A universal aim for ageing societies is that older people may remain healthy, be functionally independent, and be engaged in society. Various indicators with summary scores have been proposed, which may be used for international comparison or within country monitoring to guide ageing policy development and evaluate effectiveness of such policies. However, it is uncertain whether these indicators may be adapted to countries with different cultures and political systems. Simple indicators such as the Human Development Index may be misleading when compared to more detailed multi domain indices in reflecting the performance of ageing policies in a particular country, such as the Hong Kong Elder Quality of Life Index (EQOLHK). Construction of country specific indicators may be more relevant to shaping ageing policies rather than using indicators just for the sake of international ranking.
{"title":"Indicators of Societal Adaptations to Ageing Well","authors":"J. Woo","doi":"10.20900/agmr20200003","DOIUrl":"https://doi.org/10.20900/agmr20200003","url":null,"abstract":"A universal aim for ageing societies is that older people may remain healthy, be functionally independent, and be engaged in society. Various indicators with summary scores have been proposed, which may be used for international comparison or within country monitoring to guide ageing policy development and evaluate effectiveness of such policies. However, it is uncertain whether these indicators may be adapted to countries with different cultures and political systems. Simple indicators such as the Human Development Index may be misleading when compared to more detailed multi domain indices in reflecting the performance of ageing policies in a particular country, such as the Hong Kong Elder Quality of Life Index (EQOLHK). Construction of country specific indicators may be more relevant to shaping ageing policies rather than using indicators just for the sake of international ranking.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74219934","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}
Kurt A. Escobar, L. Visconti, A. Wallace, Trisha A. VanDusseldorp
“Diet and exercise will help you live longer” is a well-known meme. While often taken for granted, its foundations span back to our evolutionary environment and its effects extend into our intracellular environment. Humans evolved under conditions of high physical activity and periodic privation which shaped our genes. During these times of energetic challenge, an evolutionary conserved recycling system, autophagy, would have been activated to provision energy through the degradation of intracellular proteins, organelles, and lipids. With physical activity no longer a requisite for survival and caloric abundance rather than caloric shortage defining the modern human environment, the signals for autophagy are no longer obligatory. Moreover, humans have evolved an avoidance of physical activity and caloric restriction (CR). This leads to an accumulation of intracellular components causing degeneration and disruption of cellular homeostasis. This deleterious accrual of cellular materials also occurs during aging, in part, by an age-related decline in autophagy. What’s more, humans live in a period of history where advances in sanitation and medicine have allowed us to live to unprecedented ages, resulting in long-lived humans with progressive system-wide degeneration. Exercise and CR practices promote age-related health and longevity through their activation of autophagic housekeeping, but evolutionary inertia pushes us to avoid them. However, humans are unique in that we can harness our own genes as well as propagate our own memes. In order to yield the benefits of cellular housekeeping through exercise and CR practices, we should understand our genes and become memesters.
{"title":"“Diet and Exercise Will Help You Live Longer”: The Meme that Turns on Housekeeping Genes","authors":"Kurt A. Escobar, L. Visconti, A. Wallace, Trisha A. VanDusseldorp","doi":"10.20900/agmr20200002","DOIUrl":"https://doi.org/10.20900/agmr20200002","url":null,"abstract":"“Diet and exercise will help you live longer” is a well-known meme. While often taken for granted, its foundations span back to our evolutionary environment and its effects extend into our intracellular environment. Humans evolved under conditions of high physical activity and periodic privation which shaped our genes. During these times of energetic challenge, an evolutionary conserved recycling system, autophagy, would have been activated to provision energy through the degradation of intracellular proteins, organelles, and lipids. With physical activity no longer a requisite for survival and caloric abundance rather than caloric shortage defining the modern human environment, the signals for autophagy are no longer obligatory. Moreover, humans have evolved an avoidance of physical activity and caloric restriction (CR). This leads to an accumulation of intracellular components causing degeneration and disruption of cellular homeostasis. This deleterious accrual of cellular materials also occurs during aging, in part, by an age-related decline in autophagy. What’s more, humans live in a period of history where advances in sanitation and medicine have allowed us to live to unprecedented ages, resulting in long-lived humans with progressive system-wide degeneration. Exercise and CR practices promote age-related health and longevity through their activation of autophagic housekeeping, but evolutionary inertia pushes us to avoid them. However, humans are unique in that we can harness our own genes as well as propagate our own memes. In order to yield the benefits of cellular housekeeping through exercise and CR practices, we should understand our genes and become memesters.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73951584","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}
