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1.
Artigo em Inglês | MEDLINE | ID: mdl-33408084

RESUMO

INTRODUCTION: Patients with diabetes mellitus admitted to hospital with COVID-19 have poorer outcomes. However, the drivers of poorer outcomes are not fully elucidated. We performed detailed characterization of patients with COVID-19 to determine the clinical and biochemical factors that may be drivers of poorer outcomes. RESEARCH DESIGN AND METHODS: This is a retrospective cohort study of 889 consecutive inpatients diagnosed with COVID-19 between March 9 and April 22, 2020 in a large London National Health Service Trust. Unbiased multivariate logistic regression analysis was performed to determine variables that were independently and significantly associated with increased risk of death and/or intensive care unit (ICU) admission within 30 days of COVID-19 diagnosis. RESULTS: 62% of patients in our cohort were of non-white ethnic background and the prevalence of diabetes was 38%. 323 (36%) patients met the primary outcome of death/admission to the ICU within 30 days of COVID-19 diagnosis. Male gender, lower platelet count, advancing age and higher Clinical Frailty Scale (CFS) score (but not diabetes) independently predicted poor outcomes on multivariate analysis. Antiplatelet medication was associated with a lower risk of death/ICU admission. Factors that were significantly and independently associated with poorer outcomes in patients with diabetes were coexisting ischemic heart disease, increasing age and lower platelet count. CONCLUSIONS: In this large study of a diverse patient population, comorbidity (ie, diabetes with ischemic heart disease; increasing CFS score in older patients) was a major determinant of poor outcomes with COVID-19. Antiplatelet medication should be evaluated in randomized clinical trials among high-risk patient groups.


Assuntos
/epidemiologia , Diabetes Mellitus/epidemiologia , Fragilidade/diagnóstico , Unidades de Terapia Intensiva/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Diabetes Mellitus/terapia , Feminino , Fragilidade/epidemiologia , Hospitais de Ensino , Humanos , Modelos Logísticos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida , Adulto Jovem
2.
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
3.
J Frailty Aging ; 10(1): 38-43, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33331620

RESUMO

BACKGROUND: Frailty is a biological syndrome that causes adverse events in the health of older adults. However, the Clinical Frailty Scale has not yet been culturally adapted and validated into Brazilian Portuguese language. OBJECTIVES: Our aim was to translate, reproduce and validate the Clinical Frailty Scale (CFS) for the Brazilian Portuguese language. DESIGN: An observational cross-sectional study with senior patients was conducted between Jan 2018 and Nov 2018. SETTING AND PARTICIPANTS: Volunteers aged >60 and living in Brazil. The translation and cultural adaptation of the CFS into the Portuguese language, the principles and good practices were followed. MEASUREMENTS: To conduct the validation and determine the reproducibility of an inter-observer evaluation, the patients answered the scale questions in Portuguese on two occasions, delivered by two separate examiners and separated by a 10-minute interval, on their first visit; the 36-item Short Form Survey quality-of-life questionnaire (SF-36) was also applied. Seven days later, a second visit was undertaken to perform an intra-observer reproducibility assessment. RESULTS: A total of 66 older individuals were enrolled (72 ± 8 years), the majority of which did not present frailty (63.6%) and reported a low physical limitation level in the SF-36. The CFS showed a significant correlation with the SF-36 quality-of-life questionnaire (r= -0.663; p<0.0001) and no statistical difference was observed between intra-rater (p=0.641) and inter-rater (p=0.350) applications, demonstrating the reproducibility and applicability of the instrument. The standard error estimate (SEE) was evaluated and there were no differences between the CFS and the SF-36 (SEE= 1.13 points). CONCLUSION: The Brazilian Portuguese language version of the CFS is a valid, reproducible and reliable instrument for evaluating the impact of frailty on the lives of senior patients.


