Pub Date : 2021-01-01DOI: 10.12809/ajgg-2020-429-ra
T. Auyeung, Swj Lee
Frailty is a condition indicating a reduced reserve in multiple systems and their disconnections. The whole body system cannot repair or recover by itself and may go into irreversible decline should interventions not be carried out early. This review discusses frailty in terms of the conceptual framework, pathophysiology, measurement and identification, lifecourse trajectory, and clinical application of assessment. It is anticipated that clinical application of the electronic frailty index expands to various specialties beyond geriatric medicine.
{"title":"Life-course trajectory of frailty and its clinical applications: a narrative review","authors":"T. Auyeung, Swj Lee","doi":"10.12809/ajgg-2020-429-ra","DOIUrl":"https://doi.org/10.12809/ajgg-2020-429-ra","url":null,"abstract":"Frailty is a condition indicating a reduced reserve in multiple systems and their disconnections. The whole body system cannot repair or recover by itself and may go into irreversible decline should interventions not be carried out early. This review discusses frailty in terms of the conceptual framework, pathophysiology, measurement and identification, lifecourse trajectory, and clinical application of assessment. It is anticipated that clinical application of the electronic frailty index expands to various specialties beyond geriatric medicine.","PeriodicalId":38338,"journal":{"name":"Asian Journal of Gerontology and Geriatrics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66198589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.12809/ajgg-2020-436-oa
L. Dwipa, M. Apandi, Priyo Panji Utomo, Mira Hasmirani, A. Rakhimullah, F. A. Yulianto, Y. Pratiwi
Objective. To adapt and validate the Indonesian version of the FRAIL scale (Ina-FRAIL) and the SARC-F (Ina-SARC-F). Methods. The Ina-FRAIL and the Ina-SARC-F were developed through forwards-backwards translation, and their validity (itemtotal item correlations), internal consistency (Cronbach’s alpha), and test-retest reliability (kappa statistic) were determined. The diagnostic performance of the Ina-FRAIL and the Ina-SARC-F was evaluated using the receiver operating characteristic curve analysis. Results. A total of 101 (57 men and 44 women) and 64 (23 men and 41 women) patients were included in the validation of the Ina-FRAIL scale and the Ina-SARC-F, respectively. For the Ina-FRAIL scale, internal consistency coefficient was 0.530, and test-retest reliability was 0.951 (p<0.001). The correlation coefficients between the total score and items of fatigue, resistance, ambulation, illness, and loss of weight were 0.503, 0.813, 0.679, 0.561, and 0.317, respectively (all p<0.001). Correlation between the Ina-FRAIL scale and the Cardiovascular Health Study was strong (rs=0.696, p<0.001). Using the cut-off value of ≥2, the diagnostic performance of the Ina-FRAIL was 80% sensitivity and 70.4% specificity. For the Ina-SARC-F, internal consistency was 0.851, and test-retest reliability was 1.00 (p<0.001). The correlation coefficients between the total score and items of strength, ambulation, rising, climbing, and falls were 0.646, 0.775, 0.653, 0.685, and 0.580, respectively (all r>0.361 and p<0.001). Using the cut-off value of ≥3, the diagnosis performance of the Ina-SARC-F was 100% sensitivity and 61.7% specificity. Conclusions. The Ina-FRAIL scale and the Ina-SARC-F are valid and reliable tools to screen for frailty syndrome and sarcopenia, respectively.