Dementia is an increasingly common condition among the older population. It is characterised by multiple cognitive deficits leading to decline from premorbid level of functioning. In 2015 it was estimated that there were over 850,000 people in the United Kingdom (UK) living with dementia and approximately 7,000,000 family carers of people with dementia in the UK. Carers are finding themselves providing increasing amounts of care and support for their loved ones, often independently. Whilst carers find that providing support can have its rewards, it is more the case that it can be challenging and have an impact on their psychological and physical health, and can change existing relationships. It can be extremely exhausting and isolating and, additionally, be at great personal financial cost to them. The aim of this paper is to introduce an Admiral Nurse two year project established in a hospice in the West Midlands, supported by Dementia UK, a national charity often seen as the voice of dementia in the UK. It briefly describes the clinical context of this service and how an independent evaluation was commissioned with a local University to identify the impact of this service from a clinical, operational and strategic perspective. As part of the evaluation strategy, a survey of carers who had used the Admiral Nurse service was conducted. This paper will focus upon the survey and its outcomes and will consider: how these help professionals to appreciate the complex support needs of people with dementia; inform the developing Admiral Nurse’s role; and help professionals to think about future hospice services and their client populations. The paper will end with conclusions and recommendations relating to the lived experiences of family carers and the Admiral Nurse’s role and its position in future care and support of patients with dementia.
{"title":"The Admiral Nurse Role in UK Hospice Care: A Satisfaction Survey Evaluation to Explore Carer Experiences","authors":"S. Read, C. Reeves, Julie Green, K. Dening","doi":"10.20900/agmr20200001","DOIUrl":"https://doi.org/10.20900/agmr20200001","url":null,"abstract":"Dementia is an increasingly common condition among the older population. It is characterised by multiple cognitive deficits leading to decline from premorbid level of functioning. In 2015 it was estimated that there were over 850,000 people in the United Kingdom (UK) living with dementia and approximately 7,000,000 family carers of people with dementia in the UK. Carers are finding themselves providing increasing amounts of care and support for their loved ones, often independently. Whilst carers find that providing support can have its rewards, it is more the case that it can be challenging and have an impact on their psychological and physical health, and can change existing relationships. It can be extremely exhausting and isolating and, additionally, be at great personal financial cost to them. \u0000The aim of this paper is to introduce an Admiral Nurse two year project established in a hospice in the West Midlands, supported by Dementia UK, a national charity often seen as the voice of dementia in the UK. It briefly describes the clinical context of this service and how an independent evaluation was commissioned with a local University to identify the impact of this service from a clinical, operational and strategic perspective. As part of the evaluation strategy, a survey of carers who had used the Admiral Nurse service was conducted. This paper will focus upon the survey and its outcomes and will consider: how these help professionals to appreciate the complex support needs of people with dementia; inform the developing Admiral Nurse’s role; and help professionals to think about future hospice services and their client populations. The paper will end with conclusions and recommendations relating to the lived experiences of family carers and the Admiral Nurse’s role and its position in future care and support of patients with dementia.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"88 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75009560","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}
G. Boutros, K. Jacob, T. Fulop, A. Khalil, I. Dionne, D. Tessier, Barbara Trutschnigg, R. Kilgour, A. Vigano, J. Morais
Background and Objectives: Fatigue is one of the characteristics defining frailty. However, the mechanisms leading to fatigue are still poorly understood. Our objectives were to assess the efficacy of energy utilization (EU) during walking in frail older persons and their level of fatigue. Research Design and Methods: Clinical study of a convenient sample of frail older women. 10 healthy (H; 77 ± 4 year, BMI: 25 ± 3 kg/m2, MMSE: 29 ± 1) and 10 frail elderly women (F; 83 ± 6 year, 26 ± 5 kg/m2, 27 ± 3) were compared for their usual level of fatigue and changes in perceived fatigue and EU before and after walking. A 10 cm Visual Analogue Scale (VAS) prior to and following a 6-Minute Walk Test (6MWT) served to measure fatigue. EU was based on VO2 consumption adjusted for walking distance and measured using a portable Cosmed K4b2 indirect calorimeter. Participants underwent body composition measurements by DXA and venous blood sampling. Results: Groups had similar body composition and blood parameters. At rest, there were no differences in VO2 or energy expenditure, but the frail group had a lower heart rate. During 6MWT, between group differences were found for distance VO2, HR and EU. There were VAS changes in fatigue and a moderate correlation between the VAS of general fatigue and hsCRP. Discussion and Implications: Compared with their healthy counterparts, frail older women exhibited lower physical performance, efficacy of EU, and perceived more fatigue with activity. Inflammation was significantly correlated with subjective fatigue but did not characterize frailty.
