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1.
J Frailty Aging ; 9(1): 44-50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150213

RESUMO

BACKGROUND: In older people, diabetes is associated with an increased risk of falls and frailty. The value of using posturography for evaluating the risk of falling is unclear. In theory, a time-scale analysis should increase the metrological properties of the posturography assessment. OBJECTIVES: This study aimed to determine which posturographic parameters can be used to identify fall-risk patients in a frail diabetic older population and to assess their interest in comparison to usual clinical trials for gait and balance. DESIGN: This is a prospective observational cohort. SETTINGS: frail or pre-frail diabetic patients, in Bordeaux, France. PARTICIPANTS: 84 patients were included in the study (mean age 80.09 years, 64.5% of men).Criteria for inclusion were: age over 70 years, diabetes mellitus for over 2 years, and at least one of the Fried's frailty criteria. MEASUREMENTS: Gait and balance assessments were undertaken at baseline: Static posturography, the timed up and go test, short physical performance battery, and (gait) walking speed. Raw data from posturography were used for wavelet analysis. Data on self reported new falls were collected prospectively during 6 months. RESULTS: The posturography parameter most useful was area of 90% confidence ellipse of statokinesigram (COP90area): area under the ROC curve AUC = 0.617 (95% CI, 0.445-0.789) and OR=1.003 (95%CI 1.000-1.005) p =0.05. The optimum clinical test was the time to walk over 4m AUC=0.735 (95%CI, 0.587-0.882) and OR=1.42 (95%CI 1.08-1.87) p= 0.013. CONCLUSION: Posturography has limited utility for assessment of falls risk in frail older people with diabetes. Gait and balance clinical assessments such as walking speed continue to retain their value.


Assuntos
Acidentes por Quedas , Diabetes Mellitus/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Equilíbrio Postural/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , França/epidemiologia , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco/métodos
2.
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
3.
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
4.
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
5.
J Surg Oncol ; 121(4): 688-696, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31930511

RESUMO

BACKGROUND: To investigate the effect of frailty on short-term postoperative outcomes and total hospital charges (THCs) in patients with non-metastatic upper urinary tract carcinoma, treated with radical nephroureterectomy (RNU). METHODS: Within the National Inpatient Sample (NIS) database we identified 11 258 RNU patients (2000-2015). We used the Johns Hopkins frailty-indicator to stratify patients according to frailty status. Time trends and multivariable logistic, Poisson and linear regression models were applied. RESULTS: Overall, 1801 (16.0%) patients were frail, 4664 (41.4%) were older than 75 years and 1530 (13.6%) had Charlson comorbidity index ≥2. Rates of frail patients increased over time, from 7.3% to 24.9% (P < .001). Frail patients exhibited higher rates (all P < .05) of overall complications (62.6% vs 50.9%), in-hospital mortality (1.6% vs 1.0%), non-home-based discharge (22.7% vs 12.1%), longer length of stay (LOS) (6 vs 1 day) and higher THCs ($49 539 vs $39 644). Moreover, frailty independently predicted (all P < .05) overall complications (OR, 1.46), in-hospital mortality (OR, 1.52), non-home-based discharge (OR, 1.36), longer LOS (RR, 1.30) and higher THCs (RR, +$11 806). CONCLUSION: Preoperative frailty is important in RNU patients. One of four RNU patients is frail. Moreover, frailty predicts short-term postoperative complications, as well as longer LOS and higher THCs after RNU.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Nefroureterectomia/estatística & dados numéricos , Neoplasias Urológicas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nefroureterectomia/efeitos adversos , Nefroureterectomia/mortalidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Período Pré-Operatório , Neoplasias Urológicas/epidemiologia
6.
Clin Ter ; 170(1): e74-e77, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31850488