Assuntos
Fragilidade , Idioma , Inquéritos e Questionários/normas , Idoso , Brasil , Estudos Transversais , Fragilidade/diagnóstico , Humanos , Reprodutibilidade dos Testes , Traduções
4.
J Frailty Aging ; 10(1): 44-48, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33331621

RESUMO

BACKGROUND: While a multitude of definitions and operationalizations of frailty have been developed, rarely have these considered the perspective of the older adult themselves. This knowledge gap was addressed by examining older adults' self-rating of frailty. OBJECTIVES: To assess the validity of self-rated frailty and to determine whether self-rated frailty relates to mortality. DESIGN: The Manitoba Follow-up Study was initiated in 1948 as a prospective cohort study of 3,983 men. SETTING: Community dwelling older adult men. PARTICIPANTS: Survivors of the original cohort (231 men) were sent a quality of life survey in 2015. A response was received from 186 men, including 146 surveys completed by the participant himself and thus were eligible to include (completion rate of 78.4%). MEASUREMENTS: The quality of life survey is sent out annually to the study participants to ascertain information about mental, physical, and social functioning. In 2015, the Clinical Frailty Scale was adapted and added to the survey as a simple self-rating of frailty. RESULTS: The mean age of the 146 respondents in 2015 was 93.7 years (SD 2.7) Self-ratings of "moderate-severe" frailty, received from 132 men, were associated with worse measures of physical health and functional impairment, thus supporting the significance of self-rated frailty. Adjusted for age, the Hazard Ratio for mortality over the next 3 years was 3.3 (95% CI: 1.5, 7.1) for those who rated themselves as "mildly to severely frail" vs. "very fit or well, with no disease". CONCLUSION: The present study has illustrated that self-rated frailty is associated with other measures of health and that self-rated frailty predicts mortality over a three-year period. These findings support the utilization of older adult's self-ratings of frailty for new avenues of operationalizing frailty.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Mortalidade/tendências , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Fragilidade/psicologia , Humanos , Vida Independente , Masculino , Manitoba/epidemiologia , Debilidade Muscular , Estudos Prospectivos , Qualidade de Vida
5.
J Frailty Aging ; 10(1): 49-55, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33331622

RESUMO

BACKGROUND: Physical therapy initiated early in an ICU stay may reduce functional deficits in critically ill patients; however, the association of frailty with outcomes in those receiving early in-ICU rehabilitation is unknown. OBJECTIVE: To estimate the association between frailty and 3 outcomes in patients enrolled in an ICU randomized clinical trial (RCT). DESIGN: Exploratory secondary analyses of the CYCLE pilot RCT (NCT02377830). SETTING: 7 Canadian ICUs. PARTICIPANTS: Previously ambulatory critically ill adults. INTERVENTION: Participants were randomized to early in-bed cycling plus routine physiotherapy versus early routine physiotherapy alone. MEASUREMENTS: Using regression analyses, we modelled the association between pre-hospital Clinical Frailty Scale (CFS) scores, Physical Function in ICU Test-scored (PFIT-s), muscle strength, and mortality at hospital discharge, adjusting for illness severity (APACHE II) and the randomized intervention. We explored the influence of imputing mean PFIT-s and strength scores for decedents, and with listwise deletion of decedents in a sensitivity analysis. RESULTS: Of 66 patients, 2 had missing data, 2 had incomplete data, and 21 died by hospital discharge. At hospital discharge for 66 patients, frailty was not associated with PFIT-s (mean difference (MD) [95% CI]=0.20, [-2.08, 2.74]) or muscle strength (1.96, [-12.6, 16.6]). A sensitivity analysis yielded consistent results. Frailty was also not associated with hospital mortality (odds ratio 0.91, [0.28 to 2.93]). CONCLUSION: We found no association between pre-hospital frailty, physical function, strength, or mortality at hospital discharge in critically ill patients enrolled in an early rehabilitation trial. Larger sample sizes are needed to further explore the association of frailty with these outcomes at hospital discharge.