{"title":"Energy Utilization and Fatigue in Frail Older Women in Relation to Walking","authors":"G. Boutros, K. Jacob, T. Fulop, A. Khalil, I. Dionne, D. Tessier, Barbara Trutschnigg, R. Kilgour, A. Vigano, J. Morais","doi":"10.20900/agmr20190013","DOIUrl":"https://doi.org/10.20900/agmr20190013","url":null,"abstract":"Background and Objectives: Fatigue is one of the characteristics defining frailty. However, the mechanisms leading to fatigue are still poorly understood. Our objectives were to assess the efficacy of energy utilization (EU) during walking in frail older persons and their level of fatigue. Research Design and Methods: Clinical study of a convenient sample of frail older women. 10 healthy (H; 77 ± 4 year, BMI: 25 ± 3 kg/m2, MMSE: 29 ± 1) and 10 frail elderly women (F; 83 ± 6 year, 26 ± 5 kg/m2, 27 ± 3) were compared for their usual level of fatigue and changes in perceived fatigue and EU before and after walking. A 10 cm Visual Analogue Scale (VAS) prior to and following a 6-Minute Walk Test (6MWT) served to measure fatigue. EU was based on VO2 consumption adjusted for walking distance and measured using a portable Cosmed K4b2 indirect calorimeter. Participants underwent body composition measurements by DXA and venous blood sampling. \u0000Results: Groups had similar body composition and blood parameters. At rest, there were no differences in VO2 or energy expenditure, but the frail group had a lower heart rate. During 6MWT, between group differences were found for distance VO2, HR and EU. There were VAS changes in fatigue and a moderate correlation between the VAS of general fatigue and hsCRP. \u0000 \u0000 \u0000Discussion and Implications: Compared with their healthy counterparts, frail older women exhibited lower physical performance, efficacy of EU, and perceived more fatigue with activity. Inflammation was significantly correlated with subjective fatigue but did not characterize frailty.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78785339","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}
Adeline Fontvieille, D. Tremblay, T. Amamou, Morgane Du Bois-dit-Bonclaude, I. Dionne, E. Riesco
Background: It was reported that cow’s milk-based supplementation after resistance training reduced fat mass in older men. The reasons behind this beneficial impact remain to be elucidated. Hence, the aim of this study was to determine the effect of a cow’s milk-based supplementation after resistance exercise on lipid oxidation and systemic fat mobilization in older men. Methods: Older men (age range: 60–75 years) participated in a randomized, double-blind, crossover study with the two following conditions: (1) Resistance exercise + Cow’s milk (C-milk) and (2) Resistance exercise + Rice milk (R-milk; isocaloric control). During a 180-min post-exercise period, energy expenditure, substrate oxidation (indirect calorimetry), plasma levels of glycerol (systemic fat mobilization) and free fatty acids (FFA) were measured. Results: During the 180-min post-exercise period, lipid oxidation remained similar in both conditions. Glycerol levels decreased similarly in C-milk and R-milk (p ≤ 0.045). Although FFA levels increased progressively from 60 min to 180 min post-exercise in both conditions, the magnitude of changes (∆) was greater in C-milk condition between 60 and 120 min post-exercise (p < 0.018). Conclusions: These results do not support a large impact of cow’s milk supplementation after resistance exercise on lipid oxidation and systemic fat mobilization. However, the greater increase in FFA levels suggests that re-esterification may be influenced.
