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1.
J Frailty Aging ; 9(2): 94-100, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32259183

RESUMO

BACKGROUND: Diabetes (DM) is associated with an accelerated aging that promotes frailty, a state of vulnerability to stressors, characterized by multisystem decline that results in diminished intrinsic reserve and is associated with morbidity, mortality and utilization. Research suggests a bidirectional relationship between frailty and diabetes. Frailty is associated with mortality in patients with diabetes, but its prevalence and impact on hospitalizations are not well known. OBJECTIVES: Determine the association of frailty with all-cause hospitalizations and mortality in older Veterans with diabetes. DESIGN: Retrospective cohort. SETTING: Outpatient. PARTICIPANTS: Veterans 65 years and older with diabetes who were identified as frail through calculation of a 44-item frailty index. MEASUREMENTS: The FI was constructed as a proportion of healthcare variables (demographics, comorbidities, medications, laboratory tests, and ADLs) at the time of the screening. At the end of follow up, data was aggregated on all-cause hospitalizations and mortality and compared non-frail (robust, FI≤ .10 and prefrail FI=>.10, <.21) and frail (FI≥.21) patients. After adjusting for age, race, ethnicity, median income, history of hospitalizations, comorbidities, duration of DM and glycemic control, the association of frailty with all-cause hospitalizations was carried out according to the Andersen-Gill model, accounting for repeated hospitalizations and the association with all-cause mortality using a multivariate Cox proportional hazards regression model. RESULTS: We identified 763 patients with diabetes, mean age 72.9 (SD=6.8) years, 50.5% were frail. After a median follow-up of 561 days (IQR=172), 37.0% they had 673 hospitalizations. After adjustment for covariates, frailty was associated with higher all-cause hospitalizations, hazard ratio (HR)=1.71 (95%CI:1.31-2.24), p<.0001, and greater mortality, HR=2.05 (95%CI:1.16-3.64), p=.014. CONCLUSIONS: Frailty was independently associated with all-cause hospitalizations and mortality in older Veterans with diabetes. Interventions to reduce the burden of frailty may be helpful to improve outcomes in older patients with diabetes.


Assuntos
Diabetes Mellitus/mortalidade , Diabetes Mellitus/terapia , Fragilidade/epidemiologia , Hospitalização/estatística & dados numéricos , Vida Independente , Idoso , Idoso Fragilizado/estatística & dados numéricos , Humanos , Estudos Retrospectivos , Veteranos/estatística & dados numéricos
2.
J Frailty Aging ; 9(2): 74-81, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32259180

RESUMO

OBJECTIVE: A 5% change in weight is a significant predictor for frailty and obesity. We ascertained how self-reported weight change over the lifespan impacts rates of frailty in older adults. METHODS: We identified 4,984 subjects ≥60 years with body composition measures from the National Health and Nutrition Examination Survey. An adapted version of Fried's frailty criteria was used as the primary outcome. Self-reported weight was assessed at time current,1 and 10 years earlier and at age 25. Weight changes between each time point were categorized as ≥ 5%, ≤5% or neutral. Logistic regression assessed the impact of weight change on the outcome of frailty. RESULTS: Among 4,984 participants, 56.5% were female, mean age was 71.1 years, and mean BMI was 28.2kg/m2. A weight loss of ≥ 5% had a higher association with frailty compared to current weight, age 25 (OR 2.94 [1.72,5.02]), 10 years ago (OR 1.68 [1.05,2.69]), and 1 year ago (OR 1.55 [1.02,2.36]). Weight gain in the last year was associated with increased rate of frailty (1.59 [1.09,2.32]). CONCLUSION: There is an association between frailty and reported weight loss over time while only weight gain in the last year has an association with frailty.