RESUMO

BACKGROUND: The beneficial effect of physical activity on a large spectrum of diseases is well known, with particular importance for elderly people. Among the different types of activity, adapted physical activity (APA) has been applied in a number of disease-related physical deficit. OBJECTIVE: The purpose of this study is to determine the outcome of a six months APA program in elder patients with osteoarthritis concerning physical and functional health and as second endpoint to determine the potential effect of AFA on reducing the risk of institutionalization. METHODS: The clinical indexes used to assess the outcome included the Blaylock Risk Assessment Screening Score (BRASS), the Psychological General Well Being Index (PGWBI), the Cumulative Illness Rating Scale (CIRS), the Short Physical Performance Battery (SPPB), and the visual analogue scale (VAS). RESULTS: A significant difference (p = 0.047) between the pre-APA and the post-APA value was found for BRASS, and highly significant differences (p <0.0001) were found for SPBB and VAS. CONCLUSIONS: These findings show that a six months APA program in elder patients with osteoarthritis improves physical function, reduces pain intensity and decreases the risk of institutionalization. Moreover the positive outcome of APA we found in elder patients with osteoarthritis suggests a more frequent use of such rehabilitation approach, also evaluating its economic impact on this disease.


Assuntos
Terapia por Exercício/métodos , Terapia por Exercício/psicologia , Exercício/psicologia , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Osteoartrite/psicologia , Osteoartrite/reabilitação , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Rev Med Chil ; 147(7): 870-876, 2019 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-31859985

RESUMO

BACKGROUND: Frailty has a great impact in the wellbeing of older people. AIM: To evaluate the quality of life of older people with and without frailty. MATERIAL AND METHODS: We assessed sociodemographic variables, health, integral geriatric assessment, quality of life using the WHOQoL-BREF questionnaire and the level of fragility using the Tilburg Frailty Indicator (TFI) in 538 participants. RESULTS: Three hundred and five participants aged 73 ± 7 years (229 women) were classified as fragile and 233 aged 72 ± 6 years (125 women) as not having frailty. Compared with their non-fragile counterparts, frail participants had a lower number of years attending school (5.9 and 7.4 respectively), a lower Barther index (93.6 and 98.3 respectively), a lower mini mental score (21.9 and 22.8 respectively) and a higher Yessavage depression score (2.0 and 0.8 respectively). Also, frail participants had a significantly lower total quality of life score and significantly lower scores in the physical and psychological domains. No differences were observed for the social and environmental domains. Older frail participants used health services more frequently than their non-fragile counterparts. CONCLUSIONS: In this sample, frailty was associated with a lower quality of life and worse scores in several geriatric assessment tools.


Assuntos
Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Avaliação Geriátrica , Serviços de Saúde/estatística & dados numéricos , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Inquéritos e Questionários
8.
BMC Health Serv Res ; 19(1): 797, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690304

RESUMO

BACKGROUND: Although not an inevitable part of ageing, frailty is an increasingly common condition in older people. Frail older patients are particularly vulnerable to the adverse effects of hospitalisation, including deconditioning, immobility and loss of independence (Chong et al, J Am Med Dir Assoc 18:638.e7-638.e11, 2017). The 'Systematic Approach to improving care for Frail older patients' (SAFE) study co-designed, with public and patient representatives, quality improvement initiatives aimed at enhancing the delivery of care to frail older patients within an acute hospital setting. This paper describes quality improvement initiatives which resulted from a co-design process aiming to improve service delivery in the acute setting for frail older people. These improvement initiatives were aligned to five priority areas identified by patients and public representatives. METHODS: The co-design work was supported by four pillars of effective and meaningful public and patient representative (PPR) involvement in health research (Bombard et al, Implement Sci 13:98, 2018; Black et al, J Health Serv Res Policy 23:158-67, 2018). These pillars were: research environment and receptive contexts; expectations and role clarity; support for participation and inclusive representation and; commitment to the value of co-learning involving institutional leadership. RESULTS: Five priority areas were identified by the co-design team for targeted quality improvement initiatives: Collaboration along the integrated care continuum; continence care; improved mobility; access to food and hydration and improved patient information. These priority areas and the responding quality improvement initiatives are discussed in relation to patient-centred outcomes for enhanced care delivery for frail older people in an acute hospital setting. CONCLUSIONS: The co-design approach to quality improvement places patient-centred outcomes such as dignity, identity, respectful communication as well as independence as key drivers for implementation. Enhanced inter-personal communication was consistently emphasised by the co-design team and much of the quality improvement initiatives target more effective, respectful and clear communication between healthcare personnel and patients. Measurement and evaluation of these patient-centred outcomes, while challenging, should be prioritised in the implementation of quality improvement initiatives. Adequate resourcing and administrative commitment pose the greatest challenges to the sustainability of the interventions developed along the SAFE pathways. The inclusion of organisational leadership in the co-design and implementation teams is a critical factor in the success of interventions targeting service delivery and quality improvement.