{"title":"Acute Effect of Post-Resistance Exercise Milk-Based Supplement on Substrate Oxidation and Fat Mobilization in Older Men: A Pilot Study","authors":"Adeline Fontvieille, D. Tremblay, T. Amamou, Morgane Du Bois-dit-Bonclaude, I. Dionne, E. Riesco","doi":"10.20900/agmr20190012","DOIUrl":"https://doi.org/10.20900/agmr20190012","url":null,"abstract":"Background: It was reported that cow’s milk-based supplementation after resistance training reduced fat mass in older men. The reasons behind this beneficial impact remain to be elucidated. Hence, the aim of this study was to determine the effect of a cow’s milk-based supplementation after resistance exercise on lipid oxidation and systemic fat mobilization in older men. \u0000Methods: Older men (age range: 60–75 years) participated in a randomized, double-blind, crossover study with the two following conditions: (1) Resistance exercise + Cow’s milk (C-milk) and (2) Resistance exercise + Rice milk (R-milk; isocaloric control). During a 180-min post-exercise period, energy expenditure, substrate oxidation (indirect calorimetry), plasma levels of glycerol (systemic fat mobilization) and free fatty acids (FFA) were measured. \u0000Results: During the 180-min post-exercise period, lipid oxidation remained similar in both conditions. Glycerol levels decreased similarly in C-milk and R-milk (p ≤ 0.045). Although FFA levels increased progressively from 60 min to 180 min post-exercise in both conditions, the magnitude of changes (∆) was greater in C-milk condition between 60 and 120 min post-exercise (p < 0.018). \u0000Conclusions: These results do not support a large impact of cow’s milk supplementation after resistance exercise on lipid oxidation and systemic fat mobilization. However, the greater increase in FFA levels suggests that re-esterification may be influenced.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90889543","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}
Hugo Parent-Roberge, R. Maréchal, Adeline Fontvieille, I. Dionne, T. Fulop, M. Pavic, E. Riesco
Background: Kinesiophobia, the fear that movement and physical activity could worsen side effects such as fatigue and pain, is a barrier to exercise in cancer patients. Physical inactivity and deconditioning can lead to functional decline, higher mortality risk and lower quality of life, in older adults, and even more in oncogeriatrics because of a lower physical activity level during cancer treatments. The case: We present the case of an older breast cancer patient recruited in a controlled exercise trial and randomized to the control arm of the study (a 12-week supervised static stretching program). She expressed fear that physical activity might exacerbate some of her cancer-related symptoms during baseline physical capacity assessment (Senior Fitness Test, handgrip strength and maximal lower body strength). After completing the 12-week supervised static stretching program, she exhibited similar and/or larger improvements in many of the physical capacity tests than the mixed exercise intervention group, despite being in the control arm. Conclusions: These observations and physical capacity results have led us to emit the hypothesis that (1) this participant’s baseline physical capacity assessment might have been biased by kinesiophobia and (2) the supervision by exercise physiologist might have mitigated this fear over time. Hence, based on this case, we suggest that kinesiophobia should be measured in future exercise trials and clinical interventions targeting older cancer patients.
