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1.
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
2.
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
3.
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
4.
Int Heart J ; 60(6): 1366-1372, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31735775

RESUMO

The Kihon Checklist (KCL) is a reliable tool for determining frailty status in the elderly. However, there is no information in the literature about the relationship between frailty status and exercise capacity. Here, we examined the associations between cardiopulmonary exercise testing parameters and frailty status in elderly patients with stable heart failure (HF).Ninety-two elderly patients with stable HF were evaluated using cardiopulmonary exercise testing and the KCL. A KCL score of 0-3 was classified as robust, 4-7 as pre-frail, and ≥ 8 as frail.Mean age, peak VO2, and KCL score were 81.7 years, 13.2 mL/kg/minute, and 10.7, respectively. KCL score was significantly correlated with peak VO2 (r = -0.527, P < 0.001) and peak work rate (r = -0.632, P < 0.001). In patients with frailty (n = 63), the peak work rate (WR) was significantly lower than it was in patients without frailty (n = 29; 39.9 versus 69.5 W, respectively; P < 0.001). Multivariate analysis revealed that peak WR and peak systolic blood pressure were significant, independent predictors of frailty (ß = -0.108 and -0.045, respectively). In a diagnostic performance plot analysis, a cutoff value for peak WR of 51.9 W was the best predictor of frailty.Frailty status was significantly associated with peak WR and peak systolic blood pressure in elderly patients with stable HF. Therefore, cardiopulmonary exercise testing may be useful for assessing frailty status in this patient population.


Assuntos
Tolerância ao Exercício/fisiologia , Exercício/fisiologia , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Lista de Checagem , Teste de Esforço , Feminino , Fragilidade/complicações , Insuficiência Cardíaca/complicações , Humanos , Masculino , Consumo de Oxigênio/fisiologia , Valor Preditivo dos Testes
5.
J Frailty Aging ; 8(4): 176-179, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637402

RESUMO

The preponderance of studies on frailty assessment in critically ill adults have used the Clinical Frailty Scale (CFS) to quantify frailty and previous research suggests that surrogates were more likely to be optimistic than physicians in their CFS scores. Whether discordance between surrogates and physicians was relevant to prognosis has been underexplored. Therefore, in a prospective observational cohort of 298 critically ill older adults, we aimed 1) to describe factors related to discordance and 2) to estimate the relationship between such discordance and hospital mortality and other short-term outcomes. Discordance between surrogates and physician was present in 89/298 (29.9%) and independently associated with a higher risk of hospital mortality. Discordance was not associated with markers of intensity of treatment such as intubation, blood transfusion, incident dialysis for acute renal failure and prolonged hospital length of stay. Understanding factors relevant to discordance between physicians and surrogates may lend further insights into short-term prognosis for older adults with critical illness.


Assuntos
Estado Terminal/mortalidade , Fragilidade/diagnóstico , Mortalidade Hospitalar/tendências , Idoso , Humanos , Variações Dependentes do Observador , Prognóstico , Estudos Prospectivos
6.
J Frailty Aging ; 8(4): 215-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637409

RESUMO

Multiple myeloma is a malignant plasma cell disease, which typically affects older patients, with a median age at diagnosis of 70 years. The challenge in treating older patients is to accurately identify 'fit' patients that can tolerate more intensive treatment to maximize disease control, while simultaneously identifying vulnerable or 'frail' patients who may develop toxicity with significant morbidity and mortality, requiring different treatment options or dose modification. Multiple frailty scores have been devised for multiple myeloma over the years in newly-diagnosed patients. This paper gives an overview of the three common frailty measurements: the International Myeloma Working Group Frailty Score, Mayo Clinic Frailty Score and the Revised Myeloma Co-Morbidity Index. We will summarize the derivation, validation, usability and applicability of these scores in different clinical settings, emphasizing the main strengths and limitations for each index score. We will also highlight future directions in the operationalization of frailty in multiple myeloma.


