Research

11 pages, 384 KiB

Open AccessArticle

Effectiveness of a Person-Centered Prescription Model in Hospitalized Older People at the End of Life According to Their Disease Trajectories and Frailty Index

by Alexander Ferro-Uriguen, Idoia Beobide-Telleria, Javier Gil-Goikouria, Petra Teresa Peña-Labour, Andrea Díaz-Vila, Arlovia Teresa Herasme-Grullón and Enrique Echevarría-Orella

Int. J. Environ. Res. Public Health 2023, 20(4), 3542; https://doi.org/10.3390/ijerph20043542 - 17 Feb 2023

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Abstract

This study aimed to comparatively analyze the effect of the person-centered prescription (PCP) model on pharmacotherapeutic indicators and the costs of pharmacological treatment between a dementia-like trajectory and an end-stage organ failure trajectory, and two states of frailty (cut-off point 0.5). A randomized [...] Read more.

This study aimed to comparatively analyze the effect of the person-centered prescription (PCP) model on pharmacotherapeutic indicators and the costs of pharmacological treatment between a dementia-like trajectory and an end-stage organ failure trajectory, and two states of frailty (cut-off point 0.5). A randomized controlled trial was conducted with patients aged ≥65 years admitted to a subacute hospital and identified by the Necessity of Palliative Care test to require palliative care. Data were collected from February 2018 to February 2020. Variables assessed included sociodemographic, clinical, degree-of-frailty, and several pharmacotherapeutic indicators and the 28-day medication cost. Fifty-five patients with dementia-like trajectory and 26 with organ failure trajectory were recruited observing significant differences at hospital admission in the mean number of medications (7.6 vs. 9.7; p < 0.004), the proportion of people on more than 10 medications (20.0% vs. 53.8%; p < 0.002), the number of drug–drug interactions (2.7 vs. 5.1; p < 0.006), and the Medication Regimen Complexity Index (MRCI) (25.7 vs. 33.4; p < 0.006), respectively. Also, regarding dementia-like patients, after application of the PCP model, these patients improved significantly in the intervention group compared to the control group in the mean number of chronic medications, STOPP Frail Criteria, MRCI and the 28-day cost of regular medications (p < 0.05) between admission and discharge. As for the PCP effect on the control and the intervention group at the end-stage organ failure, we did not observe statistically significant differences. On the other hand, when the effect of the PCP model on different degrees of frailty was evaluated, no unequal behavior was observed. Full article

(This article belongs to the Special Issue Frailty in Older People: New Evidences for Early Detection)

10 pages, 519 KiB

Open AccessArticle

Gender Differences in Determinants of the Components of the Frailty Phenotype among Older Adults in India: Findings from LASI Wave-1

by Sayani Das and Jitender Prasad

Int. J. Environ. Res. Public Health 2023, 20(4), 3055; https://doi.org/10.3390/ijerph20043055 - 09 Feb 2023

Cited by 1 | Viewed by 1783

Abstract

This study examines the gender-specific determinants of the components of frailty in a community-dwelling setting in India. Using data from the Longitudinal Ageing Study in India (LASI) Wave-1, this study employed 30,978 (14,885 male and 16,093 female) older adults (aged 60+) to fulfil [...] Read more.

This study examines the gender-specific determinants of the components of frailty in a community-dwelling setting in India. Using data from the Longitudinal Ageing Study in India (LASI) Wave-1, this study employed 30,978 (14,885 male and 16,093 female) older adults (aged 60+) to fulfil the study objective. The modified Fried frailty phenotype criteria defines frailty by the five components: exhaustion, weak grip strength, slow walking speed, unintentional weight loss, and low physical activity. The result showed grip strength (79.1%) as the most discriminant component among males, and physical activity (81.6%) as the most discriminant component among females. The results also indicated that grip strength (male: 98.0%, female: 93.5%) and physical activity (male: 94.8%, female: 96.9%) showed a sensitivity of more than 90%, which appears to be a good indicator of frailty. Combining this dual marker increased the accuracy to 99.97% among male and 99.98% among female samples. The findings suggested adding grip strength and physical activity as a proxy measure of frailty, which can increase the precision of screening without a large additional investment of time, training, or cost. Full article

(This article belongs to the Special Issue Frailty in Older People: New Evidences for Early Detection)