Assuntos
Cuidados Críticos/organização & administração , Procedimentos Clínicos/organização & administração , Fragilidade/terapia , Melhoria de Qualidade/organização & administração , Idoso , Idoso de 80 Anos ou mais , Participação da Comunidade , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Pessoal de Saúde/psicologia , Pesquisa sobre Serviços de Saúde , Humanos , Participação do Paciente
9.
Medicine (Baltimore) ; 98(48): e18113, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770235

RESUMO

The impact of vitamin D deficiency on the recovery of patients with malnutrition remains undefined. Our aim was to study the prevalence of vitamin D deficiency in a well-characterized cohort of patients with malnutrition and its association with outcomes.Within this secondary analysis of a randomized controlled trial, we examined the association of vitamin D deficiency and adverse clinical outcomes over a follow-up of 180 days in hospitalized patients at risk for malnutrition. We measured 25-hydroxyvitamin D levels upon admission and defined Vitamin D deficiency when levels were <50nmol/l. The primary endpoint was 180-day mortality.The prevalence of vitamin D deficiency in our cohort of 828 patients was 58.2% (n = 482). Patients with vitamin D deficiency had increased 180-day mortality rates from 23.1% to 29.9% (odds ratio 1.42, 95% confidence interval [CI] 1.03-1.94, P = .03). When adjusting the analysis for demographics, comorbidities, and randomization, this association remained significant for the subgroup of patients not receiving vitamin D treatment (adjusted odds ratio 1.63, 95% CI 1.01-2.62, P = .04). There was no significantly lower risk for mortality in the subgroup of vitamin D deficient patients receiving vitamin D treatment compared to not receiving treatment (adjusted odds ratio 0.74, 95% CI 0.48-1.13, P = .15).Vitamin D deficiency is highly prevalent in the population of malnourished inpatients and is negatively associated with long-term mortality particularly when patients are not receiving vitamin D treatment. Our findings suggest that malnourished patients might benefit from vitamin D screening and treatment in case of deficiency.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/mortalidade , Desnutrição/mortalidade , Deficiência de Vitamina D/mortalidade , Deficiência de Vitamina D/terapia , Idoso , Idoso de 80 Anos ou mais , Suplementos Nutricionais , Feminino , Fragilidade/sangue , Fragilidade/complicações , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Desnutrição/sangue , Desnutrição/complicações , Prevalência , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Vitaminas/uso terapêutico
10.
BMC Health Serv Res ; 19(1): 682, 2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31581947

RESUMO

BACKGROUND: Person-centred care (PCC) focusing on personalised goals and care plans derived from "What matters to you?" has an impact on single disease outcomes, but studies on multi-morbid elderly are lacking. Furthermore, the combination of PCC, Integrated Care (IC) and Pro-active care are widely recognised as desirable for multi-morbid elderly, yet previous studies focus on single components only, leaving synergies unexplored. The effect of a synergistic intervention, which implements 1) Person-centred goal-oriented care driven by "What matters to you?" with 2) IC and 3) pro-active care is unknown. METHODS: Inspired by theoretical foundations, complexity science, previous health service research and a patient-driven evaluation of care quality, we designed the Patient-Centred Team (PACT) intervention across primary and secondary care. The PACT team collaborate with the patient to make and deliver a person-centred, integrated and proactive multi-morbidity care-plan. The control group receives conventional care. The study design is a pragmatic six months prospective, controlled clinical trial based on hospital electronic health record data of 439 multi-morbid frail elderly at risk for emergency (re) admissions referred to PACT and 779 propensity score matched controls in Norway, 2014-2016. Outcomes are emergency admissions, the sum of emergency inpatient bed days, 30-day readmissions, planned and emergency outpatient visits and mortality at three and six months follow-up. RESULTS: The Rate Ratios (RR) for emergency admissions was 0,9 (95%CI: 0,82-0,99), for sum of emergency bed days 0,68 (95%CI:0,52-0,79) and for 30-days emergency readmissions 0,72 (95%CI: 0,41-1,24). RRs were 2,3 (95%CI: 2,02-2,55) and 0,9 (95%CI: 0,68-1,20) for planned and emergency outpatient visits respectively. The RR for death at 3 months was 0,39 (95% CI: 0,22-0,70) and 0,57 (95% CI: 0,34-0,94) at 6 months. CONCLUSION: Compared with propensity score matched controls, the care process of frail multi-morbid elderly who received the PACT intervention had a reduced risk of high-level emergency care, increased use of low-level planned care, and substantially reduced mortality risk. Further study of process differences between groups is warranted to understand the genesis of these results better. TRIAL REGISTRATION: ClinicalTrials.gov (identifier: NCT02541474 ), registered Sept 2015.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Múltiplas Afecções Crônicas/terapia , Assistência Centrada no Paciente/métodos , Idoso , Serviço Hospitalar de Emergência , Feminino , Idoso Fragilizado/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Morbidade , Noruega , Planejamento de Assistência ao Paciente , Readmissão do Paciente/estatística & dados numéricos , Pontuação de Propensão , Estudos Prospectivos , Autocuidado
11.
Health Serv Res ; 54(6): 1305-1315, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31571222