Assuntos
Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Mieloma Múltiplo/epidemiologia , Idoso , Idoso Fragilizado , Humanos , Reprodutibilidade dos Testes
8.
Mayo Clin Proc ; 94(10): 1994-2003, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31585582

RESUMO

OBJECTIVE: To determine whether a low Braden skin score (BSS), reflecting increased risk for skin pressure injury, would predict lower survival in cardiac intensive care unit (CICU) patients after adjustment for illness severity and comorbidities. PATIENTS AND METHODS: This retrospective cohort study included consecutive unique adult patients admitted to a single tertiary care referral hospital CICU from January 1, 2007, through December 31, 2015, who had a BSS documented on CICU admission. The primary outcome was all-cause hospital mortality, using elastic net penalized logistic regression to determine predictors of hospital mortality. The secondary outcome was all-cause post-discharge mortality, using Cox proportional hazards models to determine predictors of post-discharge mortality. RESULTS: The study included 9552 patients with a mean age of 67.4±15.2 years (3589 [37.6%] were females) and a hospital mortality rate of 8.3%. Admission BSS was inversely associated with hospital mortality (unadjusted odds ratio, 0.70; 95% CI, 0.68-0.72; P<.001; area under the receiver operator curve, 0.80; 95% CI, 0.78-0.82), with increased short-term mortality as a function of decreasing admission BSS. After adjustment for illness severity and comorbidities using multivariable analysis, admission BSS remained inversely associated with hospital mortality (adjusted odds ratio, 0.88; 95% CI, 0.85-0.92; P<.001). Among hospital survivors, admission BSS was inversely associated with post-discharge mortality after adjustment for illness severity and comorbidities (adjusted hazard ratio, 0.89; 95% CI, 0.88-0. 90; P<.001). CONCLUSION: The admission BSS, a simple inexpensive bedside nursing assessment potentially reflecting frailty and overall illness acuity, was independently associated with hospital and post-discharge mortality when added to established multiparametric illness severity scores among contemporary CICU patients.


Assuntos
Fragilidade/diagnóstico , Fragilidade/mortalidade , Avaliação Geriátrica/métodos , Mortalidade Hospitalar , Lesão por Pressão/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos de Coortes , Unidades de Cuidados Coronarianos , Feminino , Fragilidade/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Valor Preditivo dos Testes , Lesão por Pressão/complicações , Prognóstico , Estudos Retrospectivos
9.
Lancet ; 394(10206): 1376-1386, 2019 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-31609229

RESUMO

Frailty is a complex age-related clinical condition characterised by a decline in physiological capacity across several organ systems, with a resultant increased susceptibility to stressors. Because of the heterogeneity of frailty in clinical presentation, it is important to have effective strategies for the delivery of care that range across the continuum of frailty severity. In clinical practice, we should do what works, starting with frailty screening, case identification, and management of frailty. This process is unarguably difficult given the absence of an adequate evidence base for individual and health-system interventions to manage frailty. We advocate change towards individually tailored interventions that preserve an individual's independence, physical function, and cognition. This change can be addressed by promoting the recognition of frailty, furthering advancements in evidence-based treatment options, and identifying cost-effective care delivery strategies.


Assuntos
Assistência à Saúde , Fragilidade/diagnóstico , Fragilidade/terapia , Fragilidade/epidemiologia , Humanos
10.
BMC Med ; 17(1): 185, 2019 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-31575376

