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Alqahtani B. Number of medications and polypharmacy are associated with frailty in older adults: results from the Midlife in the United States study. Front Public Health 2023; 11:1148671. [PMID: 37304087 PMCID: PMC10248878 DOI: 10.3389/fpubh.2023.1148671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives The current study aimed to examine the association between the number of medications, polypharmacy, and frailty in community-dwelling older adults. In addition, the cutoff score for the number of medications related with frailty in this sample was determined. Methods A cross-sectional analysis was performed using data of 328 individual aged between 65 and 85 years from the Midlife in the United States (MIDUS 2): Biomarker Project, 2004-2009, a multisite longitudinal study, for 328 individuals aged between 65 and 85 years. All the participants were categorized into two groups based on the number of medications used: no polypharmacy (n = 206) and polypharmacy (n = 122). The polypharmacy was defined as having 5 or more medication per day. Frailty status was measured using a modified form of Fried frailty phenotype through the presences of the following indicators include low physical activity; exhaustion; weight loss; slow gait speed and muscle weakness. Participants were categorized into three different groups based on total score: 0 as robust, 1 to 2 as prefrail, 3 or more as frail. The relationship between no. of medications, polypharmacy, and frailty was examined using a multinomial logistic regression model. The model was adjusted for age, sex, BMI, and no. of chronic conditions. Receiver operator characteristics and area under the curve were used to determine the cutoff number of medications. Results Number of medications, and polypharmacy were associated with being frail (relative risk ratio [RRR]: 1.30; 95% confidence interval [CI]: [1.12, 1.50], p = 0.001), (RRR: 4.77; 95% CI [1.69, 13.4], p = 0.003), respectively. Number of medications with cutoff 6 medication or more was associated with being in frail category with sensitivity of 62% and specificity of 73%. Conclusion Polypharmacy was shown to be significantly related to frailty. A cutoff score of 6 or more medications distinguished frail from non-frail. Addressing polypharmacy in the older population might ameliorate the impact of physical frailty.
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Banning LBD, Visser L, Zeebregts CJ, van Leeuwen BL, El Moumni M, Pol RA. Transition in Frailty State Among Elderly Patients After Vascular Surgery. World J Surg 2021; 44:3564-3572. [PMID: 32494998 PMCID: PMC7458900 DOI: 10.1007/s00268-020-05619-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Frailty in the vascular surgical ward is common and predicts poor surgical outcomes. The aim of this study was to analyze transitions in frailty state in elderly patients after vascular surgery and to evaluate influence of patient characteristics on this transition. METHODS Between 2014 and 2018, 310 patients, ≥65 years and scheduled for elective vascular surgery, were included in this cohort study. Transition in frailty state between preoperative and follow-up measurement was determined using the Groningen Frailty Indicator (GFI), a validated tool to measure frailty in vascular surgery patients. Frailty is defined as a GFI score ≥4. Patient characteristics leading to a transition in frailty state were analyzed using multivariable Cox regression analysis. RESULTS Mean age was 72.7 ± 5.2 years, and 74.5% were male. Mean follow-up time was 22.7 ± 9.5 months. At baseline measurement, 79 patients (25.5%) were considered frail. In total, 64 non-frail patients (20.6%) shifted to frail and 29 frail patients (9.4%) to non-frail. Frail patients with a high Charlson Comorbidity Index (HR = 0.329 (CI: 0.133-0.812), p = 0.016) and that underwent a major vascular intervention (HR = 0.365 (CI: 0.154-0.865), p = 0.022) had a significantly higher risk to remain frail after the intervention. CONCLUSIONS The results of this study, showing that after vascular surgery almost 21% of the non-frail patients become frail, may lead to a more effective shared decision-making process when considering treatment options, by providing more insight in the postoperative frailty course of patients.