{"title":"Breaking Barriers: Could Exercise Supervision Attenuate Kinesiophobia in an Older Cancer Patient?","authors":"Hugo Parent-Roberge, R. Maréchal, Adeline Fontvieille, I. Dionne, T. Fulop, M. Pavic, E. Riesco","doi":"10.20900/AGMR20190011","DOIUrl":"https://doi.org/10.20900/AGMR20190011","url":null,"abstract":"Background: Kinesiophobia, the fear that movement and physical activity could worsen side effects such as fatigue and pain, is a barrier to exercise in cancer patients. Physical inactivity and deconditioning can lead to functional decline, higher mortality risk and lower quality of life, in older adults, and even more in oncogeriatrics because of a lower physical activity level during cancer treatments. \u0000The case: We present the case of an older breast cancer patient recruited in a controlled exercise trial and randomized to the control arm of the study (a 12-week supervised static stretching program). She expressed fear that physical activity might exacerbate some of her cancer-related symptoms during baseline physical capacity assessment (Senior Fitness Test, handgrip strength and maximal lower body strength). After completing the 12-week supervised static stretching program, she exhibited similar and/or larger improvements in many of the physical capacity tests than the mixed exercise intervention group, despite being in the control arm. \u0000Conclusions: These observations and physical capacity results have led us to emit the hypothesis that (1) this participant’s baseline physical capacity assessment might have been biased by kinesiophobia and (2) the supervision by exercise physiologist might have mitigated this fear over time. Hence, based on this case, we suggest that kinesiophobia should be measured in future exercise trials and clinical interventions targeting older cancer patients.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81282062","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}
C. Cheong, R. Choo, N. H. L. Ha, Ivana Chan, A. Wong, L. Wee, P. Yap
Background: Frailty and cognitive impairment are closely related in sharing several possible underlying pathophysiological mechanisms. There is a lack of clarity in published literature on whether cerebral infarcts or Alzheimer’s pathology accounts for the frailty phenotype in patients with mild Alzheimer’s disease (AD). Therefore, we investigated the structural neuroimaging predictors of frailty in mild AD patients to better elucidate the underlying pathophysiology. Methods: We recruited subjects who satisfied inclusion criteria from a clinical database of patients attending a tertiary hospital memory clinic between 2012 and 2017. AD patients with Clinical Dementia Rating (CDR) 0.5 and 1.0 who had undergone MRI brain were included. Frailty Index (FI-CGA) was utilised for frailty assessment, and visual MRI rating scales were used by blinded raters to quantify the brain lesions. Results: A total of 342 mild AD patients with a mean age of 75.79 ± 7.18 were studied. A multivariate linear regression model adjusted for demographics, cognitive scores and functional status revealed only deep white matter hyperintensities (DWMH) but none other brain lesions to be significantly and positively correlated with FI-CGA (β = 0.178, SE = 0.047, p ≤ 0.001) This model which comprised age, CDR sum of boxes, basic activities of living and DWMH, accounted for 47.5% of the FI-CGA variance in the study population. Conclusions: The study has revealed DWMH to be independently associated with frailty in mild AD patients. With the current understanding of the aetiology of DWMH, control of vascular risk factors is vital to preventing and ameliorating frailty in patients with mild AD.
背景:虚弱和认知障碍在共享几个可能的潜在病理生理机制方面密切相关。关于脑梗死或阿尔茨海默病病理是导致轻度阿尔茨海默病(AD)患者虚弱表型的原因，已发表的文献尚不明确。因此，我们研究了轻度AD患者虚弱的结构神经影像学预测因素，以更好地阐明潜在的病理生理。方法:我们从2012年至2017年在三级医院记忆门诊就诊的患者临床数据库中招募符合纳入标准的受试者。纳入临床痴呆评分(CDR)为0.5和1.0并行脑MRI的AD患者。虚弱指数(FI-CGA)用于虚弱评估，视觉MRI评分量表由盲法评分者量化脑病变。结果:共纳入轻度AD患者342例，平均年龄75.79±7.18岁。经人口统计学、认知评分和功能状态调整后的多元线性回归模型显示，深度白质高信号(DWMH)与FI-CGA呈正相关(β = 0.178, SE = 0.047, p≤0.001)，其他脑损伤与FI-CGA均无显著正相关(β = 0.178, SE = 0.047, p≤0.001)。该模型包括年龄、CDR盒数、基本生活活动和DWMH，占研究人群FI-CGA方差的47.5%。结论:该研究显示DWMH与轻度AD患者的虚弱独立相关。根据目前对DWMH病因的了解，控制血管危险因素对于预防和改善轻度AD患者的虚弱至关重要。