Assuntos
Trajetória do Peso do Corpo , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/epidemiologia , Autorrelato
3.
Einstein (Sao Paulo) ; 18: eAO5263, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32267368

RESUMO

OBJECTIVE: To assess the health profile of community-dwelling older adults, according to sex, assisted by the Elderly Caregiver Program of the City of São Paulo. METHODS: Secondary data of 535 older adults, assisted by ten Elderly Caregiver Program teams from the southern region of São Paulo, were collected from medical records and the Multidimensional Evaluation of Older People in Primary Care, after verifying the inclusion and exclusion criteria for the study and obtaining subjects' consent. RESULTS: Older adults assisted by this program were predominantly female (77.6%), mean age of 76.2±8.0 years. They had negative self-rated health (67.8%), difficulties in instrumental activities of daily living (68.4%) and signs of mood changes (60.3%). A high prevalence of older adults with vision problems (58.8%), polypharmacy (58.1%), memory-related complaints (55.8%) and multiple morbidities (50.6%) were observed. The prevalence of multiple morbidities, polypharmacy, cognitive impairment and signs of mood changes were higher in women. On the other hand, men reported more hearing problems than women. CONCLUSION: The poorer health conditions of the older adults in this study, evidenced by a high prevalence of subjects with negative self-rated health, difficulties in instrumental activities of daily living, multiple morbidities, polypharmacy and other complaints (sensorial changes, depressive and cognitive symptoms), reinforce the importance of this program as a long-term care policy and as a way to ensure these older adults can continue living in their communities.


Assuntos
Avaliação Geriátrica/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Atividades Cotidianas , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Polimedicação , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
4.
Rev Saude Publica ; 54: 17, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32022145

RESUMO

INTRODUCTION: Providing care to an older adult is an activity that requires considerable physical effort and can cause stress and psychological strain, which accentuate factors that trigger the cycle of frailty, especially when the caregiver is also an older adult. However, few studies have analyzed the frailty process in older caregivers. OBJECTIVES: To investigate the prevalence of pre-frailty, frailty and associated factors in older caregivers of older adults. METHODS: A cross-sectional study was conducted including 328 community-dwelling older caregivers. Frailty was identified using frailty phenotype. Socio-demographic, behavioral and clinical aspects, characteristics related to care and functioning were covariables in the multinomial logistic regression. RESULTS: The prevalence of pre-frailty and frailty were 58.8% and 21.1%, respectively. An increased age, female sex, not having a conjugal life, depressive symptoms and pain were commonly associated with pre-frailty and frailty. Sedentary lifestyle was exclusively associated with pre-frailty, whereas living in an urban area, low income and the cognitive decline were associated with frailty. A better performance on instrumental activities of daily living reduced the chance of frailty. CONCLUSION: Many factors associated with the frailty syndrome may be related to the act of providing care, which emphasizes the importance of the development of coping strategies for this population.


Assuntos
Cuidadores/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Fatores Etários , Idoso , Brasil/epidemiologia , Cuidadores/psicologia , Estudos Transversais , Feminino , Idoso Fragilizado/psicologia , Fragilidade/psicologia , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos
5.
Arq Neuropsiquiatr ; 78(1): 2-8, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32074186

RESUMO

OBJECTIVE: The association between cognitive impairment and physical frailty has been studied in older adults. The criteria degree of frailty may be keys to associated cognitive impairment. To analyze the association between cognitive impairment and the criteria for frailty. METHODS: We cross-sectionally examined data from 667 older adults (≥60 years of age) from a study entitled 'Variables associated to cognition in elderly caregivers' involving patients in an urban and rural primary healthcare center. We defined cognitive impairment based on different groups of scores on the Mini Mental State Examination, and defined frailty and prefrailty using the criteria by the Cardiovascular Health Study. We performed multinomial regression models to analyze the association between levels of frailty and cognitive impairment. RESULTS: Similar proportions of women (54.8%) and men (45.2%) participated in the study (mean age: 71 years old). We found cognitive impairment, prefrailty and frailty in 34, 54, and 24% of the participants, respectively. Concomitant cognitive impairment and frailty was found in 13% of them. The chances of cognitive impairment increased up to 330% (Odds Ratio [OR]: 4.3; 95% confidence interval [95%CI] 2.4‒7.7; p<0.001) among frail individuals, and 70% (OR: 1.7; 95%CI 1.0‒2.8; p=0.033) among prefrail individuals compared to robust/non-frail individuals. After controlling for age, education, place of residence and functional dependence, slowness and fatigue criteria were significantly associated with cognitive impairment. CONCLUSION: Older adults with frailty have a greater likelihood of concomitant cognitive impairment than prefrail and robust older adults. The prevalence of cognitive impairment and frailty is consistent with data reported in literature. The present findings contribute to the investigation of cognitive frailty.