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Affiliation(s)
- Louise B D Banning
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Linda Visser
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Clark J Zeebregts
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, Division of Surgical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Surgery, Division of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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Furtado GE, Caldo A, Vieira-Pedrosa A, Letieri RV, Hogervorst E, Teixeira AM, Ferreira JP. Emotional Well-Being and Cognitive Function Have Robust Relationship With Physical Frailty in Institutionalized Older Women. Front Psychol 2020; 11:1568. [PMID: 32765358 PMCID: PMC7378677 DOI: 10.3389/fpsyg.2020.01568] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Frailty associated to core dimensions of psychological well-being (PwB) has appeared as a possible new frailty phenotype named psychological frailty, implying a parallel to physical frailty (PF). Very little is known about the associations between mental well-being, especially emotional, mood, and self-perception dimensions, and the frailty syndrome in institutionalized older populations. The present study aims to examine the interlink between the PF phenotype and the core dimensions of PwB in Portuguese institution-dwelling older women. Methods Cross-sectional data were collected. A total of 358 older women, aged 75 years or more, were recruited from four nursing homes within the city of Coimbra and asked to complete a sociodemographic and a general health assessment survey. The main PwB dimensions were assessed in all participants: (i) global cognitive status was assessed using The Montreal Cognitive Assessment (MoCA) Neuropsychology Test, (ii) self-perception was screened using the General Self-Efficacy Scale (GSES) and Global Self-Esteem Scale, (iii) CES-D of depression and Perceived Stress Scale (PSS) were used to screen mood states, and (iv) subjective happiness, satisfaction with life, and attitudes to aging psychometric rating scales were used to screen for emotional well-being. The syndrome of PF was assessed using Fried’s PF phenotype that includes weight loss, weakness, slowness, exhaustion, and low physical activity (PA) level assessments. Results Frail older women had a poor score in all PwB outcomes, except for global self-esteem and satisfaction with life. A hierarchical regression model analysis showed that global cognitive status and emotional well-being of subjective happiness and attitude to aging showed a significant negative relationship with PF in both unadjusted and adjusted models (explaining 34 and 40% of variance, respectively). Conclusion Emotional well-being and global cognitive performance are strongly associated with PF. Implementing active lifestyle interventions to improve positive psychological outcomes using geriatric assessments could assist in the older institutionalized patients’ physical and mental health care.
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Affiliation(s)
- Guilherme Eustáquio Furtado
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Adriana Caldo
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Ana Vieira-Pedrosa
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Rubens Vinícius Letieri
- Multidisciplinary Research Nucleus in Physical Education (NIMEF), Physical Education Department, Federal University of Tocantins (UFT), Tocantinópolis, Brazil
| | - Eef Hogervorst
- Applied Cognitive Research NCSEM, Loughborough University, Loughborough, United Kingdom
| | - Ana Maria Teixeira
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - José Pedro Ferreira
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
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Gupta S, McColl MA, Guilcher SJT, Smith K. An Adapted Model of Cost-Related Nonadherence to Medications Among People With Disabilities. JOURNAL OF DISABILITY POLICY STUDIES 2019. [DOI: 10.1177/1044207319868779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite emerging evidence on cost-related nonadherence (CRNA) to prescription medications, there is little conceptualization and exploration of this phenomenon with respect to disability. Specifically, there is a gap in the literature that explores factors influencing medication cost–adherence relationship among individuals living with a disability. To advance research on and policy for CRNA to medications among people with disabilities, we need a framework that can contribute towards guiding solutions to this problem. We examined the applicability of Piette and colleagues’ existing model for CRNA to the context of people with disabilities and suggested an adapted model (CRNA to medications for persons with disability [CRNA-d]) that can provide a more specific conceptualization of CRNA with respect to disability. The adapted CRNA-d model depicts that CRNA to prescription medications with respect to disability is a dynamic and multifaceted phenomenon, determined by various socioeconomic, disability-related, medication-related, prescriber-related, and system-related factors. We discuss how higher susceptibility to health complications, barriers to income and employment, additional health care costs, the complexity of medical regimens, limited access to physician services, and other policy-related factors increase the risk of persons with disabilities to face cost-related barriers to fulfill their necessary medications.