{"title":"Deep but Not Periventricular White Matter Disease Is a Marker for Frailty in Older Patients with Early Alzheimer’s Disease","authors":"C. Cheong, R. Choo, N. H. L. Ha, Ivana Chan, A. Wong, L. Wee, P. Yap","doi":"10.20900/agmr20190009","DOIUrl":"https://doi.org/10.20900/agmr20190009","url":null,"abstract":"Background: Frailty and cognitive impairment are closely related in sharing several possible underlying pathophysiological mechanisms. There is a lack of clarity in published literature on whether cerebral infarcts or Alzheimer’s pathology accounts for the frailty phenotype in patients with mild Alzheimer’s disease (AD). Therefore, we investigated the structural neuroimaging predictors of frailty in mild AD patients to better elucidate the underlying pathophysiology. \u0000Methods: We recruited subjects who satisfied inclusion criteria from a clinical database of patients attending a tertiary hospital memory clinic between 2012 and 2017. AD patients with Clinical Dementia Rating (CDR) 0.5 and 1.0 who had undergone MRI brain were included. Frailty Index \u0000(FI-CGA) was utilised for frailty assessment, and visual MRI rating scales were used by blinded raters to quantify the brain lesions. \u0000Results: A total of 342 mild AD patients with a mean age of 75.79 ± 7.18 were studied. A multivariate linear regression model adjusted for demographics, cognitive scores and functional status revealed only deep white matter hyperintensities (DWMH) but none other brain lesions to be significantly and positively correlated with FI-CGA (β = 0.178, SE = 0.047, p ≤ 0.001) This model which comprised age, CDR sum of boxes, basic activities of living and DWMH, accounted for 47.5% of the FI-CGA variance in the study population. \u0000Conclusions: The study has revealed DWMH to be independently associated with frailty in mild AD patients. With the current understanding of the aetiology of DWMH, control of vascular risk factors is vital to preventing and ameliorating frailty in patients with mild AD.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"121 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88765123","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}
Background: Studies of the natural progression and temporal co-occurrence of physical frailty and cognitive impairment are needed to validate the construct of cognitive frailty, a state of mild cognitive impairment caused by physical frailty. Method: We analysed data from Singapore Longitudinal Ageing Studies (SLAS-1 and SLAS-2) participants (N = 2554), free of functional disability, dementia, neurodegenerative diseases, and stroke, who were categorized at baseline as robust and cognitive normal (N = 1252), physically frail alone (N = 913), cognitively impaired alone (N = 197), and concurrently frail and cognitively impaired (N = 232) with average 5-years of follow up. Physical frailty was defined as pre-frailty/frailty (Fried criteria scores 1–5) and cognitive impairment MMSE scores <27 (age and education adjusted). Results: Among cognitively normal and robust participants, the occurrence of pre-frailty/frailty alone was 80.4%, cognitive impairment alone was 0.6%, and co-occurring pre-frailty/frailty and cognitive impairment (cognitive frailty) was 3.8%. Among cognitively normal and pre-frail/frail participants, the occurrence of cognitive frailty (5.9%) was significantly higher (OR = 1.53, 95% CI 1.02–2.28, adjusted for sex and age). Among cognitively normal and robust individuals, baseline number of comorbid medical comorbidities (OR = 1.37 (95% CI: 1.08–1.74) significantly predicted cognitive frailty. From following up a hypothetical cohort of 1000 robust and cognitively normal individuals, 88 of 91 outcome cases of co-occurring frailty and cognitive impairment were preceded by frailty alone (N = 48), or concurrent frailty and cognitive impairment (N = 40); only 3 cases were preceded by cognitive impairment alone (not cognitive frailty).Conclusions: The validity of cognitive frailty as a construct of mild cognitive impairment due to physical frailty is supported.