RESUMO

BACKGROUND: The identification of individuals at increased risk of poor health-related outcomes is a priority. Geriatric research has proposed several indicators shown to be associated with these outcomes, but a head-to-head comparison of their predictive accuracy is still lacking. We therefore aimed to compare the accuracy of five geriatric health indicators in predicting different outcomes among older persons: frailty index (FI), frailty phenotype (FP), walking speed (WS), multimorbidity, and a summary score including clinical diagnoses, functioning, and disability (the Health Assessment Tool; HAT). METHODS: Data were retrieved from the Swedish National Study on Aging and Care in Kungsholmen, an ongoing longitudinal study including 3363 people aged 60+. To inspect the accuracy of geriatric health indicators, we employed areas under the receiver operating characteristic curve (AUC) for the prediction of 3-year and 5-year mortality, 1-year and 3-year unplanned hospitalizations (1+), and contacts with healthcare providers in the 6 months before and after baseline evaluation (2+). RESULTS: FI, WS, and HAT showed the best accuracy in the prediction of mortality [AUC(95%CI) for 3-year mortality 0.84 (0.82-0.86), 0.85 (0.83-0.87), 0.87 (0.85-0.88) and AUC(95%CI) for 5-year mortality 0.84 (0.82-0.86), 0.85 (0.83-0.86), 0.86 (0.85-0.88), respectively]. Unplanned hospitalizations were better predicted by the FI [AUC(95%CI) 1-year 0.73 (0.71-0.76); 3-year 0.72 (0.70-0.73)] and HAT [AUC(95%CI) 1-year 0.73 (0.71-0.75); 3-year 0.71 (0.69-0.73)]. The most accurate predictor of multiple contacts with healthcare providers was multimorbidity [AUC(95%CI) 0.67 (0.65-0.68)]. Predictions were generally less accurate among younger individuals (< 78 years old). CONCLUSION: Specific geriatric health indicators predict clinical outcomes with different accuracy. Comprehensive indicators (HAT, FI, WS) perform better in predicting mortality and hospitalization. Multimorbidity exhibits the best accuracy in the prediction of multiple contacts with providers.


Assuntos
Avaliação Geriátrica/métodos , Indicadores Básicos de Saúde , Idoso , Idoso de 80 Anos ou mais , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Fragilidade/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mortalidade , Valor Preditivo dos Testes , Prognóstico , Suécia/epidemiologia
11.
Clin Interv Aging ; 14: 1643-1648, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31564844

RESUMO

Purpose: Oral frailty or the loss of oral functionality can be a symptomatic precursor of overall frailty. Previous studies have suggested that decreased tongue pressure causes a decline in ingesting and swallowing function and poor nutrition. This study investigated what factor(s) contribute to tongue pressure, thereby leading to frailty. Patients and methods: For the purposes of the present study, 467 residents of Hirosaki city in northern Japan aged≥60 years who completed a questionnaire about frailty and underwent an intraoral assessment, which included number of teeth, presence or absence of periodontitis, tongue pressure, and oral diadochokinesis (ODK) were recruited. Results: Of the 467 participants with complete data sets, frailty was identified in 13 (7.5%) of 173 males and in 34 (11.6%) of 294 females. Significantly fewer teeth, lower tongue pressure, and a reduced diadochokinetic syllable rate were more prevalent among frail than among healthy residents. Multivariable logistic regression analysis revealed that age, body mass index, number of teeth, and tongue pressure significantly contributed to frailty, whereas ODK did not. Multiple regression analysis showed that tongue pressure was positively associated with muscle index and number of teeth. Conclusion: The results of the present study suggest that fewer teeth and lower tongue pressure, but not ODK function, are risk factors for developing overall frailty among older residents.


Assuntos
Fragilidade/diagnóstico , Contração Isométrica/fisiologia , Saúde Bucal , Língua/fisiologia , Idoso , Feminino , Fragilidade/fisiopatologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Pressão , Fatores de Risco
12.
Ann Acad Med Singapore ; 48(6): 171-180, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31377761

