Journal of Frailty & Aging最新文献

Objective: To investigate whether direct admission to geriatric inpatient care from the emergency department (EMD) was associated with lower length of stay (LOS) and cost compared to patients admitted through an acute medical unit (AMU).

Methods: Retrospective single-centre cohort study conducted using hospital database on older patients ≥ 75 years discharged from geriatric inpatient service in a tertiary academic centre from March 2021 to September 2021 who were admitted through AMU or direct from EMD.

Intervention: Traditional AMU run by internists followed by geriatrician led-care compared with geriatrician led-care.

Measure: We evaluated the difference in median length of stay (LOS), and cost using quantile regression adjusted for primary discharge diagnoses, hospital frailty risk score (HFRS) and Age-adjusted Charlson Comorbidity Index (ACCI).

Results: Among 574 older patients, 140 (24.4%) were admitted from AMU. Mean age was 84.0 ± 6.3 years and 83.8% were categorized as high or intermediate frailty risk based on HFRS. 46% of patients admitted through EMD were discharged within three days. After adjusting for primary diagnoses, HFRS, and ACCI, patients admitted through AMU had a longer median LOS of 1.6 days (95% confidence interval (CI): 0.86-2.4, p<0.001), higher total cost $1386.0 (95% CI 733-2038, p<0.001), laboratory cost $226.0 (95% CI 131-322, p<0.001), medication cost $65.0 (95% CI 15-115, p<0.010), physiotherapy cost $45.0 (95% CI 16-75, p=0.002) and occupational therapy cost $35.0 (95% CI 12-58, p=0.003).

Conclusion: Older adults admitted through AMU had significantly longer median LOS, higher total cost, physiotherapy and occupational therapy costs, medication, and laboratory costs.

Background: Malnutrition has been variously associated with poor postoperative outcomes. Of note, 10-25 % of cardiac surgery patients are reported to be malnourished.

Objectives: To assess the impact of nutritional status (evaluated with the Geriatric Nutritional Risk Index - GNRI) on outcomes of older patients undergoing heart valve surgery.

Design: Retrospective, single-center.

Setting: Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.

Participants: 448 patients older than 75 years who had undergone isolated, elective heart valve surgery. Patients were divided into low (GNRI≥92; 346 patients) and moderate-to-high (GNRI<92; 102 patients) risk groups of nutrition-related complications.

Measurements: Demographic, clinical, and biological variables were retrieved from the institutional Heart Valve Database. GNRI was calculated as follows: [1.489 × serum albumin (g/dL)] + [41.7 × actual body weight (kg) / ideal body weight (kg)]. Operative and postoperative outcomes were compared between GNRI groups. Survival at 3 years follow-up was analyzed using the Kaplan-Meier method and log-rank test. Cox regression was used to identify variables associated with survival.

Results: Mortality at 30 days did not differ between groups (0.98% vs 0.58% for GNRI < 92 and GNRI ≥ 92, respectively; p=0.54). Those with a GNRI < 92 required more frequently dialysis (2.9% vs 0.3%, p=0.04), inotropes (33.3% vs 22.8%, p=0.04), red blood cells transfusions (63.7% vs 19.9%, p<0.01), and longer mechanical ventilation support (12 ± 2 vs 6 ± 1.5 hours, p=0.03). Intensive care unit (4.7 ± 0.9 vs 1.6 ± 0.8 days, p=0.05) and total postoperative hospital (11.1 ± 1.9 vs 5.2 ± 1.5 days, p=0.05) stays were significantly longer in the GNRI < 92 group.

Conclusion: A poor nutritional status may increase morbidity and prolong hospitalization after cardiac surgery. GNRI might improve risk assessment and should be integrated into traditional surgical risk models to offer tailored care to older patients.

Importance: Intrinsic capacity (IC), defined by the World Health Organization's Integrated Care for Older People (ICOPE) framework, is crucial for promoting healthy aging. Understanding the associations between IC impairments and age-related biomarkers can provide insights into the underlying pathophysiological mechanisms and potential interventions.

Objective: To investigate the associations between IC impairments (ICOPE step 1 and step 2, respectively) and aging-related biomarkers, including inflammatory and cardiometabolic markers, in community-dwelling middle-aged and older adults.