{"title":"Adaptation and validation of the Indonesian version of the FRAIL scale and the SARC-F in older adults","authors":"L. Dwipa, M. Apandi, Priyo Panji Utomo, Mira Hasmirani, A. Rakhimullah, F. A. Yulianto, Y. Pratiwi","doi":"10.12809/ajgg-2020-436-oa","DOIUrl":"https://doi.org/10.12809/ajgg-2020-436-oa","url":null,"abstract":"Objective. To adapt and validate the Indonesian version of the FRAIL scale (Ina-FRAIL) and the SARC-F (Ina-SARC-F). Methods. The Ina-FRAIL and the Ina-SARC-F were developed through forwards-backwards translation, and their validity (itemtotal item correlations), internal consistency (Cronbach’s alpha), and test-retest reliability (kappa statistic) were determined. The diagnostic performance of the Ina-FRAIL and the Ina-SARC-F was evaluated using the receiver operating characteristic curve analysis. Results. A total of 101 (57 men and 44 women) and 64 (23 men and 41 women) patients were included in the validation of the Ina-FRAIL scale and the Ina-SARC-F, respectively. For the Ina-FRAIL scale, internal consistency coefficient was 0.530, and test-retest reliability was 0.951 (p<0.001). The correlation coefficients between the total score and items of fatigue, resistance, ambulation, illness, and loss of weight were 0.503, 0.813, 0.679, 0.561, and 0.317, respectively (all p<0.001). Correlation between the Ina-FRAIL scale and the Cardiovascular Health Study was strong (rs=0.696, p<0.001). Using the cut-off value of ≥2, the diagnostic performance of the Ina-FRAIL was 80% sensitivity and 70.4% specificity. For the Ina-SARC-F, internal consistency was 0.851, and test-retest reliability was 1.00 (p<0.001). The correlation coefficients between the total score and items of strength, ambulation, rising, climbing, and falls were 0.646, 0.775, 0.653, 0.685, and 0.580, respectively (all r>0.361 and p<0.001). Using the cut-off value of ≥3, the diagnosis performance of the Ina-SARC-F was 100% sensitivity and 61.7% specificity. Conclusions. The Ina-FRAIL scale and the Ina-SARC-F are valid and reliable tools to screen for frailty syndrome and sarcopenia, respectively.","PeriodicalId":38338,"journal":{"name":"Asian Journal of Gerontology and Geriatrics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66198764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-20DOI: 10.12809/AJGG-2018-323-RA
K. Miu
Coexistence of osteoporosis and sarcopenia, known as osteosarcopenia, is well documented in frailty development in elderly people. Osteosarcopenia is associated with poor outcomes in terms of morbidity and mortality. This study aims to review the epidemiology and interactions of osteosarcopenia with frailty among older adults. Exercise seems to produce promising results in osteosarcopenic elderly people. Multidisciplinary assessment and management is the gold standard of care. Department of Rehabilitation and Extended Care, Wong Tai Sin Hospital, Hong Kong Correspondence to: Dr Ka Ying Doris Miu, Department of Rehabilitation and Extended Care, Wong Tai Sin Hospital, 124 Shatin Pass Road, Hong Kong. Email: miuky@ha.org.hk adjusted skeletal muscle mass of <7.26 kg/m2 in men and 5.45 kg/m2 in women as measured by DXA or <8.5 kg/m2 in men and 5.75 kg/m2 in women measured by BIA. A hand grip strength of <30 kg in men and <20 kg in women is considered at risk of sarcopenia. As body build differs between ethnic groups, the Asian Working Group for Sarcopenia (AWGS) defines sarcopenia as a height adjusted skeletal muscle mass of <7 kg/m2 in men and <5.4 kg/m2 in women measured by DXA and <7 kg/m2 in men and <5.7 kg/m2 in women measured by BIA, with a gait speed <0.8 m/s and a cut-off value of hand grip strength of <26 kg in men and <18 kg in women.8 In addition, there is a subgroup of elderly people who have both conditions with a higher risk of falls and fracture than those with osteoporosis or sarcopenia alone.9 This is known as sarco-osteopenia and later as osteosarcopenia. Studies have reported the association between osteosarcopenia and poor outcomes.10-12 Frailty is a major geriatric syndrome and is associated with greater prevalence of adverse health outcomes, including mortality, institutionalisation, falls, and recurrent hospitalisation.13-15 Frailty consists of multidimensional syndromes of loss of energy, physical activity, cognition, and health. There are many definitions of frailty.13,16,17 Fried et al16 defined frailty as the presence of three or more of the following syndromes: unintentional weight loss, INTRODUCTION With the growth of the ageing population, osteoporosis and sarcopenia are emerging.1,2 Osteoporosis is defined as low bone mass and micro-architectural deterioration of bone tissue.3 According to the World Health Organization (WHO) criteria, a t-score of bone mineral density of <–2.5 is considered as osteoporotic.4 In clinical settings, osteoporosis is defined by the WHO bone mineral density criteria or the occurrence of a fragility fracture. Osteoporosis leads to increased bone fragility and fracture risk. In Asian countries, the age-standardised annual incidence of hip fractures is higher than that in the USA and some European countries.5 Osteoporotic fractures in elderly people can result in hospitalisation, institutional care, impaired quality of life, disability, and even death.6 Sarcopenia is defined as decreased muscle m
