated with higher mortality and various adverse post-surgical outcomes in the elderly. It remains to be determined if applying the definition of sarcopenia as per the international consensus/guidelines will affect the association of adverse post-surgical outcomes and sarcopenia.


Assuntos
Fragilidade/complicações , Complicações Pós-Operatórias/etiologia , Sarcopenia/complicações , Idoso , Humanos , Tempo de Internação , Força Muscular , Período Pós-Operatório , Resultado do Tratamento
5.
J Urol ; 205(1): 191-198, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32648798

RESUMO

PURPOSE: Colpocleisis is an obliterative surgical option for women with pelvic organ prolapse that is often performed in a frail population. However, because outcomes remain largely unknown we aimed to assess the durability and perioperative safety of colpocleisis in a large population based cohort. MATERIALS AND METHODS: All women undergoing colpocleisis and other pelvic organ prolapse repairs in California (2005-2011) were identified using the Office of Statewide Health Planning and Development data sets. Durability was defined as the absence of future pelvic organ prolapse repair after index repair for the duration of the data sets. Thirty-day morbidity was assessed by identifying readmissions, repeat surgeries and complications. A metric to assess frailty in large administrative databases was applied to assess the impact of frailty on outcomes. Colpocleisis outcomes were compared to other types of pelvic organ prolapse repairs by developing propensity score matched groups. RESULTS: Among the 2,707 women undergoing colpocleisis, reoperation for prolapse occurred in 47 (1.8%). At least 1 complication occurred in 11.1% of the cohort, with serious complications occurring in 2%. Frail patients were more likely to experience any complication (23.3% vs 10.3%, p <0.01) and a serious complication (5.0% vs 1.8%, p=0.02) and was the best predictor of morbidity. Colpocleisis was associated with a more durable repair (overall failure 1.8% vs 3.5%, p <0.01) with no difference in complication rates as compared to the matched cohort. CONCLUSIONS: Colpocleisis provides a more durable outcome than reconstructive pelvic organ prolapse repairs without increased perioperative morbidity. Frailty is a better predictor than age for perioperative complications after colpocleisis.


Assuntos
Fragilidade/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Vagina/cirurgia , Fatores Etários , Idoso , California/epidemiologia , Conjuntos de Dados como Assunto , Feminino , Seguimentos , Fragilidade/complicações , Fragilidade/diagnóstico , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Readmissão do Paciente/estatística & dados numéricos , Prolapso de Órgão Pélvico/complicações , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Reoperação/estatística & dados numéricos , Fatores de Risco , Resultado do Tratamento
6.
J Am Geriatr Soc ; 69(3): 767-772, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33314116

RESUMO

BACKGROUND: Exacerbation of or new onset orthostatic hypotension in perioperative patients can occur. There is complex underlying pathophysiology with further derailment likely caused by acute cardiovascular changes associated with surgery. The implications for post-operative recovery are unclear, particularly in frail and older patients. We retrospectively explored patient notes for evidence of post-operative orthostatic intolerance in relation to pre-operative orthostatic hypotension. METHODS: Supine and 1-minute and 3-minute standing blood pressure measures obtained from adult patients before mainly general, orthopedic or uro/gynecology surgery were compared to post-operative outcome, specifically, evidence in patient notes about falls, feeling dizzy/unsteady and/or fearful to stand. Orthostatic hypotension was defined as a 20 mmHg or more and/or 10 mmHg or more fall in systolic and diastolic blood pressure, respectively, within ~3 minutes of standing after lying supine for an electrocardiogram. RESULTS: Whilst all patients included had a 1-minute standing blood pressure assessment (N = 170), 3-minute assessment was performed less commonly (N = 113). Nevertheless, one-quarter (23.5%; N = 40) of 170 patients had pre-operative orthostatic hypotension. This was not clearly explained by cardiac or neurological disease or by common medications, but did occur more frequently in older patients and in those aged 65 years or more with higher clinical frailty scale scores. The COVID-19 pandemic reduced the number of patients progressing to surgery within the planned study timescale (N = 143/170; 84.1%). Nevertheless, patients with orthostatic hypotension stayed longer in hospital post-operatively and were more likely to have an episode of fall, unsteadiness and/or dizziness documented (un-prompted) in their notes. CONCLUSIONS: These data provide further impetus for research into modifiable perioperative risk factors associated with orthostatic hypotension. These risks are not confined to those with a pre-existing dysautonomia diagnosis.