{"title":"Frailty and Cognition Transitions and the Development of Cognitive Frailty among Community-Living Older Adults in the Singapore Longitudinal Ageing Studies","authors":"T. Ng, M. Nyunt, Q. Gao, X. Gwee, K. Yap","doi":"10.20900/AGMR20190007","DOIUrl":"https://doi.org/10.20900/AGMR20190007","url":null,"abstract":"Background: Studies of the natural progression and temporal co-occurrence of physical frailty and cognitive impairment are needed to validate the construct of cognitive frailty, a state of mild cognitive impairment caused by physical frailty. Method: We analysed data from Singapore Longitudinal Ageing Studies (SLAS-1 and SLAS-2) participants (N = 2554), free of functional disability, dementia, neurodegenerative diseases, and stroke, who were categorized at baseline as robust and cognitive normal (N = 1252), physically frail alone (N = 913), cognitively impaired alone (N = 197), and concurrently frail and cognitively impaired (N = 232) with average 5-years of follow up. Physical frailty was defined as pre-frailty/frailty (Fried criteria scores 1–5) and cognitive impairment MMSE scores <27 (age and education adjusted). Results: Among cognitively normal and robust participants, the occurrence of pre-frailty/frailty alone was 80.4%, cognitive impairment alone was 0.6%, and co-occurring pre-frailty/frailty and cognitive impairment (cognitive frailty) was 3.8%. Among cognitively normal and pre-frail/frail participants, the occurrence of cognitive frailty (5.9%) was significantly higher (OR = 1.53, 95% CI 1.02–2.28, adjusted for sex and age). Among cognitively normal and robust individuals, baseline number of comorbid medical comorbidities (OR = 1.37 (95% CI: 1.08–1.74) significantly predicted cognitive frailty. From following up a hypothetical cohort of 1000 robust and cognitively normal individuals, 88 of 91 outcome cases of co-occurring frailty and cognitive impairment were preceded by frailty alone (N = 48), or concurrent frailty and cognitive impairment (N = 40); only 3 cases were preceded by cognitive impairment alone (not cognitive frailty).Conclusions: The validity of cognitive frailty as a construct of mild cognitive impairment due to physical frailty is supported.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79125035","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}
A. Whittaker, E. Asamane, J. Aunger, D. Bondarev, A. Cabbia, P. Doody, N. Gensous, Barbara Iadarola, K. Ramsey, Belina Rodrigues, Muhammad Rizwan Tahir, S. Yeung
Background: The ageing of the population is a global challenge and the period of life spent in good health, although increasing, is not keeping pace with lifespan. Consequently, understanding the important factors that contribute to healthy ageing and validating interventions and influencing policy to promote healthy ageing are vital research priorities. Method: The PANINI project is a collaboration of 20 partners across Europe examining the influence of physical activity and nutrition in ageing. Methods utilised encompass the biological to the social, from genetics to the influence of social context. For example, epigenetic, immunological, and psychological assessments, and nutritional and sports science-based interventions have been used among older adults, as well as mathematical modelling and epidemiology. The projects are multi-disciplinary and examine health outcomes in ageing from a range of perspectives. Results: The results discussed here are those emerging thus far in PANINI from 11 distinct programmes of research within PANINI as well as projects cross-cutting the network. New approaches, and the latest results are discussed. Conclusions: The PANINI project has been addressing the impact of physical activity and nutrition on healthy ageing from diverse but interlinked perspectives. It emphasises the importance of using standardized measures and the advantages of combining data to compare biomarkers and interventions across different settings and typologies of older adults. As the projects conclude, the current results and final data will form part of a shared dataset, which will be made open access for other researchers into ageing processes.
{"title":"Physical Activity and Nutrition INfluences in Ageing: Current Findings from the PANINI Project","authors":"A. Whittaker, E. Asamane, J. Aunger, D. Bondarev, A. Cabbia, P. Doody, N. Gensous, Barbara Iadarola, K. Ramsey, Belina Rodrigues, Muhammad Rizwan Tahir, S. Yeung","doi":"10.20900/AGMR20190005","DOIUrl":"https://doi.org/10.20900/AGMR20190005","url":null,"abstract":"Background: The ageing of the population is a global challenge and the period of life spent in good health, although increasing, is not keeping pace with lifespan. Consequently, understanding the important factors that contribute to healthy ageing and validating interventions and influencing policy to promote healthy ageing are vital research priorities. \u0000Method: The PANINI project is a collaboration of 20 partners across Europe examining the influence of physical activity and nutrition in ageing. Methods utilised encompass the biological to the social, from genetics to the influence of social context. For example, epigenetic, immunological, and psychological assessments, and