{"title":"Osteosarcopenia and frailty: a review","authors":"K. Miu","doi":"10.12809/AJGG-2018-323-RA","DOIUrl":"https://doi.org/10.12809/AJGG-2018-323-RA","url":null,"abstract":"Coexistence of osteoporosis and sarcopenia, known as osteosarcopenia, is well documented in frailty development in elderly people. Osteosarcopenia is associated with poor outcomes in terms of morbidity and mortality. This study aims to review the epidemiology and interactions of osteosarcopenia with frailty among older adults. Exercise seems to produce promising results in osteosarcopenic elderly people. Multidisciplinary assessment and management is the gold standard of care. Department of Rehabilitation and Extended Care, Wong Tai Sin Hospital, Hong Kong Correspondence to: Dr Ka Ying Doris Miu, Department of Rehabilitation and Extended Care, Wong Tai Sin Hospital, 124 Shatin Pass Road, Hong Kong. Email: miuky@ha.org.hk adjusted skeletal muscle mass of <7.26 kg/m2 in men and 5.45 kg/m2 in women as measured by DXA or <8.5 kg/m2 in men and 5.75 kg/m2 in women measured by BIA. A hand grip strength of <30 kg in men and <20 kg in women is considered at risk of sarcopenia. As body build differs between ethnic groups, the Asian Working Group for Sarcopenia (AWGS) defines sarcopenia as a height adjusted skeletal muscle mass of <7 kg/m2 in men and <5.4 kg/m2 in women measured by DXA and <7 kg/m2 in men and <5.7 kg/m2 in women measured by BIA, with a gait speed <0.8 m/s and a cut-off value of hand grip strength of <26 kg in men and <18 kg in women.8 In addition, there is a subgroup of elderly people who have both conditions with a higher risk of falls and fracture than those with osteoporosis or sarcopenia alone.9 This is known as sarco-osteopenia and later as osteosarcopenia. Studies have reported the association between osteosarcopenia and poor outcomes.10-12 Frailty is a major geriatric syndrome and is associated with greater prevalence of adverse health outcomes, including mortality, institutionalisation, falls, and recurrent hospitalisation.13-15 Frailty consists of multidimensional syndromes of loss of energy, physical activity, cognition, and health. There are many definitions of frailty.13,16,17 Fried et al16 defined frailty as the presence of three or more of the following syndromes: unintentional weight loss, INTRODUCTION With the growth of the ageing population, osteoporosis and sarcopenia are emerging.1,2 Osteoporosis is defined as low bone mass and micro-architectural deterioration of bone tissue.3 According to the World Health Organization (WHO) criteria, a t-score of bone mineral density of <–2.5 is considered as osteoporotic.4 In clinical settings, osteoporosis is defined by the WHO bone mineral density criteria or the occurrence of a fragility fracture. Osteoporosis leads to increased bone fragility and fracture risk. In Asian countries, the age-standardised annual incidence of hip fractures is higher than that in the USA and some European countries.5 Osteoporotic fractures in elderly people can result in hospitalisation, institutional care, impaired quality of life, disability, and even death.6 Sarcopenia is defined as decreased muscle m","PeriodicalId":38338,"journal":{"name":"Asian Journal of Gerontology and Geriatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47693847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-20DOI: 10.12809/AJGG-2018-305-OA
T. Ting, CY. Wong, S. Y. Ng
Introduction. Studies have suggested that 20% to 50% of inpatients are malnourished. This study aimed to investigate the prevalence of malnutrition risk in inpatients at an acute hospital and to evaluate the association between nutritional risk and clinical outcomes. Methods. Records of 40,105 adult patients admitted to our hospital between January and December 2016 were retrieved. We recorded patient Malnutrition Screening Tool (MST) scores (range, 0–5) and outcomes after discharge from hospital such as length of hospital stay (LOS), 28-day emergency readmission rate, and death. The malnutrition risk was categorised into three levels according to MST score: low risk (0-1), medium risk (2), and high risk (≥3). We made comparisons among the three groups, and between the low-risk group and the mediumand high-risk (at-risk) group. Results. The prevalence of malnutrition risk was 9.2%. Malnutrition risk was 12.0% among those aged ≥65 years and 6.1% among those aged 18 to 65 years. The low-, mediumand high-risk groups differed significantly in terms of the mean patient age (64.2 vs. 70.8 vs. 73.7 years, p<0.01) and the mean LOS (4.2 vs. 6.4 vs. 7.4 days, p<0.001). The emergency readmission rate within 28 days was higher in at-risk patients than in low-risk patients (25.1% vs. 14.6%, odds ratio=2.0, p<0.001), as was the mortality rate (8.5% vs. 2.3%, odds ratio=3.9, p<0.001). Conclusion. Malnutrition is a common problem among hospitalised patients. The use of a validated malnutrition screening tool to lower the malnutrition risk is necessary. A multicentre cross-sectional study on the effect of malnutrition on clinical outcomes is needed for developing service-quality enhancement measures. 