Assuntos
Disfunção Cognitiva/etiologia , Idoso Fragilizado/psicologia , Fragilidade/complicações , Fragilidade/psicologia , Atividades Cotidianas/psicologia , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Brasil/epidemiologia , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Feminino , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Vida Independente , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por Sexo
6.
Hosp Pract (1995) ; 48(sup1): 17-25, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32046544

RESUMO

Cancer occurs most frequently in patients aged 65 and older. With the increasing age of the world's population, there will be a significant increase in cancer diagnoses in older adults. Aging imposes a wide variety of physiological responses, comorbidities, and ailments, but older patients are less represented in clinical studies. Specific needs of older patients with cancer often go under-recognized and consequently unmet. In this review, common diagnoses that can affect the outcomes of this population, including frailty, malnutrition, and delirium, are discussed. Areas that need further research to improve the care of geriatric cancer patients, particularly in the hospital settings, are also identified.


Assuntos
Delírio/epidemiologia , Fragilidade/epidemiologia , Avaliação Geriátrica/métodos , Desnutrição/epidemiologia , Neoplasias/epidemiologia , Neoplasias/terapia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Comorbidade , Delírio/diagnóstico , Delírio/terapia , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/terapia , Humanos , Desnutrição/diagnóstico , Desnutrição/terapia , Obesidade/epidemiologia , Fatores de Risco
7.
Medicine (Baltimore) ; 99(2): e18501, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914020

RESUMO

The frailty represents a key determinant of elderly clinical assessment, especially because it allows the identification of risk factors potentially modifiable by clinical and therapeutic interventions. The frailty assessment in elderly patients usually is made by using of Fried criteria. However, to assess the frailty in cirrhotic patients, multiple but different tools are used by researchers. Thus, we aimed to compare frailty prevalence in elderly patients with well-compensated liver cirrhosis and without cirrhosis, according to Fried criteria.Among 205 elderly patients screened, a total of 148 patients were enrolled. The patients were divided into 2 groups according to the presence/absence of well-compensated liver cirrhosis.After clinical examination with conventional scores of cirrhosis, all patients underwent anthropometric measurements, nutritional, biochemical, comorbidity, and cognitive performances. Frailty assessment was evaluated according to Fried frailty criteria.Unexpectedly, according to the Fried criteria, non-cirrhotic patients were frailer (14.2%) than well-compensated liver cirrhotic patients (7.5%). The most represented Fried criterion was the unintentional weight loss in non-cirrhotic patients (10.1%) compared to well-compensated liver cirrhotic patients (1.4%). Moreover, cumulative illness rating scale -G severity score was significantly and positively associated with frailty status (r = 0.234, P < .004). In a multivariate linear regression model, only female gender, body mass index and mini nutritional assessment resulted associated with frailty status, independently of other confounding variables.Despite the fact that elderly cirrhotic patients are considered to be frailer than the non-cirrhotic elderly patient, relying solely on "mere visual appearance," our data show that paradoxically non-cirrhotic elderly patients are frailer than elderly well-compensated liver cirrhotic patients. Thus, clinical implication of this finding is that frailty assessment performed in the well-compensated liver cirrhotic patient can identify those cirrhotic patients who may benefit from tailored interventions similarly to non-cirrhotic elderly patients.