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12 pages, 498 KiB

Open AccessArticle

Gender Differences in Socio-Demographic Factors Associated with Pre-Frailty in Japanese Rural Community-Dwelling Older Adults: A Cross-Sectional Study

by Aki Shibata, Asuka Suzuki and Kenzo Takahashi

Int. J. Environ. Res. Public Health 2023, 20(2), 1091; https://doi.org/10.3390/ijerph20021091 - 07 Jan 2023

Cited by 1 | Viewed by 2011

Abstract

Purpose: To prevent frailty, it is necessary to focus on pre-frailty and consider preventive interventions that incorporate social aspects. This study aimed to explore socio-demographic associations with pre-frailty, focusing on modifiable social factors among community-dwelling older adults in a rural Japanese city. Methods: [...] Read more.

Purpose: To prevent frailty, it is necessary to focus on pre-frailty and consider preventive interventions that incorporate social aspects. This study aimed to explore socio-demographic associations with pre-frailty, focusing on modifiable social factors among community-dwelling older adults in a rural Japanese city. Methods: We conducted a self-administered survey on social, physical, and mental factors, and basic attributes, in September 2021. Respondents were classified as frail, pre-frail, or healthy according to their The Kihon Checklist scores. Of the 494 valid responses, 93 respondents classified as pre-frail and 110 as healthy were analyzed. The socio-demographic associations with pre-frailty were investigated by multiple logistic regression, and interactions between gender and other factors were examined. Results: The analysis identified that for both genders, no-community participation in middle age (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.16–2.92) was found to be a social factor associated with pre-frailty. Having friends who listen to one’s concerns (OR, 2.54; 95% CI, 1.26–5.10) was a factor for women. Conclusions: This study showed that modifiable social factors associated with pre-frailty were community involvement and being able to share concerns with friends. The findings suggest the need for support that emphasizes social aspects to prevent pre-frailty. Full article

(This article belongs to the Special Issue Frailty in Older People: New Evidences for Early Detection)

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9 pages, 666 KiB

Open AccessArticle

Detection of the Frail Elderly at Risk of Postoperative Sepsis

by Antonio Sarría-Santamera, Dinara Yessimova, Dmitriy Viderman, Mar Polo-deSantos, Natalya Glushkova and Yuliya Semenova

Int. J. Environ. Res. Public Health 2023, 20(1), 359; https://doi.org/10.3390/ijerph20010359 - 26 Dec 2022

Cited by 3 | Viewed by 1409

Abstract

With the increase in the elderly population, surgery in aged patients is seeing an exponential increase. In this population, sepsis is a major concern for perioperative care, especially in older and frail patients. We aim to investigate the incidence of sepsis in elderly [...] Read more.

With the increase in the elderly population, surgery in aged patients is seeing an exponential increase. In this population, sepsis is a major concern for perioperative care, especially in older and frail patients. We aim to investigate the incidence of sepsis in elderly patients receiving diverse types of surgical procedures and explore the predictive capacity of the Hospital Frailty Risk Score (HFRS) to identify patients at high risk of incidence of postoperative sepsis. This study relies on information from the Spanish Minimum Basic Data Set, including data from nearly 300 hospitals in Spain. We extracted records of 254,836 patients aged 76 years and older who underwent a series of surgical interventions within three consecutive years (2016–2018). The HFRS and Elixhauser comorbidity index were computed to determine the independent effect on the incidence of sepsis. Overall, the incidence of postoperative sepsis was 2645 (1.04%). The higher risk of sepsis was in major stomach, esophageal, and duodenal (7.62%), followed by major intestinal procedures (5.65%). Frail patients are at high risk of sepsis. HFRS demonstrated a high predictive capacity to identify patients with a risk of postoperative sepsis and can be a valid instrument for risk stratification and vigilant perioperative monitoring for the early identification of patients at high risk of sepsis. Full article

(This article belongs to the Special Issue Frailty in Older People: New Evidences for Early Detection)

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14 pages, 1285 KiB

Open AccessArticle

Sex Differences in Frailty Factors and Their Capacity to Identify Frailty in Older Adults Living in Long-Term Nursing Homes

by Nagore Arizaga-Iribarren, Amaia Irazusta, Itxaso Mugica-Errazquin, Janire Virgala-García, Arantxa Amonarraiz and Maider Kortajarena

Int. J. Environ. Res. Public Health 2023, 20(1), 54; https://doi.org/10.3390/ijerph20010054 - 21 Dec 2022

Cited by 2 | Viewed by 1577

Abstract

Frailty is a phenomenon that precedes adverse health events in older people. However, there is currently no consensus for how to best measure frailty. Several studies report that women have a higher prevalence of frailty than men, but there is a gap in [...] Read more.