RESUMO

OBJECTIVE: There is relative consensus that chronic conditions, disability, and time-to-death are key drivers of age-related health care expenditures. In this paper, we analyze the specific impact of frailty transitions on a wide range of health care outcomes comprising hospital, ambulatory care, and dental care use. DATA SOURCE: Five regular waves of the SHARE survey collected between 2004 and 2015. STUDY DESIGN: We estimate dynamic panel data models on the balanced panel (N = 6078; NT = 30 390 observations). Our models account for various sources of selection into frailty, that is, observed and unobserved time-varying and time-invariant characteristics. PRINCIPAL FINDINGS: We confirm previous evidence showing that frailty transitions have a statistically significant and positive impact on hospital use. We find new evidence on ambulatory and dental care use. Becoming frail has greater impact on specialist compared to GP visit, and frail elderly are less likely to access dental care. CONCLUSIONS: By preventing transitions toward frailty, policy planners could prevent hospital and ambulatory care uses. Further research is needed to investigate the relationship between frailty and dental care by controlling for reverse causation.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Assistência Odontológica/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Europa (Continente) , Feminino , Humanos , Masculino
12.
Clin Interv Aging ; 14: 1671-1680, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31631988

RESUMO

Purpose: The co-occurrence of frailty and depression in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality have rarely been investigated. We aimed to examine the co-occurrence of frailty and depressive symptoms in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality using all the information from a longitudinal study. Patients and methods: We used the Taiwan Longitudinal Study of Aging (TLSA) for this study. TLSA was initiated in 1989 and followed periodically. We included participants from 1989 to 2007, who had data on frailty and depressive symptoms. Frailty was assessed by accumulation of functional deficits in 6 dimensions including disease status, sensory dysfunction, balance, functional limitations, health risk behaviors, and life satisfaction. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). A multistate model with interval censoring was used to examine the transition between states of frailty with or without depressive symptoms, and finally to death. A mixed model was used to examine the relationships between frailty and depressive symptoms. Results: The coexistence of frailty and depressive symptoms was associated with higher mortality. Individuals with depressive symptom had a lower probability of reversal to a better state. Previous depression score predicted current frailty, but the coefficient was smaller than that of previous frailty. Previous frailty predicted current depression score, and the coefficient was stronger than that of previous depression. Conclusion: Depressive symptoms increased the mortality and decreased the probability of reversal in the frail older adults.


Assuntos
Depressão/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Depressão/psicologia , Transtorno Depressivo/epidemiologia , Feminino , Idoso Fragilizado/psicologia , Fragilidade/psicologia , Avaliação Geriátrica/métodos , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Taiwan/epidemiologia
13.
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
14.
Int J Med Inform ; 132: 103979, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31585259