Assuntos
Fragilidade/epidemiologia , Hepatite C/complicações , Cirrose Hepática/complicações , Cirrose Hepática/epidemiologia , Idoso , Índice de Massa Corporal , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Comorbidade , Estudos Transversais , Feminino , Hepacivirus/isolamento & purificação , Hepatite C/epidemiologia , Humanos , Cirrose Hepática/diagnóstico , Masculino , Avaliação Nutricional , Prevalência , Fatores de Risco , Índice de Gravidade de Doença
8.
Adv Exp Med Biol ; 1216: 21-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894543

RESUMO

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


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Avaliação Geriátrica , Humanos , Vida Independente , Estado Nutricional , Prevalência
9.
Adv Exp Med Biol ; 1216: 39-50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894545

RESUMO

Cardiovascular disease burden increases with the increasing age of populations. Also, with increasing longevity, some individuals are ageing along an unfavourable path developing frailty syndrome. Epidemiologic studies indicate that frailty is overrepresented among the persons with cardiovascular disease. On the other hand, frail subjects tend to be burdened with cardiovascular disease to a greater degree than their biologically better-off peers. Hypertension, diabetes, and obesity, especially abdominal, and at least some other risk factors appear to be shared between frailty and cardiovascular disease. The probable common underlying pathophysiologic feature is inflammation and associated phenomena, possibly having its root in the inflammageing. We discuss these issues based on the results of original studies, comprehensive literature reviews, and metaanalyses, by hundreds of dedicated researchers worldwide.


Assuntos
Doenças Cardiovasculares , Fragilidade , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/complicações , Fragilidade/epidemiologia , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Obesidade Abdominal/complicações , Obesidade Abdominal/epidemiologia , Fatores de Risco
10.
Adv Exp Med Biol ; 1216: 51-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894546

RESUMO

The prevalence of frailty seems to be higher in people with cardiovascular disease (CVD) compared to those without, but also the prevalence of CVD is higher in people with frailty compared to robust ones. In longitudinal studies and meta-analyses dealing with the role of frailty as potential risk factor for incident CVD, we have an  increasing literature suggesting that frailty increases the risk of these conditions, particularly of fatal events, and independently from several potential confounding factors. Among the domains usually included in the definition of physical frailty, exhaustion, low physical activity, slow gait speed and weakness are significantly associated with the onset of CVD in older people. However, also CVD can be considered as potential risk factor for incident frailty even if the literature is more limited. In this chapter, I will therefore report and discuss the most recent and relevant findings in this topic, of extreme importance in actual geriatric medicine.


Assuntos
Doenças Cardiovasculares/complicações , Idoso Fragilizado , Fragilidade/complicações , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Prevalência , Fatores de Risco
11.
Anesthesiology ; 132(1): 82-94, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31834870

RESUMO

BACKGROUND: Frailty is associated with adverse postoperative outcomes, but it remains unclear which measure of frailty is best. This study compared two approaches: the Modified Frailty Index, which is a deficit accumulation model (number of accumulated deficits), and the Hopkins Frailty Score, which is a phenotype model (consisting of shrinking, weakness, exhaustion, slowness, and low physical activity). The primary aim was to compare the ability of each frailty score to predict prolonged hospitalization. Secondarily, the ability of each score to predict 30-day readmission and/or postoperative complications was compared. METHODS: This study prospectively enrolled adults presenting for preanesthesia evaluation before elective noncardiac surgery. The Hopkins Frailty Score and Modified Frailty Index were both determined. The ability of each frailty score to predict the primary outcome (prolonged hospitalization) was compared using a ratio of root-mean-square prediction errors from linear regression models. The ability of each score to predict the secondary outcome (readmission and complications) was compared using ratio of root-mean-square prediction errors from logistic regression models. RESULTS: The study included 1,042 patients. The frailty rates were 23% (Modified Frailty Index of 4 or higher) and 18% (Hopkins Frailty Score of 3 or higher). In total, 12.9% patients were readmitted or had postoperative complications. The error of the Modified Frailty Index and Hopkins Frailty Score in predicting the primary outcome was 2.5 (95% CI, 2.2, 2.9) and 2.6 (95% CI, 2.2, 3.0) days, respectively, and their ratio was 1.0 (95% CI, 1.0, 1.0), indicating similarly poor prediction. Similarly, the error of respective frailty scores in predicting the probability of secondary outcome was high, specifically 0.3 (95% CI, 0.3, 0.4) and 0.3 (95% CI, 0.3, 0.4), and their ratio was 1.00 (95% CI, 1.0, 1.0). CONCLUSIONS: The Modified Frailty Index and Hopkins Frailty Score were similarly poor predictors of perioperative risk. Further studies, with different frailty screening tools, are needed to identify the best method to measure perioperative frailty.