RESUMO

INTRODUCTION: Frailty begins in middle life and manifests as a decline in functional fitness. We described a model for community frailty screening and factors associated with prefrailty and frailty and fitness measures to distinguish prefrail/frail from robust older adults. We also compared the Fatigue, Resistance, Ambulation, Illnesses and Loss of weight (FRAIL) scale against Fried frailty phenotype and Frailty Index (FI). MATERIALS AND METHODS: Community-dwelling adults ≥55 years old were designated robust, prefrail or frail using FRAIL. The multidomain geriatric screen included social profiling and cognitive, psychological and nutritional assessments. Physical fitness assessments included flexibility, grip strength, upper limb dexterity, lower body strength and power, tandem and dynamic balance and cardiorespiratory endurance. RESULTS: In 135 subjects, 99 (73.3%) were robust, 34 (25.2%) were prefrail and 2 (1.5%) were frail. After adjusting for age and sex, depression (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.05-7.90; P = 0.040) and malnutrition (OR, 6.07; 95% CI, 2.52-14.64; P <0.001) were independently associated with prefrailty/frailty. Prefrail/frail participants had significantly poorer performance in upper limb dexterity (P = 0.030), lower limb power (P = 0.003), tandem and dynamic balance (P = 0.031) and endurance (P = 0.006). Except for balance and flexibility, all fitness measures differentiated prefrail/frail from robust women. In men, only lower body strength was significantly associated with frailty. Area under receiver operating characteristic curves for FRAIL against FI and Fried were 0.808 (0.688-0.927, P <0.001) and 0.645 (0.546-0.744, P = 0.005), respectively. CONCLUSION: Mood and nutrition are targets in frailty prevention. Physical fitness declines early in frailty and manifests differentially in both genders.


Assuntos
Depressão/epidemiologia , Fragilidade/diagnóstico , Desnutrição/epidemiologia , Força Muscular , Resistência Física , Aptidão Física , Atividades Cotidianas , Idoso , Teste de Esforço , Feminino , Fragilidade/epidemiologia , Avaliação Geriátrica , Força da Mão , Humanos , Vida Independente , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Razão de Chances , Características de Residência , Fatores de Risco , Fatores Sexuais , Singapura/epidemiologia , Classe Social , Teste de Caminhada
13.
Maturitas ; 127: 1-11, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351514

RESUMO

OBJECTIVES: We sought to identify frailty profiles in individuals aged 50-75 by considering frailty as an unobservable latent variable in a latent class analysis (LCA). STUDY DESIGN: 589 prospectively enrolled community-dwelling individuals aged 50-75 (median: 61.7 years) had undergone a standardized, multidomain assessment in 2010-2015. Adverse health outcomes (non-accidental falls, fractures, unplanned hospitalizations, and death) that had occurred since the assessment were recorded in 2016-2017. MAIN OUTCOME MEASURES: The LCA used nine indicators (unintentional weight loss, relative slowness, weakness, impaired balance, osteoporosis, impaired cognitive functions, executive dysfunction, depression, and hearing impairment) and three covariates (age, gender, and consultation for health complaints). The resulting profiles were characterized by the Fried phenotype and adverse health outcomes. RESULTS: We identified five profiles: "fit" (LC1, 29.7% of the participants; median age: 59 years); "weight loss, relative slowness, and osteoporosis" (LC2, 33.2%; 63 years); "weakness and osteopenia" (LC3, 21.9%; 60 years); "impaired physical and executive functions" (LC4, 11%; 67 years); and "impaired balance, cognitive functions, and depression" (LC5, 4.3%; 70 years). Almost all members of LC3 and LC4 were female, and were more likely than members of other profiles to have a frail or pre-frail Fried phenotype. Non-accidental falls were significantly more frequent in LC4. LC5 (almost all males) had the highest number of comorbidities and cardiovascular risk factors but none was frail. CONCLUSIONS: Our data-driven approach covered most geriatric assessment domains and identified five frailty profiles. With a view to tailoring interventions and prevention, frailty needs to be detected among young seniors.