1 Dietetics Department, North District Hospital, New Territories, Hong Kong 2 Department of Surgery, North District Hospital, New Territories, Hong Kong 3 Central Nursing Department, North District Hospital, New Territories, Hong Kong Correspondence to: Dr Terry HY Ting, 1/F, Dietetics Department, North District Hospital, New Territories, Hong Kong. Email: tinghoyan@gmail.com intake owing to neurological disorders (including dysphagia) that decrease the ability to self-feed, sideeffects of drugs or treatments, or deterioration in taste and smell leading to a poor appetite.2 Malnutrition is more likely to develop in older adults with comorbid chronic conditions, impaired adaptation to inflammatory-catabolic states, or a heightened risk of acute diseases.3 By 2050, the number of older INTRODUCTION Malnutrition is defined as a state of nutrition in which an excess or deficiency of energy, macroand micro-nutrients causes adverse effects on clinical, functional, and economic outcomes.1 Malnutrition is common in health care settings, particularly in an acute care hospitals, when patients reduce their food
介绍研究表明，20%至50%的住院患者营养不良。本研究旨在调查急性医院住院患者营养不良风险的患病率，并评估营养风险与临床结果之间的关系。方法。检索了2016年1月至12月期间入住我院的40105名成年患者的记录。我们记录了患者营养不良筛查工具（MST）评分（范围，0-5）和出院后的结果，如住院时间（LOS）、28天急诊再次入院率和死亡。根据MST评分，营养不良风险分为三个级别：低风险（0-1）、中风险（2）和高风险（≥3）。我们在三组之间以及低风险组和中高风险组之间进行了比较。后果营养不良风险的患病率为9.2%，≥65岁人群的营养不良风险为12.0%，18-65岁人群为6.1%。低、中、高危组的平均患者年龄（64.2 vs.70.8 vs.73.7岁，p<0.01）和平均LOS（4.2 vs.6.4 vs.7.4天，p<0.001）存在显著差异。高危患者28天内的急诊再入院率高于低风险患者（25.1%vs.14.6%，比值比=2.0，p<0.001），死亡率也是如此（8.5%对2.3%，比值比=3.9，p＜0.001）。营养不良是住院病人的常见问题。使用经过验证的营养不良筛查工具来降低营养不良风险是必要的。需要对营养不良对临床结果的影响进行多中心横断面研究，以制定提高服务质量的措施。1香港新界北区医院饮食科2香港新界北区医院外科3香港新界北区医院中央护理部致香港新界北区医院一楼Terry HY Ting医生。电子邮件：tinghoyan@gmail.com由于神经系统疾病（包括吞咽困难）导致的进食能力下降，药物或治疗的副作用，或味觉和嗅觉下降导致食欲下降。2老年人更容易出现营养不良，患有慢性病，对炎症分解代谢状态的适应受损，或患急性疾病的风险增加。3到2050年，老年人的数量引言营养不良被定义为一种营养状态，在这种状态下，能量、宏量和微量营养素的过量或缺乏会对临床、功能和经济结果产生不利影响。1营养不良在医疗保健环境中很常见，尤其是在急性护理医院，当患者减少食物时
{"title":"Malnutrition risk prevalence and clinical outcomes among acute hospital inpatients in Hong Kong","authors":"T. Ting, CY. Wong, S. Y. Ng","doi":"10.12809/AJGG-2018-305-OA","DOIUrl":"https://doi.org/10.12809/AJGG-2018-305-OA","url":null,"abstract":"Introduction. Studies have suggested that 20% to 50% of inpatients are malnourished. This study aimed to investigate the prevalence of malnutrition risk in inpatients at an acute hospital and to evaluate the association between nutritional risk and clinical outcomes. Methods. Records of 40,105 adult patients admitted to our hospital between January and December 2016 were retrieved. We recorded patient Malnutrition Screening Tool (MST) scores (range, 0–5) and outcomes after discharge from hospital such as length of hospital stay (LOS), 28-day emergency readmission rate, and death. The malnutrition risk was categorised into three levels according to MST score: low risk (0-1), medium risk (2), and high risk (≥3). We made comparisons among the three groups, and between the low-risk group and the mediumand high-risk (at-risk) group. Results. The prevalence of malnutrition risk was 9.2%. Malnutrition risk was 12.0% among those aged ≥65 years and 6.1% among those aged 18 to 65 years. The low-, mediumand high-risk groups differed significantly in terms of the mean patient age (64.2 vs. 70.8 vs. 73.7 years, p<0.01) and the mean LOS (4.2 vs. 6.4 vs. 7.4 days, p<0.001). The emergency readmission rate within 28 days was higher in at-risk patients than in low-risk patients (25.1% vs. 14.6%, odds ratio=2.0, p<0.001), as was the mortality rate (8.5% vs. 2.3%, odds ratio=3.9, p<0.001). Conclusion. Malnutrition is a common problem among hospitalised patients. The use of a validated malnutrition screening tool to lower the malnutrition risk is necessary. A multicentre cross-sectional study on the effect of malnutrition on clinical outcomes is needed for developing service-quality enhancement measures. 1 Dietetics Department, North District Hospital, New Territories, Hong Kong 2 Department of Surgery, North District Hospital, New Territories, Hong Kong 3 Central Nursing Department, North District Hospital, New Territories, Hong Kong Correspondence to: Dr Terry HY Ting, 1/F, Dietetics Department, North District Hospital, New Territories, Hong Kong. Email: tinghoyan@gmail.com intake owing to neurological disorders (including dysphagia) that decrease the ability to self-feed, sideeffects of drugs or treatments, or deterioration in taste and smell leading to a poor appetite.2 Malnutrition is more likely to develop in older adults with comorbid chronic conditions, impaired adaptation to inflammatory-catabolic states, or a heightened risk of acute diseases.3 By 2050, the number of older INTRODUCTION Malnutrition is defined as a state of nutrition in which an excess or deficiency of energy, macroand micro-nutrients causes adverse effects on clinical, functional, and economic outcomes.1 Malnutrition is common in health care settings, particularly in an acute care hospitals, when patients reduce their food","PeriodicalId":38338,"journal":{"name":"Asian Journal of Gerontology and Geriatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44325304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-20DOI: 10.12809/AJGG-2018-300-CR