Assuntos
Fragilidade/epidemiologia , Hospitalização/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Fenótipo , Estudos Prospectivos , Fatores de Risco , Tempo
12.
Maturitas ; 132: 30-34, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31883660

RESUMO

OBJECTIVES: 25-hydroxyvitamin D [25(OH)D] deficiency is related to an increase in cardiovascular risk but the association between low 25(OH)D and hospitalization and mortality in heart failure (HF) patients remains unclear. The objective of this study was therefore to determine whether 25(OH)D deficiency is associated with a higher risk of all-cause hospitalizations and mortality in veterans with HF, as well as the differential effect of frailty. STUDY DESIGN: A retrospective cohort study of veterans with HF. MAIN OUTCOME: Association between 25(OH)D deficiency and risk of hospitalization and mortality. MEASURES: 25(OH)D status was dichotomized as deficiency (<30 ng/mL) and non-deficiency (≥30 ng/mL). A 44-item Frailty Index (FI) was constructed and used to categorize patients as non-frail (FI < .21) or frail (FI ≥ .21). The association of 25(OH)D deficiency with recurrent hospitalization was analyzed through an Andersen-Gill model and the association with mortality using Cox regression. RESULTS: We identified 284 patients, of whom 141 (50 %) exhibited 25(OH)D deficiency (67.3 ±â€¯10.5 years of age). The mean 25(OH)D levels in the deficiency and non-deficiency groups were 21.3±5.9 ng/mL and 40.9 ±â€¯10.9 ng/mL, respectively. Over a median follow-up of 1136 days (IQR = 691), there were 617 hospitalizations (68 % in those with 25(OH)D deficiency) and 131 deaths (40 % in those with 25(OH)D deficiency). A significantly higher risk of hospitalization was found in patients with 25(OH)D deficiency: hazard ratio (HR) = 1.8 (95 % CI:1.3-2.5),p < 0.001. Frail veterans had a greater risk of hospitalization than non-frail veterans: HR = 1.7 (95 % CI:1.2-2.7),p < 0.05. Mortality did not show any significant association with 25(OH)D deficiency. CONCLUSIONS: 25(OH)D deficiency was an independent risk factor for hospitalization in patients with HF and the effect persisted in those with frailty.


Assuntos
Fragilidade/epidemiologia , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricos , Vitamina D/sangue , Deficiência de Vitamina D/sangue
13.
Artigo em Inglês | MEDLINE | ID: mdl-31861327

RESUMO

Objective: The investigation aims to study the prevalence and correlates of frailty in a national community-dwelling sample of older Indonesians. Methods: Participants were 2630 older adults, 60 years and older (median age 66.0 years, interquartile range = 9.0) who took part in the cross-sectional Indonesia Family Life Survey (IFLS-5) in 2014-2015. They were requested to provide information about sociodemographic and various health variables, including frailty. Multivariable Poisson regression analysis was utilized to estimate the correlates of socio-demographic factors, health variables, and frailty. Results: The overall prevalence of frailty was 8.1%; 61.6% were prefrail. In adjusted Poisson regression analysis, older age, being unmarried, separated, divorced or widowed, residing in Java and major island groups, poor cognitive functioning, loneliness, and functional disability were associated with frailty. Conclusion: Several sociodemographic and health risk factors for frailty were identified that can help in guiding intervention strategies in Indonesia.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Vida Independente , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Fragilidade/diagnóstico , Fragilidade/etiologia , Avaliação Geriátrica , Inquéritos Epidemiológicos , Humanos , Indonésia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
14.
Colomb Med (Cali) ; 50(2): 89-101, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31607766