Assuntos
Fragilidade/diagnóstico , Vida Independente/estatística & dados numéricos , Idoso , Feminino , Idoso Fragilizado , Avaliação Geriátrica/métodos , Inquéritos Epidemiológicos , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade
14.
Anesthesiol Clin ; 37(3): 423-436, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31337476

RESUMO

Older patients undergoing surgery have reduced physiologic reserve caused by the combined impact of physiologic age-related changes and the increased burden of comorbid conditions. The preoperative assessment of older patients is directed at evaluating the patient's functional reserve and identifying opportunities to minimize any potential for complications. In addition to a standard preoperative evaluation that includes cardiac risk and a systematic review of systems, the evaluation should be supplemented with a review of geriatric syndromes. Age-based laboratory testing protocols can lead to unnecessary testing, and all testing should be requested if indicated by underlying disease and surgical risk.


Assuntos
Avaliação Geriátrica/métodos , Cuidados Pré-Operatórios/normas , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/diagnóstico , Humanos , Medição de Risco
15.
Anesthesiol Clin ; 37(3): 453-474, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31337478

RESUMO

Understanding geriatric physiology is critical for successful perioperative management of older surgical patients. The frailty syndrome is evolving as an important, potentially modifiable process capturing a patient's biologic age and is more predictive of adverse perioperative outcomes than chronologic age. Use of frailty in risk stratification and perioperative decision-making allows providers to effectively diagnose, risk stratify, and treat patients in the perioperative setting. Further study is needed to develop a universal definition of frailty, to identify comprehensive yet feasible screening tools that allow for accurate detection of frailty in the perioperative setting, and to refine treatment programs for frail surgical patients.


Assuntos
Envelhecimento/patologia , Fragilidade/fisiopatologia , Diretivas Antecipadas , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Idoso Fragilizado , Fragilidade/diagnóstico , Cirurgia Geral , Avaliação Geriátrica , Humanos
16.
Geriatr Psychol Neuropsychiatr Vieil ; 17(3): 271-278, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31339491

RESUMO

The SEGA instrument has demonstrated good performance in screening for frailty. However, its predictive ability in elderly patients presenting with acute coronary syndrome have never been evaluated. We aimed to study the prognostic value at one year of the frailty level assessed by the SEGA instrument, in a population of patients aged 80 years old or more hospitalised for acute coronary syndrome. All consecutive patients aged 80 years or older hospitalised for myocardial infarction type 1 between November 2016 and October 2017 were included. All underwent standardised geriatric assessment including estimation of frailty by the SEGA instrument. The primary outcome was the time to death from any cause. In all 64 patients were included for a mean age of 85.3±4 years. Using the SEGA instrument, 24% patients were classified "frail" and 44% "very frail"; 18 (28%) deaths were observed during follow-up. When adjusted for patient age, body mass index and arterial hypertension, survival status was not significantly related with frailty status (HR=1.1, 95% CI=0.4-3.1, p=0.8).


Assuntos
Síndrome Coronariana Aguda/fisiopatologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Síndrome Coronariana Aguda/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fragilidade/mortalidade , Humanos , Masculino , Infarto do Miocárdio/complicações , Infarto do Miocárdio/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
17.
Nutrients ; 11(8)2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31349606

RESUMO

Aging and frailty are associated with a high risk of lean mass (LM) loss, which leads to physical disability and can be effectively alleviated by protein supplementation (PS) and muscle strengthening exercise (MSE). In this study, the associations between LM gain and PS + MSE efficacy (measured using physical outcomes) in elderly patients with a high risk of sarcopenia or frailty were identified. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) reporting the efficacy of PS + MSE in elderly patients with sarcopenia or frailty. The included RCTs were analyzed using meta-analysis and risk of bias assessment. We finally included 19 RCTs in this meta-analysis with a median (range/total) Physiotherapy Evidence Database score of 7/10 (5-9/10). The PS + MSE group exhibited significant improvements in the whole-body LM (standard mean difference (SMD) = 0.66; p < 0.00001), appendicular LM (SMD = 0.35; p < 0.00001), leg strength (SMD = 0.65; p < 0.00001), and walking capability (SMD = 0.33; p = 0.0006). Meta-regression analyses showed that changes in appendicular LM were significantly associated with the effect sizes of leg strength (ß = 0.08; p = 0.003) and walking capability (ß = 0.17; p = 0.04), respectively. Our findings suggest that LM gain after PS + MSE significantly contributes to the efficacy of the intervention in terms of muscle strength and physical mobility in elderly patients with a high risk of sarcopenia or frailty.