Assuntos
Pressão Sanguínea , Fragilidade/fisiopatologia , Hipotensão Ortostática/diagnóstico , Intolerância Ortostática/etiologia , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial , Feminino , Fragilidade/complicações , Fragilidade/cirurgia , Avaliação Geriátrica , Humanos , Hipotensão Ortostática/etiologia , Masculino , Período Pré-Operatório , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
7.
Artigo em Inglês | MEDLINE | ID: mdl-33327401

RESUMO

Diabetes mellitus is an important risk factor for the development of cardiovascular diseases. Peripheral arterial disease affecting lower limb arteries is one of the clinical manifestations of atherosclerosis. The frailty syndrome (Frailty) is a problem associated with diminution of physiological reserves. The ankle-brachial index is a commonly used tool for diagnosing peripheral arterial disease (PAD). The usefulness of the ankle-brachial index (ABI) is limited in people with diabetes because of calcification of the middle layer of arteries. In this population, toe-brachial index should be measured. Frailty may be associated with worse prognosis for patients undergoing revascularization. Amputation may be an important factor leading to the development of Frailty. The risk of amputation and the prognosis after revascularization may be modified by some medications and blood glucose levels. The purpose of this paper is to review the literature about the association between PAD, especially in patients living with diabetes and Frailty.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Fragilidade , Doença Arterial Periférica , Idoso , Índice Tornozelo-Braço , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/patologia , Diabetes Mellitus/epidemiologia , Idoso Fragilizado , Fragilidade/complicações , Humanos , Isquemia/etiologia , Doença Arterial Periférica/epidemiologia , Fatores de Risco
8.
BMC Med ; 18(1): 408, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33334341

RESUMO

BACKGROUND: The COVID-19 pandemic has placed significant pressure on health and social care. Survivors of COVID-19 may be left with substantial functional deficits requiring ongoing care. We aimed to determine whether pre-admission frailty was associated with increased care needs at discharge for patients admitted to hospital with COVID-19. METHODS: Patients were included if aged over 18 years old and admitted to hospital with COVID-19 between 27 February and 10 June 2020. The Clinical Frailty Scale (CFS) was used to assess pre-admission frailty status. Admission and discharge care levels were recorded. Data were analysed using a mixed-effects logistic regression adjusted for age, sex, smoking status, comorbidities, and admission CRP as a marker of severity of disease. RESULTS: Thirteen hospitals included patients: 1671 patients were screened, and 840 were excluded including, 521 patients who died before discharge (31.1%). Of the 831 patients who were discharged, the median age was 71 years (IQR, 58-81 years) and 369 (44.4%) were women. The median length of hospital stay was 12 days (IQR 6-24). Using the CFS, 438 (47.0%) were living with frailty (≥ CFS 5), and 193 (23.2%) required an increase in the level of care provided. Multivariable analysis showed that frailty was associated with an increase in care needs compared to patients without frailty (CFS 1-3). The adjusted odds ratios (aOR) were as follows: CFS 4, 1.99 (0.97-4.11); CFS 5, 3.77 (1.94-7.32); CFS 6, 4.04 (2.09-7.82); CFS 7, 2.16 (1.12-4.20); and CFS 8, 3.19 (1.06-9.56). CONCLUSIONS: Around a quarter of patients admitted with COVID-19 had increased care needs at discharge. Pre-admission frailty was strongly associated with the need for an increased level of care at discharge. Our results have implications for service planning and public health policy as well as a person's functional outcome, suggesting that frailty screening should be utilised for predictive modelling and early individualised discharge planning.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Fragilidade/complicações , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , /reabilitação , Estudos de Coortes , Comorbidade , Feminino , Fragilidade/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente
9.
BMC Med ; 18(1): 401, 2020 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-33357217