RESUMO

Objective: To estimate the prevalence of frailty and evaluate the relationship with the social determinants of health in elderly residents in urban and rural areas of Colombia. Methods: The SABE (Health, Wellbeing, and Aging) Colombia project is a cross-sectional study, carried out in 2014-2015, involving 24,553 men and women aged 60 years and older who live in the community in Colombia. For this analysis, we used data from 4,474 participants included as a subsample with grip strength measurements. The frailty syndrome was diagnosed according to the Fried criteria (weakness, low speed, low physical activity, exhaustion, and weight loss). The independent variables were grouped as (a) biological and genetic flow, (b) lifestyle (adverse conditions in childhood) (c) social networks and community, and (d) socio-economic, cultural and environmental conditions. Multiple logistic and linear regression analyses were used to assess the prognostic value of frailty for the outcomes of interest. Results: The prevalence of frailty was 17.9%. The factors significantly associated with frailty were older age, being women, living in rural areas, having low education, a greater number of medical conditions, insufficient current income, childhood health problems and a poor economic situation in childhood. Conclusion: Our results support the need to include frailty prevention programs, to improve the socioeconomic health conditions of infants to avoid future development of frailty.


Assuntos
Idoso Fragilizado , Fragilidade/epidemiologia , Determinantes Sociais da Saúde , Idoso , Colômbia/epidemiologia , Estudos Transversais , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos
15.
Lancet ; 394(10206): 1365-1375, 2019 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-31609228

RESUMO

Frailty is an emerging global health burden, with major implications for clinical practice and public health. The prevalence of frailty is expected to rise alongside rapid growth in the ageing population. The course of frailty is characterised by a decline in functioning across multiple physiological systems, accompanied by an increased vulnerability to stressors. Having frailty places a person at increased risk of adverse outcomes, including falls, hospitalisation, and mortality. Studies have shown a clear pattern of increased health-care costs and use associated with frailty. All older adults are at risk of developing frailty, although risk levels are substantially higher among those with comorbidities, low socioeconomic position, poor diet, and sedentary lifestyles. Lifestyle and clinical risk factors are potentially modifiable by specific interventions and preventive actions. The concept of frailty is increasingly being used in primary, acute, and specialist care. However, despite efforts over the past three decades, agreement on a standard instrument to identify frailty has not yet been achieved. In this Series paper, we provide an overview of the global impact and burden of frailty, the usefulness of the frailty concept in clinical practice, potential targets for frailty prevention, and directions that need to be explored in the future.


Assuntos
Efeitos Psicossociais da Doença , Fragilidade/epidemiologia , Fragilidade/terapia , Saúde Pública , Humanos , Prevalência
16.
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
17.
Artigo em Inglês | MEDLINE | ID: mdl-31614836