Assuntos
Fragilidade/diagnóstico , Unidades de Terapia Intensiva , Força Muscular/fisiologia , Reabilitação , Canadá , Estado Terminal , Humanos , Respiração Artificial
6.
J Frailty Aging ; 10(1): 56-62, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33331623

RESUMO

BACKGROUND: In frail older people with natural teeth factors like polypharmacy, reduced salivary flow, a decrease of oral self-care, general healthcare issues, and a decrease in dental care utilization contribute to an increased risk for oral complications. On the other hand, oral morbidity may have a negative impact on frailty. OBJECTIVE: This study explored associations between oral health and two frailty measures in community-dwelling older people. DESIGN: A cross-sectional study. SETTING: The study was carried out in a Primary Healthcare Center (PHC) in The Netherlands. PARTICIPANTS: Of the 5,816 persons registered in the PHC, 1,814 persons were eligible for participation at the start of the study. MEASUREMENTS: Two frailty measures were used: 1. Being at risk for frailty, using Electronical Medical Record (EMR) data, and: 2. Survey-based frailty using 'The Groningen Frailty Indicator' (GFI). For oral health measures, dental-record data (dental care utilization, dental status, and oral health information) and self-reported oral problems were recorded. Univariate regression analyses were applied to determine the association between oral health and frailty, followed by age- and sex-adjusted multivariate logistic regressions. RESULTS: In total 1,202 community-dwelling older people were included in the study, 45% were male and the mean age was 73 years (SD=8). Of all participants, 53% was at risk for frailty (638/1,202), and 19% was frail based on the GFI (222/1,202). A dental emergency visit (Odds Ratio (OR)= 2.0, 95% Confidence Interval (CI)=1.33;3.02 and OR=1.58, 95% CI=1.00;2.49), experiencing oral problems (OR=2.07, 95% CI=1.52;2.81 and OR=2.87, 95% CI= 2.07;3.99), and making dietary adaptations (OR=2.66, 95% CI=1.31;5.41 and OR=5.49, 95% CI= 3.01;10.01) were associated with being at risk for frailty and survey-based frailty respectively. CONCLUSIONS: A dental emergency visit and self-reported oral health problems are associated with frailty irrespective of the approach to its measurement. Healthcare professionals should be aware of the associations of oral health and frailty in daily practice.


Assuntos
Idoso Fragilizado , Fragilidade/epidemiologia , Saúde Bucal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Fragilidade/diagnóstico , Avaliação Geriátrica , Humanos , Vida Independente , Masculino , Países Baixos/epidemiologia
7.
Hu Li Za Zhi ; 67(6): 51-60, 2020 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-33274426

RESUMO

BACKGROUND: Most advanced lung cancer patients have already received many types of treatment before starting immunotherapy. Compared with advanced lung cancer patients under first-line treatment, those receiving immunotherapy are vulnerable to many health problems and increased frailty. PURPOSE: This study was designed to investigate frailty in advanced lung cancer patients before starting immunotherapy. METHODS: A total of 52 pre-immunotherapy patients completed the survey. Frailty status was determined using the Fried standard and survey questionnaires included the Barthel Index, Center for Epidemiologic Studies Depression Scale, the Chinese version of scales of international physical activities questionnaire (short version). In addition, the handgrip and 4.6-meter walk speed of the participants were measured. RESULTS: The ratio of frailty was 17.3%, with comorbidities (p = .023), body mass index (p = .004), Eastern Cooperative Oncology Group Status (p < .001), activities of daily living status (p < .001), albumin (p = .042), and C-reactive protein (p = .048) all associated with frailty. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: In this study, weight loss and low physical activity were the main symptoms of frailty in patients with advanced lung cancer. Therefore, healthcare workers should assess the nutrition and physical activity status of patients before initiating immunotherapy. We suggest that clinical care workers provide frailty care to patients before administering immunotherapy.