RESUMO

OBJECTIVE: Recognizing frailty, also known as clinical geriatric syndrome in the elderly that is characterized by high vulnerability and low resilience, and its extensive influence in clinical practice is challenging. This study aims to develop a social frailty prediction system based on machine learning approaches in order to identify the social frailty status of the elders in order to advance appropriate social services provision. MATERIALS AND METHODS: This cross-sectional study enrolled and collected information from 595 community-dwelling seniors aged 65+. Fourteen predictors established from questionnaires and electronic medical records were used to predict the social frailty of participants. Bagged classification and regression trees, model average neural network, random forest, C5.0, eXtreme gradient boosting, and stochastic gradient boosting were used to build the predictive model in use. Performance was compared using accuracy, kappa, area under receiver operating characteristic curve, sensitivity, and specificity. The frailty predictive system was web-based and built upon representational state transfer application program interfaces. RESULTS: C5.0 achieved the best overall performance than remaining learners, and was adopted as the base learner for the social frailty prediction system. In terms of the area under receiver operating characteristic curve (AUC), health literacy (AUC = 0.68) was found to be the most important variable for predicting one's social frailty, followed by comorbidity (AUC = 0.67), religious participation (AUC = 0.67), physical activity (AUC = 0.66), and geriatric depression score (AUC = 0.62). CONCLUSIONS: Results suggest that a combination of such data that is both available and unavailable from electronic medical records is predictive of the social frailty of an elderly population.


Assuntos
Registros Eletrônicos de Saúde , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Aprendizado de Máquina , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Curva ROC , Software , Inquéritos e Questionários
15.
Artigo em Inglês | MEDLINE | ID: mdl-31546837

RESUMO

The oral health state plays an important role in the concept of 'elderly frailty', since institutionalized older people are prone to suffering from bad oral conditions. The aim of this study is to assess the state of oral health in the older residents of nursing homes and to measure its potential association with the cognitive state, the degree of functional autonomy, and the malnutrition risk. Methods: We enrolled 176 subjects from 292 residents in five nursing homes in Florence. For each subject, we performed the Malnutrition Universal Screening Tool, the Pfeiffer test, the Minimum Data Set-Long Form, a dental examination, and the Geriatric Oral Health Assessment Index questionnaire. The results show that the oral condition was poor in 43.8% of cases, medium in 38.1%, and good in 18.2%. A worse oral health state was significantly associated (p < 0.05) with a worse cognitive state and with a higher dependency in daily living activities. The malnutrition score among the older people was unrelated to the oral health condition (p = 0.128). It can be concluded that the oral health condition in older institutionalized subjects is an open challenge for the public healthcare system, since the maintenance of adequate good oral health is an essential element of good physical as well as cognitive and psychological health.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Itália , Masculino
16.
Metas enferm ; 22(7): 24-32, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184098

RESUMO

Objetivo: evaluar la efectividad de una intervención de promoción de la salud para personas de edad avanzada, con el objetivo de promover la adopción de hábitos saludables y de mejorar la calidad de vida relacionada con la salud (CVRS), la salud mental y el apoyo social. Método: se llevó a cabo un estudio de evaluación con diseño pre/post, no-experimental. Se trataba de captar a mayores de 65 años, residentes en la comunidad, de dos barrios de nivel socioeconómico desfavorecido de la ciudad de Barcelona. La intervención consistió en un taller estructurado en ocho sesiones cuyo objetivo era la adopción de hábitos saludables. Se obtuvo información sobre la actividad física, CVRS, hábitos dietéticos, salud mental y apoyo social a partir de cuestionarios validados (IPAQ, SF-36, PREDIMED, GHQ-12, MOS y NSHAP, respectivamente). Se analizaron diferencias antes y después de la intervención mediante los test de McNemar, t de Student y de Wilcoxon para datos apareados según correspondiese. Resultados: la muestra se compuso de 22 adultos. Tras la intervención, la mediana de actividad física se incrementó en 842,5 MET/semana. La CVRS también mejoró: las puntuaciones para dimensión mental se incrementaron en un 30% y las de la dimensión física un 22%. No se observaron cambios en la dieta o en la salud mental. Conclusiones: las intervenciones de promoción de la salud, orientadas a personas mayores pueden jugar un papel clave en la mejora de la calidad de vida y el bienestar