RESUMO

BACKGROUND: Atrial fibrillation (AF) is common in older people with frailty and is associated with an increased risk of stroke and systemic embolism. Whilst oral anticoagulation is associated with a reduction in this risk, there is a lack of data on the safety and efficacy of direct oral anticoagulants (DOACs) in people with frailty. This study aims to report clinical outcomes of patients with AF in the Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48 (ENGAGE AF-TIMI 48) trial by frailty status. METHODS: Post hoc analysis of 20,867 participants in the ENGAGE AF-TIMI 48 trial, representing 98.8% of those randomised. This double-blinded double-dummy trial compared two once-daily regimens of edoxaban (a DOAC) with warfarin. Participants were categorised as fit, living with pre-frailty, mild-moderate, or severe frailty according to a standardised index, based upon the cumulative deficit model. The primary efficacy endpoint was stroke or systemic embolism and the safety endpoint was major bleeding. RESULTS: A fifth (19.6%) of the study population had frailty (fit: n = 4459, pre-frailty: n = 12,326, mild-moderate frailty: n = 3722, severe frailty: n = 360). On average over the follow-up period, the risk of stroke or systemic embolism increased by 37% (adjusted HR 1.37, 95% CI 1.19-1.58) and major bleeding by 42% (adjusted HR 1.42, 1.27-1.59) for each 0.1 increase in the frailty index (four additional health deficits). Edoxaban was associated with similar efficacy to warfarin in every frailty category, and a lower risk of bleeding than warfarin in all but those living with severe frailty. CONCLUSIONS: Edoxaban was similarly efficacious to warfarin across the frailty spectrum and was associated with lower rates of bleeding except in those with severe frailty. Overall, with increasing frailty, there was an increase in stroke and bleeding risk. There is a need for high-quality, frailty-specific population randomised control trials to guide therapy in this vulnerable population. TRIAL REGISTRATION: ClinicalTrials.gov NCT00781391 . First registered on 28 October 2008.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Fragilidade/diagnóstico , Fragilidade/tratamento farmacológico , Piridinas/administração & dosagem , Tiazóis/administração & dosagem , Varfarina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Coagulação Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Esquema de Medicação , Inibidores do Fator Xa/uso terapêutico , Feminino , Seguimentos , Fragilidade/complicações , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/tratamento farmacológico , Prognóstico , Piridinas/efeitos adversos , Tiazóis/efeitos adversos , Resultado do Tratamento
11.
BMC Geriatr ; 20(1): 409, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066750

RESUMO

BACKGROUND: There is a need for more observational studies across different clinical settings to better understand the epidemiology of the novel COVID-19 infection. Evidence on clinical characteristics of COVID-19 infection is scarce in secondary care settings in Western populations. METHODS: We describe the clinical characteristics of all consecutive COVID-19 positive patients (n = 215) admitted to the acute medical unit at Fairfield General Hospital (secondary care setting) between 23 March 2020 and 30 April 2020 based on the outcome at discharge (group 1: alive or group 2: deceased). We investigated the risk factors that were associated with mortality using binary logistic regression analysis. Kaplan-Meir (KM) curves were generated by following the outcome in all patients until 12 May 2020. RESULTS: The median age of our cohort was 74 years with a predominance of Caucasians (87.4%) and males (62%). Of the 215 patients, 86 (40%) died. A higher proportion of patients who died were frail (group 2: 63 vs group 1: 37%, p < 0.001), with a higher prevalence of cardiovascular disease (group 2: 58 vs group 1: 33%, p < 0.001) and respiratory diseases (group 2: 38 vs group 1: 25%, p = 0.03). In the multivariate logistic regression models, older age (odds ratio (OR) 1.03; p = 0.03), frailty (OR 5.1; p < 0.001) and lower estimated glomerular filtration rate (eGFR) on admission (OR 0.98; p = 0.01) were significant predictors of inpatient mortality. KM curves showed a significantly shorter survival time in the frail older patients. CONCLUSION: Older age and frailty are chief risk factors associated with mortality in COVID-19 patients hospitalised to an acute medical unit at secondary care level. A holistic approach by incorporating these factors is warranted in the management of patients with COVID-19 infection.