Assuntos
Idoso Fragilizado , Fragilidade/diagnóstico , Neoplasias Pulmonares/diagnóstico , Atividades Cotidianas , Idoso , Feminino , Avaliação Geriátrica/métodos , Força da Mão , Humanos , Imunoterapia , Neoplasias Pulmonares/terapia , Masculino , Pacientes
10.
BMC Med ; 18(1): 355, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33167965

RESUMO

BACKGROUND: Frailty has been associated with worse prognosis following COVID-19 infection. While several studies have reported the association between frailty and COVID-19 mortality or length of hospital stay, there have been no community-based studies on the association between frailty and risk of severe infection. Considering that different definitions have been identified to assess frailty, this study aimed to compare the association between frailty and severe COVID-19 infection in UK Biobank using two frailty classifications: the frailty phenotype and the frailty index. METHODS: A total of 383,845 UK Biobank participants recruited 2006-2010 in England (211,310 [55.1%] women, baseline age 37-73 years) were included. COVID-19 test data were provided by Public Health England (available up to 28 June 2020). An adapted version of the frailty phenotype derived by Fried et al. was used to define frailty phenotype (robust, pre-frail, or frail). A previously validated frailty index was derived from 49 self-reported questionnaire items related to health, disease and disability, and mental wellbeing (robust, mild frailty, and moderate/severe frailty). Both classifications were derived from baseline data (2006-2010). Poisson regression models with robust standard errors were used to analyse the associations between both frailty classifications and severe COVID-19 infection (resulting in hospital admission or death), adjusted for sociodemographic and lifestyle factors. RESULTS: Of UK Biobank participants included, 802 were admitted to hospital with and/or died from COVID19 (323 deaths and 479 hospitalisations). After analyses were adjusted for sociodemographic and lifestyle factors, a higher risk of COVID-19 was observed for pre-frail (risk ratio (RR) 1.47 [95% CI 1.26; 1.71]) and frail (RR 2.66 [95% CI 2.04; 3.47]) individuals compared to those classified as robust using the frailty phenotype. Similar results were observed when the frailty index was used (RR mildly frail 1.46 [95% CI 1.26; 1.71] and RR moderate/severe frailty 2.43 [95% CI 1.91; 3.10]). CONCLUSIONS: Frailty was associated with a higher risk of severe COVID-19 infection resulting in hospital admission or death, irrespective of how it was measured and independent of sociodemographic and lifestyle factors. Public health strategies need to consider the additional risk that COVID-19 poses in individuals with frailty, including which additional preventive measures might be required.


Assuntos
Infecções por Coronavirus/mortalidade , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/mortalidade , Adulto , Idoso , Betacoronavirus , Bancos de Espécimes Biológicos , Infecções por Coronavirus/epidemiologia , Inglaterra/epidemiologia , Feminino , Fragilidade/fisiopatologia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia Viral/epidemiologia , Medição de Risco , Autorrelato , Reino Unido
11.
Rev Med Suisse ; 16(714): 2160-2164, 2020 Nov 11.
Artigo em Francês | MEDLINE | ID: mdl-33174697

RESUMO

What are the criteria for admitting an elderly polymorbid patient to intensive care ? The multidimensional geriatric evaluation is a tool to screen for geriatric syndromes, with the division of elderly patients into 3 categories: robust, vulnerable and dependent. Targeting certain co-morbidities such as cognitive disorders, delirium, frailty, polymedication and malnutrition, allows clinicians to estimate the risks of mortality and functional and cognitive handicaps during a stay in intensive care. Based on a review of the literature, this article offers some guidelines for triage of older patients for admission to intensive care, using an ethical, multidisciplinary approach that takes into account the patient's fears and preferences.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Idoso , Transtornos Cognitivos/diagnóstico , Delírio/diagnóstico , Idoso Fragilizado/psicologia , Humanos , Desnutrição/diagnóstico
12.
BMC Geriatr ; 20(1): 443, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33143651