Assuntos
Composição Corporal , Proteínas na Dieta/administração & dosagem , Suplementos Nutricionais , Terapia por Exercício , Fragilidade/prevenção & controle , Músculo Esquelético/fisiopatologia , Sarcopenia/prevenção & controle , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Proteínas na Dieta/efeitos adversos , Proteínas na Dieta/metabolismo , Suplementos Nutricionais/efeitos adversos , Terapia por Exercício/efeitos adversos , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/metabolismo , Fragilidade/fisiopatologia , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Músculo Esquelético/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Sarcopenia/diagnóstico , Sarcopenia/metabolismo , Sarcopenia/fisiopatologia , Resultado do Tratamento , Caminhada
18.
Scand Cardiovasc J ; 53(6): 348-354, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31304801

RESUMO

Objectives. Typically, patients referred to cardiac surgery are aged. Because EuroSCORE tend to overestimate and STS tend to underestimate the risk of mortality after cardiac surgery, frailty has become interesting as a potential predictor for mortality after cardiac surgery. Therefore, we conducted a study to identify the number of frail patients undergoing cardiac surgery and describe the risk of short-term complications and mortality. Design. In a prospective observational study, we have compared the surgical outcome in frail versus non-frail patients. Patients aged > 65 years and undergoing non-acute cardiac surgery were included. Frailty was assessed using the comprehensive assessment of frailty (CAF) score. The CAF evaluates the patient's physical condition through performing physical tests. Results. 604 patients included, 477 were men and the median age was 73 years (range, 65-90). Twenty-five percent were deemed frail. Frail patients had a four times higher 30-day mortality. Furthermore, frail patients had higher postoperative complication rates of atrial fibrillation, prolonged ventilation, re-operations, renal failure, transfusion requirements, and increased length of stay. Patients who died within 30 days had a significantly higher CAF score than those who survived (p = .039). Based on ROC curves, the area under the curve (AUC) for CAF score was 0.700, EuroSCORE 0.664 and STS score 0.748. Conclusion. Frailty is common in patients undergoing cardiac surgery and carries increased risk of 30-day mortality and postoperative complications. The AUC indicates similar prediction of mortality for CAF score compared to the existing risk scores. Clinical Trials Registration ID: NCT02992587.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Idoso Fragilizado , Fragilidade/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Dinamarca , Feminino , Fragilidade/diagnóstico , Avaliação Geriátrica , Humanos , Masculino , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
19.
An Sist Sanit Navar ; 42(2): 169-178, 2019 Aug 23.
Artigo em Espanhol | MEDLINE | ID: mdl-31322141

RESUMO

BACKGROUND: Frailty means a state of vulnerability with a predisposition to adverse health outcomes, closely related to age and a consequent loss of functional capability. Early detection is important for initiating measures to slow its progression. Primary Health Care (PHC) occupies a privileged place in this. However, we do not possess a gold standard tool for its detection. Our aim is to analyse the prevalence of frailty in PHC and define the most useful diagnostic tool for this area. METHODS: Cross-sectional study with 225 people were selected from a population of 4,252 people aged over 75 years-old, from three different basic health zones of Navarre. Four different diagnostic tests for frailty were conducted: the Fried phenotype, the Short Physical Performance Battery (SPPB), the Timed Up-to-Go test (TUG) and the Gait Speed test (GS). Patients who were unable to finish any of the tests weren't included in the subsequent analysis. RESULTS: Fifty-one percent of participants were men, with mean age 80.5 years-old, 80% were taking more than five daily drugs, 8.4% had cognitive impairment, and 31.1 and 41.3% were independent for basic and instrumental activities, respectively, of daily living. The frailty prevalence was 8.3% for Fried phenotype, 13.7% for SPPB, 46.2% for TUG and 52.2% for Gait Speed. CONCLUSION: Great heterogeneity in the prevalence of frailty was shown depending on the tool employed. As a reliable, fast and simple tool for early detection of frailty is needed in PHC, based on our results and the particularities of PHC, we propose TUG or GS as good early predictors of this decline.