Frailty is a phenomenon that precedes adverse health events in older people. However, there is currently no consensus for how to best measure frailty. Several studies report that women have a higher prevalence of frailty than men, but there is a gap in studies of the high rates of frailty in older people living in long-term nursing homes (LTNHs) stratified by sex. Therefore, we analyzed health parameters related to frailty and measured their capacity to identify frailty stratified by sex in older people living in LTNHs. According to the Fried Frailty Phenotype (FFP), anxiety increased the risk of frailty in women, while for men functionality protected against the risk of frailty. Regarding the Tilburg Frailty Indicator (TFI), functionality had a protective effect in men, while for women worse dynamic balance indicated a higher risk of frailty. The analyzed parameters had a similar capacity for detecting frailty measured by the TFI in both sexes, while the parameters differed in frailty measured by the FFP. Our study suggests that assessment of frailty in older adults should incorporate a broad definition of frailty that includes not only physical parameters but also psycho-affective aspects as measured by instruments such as the TFI. Full article

(This article belongs to the Special Issue Frailty in Older People: New Evidences for Early Detection)

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10 pages, 726 KiB

Open AccessArticle

Relationship between Eye Frailty and Physical, Social, and Psychological/Cognitive Weaknesses among Community-Dwelling Older Adults in Japan

by Masafumi Itokazu, Masahiro Ishizaka, Yoshikazu Uchikawa, Yoshiaki Takahashi, Takahiro Niida, Tamaki Hirose, Akihiro Ito, Akihiro Yakabi, Yoshiaki Endo, Yohei Sawaya, Tatsuya Igawa, Kaoru Kobayashi, Tsuyoshi Hara, Miyoko Watanabe, Akira Kubo and Tomohiko Urano

Int. J. Environ. Res. Public Health 2022, 19(20), 13011; https://doi.org/10.3390/ijerph192013011 - 11 Oct 2022

Cited by 1 | Viewed by 2468

Abstract

This study investigated the relationship between eye frailty and physical, social, and psychological/cognitive weaknesses among older adults in Japan. The participants were 192 community-dwelling older adult women. We measured handgrip strength, walking speed, and skeletal muscle mass; additionally, their physical, social, and psychological/cognitive [...] Read more.

This study investigated the relationship between eye frailty and physical, social, and psychological/cognitive weaknesses among older adults in Japan. The participants were 192 community-dwelling older adult women. We measured handgrip strength, walking speed, and skeletal muscle mass; additionally, their physical, social, and psychological/cognitive frailties were surveyed using questionnaires. Eye frailty self-checks were used to assess eye frailty. Exploratory and confirmatory factor analyses were employed to verify the validity of the eye frailty self-checks. Eye frailty prevalence and related factors were investigated by conducting a binomial logistic regression analysis, with eye frailty as the dependent variable. The factor analysis results showed that a model could be constructed with the two factors of visual acuity or contrast and visual field. The model’s goodness of fit was acceptable, supporting the validity of the self-checking construct. The Kihon checklist was the only variable with a significant relationship to eye frailty. Regarding the relationship between eye frailty and subordinate items of the Kihon checklist, social withdrawal [odds ratio (OR) 2.437, 95% confidence interval 1.145–5.188], cognitive function (OR 2.047, 95%CI 1.051–3.984), and depressed mood (OR 1.820, 95%CI 1.163–2.848) were significant. Eye frailty can be considered a factor reflecting the existence of social and psychological/cognitive frailties. Full article

(This article belongs to the Special Issue Frailty in Older People: New Evidences for Early Detection)

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14 pages, 1166 KiB

Open AccessArticle

Development and Validation of the Chinese Frailty Screening Scale: A Study among Community-Dwelling Older Adults in Shanghai

by Bo Ye, Yi Wang, Hao Chen, Yingwei Chen, Huihui Yan, Hua Fu, Zhijun Bao and Junling Gao

Int. J. Environ. Res. Public Health 2022, 19(18), 11811; https://doi.org/10.3390/ijerph191811811 - 19 Sep 2022

Cited by 2 | Viewed by 2088

Abstract

Background: Based on intrinsic capacity (IC) as defined by the World Health Organization, an accelerated decline may be an important precursor of frailty among older adults; however, there is a lack of validated instruments that both screen for frailty and monitor IC. This [...] Read more.