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Affiliation(s)
| | | | | | - Karen Smith
- Queen’s University, Kingston, Ontario, Canada
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Nguyen AL, Seal D, Bruce O, Dalton M, Palmer A, Pardini M, Quiroga B, Ryu J, Soliman S, Welty JC, Younus I. Caregiving preferences and advance care planning among older adults living with HIV. AIDS Care 2018; 31:243-249. [PMID: 30146895 DOI: 10.1080/09540121.2018.1515472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
With the increase in the US of the number of older adults living with HIV, more research is needed to understand the caregiving and advance care planning needs of this population. This descriptive study examined the relationship between social support and caregiving preferences and advance care planning. Older adults living with HIV were recruited from clinics in Los Angeles, CA and New Orleans, LA to complete cross-sectional surveys (n = 154). Logistic regression analyses were modeled to determine the characteristics associated with 1) preference for formal short-term term care, 2) preference for formal long-term care, 3) having at least one contact for emergency care, 4) having an advance directive or living will, and 5) having a healthcare proxy or agent. The mean age was 56.8 years. The majority of participants indicated a preference for informal support for both short-term (73.4%) and long-term care (66.2%), 13.2% had no one they could call for emergency care, 26.0% had an advance directive/living will, and 30.5% had a healthcare proxy/agent. In adjusted models, greater social support was associated with preference for informal short-term care and with having at least one emergency contact. Findings suggest that older adults living with HIV prefer informal sources of support for their caregiving needs despite having small social networks and individuals with limited social networks are particularly vulnerable due to lack of access to caregivers in sudden or unexpected health situations.
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Affiliation(s)
- Annie L Nguyen
- a Department of Family Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | - David Seal
- b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA
| | - Omar Bruce
- a Department of Family Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | - Margarida Dalton
- b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA
| | - Allison Palmer
- b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA
| | - Marissa Pardini
- b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA
| | - Bailey Quiroga
- b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA
| | - Jenica Ryu
- a Department of Family Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | - Sarah Soliman
- a Department of Family Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | - James C Welty
- b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA
| | - Imamah Younus
- a Department of Family Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
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Gobbens RJ. Associations of ADL and IADL disability with physical and mental dimensions of quality of life in people aged 75 years and older. PeerJ 2018; 6:e5425. [PMID: 30123720 PMCID: PMC6087617 DOI: 10.7717/peerj.5425] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background Quality of life is an important health outcome for older persons. It predicts the adverse outcomes of institutionalization and premature death. The aim of this cross-sectional study was to determine the influence of both disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) on physical and mental dimensions of quality of life. Methods A total of 377 Dutch people aged 75 years and older completed a web-based questionnaire. This questionnaire contained the Groningen Activity Restriction Scale (GARS) for measuring ADL and IADL and the Short-Form Health Survey (SF-12) for measuring quality of life. The SF-12 distinguishes two dimensions of quality of life, a physical and mental dimension. Results All ADL disability items combined and all IADL disability items combined explained a significant part of the variance of the physical and the mental dimension of quality of life. Only ADL item "stand up from sitting in a chair", and IADL items "do "heavy" household activities" and "do the shopping" were negatively associated with both quality of life dimensions after controlling for all the variables in the model. Discussion This study showed that disability in ADL and IADL is negatively associated with quality of life in older people. Therefore, it is important for health care professionals to carry out interventions aimed to prevent and diminish disability or the adverse outcomes of disability such as a lower quality of life. In order to be effective these interventions should be inexpensive, feasible, and easy to implement.
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Affiliation(s)