RESUMO

Measuring health-related quality of life (HRQOL) is critical to evaluate the burden of frailty in the older population.This study explored the prevalence of frailty among Vietnamese older people in rural communities, determined the factors associated with frailty, and examined the differences in HRQOL between non-frail, pre-frail, and frail people. A cross-sectional study was conducted on older adults (≥60 years old) residing in Soc Son district, northern Vietnam. Non-frailty, pre-frailty, and frailty conditions were evaluated using Fried's frailty criteria. The EuroQol-5 Dimensions-5 Levels(EQ-5D-5L) instrument was employed to measure HRQOL. Socioeconomic, behavioral, health status, and healthcare utilization characteristics were collected as covariates. Among 523 older adults, 65.6% were pre-frail, and 21.7% were frail. The mean EQ-5D-5L indexes of the non-frailty, pre-frailty, and frailty groups were 0.70 (SD = 0.18), 0.70 (SD = 0.19), and 0.58 (SD = 0.20), respectively. The differences were found between non-frailty and frailty groups (p < 0.01), as well as the pre-frailty and frailty groups (p<0.01). After adjusting for covariates, the estimated mean difference in the HRQOL between the non-frailty and frailty groups was -0.10 (95%CI= -0.17; -0.02) (R2 = 45.2%), showing a 10% reduction of the maximum EQ-5D-5L index.This study emphasized the high prevalence of frailty among older adults in the rural communities of Vietnam. Frailty was found to be associated with a small reduction of HRQOL in this population.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Vida Independente/estatística & dados numéricos , Qualidade de Vida/psicologia , População Rural/estatística & dados numéricos , Classe Social , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Vietnã/epidemiologia
18.
Vasc Health Risk Manag ; 15: 399-408, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31571891

RESUMO

Stroke prevention with oral anticoagulants in patients with atrial fibrillation predisposes for bleeding. As a result, in select patient groups anticoagulation is withheld because of a perceived unfavorable risk-benefit ratio. Reasons for withholding anticoagulation can vary greatly between clinicians, often leading to discussion in daily clinical practice on the best approach. To guide clinical decision-making, we have reviewed available evidence on the most frequently reported reasons for withholding anticoagulation: previous bleeding, frailty and age, and an overall high bleeding risk.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Hemorragia/induzido quimicamente , Acidente Vascular Cerebral/prevenção & controle , Suspensão de Tratamento , Administração Oral , Fatores Etários , Anticoagulantes/administração & dosagem , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Tomada de Decisão Clínica , Fragilidade/epidemiologia , Nível de Saúde , Hemorragia/epidemiologia , Humanos , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia
19.
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
20.
J Frailty Aging ; 8(4): 169-175, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637401

RESUMO

BACKGROUND: Frailty and the metabolic Syndrome (MetS) are frequently found in old subjects and have been associated with increased risk of functional decline and dependency. Moreover, central characteristics of the MetS like inflammation, obesity and insulin resistance have been associated with the frailty syndrome. However, the relationship between MetS and frailty has not yet been studied in detail. Aim of the current analysis within the Berlin Aging Study II (BASE-II) was to explore associations between MetS and frailty taking important co-variables such as nutrition (total energy intake, dietary vitamin D intake), physical activity and vitamin D-status into account. METHODS: Complete cross-sectional data of 1,486 old participants (50.2% women, 68.7 (65.8-71.3) years) of BASE-II were analyzed. MetS was defined following the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity in 2009. Frailty was defined according to the Fried criteria. Limitations in physical performance were assessed via questionnaire, muscle mass was measured using dual energy X-ray absorptiometry (DXA) and grip strength using a Smedley dynamometer. Adjusted regression models were calculated to assess the association between MetS and Frailty. RESULTS: MetS was prevalent in 37.6% of the study population and 31.9% were frail or prefrail according to the here calculated frailty index. In adjusted models the odds of being frail/prefrail were increased about 50% with presence of the MetS (OR1.5; 95% CI 1.2,1.9; p= 0.002). Moreover the odds of being prefrail/frail were significantly increased with low HDL-C (OR: 1.5 (95%CI: 1.0-2.3); p = 0.037); and elevated waist circumference (OR: 1.65 (95%CI: 1.1-2.3); p = 0.008). CONCLUSION: The current analysis supports an association between MetS and frailty. There are various metabolic, immune and endocrine alterations in MetS that also play a role in mechanisms underlying the frailty syndrome. To what extent cytokine alterations, inflammatory processes, vitamin D supply and hormonal changes in age and in special metabolic states as MetS influence the development of frailty should be subject of further research.


Assuntos
Fragilidade/epidemiologia , Síndrome Metabólica/epidemiologia , Idoso , Berlim/epidemiologia , Estudos Transversais , Feminino , Idoso Fragilizado , Humanos , Masculino
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