Background: Based on intrinsic capacity (IC) as defined by the World Health Organization, an accelerated decline may be an important precursor of frailty among older adults; however, there is a lack of validated instruments that both screen for frailty and monitor IC. This study aims to develop a comprehensive and acculturative frailty screening scale to determine healthy aging among older Chinese adults. Setting and participants: A cross-sectional and a cohort study both based on community-dwelling older adults aged 65 and older. Methods: This study mainly consisted of two parts. First, the selection and revision of 20 items related to frailty based on a literature review, expert consultation, and stakeholder analysis; second, a cross-sectional study was conducted to simplify the scale and test the reliability and validity of the new frailty screening tool. The fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale, the Tilburg frailty indictor (TFI), and a 49-item Frailty Index (FI) were investigated as criteria. Additionally, a cohort study in Shanghai was conducted to verify the predictive validity of the new screening scale. The disability measured by the activity of daily living (ADL), instrumental activity of daily living (IADL) and all-cause mortality were documented as outcomes. Results: A 10-item Chinese frailty screening scale (CFSS-10) was successfully developed and validated. It presented a Cronbach’s α of 0.63 and an intraclass correlation coefficient of 0.73, which indicated good reliability. Taking the other frailty tools as criteria, Kappa values of 0.54–0.58 and an area under the curve of 0.87–0.91 showed good validity. The results of the log-binomial and Poisson models showed a high score, which predicted a higher risk of disability and all-cause mortality. An optimal cut-off point of 5 gave an excellent prediction of one-year disability. Conclusions: The CFSS-10 has good validity and reliability as a quick and acculturative frailty screening scale for community-dwelling older adults in Shanghai. It may also supplement existing frailty screening tools. Full article

(This article belongs to the Special Issue Frailty in Older People: New Evidences for Early Detection)

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15 pages, 1201 KiB

Open AccessArticle

Differences in Characteristics between Older Adults Meeting Criteria for Sarcopenia and Possible Sarcopenia: From Research to Primary Care

by Hyung Eun Shin, Miji Kim and Chang Won Won

Int. J. Environ. Res. Public Health 2022, 19(7), 4312; https://doi.org/10.3390/ijerph19074312 - 04 Apr 2022

Cited by 9 | Viewed by 2376

Abstract

Identification of possible sarcopenia, which is a simple assessment of sarcopenia, has been proposed for the earlier detection of sarcopenia in primary care settings; however, there are no studies comparing the differences in characteristics of older adults with possible sarcopenia or sarcopenia. This [...] Read more.

Identification of possible sarcopenia, which is a simple assessment of sarcopenia, has been proposed for the earlier detection of sarcopenia in primary care settings; however, there are no studies comparing the differences in characteristics of older adults with possible sarcopenia or sarcopenia. This study aimed to compare the characteristics of “possible sarcopenia” in real-world primary care and “sarcopenia” in research settings. A total of 2129 older adults were enrolled from the Korean Frailty and Aging Cohort Study. Possible sarcopenia and sarcopenia were defined using Asian Working Group for Sarcopenia 2019; the possible sarcopenia for real-world primary care was defined by a combination of case findings using low calf circumference or the SARC-F questionnaire and 5-times chair stand test, without considering the measurement of handgrip strength. The prevalence of possible sarcopenia was higher in women than in men; however, that of sarcopenia was higher in men than in women (all, p < 0.001). Older men and women with possible sarcopenia had a lower education level, longer time taken for the Timed Up and Go test, more severe mobility limitation, lower scores on the EuroQol-5 dimension and 12-item short-form survey for physical health, and more cognitive dysfunction than those with sarcopenia did (all, p < 0.05). In conclusion, the participants with possible sarcopenia differed from those with sarcopenia in some characteristics. Identifying differences in characteristics may be helpful to screening and earlier diagnosis of sarcopenia in real-world primary care, as well as in research, which can lay the foundations for personalized lifestyle intervention in diet and exercise. Full article

(This article belongs to the Special Issue Frailty in Older People: New Evidences for Early Detection)

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