RESUMO

BACKGROUND: Focus on frailty status has become increasingly important when determining care plans within and across health care sectors. A standardized frailty measure applicable for both primary and secondary health care sectors is needed to provide a common reference point. The aim of this study was to translate the Clinical Frailty Scale (CFS) into Danish (CFS-DK) and test inter-rater reliability for key health care professionals in the primary and secondary sectors using the CFS-DK. METHODS: The Clinical Frailty Scale was translated into Danish using the ISPOR principles for translation and cultural adaptation that included forward and back translation, review by the original developer, and cognitive debriefing. For the validation exercise, 40 participants were asked to rate 15 clinical case vignettes using the CFS-DK. The raters were distributed across several health care professions: primary care physicians (n = 10), community nurses (n = 10), hospital doctors from internal medicine (n = 10) and intensive care (n = 10). Inter-rater reliability was assessed using intraclass correlation coefficients (ICC), and sensitivity analysis was performed using multilevel random effects linear regression. RESULTS: The Clinical Frailty Scale was translated and culturally adapted into Danish and is presented in this paper in its final form. Inter-rater reliability in the four professional groups ranged from ICC 0.81 to 0.90. Sensitivity analysis showed no significant impact of professional group or length of clinical experience. The health care professionals considered the CFS-DK to be relevant for their own area of work and for cross-sectoral collaboration. CONCLUSION: The Clinical Frailty Scale was translated and culturally adapted into Danish. The inter-rater reliability was high in all four groups of health care professionals involved in cross-sectoral collaborations. However, the use of case vignettes may reduce the generalizability of the reliability findings to real-life settings. The CFS has the potential to serve as a common reference tool when treating and rehabilitating older patients.


Assuntos
Fragilidade , Dinamarca/epidemiologia , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Humanos , Reprodutibilidade dos Testes , Tradução , Traduções
13.
BMC Geriatr ; 20(1): 393, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028215

RESUMO

BACKGROUND: Frailty is increasingly recognized as an important construct which has health implications for older adults. The Clinical Frailty Scale (CFS) is a judgement-based frailty tool that evaluates specific domains including comorbidity, function, and cognition to generate a frailty score ranging from 1 (very fit) to 9 (terminally ill). The aim of this scoping review is to identify and document the nature and extent of research evidence related to the CFS. METHODS: We performed a comprehensive literature search to identify original studies that used the Clinical Frailty Scale. Medline OVID, Scopus, Web of Science, CINAHL, PsycINFO, Cochrane Library and Embase were searched from January 2005 to March 2017. Articles were screened by two independent reviewers. Data extracted included publication date, setting, demographics, purpose of CFS assessment, and outcomes associated with CFS score. RESULTS: Our search yielded 1688 articles of which 183 studies were included. Overall, 62% of studies were conducted after 2015 and 63% of the studies measured the CFS in hospitalized patients. The association of the CFS with an outcome was examined 526 times; CFS was predictive in 74% of the cases. Mortality was the most common outcome examined with CFS being predictive 87% of the time. CFS was associated with comorbidity 73% of the time, complications 100%, length of stay 75%, falls 71%, cognition 94%, and function 91%. The CFS was associated with other frailty scores 94% of the time. CONCLUSIONS: This scoping review revealed that the CFS has been widely used in multiple settings. The association of CFS score with clinical outcomes highlights its utility in the care of the aging population.


Assuntos
Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Exame Físico/normas , Inquéritos e Questionários/normas , Idoso , Comorbidade , Feminino , Idoso Fragilizado , Fragilidade/epidemiologia , Humanos , Exame Físico/métodos
14.
J Stroke Cerebrovasc Dis ; 29(12): 105346, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33032021

RESUMO

OBJECTIVE: Frailty is a major problem in super-aged societies. Because frailty assessments are largely unstudied in acute stroke settings, few reports have evaluated the association between pre-stroke frailty and stroke severity. The aim of this study was to determine the association between pre-stroke frailty and stroke severity in elderly patients with acute stroke. MATERIALS AND METHODS: This cross-sectional study enrolled consecutive elderly patients with acute stroke. We assessed stroke severity with the National Institutes of Stroke Scale (NIHSS), and pre-stroke frailty with a Frailty Screening Index in elderly patients with acute stroke. Patients were divided according to their Frailty Screening Index: the robust group, pre-frailty group, and frailty group. Multiple linear regression analysis was used to determine whether pre-stroke frailty was independently associated with NIHSS score. RESULTS: In total, 234 elderly patients with acute stroke (age: 75.7 years; 149 men, 85 women) were enrolled in this study. Of these, the robust group comprised 76 patients, the pre-frailty group comprised 129 patients, and the frailty group comprised 29 patients. The prevalence of pre-stroke frailty was 12.4%. Multiple linear regression analysis showed that pre-stroke pre-frailty and frailty were significantly associated with NIHSS score (pre-frailty; ß = 1.191, P = .005, frailty; ß = 1.708, P = .009). CONCLUSIONS: The present study indicated that the pre-stroke frailty was significantly associated with stroke severity in elderly patients with acute stroke. Additional study is needed to clarify the association between pre-stroke frailty and post-stroke prognosis.