Assuntos
Infecções por Coronavirus/mortalidade , Idoso Fragilizado , Fragilidade/complicações , Pneumonia Viral/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pandemias , Prevalência , Atenção Secundária à Saúde
13.
PLoS One ; 15(8): e0237454, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764814

RESUMO

There is growing interest in "osteosarcopenia" as the coexistence of osteoporosis and sarcopenia exacerbates negative outcomes. However, limited information is available regarding the risk factors of osteosarcopenia development in patients with osteoporosis. Therefore, we retrospectively reviewed 276 consecutive patients with postmenopausal osteoporosis who regularly visited Showa University Hospital. Patients were eligible for the study if they were ≥65 years of age and underwent dual-energy X-ray absorptiometry, blood sampling, and physical performance assessment. Patients were divided into the osteosarcopenia and osteoporosis alone groups according to the diagnostic criteria of the Asian Working Group for Sarcopenia. Of the 276 patients with osteoporosis, 54 patients (19.6%) had osteosarcopenia. Patients in the osteosarcopenia group had a greater risk of frailty than did those in the osteoporosis alone group (odds ratio 2.33; 95% confidence interval, 1.13-4.80, P = 0.028). Low body mass index seemed to be the strongest factor related to the development of osteosarcopenia, and none of the patients in the osteosarcopenia group were obese (BMI ≥27.5 kg/m2). Multiple logistic analyses revealed that patients aged 65-74 years who had comorbidities such as kidney dysfunction and high levels of HbA1c were at risk of developing osteosarcopenia. Thus, we strongly recommend the assessment of the key components of the diagnosis of osteosarcopenia in an osteoporosis clinic for patients with low body mass index. Furthermore, appropriate assessments, including comorbidities, will help in identifying patients at greater risk of developing osteosarcopenia.


Assuntos
Osteoporose/diagnóstico , Osteossarcoma/diagnóstico , Absorciometria de Fóton , Acidentes por Quedas/estatística & dados numéricos , Idoso , Índice de Massa Corporal , Feminino , Fragilidade/complicações , Fragilidade/diagnóstico , Humanos , Fator de Crescimento Insulin-Like I/análise , Modelos Logísticos , Força Muscular , Razão de Chances , Osteoporose/complicações , Osteossarcoma/complicações , Pós-Menopausa , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/complicações , Sarcopenia/diagnóstico
14.
Vasc Health Risk Manag ; 16: 307-316, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764951

RESUMO

Purpose: This study was conducted to investigate the relationships between arterial stiffness, frailty and fall-related injuries among community-dwelling older adults. Materials and Methods: A cross-sectional study of a random sample of older adults aged 60 years and older was conducted. Main study parameters: arterial stiffness was measured by the determining the cardio-ankle vascular index (CAVI); Frailty status was defined using a 7-item frailty screening scale, developed in Russia. This questionnaire included question about falls and fall-related injuries. Orthostatic test and anthropometric tests were done. Medical history (comorbidity, medications), the Osteoporosis Self-assessment Tool (OST), nutritional, physical, cognitive and functional status were evaluated. Results: The study population included 163 people aged 60-89 years. The average predicted value of CAVI in women aged 60-69 was 9.13 ± 0.13, in men, 9.49 ± 0.05; in women aged 70-79, it was 9.49 ± 0.16, in men, 9.73 ±0.11; in women aged 80 and older it was 10.04 ±0.18, in men, 10.24 ±0.10 units. The CAVI above the predicted value was associated with fall-related injuries even after adjustment for age, sex, use of ß-blockers (BBs), history of stroke, and region of residence with the odds ratio 3.52 (95% CI: 1.03 -12.04). Conclusion: Our study revealed an independent association between arterial stiffness and fall-related injuries in older adults over 60 years. The findings suggest that clinicians, especially geriatricians, should pay attention to arterial stiffness of patients with fall-related injuries. Similarly, the patients with CAVI above age-predicted value should be evaluated for risk of falls for prevention of fall-related injuries.


Assuntos
Acidentes por Quedas , Doenças Cardiovasculares/complicações , Idoso Fragilizado , Fragilidade/complicações , Rigidez Vascular , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Feminino , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco
15.
Curr Opin Anaesthesiol ; 33(6): 732-739, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32769745