L. Onn, S. Teo
{"title":"Hip osteomyelitis secondary to pressure injury: a case report","authors":"L. Onn, S. Teo","doi":"10.12809/AJGG-2018-300-CR","DOIUrl":"https://doi.org/10.12809/AJGG-2018-300-CR","url":null,"abstract":"","PeriodicalId":38338,"journal":{"name":"Asian Journal of Gerontology and Geriatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49245358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stroke is the second most common cause of disability-adjusted life years worldwide, and the incidence of stroke is highest in east Asia.1 In Hong Kong, every year approximately 22,000 people who suffer from stroke are discharged to home or institutional care.2 Risk factors for stroke are mainly associated with three aspects, including factors such as high systolic blood pressure and high level of cholesterol; behavioural factors such as smoking, physical inactivity, and diet; and environmental factors such as air pollution. Stroke survivors have three silent needs during rehabilitation: (1) need for rehabilitation of physical, cognitive, psychological and social functions, (2) need to regain an active lifestyle corresponding to their physical and/or mental limitations, and (3) need for environmental adaptation to regain an active lifestyle in a safe, accessible, and empowering environment.3
{"title":"Optimal rehabilitation and community integration for family caregivers of stroke patients","authors":"V. Lou","doi":"10.12809/AJGG-V14N1-ED","DOIUrl":"https://doi.org/10.12809/AJGG-V14N1-ED","url":null,"abstract":"Stroke is the second most common cause of disability-adjusted life years worldwide, and the incidence of stroke is highest in east Asia.1 In Hong Kong, every year approximately 22,000 people who suffer from stroke are discharged to home or institutional care.2 Risk factors for stroke are mainly associated with three aspects, including factors such as high systolic blood pressure and high level of cholesterol; behavioural factors such as smoking, physical inactivity, and diet; and environmental factors such as air pollution. Stroke survivors have three silent needs during rehabilitation: (1) need for rehabilitation of physical, cognitive, psychological and social functions, (2) need to regain an active lifestyle corresponding to their physical and/or mental limitations, and (3) need for environmental adaptation to regain an active lifestyle in a safe, accessible, and empowering environment.3","PeriodicalId":38338,"journal":{"name":"Asian Journal of Gerontology and Geriatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48149526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-20DOI: 10.12809/AJGG-2018-315-OA
Sunil Kumar, Shraddha Jain, A. Wanjari, S. Mandal
Background. Frailty is a reversible age-related condition characterised by declines across multiple physiologic systems and associated with an increased risk of mortality or unplanned hospitalisation. We developed and validated a new frailty index that is easy to apply in elderly people in rural India and has predictive accuracy for all-cause mortality at 6 and 12 months. Methods. 1000 participants aged >60 years who were admitted to a geriatric unit of a rural hospital for screening or treatment of any illness were recruited for development and validation of the Frailty Index in Rural Elderly – Mental status, Activities of daily living, Depression, and Events (FIRE-MADE), which combines the Cumulative Deficits Model and the Comprehensive Geriatric Assessment Model and takes into account of four domains: physical, cognitive, psychosocial, and functional. Results. The FIRE-MADE score increased with age and was higher in men than in women. Higher FIRE-MADE score was associated with higher rates of mortality and unplanned hospitalisation. In multivariable analysis, predictors for mortality were Mini-Mental State Examination, activities of daily living, ischaemic heart disease, history of stroke, and polypharmacy. In Kaplan-Meier survival analysis, 4.9%, 7.1%, and 16.7% of participants with mild (FIRE-MADE score, 0.3-0.4), moderate (0.5-0.6), and severe (>0.7) frailty died at the end of 1 year. The cut-off values for mortality and unplanned hospitalisation were 0.32 and 0.27, respectively, with the area under the receiver operating characteristic curve for the severity being 0.883 and 0.794, respectively. Compared with the Longitudinal Aging Study Amsterdam frailty index score in predicting mortality and unplanned hospitalisation, the FIRE-MADE score had positive predictive values of 88.89% and 88.89%, respectively, and negative predictive values of 65.93% and 41.10%, respectively. Association between the two indices was strong. Conclusions. FIRE-MADE is easy to apply in clinical practice as a screening tool to detect frailty in elderly people in rural India.