Assuntos
Avaliação da Deficiência , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Acidente Vascular Cerebral/diagnóstico , Inquéritos e Questionários , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Fragilidade/epidemiologia , Humanos , Japão/epidemiologia , Masculino , Valor Preditivo dos Testes , Prevalência , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/epidemiologia
15.
PLoS One ; 15(10): e0240128, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33048965

RESUMO

Physical inactivity and a sedentary lifestyle are associated with a chronic low-level inflammatory state which has been implicated in the pathogenesis of cardiovascular disease. There is growing interest in exercise programs as part of surgical 'prehabilitation'. We therefore studied preoperative physical activity levels of patients undergoing elective Coronary Artery Bypass Graft (CABG) surgery, and performed an exploratory analysis of the influence of physical activity on postoperative outcome. The Short Questionnaire to Assess Health (SQUASH) was used to assess physical activity among 100 patients, of mean (SD) age 65.4 (7.6) years. Additionally, handgrip strength was measured, and the get-up-and-go test was conducted. Anxiety, depression, and quality of life were assessed, and a computerised cognitive test battery was used to assess cognitive performance preoperatively, and three months after surgery. Preoperatively, 76% of patients met the recommended national guidelines for physical activity. The incidence of pre-existing medical conditions, and other pre-operative patient features were similar in active and inactive patients. Preoperative physical activity was significantly inversely related to the logistic EuroSCORE. The level of physical activity was also significantly inversely related with preoperative C-reactive protein (CRP) and peak postoperative CRP, but physical activity did not appear to be associated with any adverse postoperative outcomes or extended length of hospital stay. The incidence of postoperative neurocognitive disorder (PNCD) at 3 months postoperatively was 26%. Cognitive performance was not related with physical activity levels. In summary, this was the first study to assess activity levels of cardiac surgical patients with the SQUASH questionnaire. The majority of patients were physically active. Although physical activity was associated with lower levels of inflammation in this pilot study, it was not associated with an improved clinical or cognitive postoperative outcome.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Doença das Coronárias/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Exercício Físico/fisiologia , Transtornos Neurocognitivos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Doença das Coronárias/complicações , Doença das Coronárias/fisiopatologia , Estudos de Viabilidade , Feminino , Seguimentos , Fragilidade/diagnóstico , Fragilidade/etiologia , Fragilidade/fisiopatologia , Força da Mão/fisiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Transtornos Neurocognitivos/diagnóstico , Transtornos Neurocognitivos/etiologia , Transtornos Neurocognitivos/fisiopatologia , Testes Neuropsicológicos/estatística & dados numéricos , Projetos Piloto , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Qualidade de Vida , Fatores de Risco , Sarcopenia/diagnóstico , Sarcopenia/etiologia , Sarcopenia/fisiopatologia , Comportamento Sedentário
16.
BMC Geriatr ; 20(1): 388, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023480

RESUMO

BACKGROUND: Frailty, which is defined as aging-related multisystem impairments, can lead to adverse health outcomes. However, evidence for such a connection in Chinese older adults remains lacking. This study examined the association between frailty and future falls and disability among community-dwelling Chinese older adults. METHODS: Data were obtained from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. Participants were aged 60 years and above at baseline in 2011 and completed the follow-up survey in 2015. Outcome measures were future falls, incident disability in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and worsening performance of ADLs and IADLs. A multivariate logistic regression was conducted to examine the association between frailty phenotype and falls, incident disability, and worsening disability during a four-year period. RESULTS: We found that frail participants were at increased risk at follow-up for: falls (OR 1.54, 95% CI, 1.14-2.08); developing new ADL difficulties (OR 4.10, 95% CI, 2.79-6.03) and IADL difficulties (OR 3.06, 95% CI, 2.03-4.61); and worsening ADLs performance (OR 2.27, 95% CI, 1.27-4.06), after adjusting for potential confounders. Prefrailty was also significantly associated with future falls, incident disability in ADLs and IADLs, but with a lower magnitude of effect. CONCLUSIONS: Frailty phenotype is an independent predictor of future falls, incident disability, and worsening performance in ADLs among Chinese older adults. The association suggests the need to pay special attention in caring for frail and prefrail elders and improving individuals' frailty status.