Design, setting, and participants: Cross-sectional analysis of data from 755 participants (aged 50-64 years, n=212; 65-74 years, n=357; ≥75 years, n=186) enrolled in the Gan-Dau Healthy Longevity Plan, a community-based survey in Taipei City, Taiwan, from 2022.

Exposures: IC impairments assessed by ICOPE Step 1 (screening) and Step 2 (in-depth assessment) across six domains: locomotion, vitality, vision, hearing, cognition, and psychological well-being.

Main outcomes and measures: Levels of inflammatory biomarkers (albumin, white blood cell count, neutrophils, lymphocytes, monocytes, neutrophil-to-lymphocyte ratio [NLR], lymphocyte-to-monocyte ratio [LMR], platelet-to-lymphocyte ratio [PLR]) and cardiometabolic biomarkers (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], total cholesterol, fasting glucose, triglycerides, triglyceride-glucose [TyG] index).

Results: Of the 755 participants, the mean age was 68.5 years, and 68.2% were women. The proportion of participants with any IC impairment increased with age: 63.2% for those aged 50-64, 65.8% for those aged 65-74, and 74.7% for those aged ≥75 years based on ICOPE Step 1. For ICOPE Step 2, the proportions were 59.9%, 56.9%, and 64.0%, respectively. Impairments in locomotion and cognition were significantly higher in the oldest age group (≥75 years). Adjusted for covariates, IC impairment (ICOPE Step 2) was associated with higher levels of neutrophil count (β = 3.17, p = 0.015) and NLR (β = 0.34, p = 0.021) in those aged 50-64 years, and higher levels of monocyte count in those aged 65-74 years (β = 0.65, p = 0.001) and ≥75 years (β = 0.68, p = 0.037).

Conclusions and relevance: In conclusion, IC impairments were associated with alterations in specific inflammatory biomarkers, suggesting potential interactions between IC, age, and inflammatory processes. Longitudinal studies are warranted to establish causal relationships and elucidate the underlying mechanisms linking IC impairments, immune dysregulation, and the aging process.

Background: Maintaining physical function is important for independence and frailty prevention in later life, but very few older adults meet exercise recommendations. Previous studies found that 4-week 'exercise and Tai-chi snacking' as a viable alternative to traditional exercise is acceptable to healthy older adults.

Objectives: This study aimed to investigate the effectiveness of a 12-week progressive exercise and Tai-chi snacking programme on physical function and psychological outcomes in pre-frail older adults.

Design: Randomised controlled trial.

Setting: Community-dwelling older adults.

Participants: 90 older adults with impaired strength and balance were recruited. Participants were randomly allocated to an intervention or waitlist control group.

Intervention: A 12-week progressive exercise and Tai-chi snacking programme.

Measurements: Physical function (the short physical performance battery (SPPB), single-leg balance test and sit-to-stand test) was remotely measured at participants' homes via video calls at baseline, 4-, 8-, and 12-weeks. The self-reported psychological outcomes were also assessed every 4 weeks using online questionnaires. A subset of 40 participants also completed in-person functional assessments, and 26 intervention participants underwent semi-structured interviews to feedback on their experiences.

Results: The 12-week progressive home-based exercise and Tai-chi snacking improved SPPB strength (estimated mean difference in week 4: 1.05; week 8: 0.79; and week 12: 0.79) and balance (estimated mean difference in week 4: 0.71; week 8: 0.57; and week 12: 0.65) at each timepoint compared to control group. Timed-up-and-go (estimated mean difference in week 4: 1.94; week 8: 1.58; and week 12: 1.1) and total SPPB scores (estimated mean difference in week 4: 2.24; week 8: 1.79; and week 12: 1.76) were also better in the intervention group compared to the control group in lab subset participants. Based on the qualitative findings, Participants found the programme accessible and beneficial, making it suitable for older adults and increasing self-efficacy in physical activities.

Conclusion: The home-based exercise and Tai-chi snacking programme significantly improved lower extremity strength, balance, and mobility in pre-frail older adults. This programme is considered to be a beneficial, acceptable and easy implemented physical function intervention.

Background: Loneliness is highly prevalent among older adults and is associated with frailty. Most studies consider loneliness in isolation without consideration for structural and functional measures of social relationships - and longitudinal studies are scarce.

Objectives: This study examined longitudinal associations between loneliness and frailty and analyzed how structural and functional social measures influence these associations.