Objective: to assess the efficacy of a health promotion intervention for persons of advanced age, with the objective of promoting the adoption of healthy habits and improving health-related quality of life (HRQoL), mental health, and social support. Methods: an evaluation study was conducted with pre/post, non-experimental design. The objective was to recruit >65-year-old persons living in the community, from two areas in the city of Barcelona with underprivileged socioeconomic levels. The intervention consisted in a workshop structured into eight sessions, with the objective of adopting healthy habits. Information was collected about physical activity, HRQoL, diet habits, mental health, and social support, through validated questionnaires (IPAQ, SF-36, PREDIMED, GHQ-12, MOS and NSHAP, respectively). Any differences before and after the intervention were analyzed through the McNemar, Student's t and Wilcoxon tests for paired data, as relevant. Results: the sample included 22 adults. After the intervention, there was an increase in the median physical activity of 842.5 MET/week. There was also an improvement in HRQoL: the scores for the mental dimension increased by 30% and the physical dimension by 22%. No changes were observed in diet or mental health. Conclusions: health promotion interventions, oriented to elderly persons, can play a key role in the improvement of QoL and wellbeing


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Avaliação de Resultado de Intervenções Terapêuticas , Promoção da Saúde/métodos , Idoso Fragilizado/estatística & dados numéricos , Resultado do Tratamento , Atividade Motora/fisiologia , Comportamento Alimentar , Qualidade de Vida , Populações Vulneráveis , Apoio Social , Inquéritos e Questionários , Saúde do Idoso
17.
Artigo em Inglês | MEDLINE | ID: mdl-31394719

RESUMO

Population aging is a challenge, therefore efficient frailty screening has been increasingly emphasized for mass older populations. This study aimed to evaluate the prevalence of social frailty and its association with physical frailty, geriatric syndromes and activity of daily living (ADL) disability in community-dwelling older adults. A cross-sectional study was conducted with 408 older adults (mean age, 75 years; 58% female) in the Aging Study of PyeongChang Rural Area. A five-item social frailty index was administered (range: 0-5); (1) going out less frequently; (2) rarely visiting the homes of friends; (3) feeling unhelpful to friends and family; (4) being alone; and (5) not talking with someone every day. Social frailty was defined as ≥2 positive responses. Physical frailty was assessed according to the Cardiovascular Health Study frailty phenotype criteria. We used logistic regression to examine whether social frailty can identify older adults with common geriatric syndromes including ADL disability, independently of age, gender, and physical frailty. Social frailty was present in 20.5% (14.5% in male and 25.0% in female) and 11.5% was not overlapped with physical frailty. Social frailty increased risk of ADL disability (odds ratio, 2.53; 95% confidence interval, 1.26-5.09) and depressed mood (odds ratio, 4.01; 95% confidence interval, 1.30-12.39) independently of age, gender, and physical frailty. The predictive power for disability was maximized by using both frailty indices (C statistic 0.73) compared with either frailty index alone (C statistic: 0.71 for social frailty and 0.68 for physical frailty). Social frailty screening is important as it can identify frail older adults who are not captured by demographic characteristics and physical frailty. Moreover, assessment of both social frailty and physical frailty can better detect disability and geriatric syndromes.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Avaliação Geriátrica/estatística & dados numéricos , Vida Independente/estatística & dados numéricos , Relações Interpessoais , Comportamento Social , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , República da Coreia/epidemiologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-31398821

RESUMO

The aim of this paper is to describe frail older persons' experiences of hospital care of information and participation when being an inpatient at a hospital. A qualitative method was used. Data were collected at the hospital from 20 interviews with frail older patients, together with observations in the environment at the hospital ward. A content analysis was performed. Patients experienced not receiving information about their care and rehabilitation, or receiving such information in noisy surroundings. They experienced situations of misunderstanding related to their medication, which indicates the need for appropriate discharge calls for frail older patients. They expressed feelings of distress concerning the future, caused by hasty admissions or relatives' problems to handle the situation. The results highlight the need to receive appropriate information and to participate in decision-making. The level of health literacy should be taken notice of when giving information, using peaceful and quiet environments when informing frail older persons. Person-centered care should be recognized to a greater extent in order for healthcare professionals to give information to frail older people in a health literacy-friendly way. This might make it easier for frail older persons to participate in a partnership in care.