{"title":"Development and validation of a modified Frailty Risk Index as a predictor of mortality in rural elderly people","authors":"Sunil Kumar, Shraddha Jain, A. Wanjari, S. Mandal","doi":"10.12809/AJGG-2018-315-OA","DOIUrl":"https://doi.org/10.12809/AJGG-2018-315-OA","url":null,"abstract":"Background. Frailty is a reversible age-related condition characterised by declines across multiple physiologic systems and associated with an increased risk of mortality or unplanned hospitalisation. We developed and validated a new frailty index that is easy to apply in elderly people in rural India and has predictive accuracy for all-cause mortality at 6 and 12 months. Methods. 1000 participants aged >60 years who were admitted to a geriatric unit of a rural hospital for screening or treatment of any illness were recruited for development and validation of the Frailty Index in Rural Elderly – Mental status, Activities of daily living, Depression, and Events (FIRE-MADE), which combines the Cumulative Deficits Model and the Comprehensive Geriatric Assessment Model and takes into account of four domains: physical, cognitive, psychosocial, and functional. Results. The FIRE-MADE score increased with age and was higher in men than in women. Higher FIRE-MADE score was associated with higher rates of mortality and unplanned hospitalisation. In multivariable analysis, predictors for mortality were Mini-Mental State Examination, activities of daily living, ischaemic heart disease, history of stroke, and polypharmacy. In Kaplan-Meier survival analysis, 4.9%, 7.1%, and 16.7% of participants with mild (FIRE-MADE score, 0.3-0.4), moderate (0.5-0.6), and severe (>0.7) frailty died at the end of 1 year. The cut-off values for mortality and unplanned hospitalisation were 0.32 and 0.27, respectively, with the area under the receiver operating characteristic curve for the severity being 0.883 and 0.794, respectively. Compared with the Longitudinal Aging Study Amsterdam frailty index score in predicting mortality and unplanned hospitalisation, the FIRE-MADE score had positive predictive values of 88.89% and 88.89%, respectively, and negative predictive values of 65.93% and 41.10%, respectively. Association between the two indices was strong. Conclusions. FIRE-MADE is easy to apply in clinical practice as a screening tool to detect frailty in elderly people in rural India.","PeriodicalId":38338,"journal":{"name":"Asian Journal of Gerontology and Geriatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42214935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-20DOI: 10.12809/AJGG-2018-304-OA
Nicholette Goh, K. Tan
Objective. To determine the effect of the start-to-finish programme by comparing outcomes of elderly patients who underwent colorectal surgery before and after introduction of the programme. Methods: Data of consecutive patients aged ≥75 years who underwent major colorectal surgery (open, minimally invasive, elective, or emergency) between February 2007 and November 2015 at our institution were collected prospectively. Postoperative outcomes of patients were compared before and after the July 2013 introduction of the start-to-finish programme. Patients were risk-stratified for decision on whether prehabilitation was required, based on frailty syndrome, weighted Charlson Comorbidity Index, and ambulatory status. Frailty was defined as presentation of three or more of the following criteria: unintentional weight loss, self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. Outcome measures included discharge destination, functional decline in terms of a loss of ≥10 points in the Barthel Index at postoperative week 6, length of hospital stay, postoperative complication in terms of a Clavien-Dindo score of ≥3, and 30-day mortality. Results: A total of 121 geriatric patients were recruited and followed up for a mean duration of 36 months. Of whom, 49 (40.1%) were recruited after the introduction of start-to-finish programme in July 2013. 34 (28.1%) of the 121 patients were determined to be frail. In multivariate analysis, frailty was the only predictor of discharge destination (odds ratio [OR]=6.067, p=0.001). Patients with a Clavien-Dindo score of ≥3 were more likely to have functional decline at postoperative week 6 (OR=83.926, p=0.003). The start-to-finish programme (OR=0.067, p=0.023) and elective surgery (OR=0.091, p=0.024) were associated with maintenance of functional. Frailty was associated with discharge to facilities other than home (OR=6.067, p=0.001) and a steeper decline on longer-term follow-up. Conclusion: The start-to-finish programme had a positive effect on reducing functional decline after colorectal surgery. Frail patients and patients with major complications require special attention to mitigate the steep functional decline.