Design: Linear mixed effects models examined longitudinal associations between loneliness and frailty assessed with the frailty index (scale 0-100). Models were adjusted for baseline age, gender, education, depressive symptoms, global cognition, and structural (e.g., social network, marital status), and functional social measures (e.g., social, cognitive, and physical activity, and social support).

Participants: Loneliness and frailty data from 1,931 older adults without dementia at baseline from the Rush Memory and Aging Project were examined (mean age 79.6 ± 7.7 years, 74.9% female).

Measurements: Baseline loneliness assessed by the de Jong Gierveld Loneliness Scale was the predictor of interest.

Results: Frailty increased significantly over a mean follow-up period of 4.6 years. Effects of loneliness on frailty were modified by marital status. Loneliness predicted an additional accumulation of 0.37 and 0.34 deficits on the frailty index per year in married and widowed individuals respectively, compared to those who were not lonely (married: p=0.009, CI 0.09, 0.64; widowed: p=0.005, CI 0.1, 0.58). Loneliness did not predict frailty progression in unmarried individuals.

Conclusions: Loneliness predicts frailty progression, highlighting the importance of social determinants on physical health in aging.

Healthcare demand from falls in older adults is increasing, but guidance from the literature is lacking on the value of neuroimaging, particularly for those who have fallen but have no head injury or an unclear history. We carried out retrospective analysis of data from Emergency Department attendances at a large English hospital to assess compliance with guidelines and explore utility of CT scans for those not covered by existing guidance. Following a fall, 49% (577) of older adults received a cranial CT scan, 4.9% (28) of whom had an intracranial haemorrhage and only 2 received neurosurgical intervention. Only 59% who had a CT had a clear history of head injury, unwitnessed falls were common (71%) and there was a high prevalence of dementia (23%); those scanned without a clear history of head injury were significantly more frail, but not older. There was some indication that seizure, reduced GCS and neurological signs are predictive of intracranial haemorrhage regardless of head injury history, but further research is recommended to provide clarity on which groups stand to benefit most and how clinicians can be supported in decision making that balances diagnostic yield, patient benefit and imaging demand.

Background: Muscle power assessment entails the use of complex equipment which impacts its clinical applicability. Recently, equations to estimate lower-limb muscle power measures based on 5-repetition sit-to-stand (5STS) performance and anthropometric parameters were validated. However, their ability to discriminate physical performance status in older adults is still unknown. Moreover, the analysis of the biomechanical aspects of 5STS might represent a valid instrument to identify people with different physical statuses.

Objectives: Explore and examine the biomechanical aspects of 5STS performance, and compare the capacity of this measure and 5STS muscle power equations to discriminate older women with different physical function levels.

Design: Cross-sectional study.

Setting: Community.

Participants: Older women.

Measurements: 5STS using a linear encoder, Timed "Up-andGo" (TUG), isometric handgrip strength (IHG) and walking speed (WS).

Results: Results from ANOVA analysis indicated that peak concentric muscle power was reached in the first 5STS repetition and then declined significantly (P= 0.006). When participants were divided in high and low physical performance groups according to median results of TUG, IHG and WS tests, significant differences in 5STS biomechanical aspects were observed, according to independent t-test results (P< 0.05). However, no differences were found for 5STS muscle power equations. Pearson's correlation analysis indicated that 5STS biomechanical aspects (P< 0.05), but not 5STS muscle power equations, were significantly associated with physical performance.

Conclusion: Findings of the present study suggest that 5STS biomechanical aspects might contribute to discriminating older women with high and low physical performance.

Background: Falls among the older population have attracted global attention, with a specific emphasis on the regional contexts of falls. This study reports the incidence and characteristics of falls in the State of Kuwait, where there is currently no national fall prevention strategy.

Methodology: A prospective, cross-sectional study reported on 420 individuals aged 55 years and above admitted to Alrazi Orthopaedic Hospital in Kuwait City due to falls between March 2022 and February 2023. ICD-10 codes were used to classify the fall causes. The National Database of Nursing Quality Indicators injury severity classification was used to classify the fall-related injuries. Structured interviews were used to identify 10 main fall risk factors. Annual fall-rate was calculated and fall-related injuries were reported in frequencies and percentages. Chi-square tests and multinomial logistic regression models were used to examine the cross-sectional associations between fall severity and risk factors to determine the factors that could predict more severe fall-related injuries.