RESUMO

PURPOSE OF REVIEW: The number and the complexity of procedures taking place at ambulatory surgery centers is steadily increasing. The rate at which medically complex patients, including those with baseline neurocognitive disorders, are undergoing ambulatory procedures is seeing a concurrent rise. Given the significant physical and psychological stress associated with surgery even in the ambulatory setting, it is essential to evaluate the ability of a patient to acclimate to stressful triggers in order to assess risk of subpar medical outcomes and increased mortality. In this review, we discuss recent advances in the assessment of both cognition and frailty and describe the implementation of these tools in the ambulatory surgery setting. RECENT FINDINGS: Recent Society for Perioperative Assessment and Quality Improvement (SPAQI) recommendations for evaluating at-risk patients focus on a two-pronged approach that encompasses screening for both impaired cognition and frailty. Screening should ideally occur as early as possible, but tools such as the Mini-Cog examination and FRAIL Questionnaire are efficient and effective even when used the day of surgery in high-risk patients. SUMMARY: The recognition of at-risk patients using standardized screening and the use of this assessment to guide perioperative monitoring and interventions is essential for optimizing outcomes for the complex ambulatory surgery patient.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Disfunção Cognitiva , Idoso Fragilizado , Fragilidade/complicações , Avaliação Geriátrica/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Medição de Risco/métodos , Idoso , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Fragilidade/diagnóstico , Humanos , Pacientes Ambulatoriais , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Inquéritos e Questionários
16.
Medicine (Baltimore) ; 99(34): e21805, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846817

RESUMO

BACKGROUND: Impaired physical mobility, most often seen in people with neurological disorders (i.e., stroke and spinal cord injury survivors), musculoskeletal diseases or frailty, is a limitation in independent and purposeful physical movement of the body or one or more extremities. The physical restrictions result in negative consequences on an individual's physical and psychosocial functions. This proposal describes a systematic review protocol to determine the effectiveness and approaches of sitting Tai Chi intervention for individuals with impaired physical mobility. Our review would inform stakeholders' decisions in integrating this complementary therapy into current rehabilitation services. METHODS: Randomized controlled trials or quasi-experimental studies that compared an intervention group receiving sitting Tai Chi with a control group among adult participants with impaired physical mobility resulting from any health condition(s) will be included. Outcomes of interest will include physical and psychosocial health outcomes. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, Scopus, Web of Science, AMED, PsycINFO, SPORDiscus, PEDro, WanFang Data and China National Knowledge Infrastructure will be searched from their inception to January 2020. Additional searches will be performed to identify studies that are being refereed, to be published, unpublished or ongoing. Two reviewers will select the trials and extract data independently. The risk of bias of the included studies will be assessed using the Cochrane risk-of-bias tools. The Grading of Recommendations, Assessment, Development and Evaluation will be used to assess evidence quality for each review outcome. Data synthesis will be performed using Review Manager 5.3. When a meta-analysis is possible, we will assess the heterogeneity across the studies by computing the I statistics. RESULTS: A high-quality synthesis of current evidence of sitting Tai Chi for impaired physical mobility will be stated from several aspect using subjective reports and objective measures of performance. CONCLUSION: This protocol will present the evidence of whether sitting Tai Chi is an effective intervention for impaired physical mobility. PROSPERO REGISTRATION NUMBER: CRD 42019142681.


Assuntos
Fragilidade/reabilitação , Limitação da Mobilidade , Doenças Musculoesqueléticas/reabilitação , Doenças do Sistema Nervoso/reabilitação , Tai Ji , Fragilidade/complicações , Fragilidade/psicologia , Humanos , Doenças Musculoesqueléticas/complicações , Doenças Musculoesqueléticas/psicologia , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/psicologia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
19.
Eur Geriatr Med ; 11(5): 851-855, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32683576

RESUMO

PURPOSE: Our aim was to quantify the mortality from COVID-19 and identify any interactions with frailty and other demographic factors. METHODS: Hospitalised patients aged ≥ 70 were included, comparing COVID-19 cases with non-COVID-19 controls admitted over the same period. Frailty was prospectively measured and mortality ascertained through linkage with national and local statutory reports. RESULTS: In 217 COVID-19 cases and 160 controls, older age and South Asian ethnicity, though not socioeconomic position, were associated with higher mortality. For frailty, differences in effect size were evident between cases (HR 1.02, 95% CI 0.93-1.12) and controls (HR 1.99, 95% CI 1.46-2.72), with an interaction term (HR 0.51, 95% CI 0.37-0.71) in multivariable models. CONCLUSIONS: Our findings suggest that (1) frailty is not a good discriminator of prognosis in COVID-19 and (2) pathways to mortality may differ in fitter compared with frailer older patients.


Assuntos
Infecções por Coronavirus , Idoso Fragilizado/estatística & dados numéricos , Fragilidade , Pandemias , Pneumonia Viral , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Feminino , Fragilidade/complicações , Fragilidade/epidemiologia , Fragilidade/mortalidade , Hospitalização , Humanos , Masculino , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade
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