nutritional and sports science-based interventions have been used among older adults, as well as mathematical modelling and epidemiology. The projects are multi-disciplinary and examine health outcomes in ageing from a range of perspectives. \u0000Results: The results discussed here are those emerging thus far in PANINI from 11 distinct programmes of research within PANINI as well as projects cross-cutting the network. New approaches, and the latest results are discussed. \u0000Conclusions: The PANINI project has been addressing the impact of physical activity and nutrition on healthy ageing from diverse but interlinked perspectives. It emphasises the importance of using standardized measures and the advantages of combining data to compare biomarkers and interventions across different settings and typologies of older adults. As the projects conclude, the current results and final data will form part of a shared dataset, which will be made open access for other researchers into ageing processes.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78139584","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}
L. Brown, John B. Young, E. Teale, G. Santorelli, A. Clegg
Background: Pain prevalence is higher in older people with frailty compared to fit older people. However, little is known about pain impact on the lives of older people with frailty. Objectives: To investigate pain impact in community dwelling older people (≥75 years) using data from the Community Ageing Research 75+ (CARE75+) cohort study (UKCRN 18043). Methods: Participants were assessed as not frail, pre-frail or frail (phenotype model of frailty). Pain impact was measured using the Geriatric Pain Measure Short-Form (GPM-12), an instrument incorporating 10 items on how pain impacts on ambulation, social engagement, ability to accomplish tasks and sleep, along with current pain intensity and average pain intensity (last 7 days). Intrusive pain was calculated from an item in the Short-Form 36 questionnaire. Differences in the GPM-12 scores between frailty categories were compared using Kruskal-Wallis H tests. Logistic regression models were used to investigate the association between frailty and intrusive pain. Results: 887 participants: not frail 139; pre-frail 471; and frail 268. Total GPM-12 median (IQR): not-frail 5.0 (0.0, 12.5); pre-frail 10.0 (0.0, 27.5); and frail 40.0 (10.0, 65.0) (p ≤ 0.0001). Current pain: not frail 0.0 (0.0, 1.0); pre-frail 0 (0.0, 3.0); and frail 3.0 (0.0, 5.0) (p ≤ 0.0001). Average pain: not-frail 0.0 (0.0, 2.0); pre-frail 1 (0.0, 4.0); frail 4.0 (2.0, 6.8) (p ≤ 0.0001). There was a strong association between being frail and intrusive pain (adjusted for sex, ethniciaty, mood and high comorbid burden): OR 3.53 (95% CI 2.47, 5.04). Conclusions: This research has identified an important new finding that pain in older people with frailty appears to be of sufficient severity to impact negatively on multiple aspects of day-to-day life
{"title":"A Cross-Sectional Study of the Impact of Pain in Older People with Frailty: Findings from the Community Ageing Research 75+ (CARE75+) Study","authors":"L. Brown, John B. Young, E. Teale, G. Santorelli, A. Clegg","doi":"10.20900/AGMR20190002","DOIUrl":"https://doi.org/10.20900/AGMR20190002","url":null,"abstract":"Background: Pain prevalence is higher in older people with frailty compared to fit older people. However, little is known about pain impact on the lives of older people with frailty. Objectives: To investigate pain impact in community dwelling older people (≥75 years) using data from the Community Ageing Research 75+ (CARE75+) cohort study (UKCRN 18043). Methods: Participants were assessed as not frail, pre-frail or frail (phenotype model of frailty). Pain impact was measured using the Geriatric Pain Measure Short-Form (GPM-12), an instrument incorporating 10 items on how pain impacts on ambulation, social engagement, ability to accomplish tasks and sleep, along with current pain intensity and average pain intensity (last 7 days). Intrusive pain was calculated from an item in the Short-Form 36 questionnaire. Differences in the GPM-12 scores between frailty categories were compared using Kruskal-Wallis H tests. Logistic regression models were used to investigate the association between frailty and intrusive pain. Results: 887 participants: not frail 139; pre-frail 471; and frail 268. Total GPM-12 median (IQR): not-frail 5.0 (0.0, 12.5); pre-frail 10.0 (0.0, 27.5); and frail 40.0 (10.0, 65.0) (p ≤ 0.0001). Current pain: not frail 0.0 (0.0, 1.0); pre-frail 0 (0.0, 3.0); and frail 3.0 (0.0, 5.0) (p ≤ 0.0001). Average pain: not-frail 0.0 (0.0, 2.0); pre-frail 1 (0.0, 4.0); frail 4.0 (2.0, 6.8) (p ≤ 0.0001). There was a strong association between being frail and intrusive pain (adjusted for sex, ethniciaty, mood and high comorbid burden): OR 3.53 (95% CI 2.47, 5.04). Conclusions: This research has identified an important new finding that pain in older people with frailty appears to be of sufficient severity to impact negatively on multiple aspects of day-to-day life","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90952421","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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