Assuntos
Idoso Fragilizado , Fragilidade/diagnóstico , Programas de Rastreamento/métodos , Atenção Primária à Saúde/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Fragilidade/epidemiologia , Análise da Marcha/métodos , Humanos , Masculino , Desempenho Físico Funcional , Prevalência , Espanha , Velocidade de Caminhada/fisiologia
20.
S Afr Med J ; 109(7): 535-540, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31266582

RESUMO

BACKGROUND: Frailty is a state characterised by diminished physiological reserve that leaves an individual vulnerable to external stressors and delays recovery. Frailty assessments are proving to be more valuable in predicting poor perioperative outcomes than other well-known perioperative risk assessment tools. Very few studies using validated frailty assessment tools have been done to assess the prevalence of frailty in South Africa (SA), and none have assessed the intraoperative implications of frailty in a surgical population. OBJECTIVES: To determine the demographics and frailty levels of patients presenting for surgery at three academic hospitals in Johannesburg, compare intraoperative complications between the frail and non-frail patients, and compare the association between frailty scores and American Society of Anesthesiologists Physical Status (ASA-PS) scores. METHODS: We prospectively enrolled 299 patients aged 18 - 90 years undergoing various types of elective surgery between mid-November 2016 and mid-March 2017 in three SA academic hospitals. Frailty was assessed using the nine-point Clinical Frailty Scale (CFS) and defined as a score of ≥5. The CFS and demographic and clinical data were documented by the anaesthetists assigned to the respective elective lists. The primary outcome measure was intraoperative complications (hypotension, desaturation, and need for vasopressors and blood transfusion). We also compared associations between the patients' comorbidities and frailty and those between the CFS and ASA-PS scores. RESULTS: Of a total of 299 patients included in the study (mean age (standard deviation) 50.6 (15.8) years), 156 (52%) were women and 67 (22%) were classified as frail. Compared with patients who were not classified as frail, the frail group had significantly higher incidences of hypotension (odds ratio (OR) 1.87, 95% confidence interval (CI) 1.083 - 3.259; p=0.02) and desaturation (OR 3.79, 95% CI 1.367 - 10.54; p=0.01), and were more likely to need vasopressors (OR 2.81, 95% CI 1.607 - 4.912; p=0.00) and blood transfusion (OR 3.26, 95% CI 1.138 - 9.368; p=0.02). On multivariable logistic regression analysis, adjusting for factors related to frailty such as age, gender and comorbidities, desaturation was significantly associated with frailty (adjusted OR (aOR) 4.21, 95% CI 1.31 - 13.53; p=0.01), and the frail were more likely to require blood transfusion (aOR 5.36, 95% CI 1.50 - 19.16; p=0.01) and were older and had more comorbidities. Higher ASA-PS scores were also strongly associated with frailty. CONCLUSIONS: The prevalence of frailty was high among surgical patients. Consistent with other studies, frailty was associated with older age and multiple comorbidities. The association between frailty and intraoperative complications found in this study may indicate and help inform areas of further research.


Assuntos
Procedimentos Cirúrgicos Eletivos , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Centros Médicos Acadêmicos , Adolescente , Adulto , Fatores Etários , Idoso , Transfusão de Sangue/estatística & dados numéricos , Comorbidade , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Hipotensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Prevalência , Estudos Prospectivos , África do Sul/epidemiologia , Vasoconstritores/uso terapêutico , Adulto Jovem
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