Assuntos
Fragilidade , Acidentes por Quedas , Atividades Cotidianas , Idoso , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Seguimentos , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Humanos , Estudos Longitudinais
17.
BMC Geriatr ; 20(1): 389, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023490

RESUMO

BACKGROUND: Frailty is frequently found to be associated with increased healthcare utilisation in western countries, but little is known in Asian population. This study was conducted to investigate the association between frailty and healthcare utilisation in different care settings among community-dwelling older adults in Singapore. METHODS: Data from a population health survey among community-dwelling adults were linked with an administrative database to retrieve data of healthcare utilisation (including government primary care clinic visits, specialised outpatient clinic visits, emergency department visits, day surgery and hospitalisations) occurred during a six-month look-back period and six-month post-baseline respectively. Baseline frailty status was measured using the five-item FRAIL scale, which was categorised into three groups: robust (0), pre-frail (1-2), and frail (3-5). Negative binomial regression was applied to examine the association between frailty with respective healthcare utilisation (dependent variables), controlling for other confounding variables. RESULTS: In our sample of 701 older adults, 64.8% were of robust health, 27.7% were pre-frail, and 7.6% were frail. Compared to the robust group, frail individuals had a higher rate of specialised outpatient clinic visits (incidence rate ratio (IRR): 2.8, 95% confidence interval (CI): 1.2-6.5), emergency department visits (IRR: 3.1, 95%CI: 1.1-8.1), day surgery attendances (IRR: 6.4, 95%CI: 1.3-30.9), and hospitalisations (IRR: 6.7, 95%CI: 2.1-21.1) in the six-month period prior to the baseline and in subsequent 6 months (IRR: 3.3, 95%CI: 1.6-7.1; 6.4, 2.4-17.2; 5.8, 1.3-25.8; 13.1, 4.9-35.0; respectively), controlling for covariates. CONCLUSIONS: Frailty was positively associated with the number of specialised outpatient clinic visits, emergency department visits, day surgeries and hospitalisations occurred during 6 months prior to and after the baseline. As frailty is a potentially reversible health state with early screening and intervention, providing preventive activities that delay the onset or progression of frailty should have potential effect on delaying secondary and tertiary care utilisation.


Assuntos
Fragilidade , Idoso , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Fragilidade/terapia , Avaliação Geriátrica , Hospitalização , Humanos , Vida Independente , Aceitação pelo Paciente de Cuidados de Saúde , Singapura/epidemiologia
18.
BMC Geriatr ; 20(1): 403, 2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054731

RESUMO

BACKGROUND: It has not been clarified whether physical frailty symptoms predict social. frailty. The purpose of this study was to elucidate the effect of physical frailty on social frailty, and to determine which domains of physical frailty predict the development of social frailty. METHODS: We employed a two-year prospective cohort study. A total of 342 socially robust community-dwelling older adults were recruited. We used a modified social frailty screening index consisting of four social domains including financial difficulties, living alone, social activity, and contact with neighbors. Physical frailty status was also assessed at baseline. At the two-year follow-up, we assessed the development of social frailty. Social status was assessed using four social subdomains for the primary analysis. Social status was assessed using the two social subdomains of social activity and contact with neighbors, which would be affected by the physical frailty component, for the secondary analysis. The risk ratios (RR) of physical frailty for the development of social frailty were estimated. RESULTS: Although physical frailty symptoms were not a significant risk factor for future development of social frailty as assessed by four social subdomains (adjusted RR 1.39, 95% CI 0.95-2.15), it became significant when development of social frailty was assessed by the two social subdomains (adjusted RR 1.78, 95% CI 1.10-2.88). An analysis using the physical frailty subdomain showed that slow gait speed (adjusted RR 3.41, 95% CI 1.10-10.53) and weakness (adjusted RR 1.06, 95% CI 1.01-1.12) were independent risk factors for development of social frailty as assessed by two social subdomains. CONCLUSIONS: Physical frailty symptoms predict the development of social frailty. Among physical frailty subdomains, gait speed and muscle strength are critical independent risk factors for future decline in the social aspect. The prevention of physical frailty, especially by maintaining gait ability and muscle strength, may be effective for avoiding social frailty.