Results: Fall-related injuries comprised 24.1% of the total hospital admissions, with 4% mortality rate. Around 31.6% of the falls led to temporary impairment injuries, 23.5% resulted in long-term impairment injuries, and 44.8% created potentially fatal injuries. The results of this study show that being between 55 and 74 years of age, having no history of falls, suffering from at least one illness, with no polypharmacy effect, and possessing fair vision are significantly associated with the severity of fall injuries. Being male (odds ratio [OR] = 3.38), being over 65 years of age (OR = 3.46), having a history of falls (OR = 2.49), and limitations in visual acuity predict more severe fall injuries among older individuals.

Conclusion: The severity of fall injuries is significantly associated with more capable older people. Government officials should immediately design and implement culture-specific fall-prevention strategies tailored to the targeted population.

Background: Handgrip strength (HGS) is a crucial measurement for diagnosing sarcopenia, and HGS asymmetry indicates functional impairment and correlates with adverse health outcomes. Although chronic low back pain (CLBP) often coexists with sarcopenia in older people, the association between HGS asymmetry and sarcopenia in that population has not been investigated.

Objectives: This study examines the association between HGS asymmetry and sarcopenia in older patients with CLBP and explores differences in the proportion of sarcopenia and severe sarcopenia according to the severity of HGS asymmetry.

Design: A retrospective observational study.

Setting: The study included patients who visited the outpatient department for pain management at a university hospital.

Participants: Ambulatory patients 65 years and older with CLBP assessed for sarcopenia per the Asian Working Group for Sarcopenia (AWGS) 2019 protocol were enrolled.

Measurements: HGS asymmetry was categorized into three groups (< 10%, 10-20%, and > 20%) based on the difference between the hands.

Results: A total of 575 CLBP patients aged 65-90 years was analyzed. In females, physical performance scores declined as HGS asymmetry severity increased (p < 0.001), alongside a proportional rise in the proportion of sarcopenia (p = 0.006) and severe sarcopenia (p = 0.002). Conversely, males showed no such association. Moreover, patients with low HGS (meeting the AWGS 2019 criteria) had a higher proportion of sarcopenia (p = 0.019) and severe sarcopenia (p = 0.017) as HGS asymmetry severity increased. The multivariable analysis identified > 20% HGS asymmetry as an independent predictor of sarcopenia (adjusted odds ratio (OR) 3.296, 95% confidence interval (CI) 1.595-6.811, p = 0.001) and severe sarcopenia (adjusted OR 3.092, 95% CI 1.467-6.517, p = 0.003) exclusively in females.

Conclusions: Severe HGS asymmetry was associated with poor physical performance and a higher proportion of sarcopenia in older female patients with CLBP.

Background: Oral health is a relevant component for overall health. Oral disease onset at an early age and may harm several health dimensions, especially among older people, and has been associated with frailty.

Objective: To evaluate associations between the Frailty Index (FI) and self-reported oral diseases among older, community-dwelling Japanese people.

Design: Cross-sectional and prospective analyses were performed.

Setting and participants: We analyzed data from 2,529 participants at the baseline and four-year follow-up of the Nihon University Japanese Longitudinal Study of Aging, which had a four-year follow-up.

Measurements: We used the self-reported number of teeth, self-reported satisfaction with dentures, and self-reported ability to chew hard food as independent variables. We computed an FI that included 40 deficits as the dependent variable. The FI score ranged from 0 to 1, with a higher score associated with adverse health outcomes and mortality. Considering a gamma distribution and controlling for age, gender, marital status, education, working status, and residence area, we fitted generalized linear models.

Results: We found that dissatisfied denture users had a 2.1% (95% CI 1.006-3.279) higher frailty score than non-denture users at the baseline and a 2.1% (95% CI 0.629-3.690) higher frailty score than non-denture users at the four-year follow-up. In the cross-sectional analysis, with each additional reported tooth at the baseline, the FI score was lower by 1.5% (95% CI -2.878 to -0.208) at the four-year follow-up. In both the cross-sectional and the prospective analyses, the FI scores increased as the ability to chew hard food decreased.

Conclusions: Self-reported oral diseases are associated with the FI score cross-sectionally and prospectively. Identifying factors prospectively associated with frailty may improve strategies for the next generation of older people. Considering oral diseases may help clinicians personalize treatment plans for older people.