{"title":"Effect of multidisciplinary prehabilitation-rehabilitation on outcomes after colorectal surgery in elderly patients","authors":"Nicholette Goh, K. Tan","doi":"10.12809/AJGG-2018-304-OA","DOIUrl":"https://doi.org/10.12809/AJGG-2018-304-OA","url":null,"abstract":"Objective. To determine the effect of the start-to-finish programme by comparing outcomes of elderly patients who underwent colorectal surgery before and after introduction of the programme. Methods: Data of consecutive patients aged ≥75 years who underwent major colorectal surgery (open, minimally invasive, elective, or emergency) between February 2007 and November 2015 at our institution were collected prospectively. Postoperative outcomes of patients were compared before and after the July 2013 introduction of the start-to-finish programme. Patients were risk-stratified for decision on whether prehabilitation was required, based on frailty syndrome, weighted Charlson Comorbidity Index, and ambulatory status. Frailty was defined as presentation of three or more of the following criteria: unintentional weight loss, self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. Outcome measures included discharge destination, functional decline in terms of a loss of ≥10 points in the Barthel Index at postoperative week 6, length of hospital stay, postoperative complication in terms of a Clavien-Dindo score of ≥3, and 30-day mortality. Results: A total of 121 geriatric patients were recruited and followed up for a mean duration of 36 months. Of whom, 49 (40.1%) were recruited after the introduction of start-to-finish programme in July 2013. 34 (28.1%) of the 121 patients were determined to be frail. In multivariate analysis, frailty was the only predictor of discharge destination (odds ratio [OR]=6.067, p=0.001). Patients with a Clavien-Dindo score of ≥3 were more likely to have functional decline at postoperative week 6 (OR=83.926, p=0.003). The start-to-finish programme (OR=0.067, p=0.023) and elective surgery (OR=0.091, p=0.024) were associated with maintenance of functional. Frailty was associated with discharge to facilities other than home (OR=6.067, p=0.001) and a steeper decline on longer-term follow-up. Conclusion: The start-to-finish programme had a positive effect on reducing functional decline after colorectal surgery. Frail patients and patients with major complications require special attention to mitigate the steep functional decline.","PeriodicalId":38338,"journal":{"name":"Asian Journal of Gerontology and Geriatrics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42013163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-30DOI: 10.12809/ajgg-2017-276-oa
S. L. Ling, Chia-Ti Cheng, Frank, Liu, D. Irwanto, F. Kohler, Matthew Smith, D. Chan
Background. Prior to May 2015, our hospital provided only non-urgent geriatric services for nursing home residents. Thereafter, the Connecting Care Programme was introduced to provide acute geriatric services, including administration of intravenous antibiotics and fluids and a variety of other procedures. This audit aimed to investigate the impact of acute geriatric services for nursing home residents on emergency department presentation and hospitalisation. Methods. Medical records of nursing home residents who presented to the Bankstown-Lidcombe Hospital before (from May to August 2014) and after (from May to August 2015) the Connecting Care Programme were retrospectively reviewed. The two groups were compared in terms of emergency department presentation and discharge rates. Results. Respectively for the group before and after the programme, of all presentations to the emergency department, 276 and 318 involved nursing home residents (6.1% vs 7.1%, p=0.056). Of these, 106 and 167 were discharged from the emergency department (38.4% vs 52.5%, odds ratio=1.76, 95% confidence interval=1.2-2.4, p=0.0008). The Connecting Care Programme increased the discharge rate in those with a diagnosis of fall without fracture (70% vs 88%, p=0.021), respiratory (11% vs 31%, p=0.020), gastrointestinal (34% vs 50%, p=0.025), or cardiovascular (24% vs 60%, p=0.010) complaints. Conclusion. The Connecting Care Programme resulted in an increased discharge rate and decreased hospital admission rate for nursing home residents who presented with fall without fracture, respiratory, gastrointestinal, or cardiovascular complaints. The programme may enable better utilisation of healthcare resources.