Assuntos
Fragilidade , Idoso , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Vida Independente , Estudos Prospectivos , Velocidade de Caminhada
19.
BMC Geriatr ; 20(1): 414, 2020 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-33076841

RESUMO

BACKGROUND: Frailty is now seen as a significant factor in older people with diabetes, whose mortality and disability increased. This study aims to investigate the association between calf circumference (CC) with frailty in diabetic adults aged over 80 years. METHODS: A cross-sectional analysis was performed on the data of 426 diabetic adults aged over 80 years. On admission, demographic data and laboratory parameters were recorded. CC was measured on the lower right leg at the point of the maximal circumference. All participants accepted frailty assessments. Frailty was mainly defined using the Fried frailty phenotype criteria. RESULTS: The CC levels were significantly lower in the frail than the non-frail (26.7 ± 4.0 vs. 31.2 ± 4.0, P < 0.001). CC was negatively correlated with the Fried frailty phenotype index (P < 0.001). Logistic regression analysis of frailty revealed that age (Odds Ratio (OR), 1.368; 95% Confidential Interval (CI) 1.002-1.869; P = 0.049), CC (OR, 0.756; 95%CI 0.598-0.956; P = 0.019) were independent impact factors of frailty after adjusting all the potential confounders. Participants with low CC tertile had a significantly higher Fried frailty phenotype index than those with high CC tertiles. The best CC cut-off value for predicting frailty was 29.3 cm, its sensitivity was 75.0%, and the specificity was 78.6%, and areas under the curve (AUC) was 0.786 (P < 0.001). CONCLUSIONS: CC was strongly related to frailty in diabetic adults aged over 80 years, suggesting that CC may be helpful for monitoring physical frailty in older adults in clinical and research settings.


Assuntos
Diabetes Mellitus , Fragilidade , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Perna (Membro)
20.
BMC Geriatr ; 20(1): 420, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-33087053

RESUMO

BACKGROUND: Apelin, an active endogenous peptide, has been recently receiving great attention as a promising target for antiaging intervention, primarily based on results from genetically altered mice. To validate previous experimental data and investigate the possible role of apelin in humans, in this study, we examined serum apelin level in relation to frailty and its associated parameters in a cohort of ambulatory, community-dwelling older adults. METHODS: Blood samples were collected from 80 participants who underwent a comprehensive geriatric assessment, and apelin level was measured using an enzyme immunoassay kit. Phenotypic frailty and deficit-accumulation frailty index (FI) were assessed using widely validated approaches, proposed by Fried and Rockwood groups, respectively. RESULTS: After adjustment for sex, age, and body mass index, serum apelin level was found to be not significantly different according to phenotypic frailty status (P = 0.550) and not associated with FI, grip strength, gait speed, time to complete 5 chair stands, and muscle mass (P = 0.433 to 0.982). To determine whether the association between serum apelin level and frailty has a threshold effect, we divided the participants into quartiles according to serum apelin level. However, there were no differences in terms of frailty-related parameters and the risk for frailty among the quartile groups (P = 0.248 to 0.741). CONCLUSIONS: The serum apelin level was not associated with both phenotypic frailty and functional parameters in older adults, despite its beneficial effects against age-related physiologic decline in animal models. Further large-scale longitudinal studies are necessary to understand the definite role of circulating apelin in frailty risk assessment.


Assuntos
Fragilidade , Idoso , Animais , Apelina , Estudos Transversais , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Humanos , Camundongos
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