Assuntos
Comunicação , Idoso Fragilizado/psicologia , Disseminação de Informação/métodos , Pacientes Internados/psicologia , Participação do Paciente/psicologia , Assistência Centrada no Paciente/métodos , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Idoso Fragilizado/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Participação do Paciente/estatística & dados numéricos
19.
Clin Interv Aging ; 14: 1343-1352, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413555

RESUMO

Purpose: This study was aimed at determining the presence of cognitive frailty and its associated factors among community-dwelling older adults from the "LRGS-Towards Useful Aging (TUA)" longitudinal study. Patients and methods: The available data related to cognitive frailty among a sub-sample of older adults aged 60 years and above (n=815) from two states in Malaysia were analysed. In the LRGS-TUA study, a comprehensive interview-based questionnaire was administered to obtain the socio-demographic information of the participants, followed by assessments to examine the cognitive function, functional status, dietary intake, lifestyle, psychosocial status and biomarkers associated with cognitive frailty. The factors associated with cognitive frailty were assessed using a bivariate logistic regression (BLR). Results: The majority of the older adults were categorized as robust (68.4%), followed by cognitively pre-frail (37.4%) and cognitively frail (2.2%). The data on the cognitively frail and pre-frail groups were combined for comparison with the robust group. A hierarchical BLR indicated that advancing age (OR=1.04, 95% CI:1.01-1.08, p<0.05) and depression (OR=1.49, 95% CI:1.34-1.65, p<0.001) scored lower on the Activity of Daily Living (ADL) scale (OR=0.98, 95% CI:0.96-0.99, p<0.05), while low social support (OR=0.98, 95% CI:0.97-0.99, p<0.05) and low niacin intake (OR=0.94, 95% CI:0.89-0.99, p<0.05) were found to be significant factors for cognitive frailty. Higher oxidative stress (MDA) and lower telomerase activity were also associated with cognitive frailty (p<0.05). Conclusion: Older age, a lower niacin intake, lack of social support, depression and lower functional status were identified as significant factors associated with cognitive frailty among older Malaysian adults. MDA and telomerase activity can be used as potential biomarkers for the identification of cognitive frailty.


Assuntos
Disfunção Cognitiva/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Cognição , Estudos Transversais , Dieta , Feminino , Humanos , Vida Independente , Estilo de Vida , Modelos Logísticos , Estudos Longitudinais , Malásia/epidemiologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Niacina/sangue , Estresse Oxidativo/fisiologia , Desempenho Físico Funcional , Fatores Socioeconômicos , Telomerase/metabolismo
20.
Public Health ; 175: 90-100, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31454631

RESUMO

OBJECTIVE: Frailty is considered to be one of the risk factors of disability. However, the results of original reported studies are not consistent with respect to the frailty and incidence of disability, and previously published meta-analyses have also shown inconsistent results. This meta-analysis was conducted to investigate the relationship between the different stages of frailty and the incidence of disability by examining updated overall trends in community-dwelling elders. STUDY DESIGN: Cohort studies in English or Chinese based on associations between frailty and incident disability risks that were published from 2000 until the current date were researched using PubMed, Embase, Web of Science, and CENTRAL databases. METHODS: The Q test and I2 statistic were used to examine between-study heterogeneity. Random-effect models were adopted to synthesize the results based on the study heterogeneity. Subgroup analyses were also conducted to explore the possible sources of between-study heterogeneity based on the characteristics of participants. RESULTS: Eighteen cohort studies with 88,906 participants were included in our meta-analyses. Compared with the non-frailty category, the combined relative risks (RRs) (95% confidence interval [CI]) of the disability were 1.66 (1.49-1.85) and 2.53 (2.01-3.14) for the category of prefrailty and frailty, respectively. Results suggested that the incident risk of disability at follow-up times <5 (RR = 3.19, 95% CI = 2.25-4.53) was significantly higher than for follow-up times ≥5 in the frailty category (RR = 2.00, 95% CI = 1.55-2.56). The risk in a sample size of ≥1000 (RR = 2.78, 95% CI = 2.04-3.14) was significantly higher than that when the sample size was <1000 (RR = 1.91, 95% CI = 1.53-2.37) in the frailty group. Compared with a value adjusted for comorbidity, the unadjusted comorbidity was significantly higher in the prefrailty category (1.90 vs. 1.52). Compared with a value adjusted for education, the unadjusted education was significantly higher in the prefrailty category (1.81 vs. 1.46). No publication bias was observed. CONCLUSION: The overall meta-analysis confirms that frailty has significantly increased the incident risk of disability. Frail, elderly people are at the highest risk of future disability and may be adequate candidates for taking part in prevention and intervention programs.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Vida Independente/estatística & dados numéricos , Idoso , Humanos , Incidência , Fatores de Risco
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