背景。2015年5月之前，我院仅为养老院居民提供非紧急老年服务。此后，实施了连接护理方案，以提供急性老年服务，包括静脉注射抗生素和液体以及各种其他程序。本审计旨在调查急性老年护理服务对急诊科表现和住院的影响。方法。回顾性回顾了在连接护理计划之前(2014年5月至8月)和之后(2015年5月至8月)到bankown - lidcombe医院就诊的养老院居民的医疗记录。比较两组在急诊科的表现和出院率。结果。在计划之前和之后的小组中，所有到急诊科的报告中，276和318涉及养老院居民(6.1%对7.1%，p=0.056)。其中106例和167例从急诊科出院(38.4% vs 52.5%，优势比=1.76,95%可信区间=1.2 ~ 2.4,p=0.0008)。连接护理计划提高了诊断为跌倒无骨折的患者的出院率(70%对88%，p=0.021)、呼吸道疾病(11%对31%，p=0.020)、胃肠道疾病(34%对50%，p=0.025)或心血管疾病(24%对60%，p=0.010)。结论。“连接护理计划”提高了养老院居民的出院率，降低了住院率，这些人出现了跌倒，但没有骨折、呼吸系统、胃肠道或心血管疾病。该方案可使医疗资源得到更好的利用。
{"title":"Impact of acute geriatric services for nursing home residents on emergency department presentation and hospitalisation","authors":"S. L. Ling, Chia-Ti Cheng, Frank, Liu, D. Irwanto, F. Kohler, Matthew Smith, D. Chan","doi":"10.12809/ajgg-2017-276-oa","DOIUrl":"https://doi.org/10.12809/ajgg-2017-276-oa","url":null,"abstract":"Background. Prior to May 2015, our hospital provided only non-urgent geriatric services for nursing home residents. Thereafter, the Connecting Care Programme was introduced to provide acute geriatric services, including administration of intravenous antibiotics and fluids and a variety of other procedures. This audit aimed to investigate the impact of acute geriatric services for nursing home residents on emergency department presentation and hospitalisation. Methods. Medical records of nursing home residents who presented to the Bankstown-Lidcombe Hospital before (from May to August 2014) and after (from May to August 2015) the Connecting Care Programme were retrospectively reviewed. The two groups were compared in terms of emergency department presentation and discharge rates. Results. Respectively for the group before and after the programme, of all presentations to the emergency department, 276 and 318 involved nursing home residents (6.1% vs 7.1%, p=0.056). Of these, 106 and 167 were discharged from the emergency department (38.4% vs 52.5%, odds ratio=1.76, 95% confidence interval=1.2-2.4, p=0.0008). The Connecting Care Programme increased the discharge rate in those with a diagnosis of fall without fracture (70% vs 88%, p=0.021), respiratory (11% vs 31%, p=0.020), gastrointestinal (34% vs 50%, p=0.025), or cardiovascular (24% vs 60%, p=0.010) complaints. Conclusion. The Connecting Care Programme resulted in an increased discharge rate and decreased hospital admission rate for nursing home residents who presented with fall without fracture, respiratory, gastrointestinal, or cardiovascular complaints. The programme may enable better utilisation of healthcare resources.","PeriodicalId":38338,"journal":{"name":"Asian Journal of Gerontology and Geriatrics","volume":"6 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41256882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-30DOI: 10.12809/ajgg-2018-320-letter
Iris F. K. Lee, F. Yau, S. Yim, D. Lee
In Hong Kong, the overload of the health care system and the heavy burden on caregivers urge the revisit of the local community rehabilitation services. Owing to the ageing population, high demand for hospital beds inevitably leads to early discharge of patients. Post-discharge rehabilitation services thus become exceptionally important to older patients. The transition period from hospital to home is critical for rehabilitation, as it affects patient recovery and adjustment to daily activities and quality of life.1 In addition, the stress of caregivers should not be overlooked. For instance, in 2017 an old man killed his wife, who had physical deconditioning at home, because of stress from prolonged caregiving.2 To prevent such tragedies, rehabilitation services should provide caregiver support such as skill training and referral to social services. However, there are gaps in the existing subsidised rehabilitation services for the older people in Hong Kong.
{"title":"Can home-based rehabilitation services facilitate rehabilitation transition from hospital to community?","authors":"Iris F. K. Lee, F. Yau, S. Yim, D. Lee","doi":"10.12809/ajgg-2018-320-letter","DOIUrl":"https://doi.org/10.12809/ajgg-2018-320-letter","url":null,"abstract":"In Hong Kong, the overload of the health care system and the heavy burden on caregivers urge the revisit of the local community rehabilitation services. Owing to the ageing population, high demand for hospital beds inevitably leads to early discharge of patients. Post-discharge rehabilitation services thus become exceptionally important to older patients. The transition period from hospital to home is critical for rehabilitation, as it affects patient recovery and adjustment to daily activities and quality of life.1 In addition, the stress of caregivers should not be overlooked. For instance, in 2017 an old man killed his wife, who had physical deconditioning at home, because of stress from prolonged caregiving.2 To prevent such tragedies, rehabilitation services should provide caregiver support such as skill training and referral to social services. However, there are gaps in the existing subsidised rehabilitation services for the older people in Hong Kong.","PeriodicalId":38338,"journal":{"name":"Asian Journal of Gerontology and Geriatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43556512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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