- Robbert J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Veronese N, Solmi M, Maggi S, Noale M, Sergi G, Manzato E, Prina AM, Fornaro M, Carvalho AF, Stubbs B. Frailty and incident depression in community-dwelling older people: results from the ELSA study. Int J Geriatr Psychiatry 2017; 32:e141-e149. [PMID: 28195361 DOI: 10.1002/gps.4673] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 01/10/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Frailty and pre-frailty are two common conditions in the older people, but whether these conditions could predict depression is still limited to a few longitudinal studies. In this paper, we aimed to investigate whether frailty and pre-frailty are associated with an increased risk of depression in a prospective cohort of community-dwelling older people. METHODS Four thousand seventy-seven community-dwelling men and women over 60 years without depression at baseline were included from the English Longitudinal Study of Ageing. Frailty status was defined according to modified Fried's criteria (weakness, weight loss, slow gait speed, low physical activity and exhaustion) and categorized as frailty (≥3 criteria), pre-frailty (1-2 criteria) or robustness (0 criterion). Depression was diagnosed as ≥4 out of 8 points of Center for Epidemiologic Studies Depression Scale, after 2 years of follow-up. RESULTS Over a 2-year follow-up, 360 individuals developed depression. In a logistic regression analysis, adjusted for 18 potential baseline confounders, pre-frailty (odds ratio (OR) = 0.89; 95% confidence interval (CI), 0.54-1.46; p = 0.64) and frailty (OR = 1.22; 95% CI, 0.90-1.64; p = 0.21) did not predict the onset of depression at follow-up. Among the criteria included in the frailty definition, only slow gait speed (OR = 1.82; 95% CI, 1.00-3.32; p = 0.05) appeared to predict a higher risk of depression. CONCLUSIONS Among older community dwellers, frailty and pre-frailty did not predict the onset of depression during 2 years of follow-up, when accounting for potential confounders, whilst slow gait speed considered alone may predict depression in the older people. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nicola Veronese
- Department of Medicine DIMED, Geriatrics Division, University of Padua, Padua, Italy.,Institute of Clinical Research and Education in Medicine (IREM), Padua, Italy.,National Research Council, Neuroscience Institute, Padua, Italy
| | - Marco Solmi
- Institute of Clinical Research and Education in Medicine (IREM), Padua, Italy.,Department of Neuroscience, University of Padua, Padua, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Giuseppe Sergi
- Department of Medicine DIMED, Geriatrics Division, University of Padua, Padua, Italy
| | - Enzo Manzato
- Department of Medicine DIMED, Geriatrics Division, University of Padua, Padua, Italy.,National Research Council, Neuroscience Institute, Padua, Italy
| | - A Matthew Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michele Fornaro
- New York Psychiatric Institute, Columbia University, New York, NY, USA
| | - André F Carvalho
- Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Brendon Stubbs
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
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Kim HY, Jang JW. Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score. World J Gastroenterol 2015; 21:7637-7647. [PMID: 26167066 PMCID: PMC4491953 DOI: 10.3748/wjg.v21.i25.7637] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/20/2015] [Accepted: 05/07/2015] [Indexed: 02/06/2023] Open
Abstract
Estimating the prognosis of patients with cirrhosis remains challenging, because the natural history of cirrhosis varies according to the cause, presence of portal hypertension, liver synthetic function, and the reversibility of underlying disease. Conventional prognostic scoring systems, including the Child-Turcotte-Pugh score or model for end-stage liver diseases are widely used; however, revised models have been introduced to improve prognostic performance. Although sarcopenia is one of the most common complications related to survival of patients with cirrhosis, the newly proposed prognostic models lack a nutritional status evaluation of patients. This is reflected by the lack of an optimal index for sarcopenia in terms of objectivity, reproducibility, practicality, and prognostic performance, and of a consensus definition for sarcopenia in patients with cirrhosis in whom ascites and edema may interfere with body composition analysis. Quantifying skeletal muscle mass using cross-sectional abdominal imaging is a promising tool for assessing sarcopenia. As radiological imaging provides direct visualization of body composition, it is useful to evaluate sarcopenia in patients with cirrhosis whose body mass index, anthropometric measurements, or biochemical markers are inaccurate on a nutritional assessment. Sarcopenia defined by cross-sectional imaging-based muscular assessment is prevalent and predicts mortality in patients with cirrhosis. Sarcopenia alone or in combination with conventional prognostic systems shows promise for a cirrhosis prognosis. Including an objective assessment of sarcopenia with conventional scores to optimize the outcome prediction for patients with cirrhosis needs further research.
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The Prediction of ADL and IADL Disability Using Six Physical Indicators of Frailty: A Longitudinal Study in the Netherlands. Curr Gerontol Geriatr Res 2014; 2014:358137. [PMID: 24782894 PMCID: PMC3982262 DOI: 10.1155/2014/358137] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/24/2014] [Indexed: 12/30/2022] Open
Abstract
Frailty is a predictor of disability. A proper understanding of the contribution of individual indicators of frailty in the prediction of disability is a requisite for preventive interventions. The aim of this study was to determine the predictive power of the individual physical frailty indicators: gait speed, physical activity, hand grip strength, Body Mass Index (BMI), fatigue, and balance, for ADL and IADL disability. The sample consisted of 505 community-dwelling persons (≥75 years, response rate 35.1%). Respondents first participated between November 2007 and June 2008, and a subset of all respondents participated again one year later (N = 264, 52.3% response rate). ADL and IADL disability were assessed by the Groningen Activity Restriction Scale. BMI was assessed by self-report, and the other physical frailty indicators were assessed with the TUG test (gait speed), the LAPAQ (physical activity), a hand grip strength test, the SFQ (fatigue), and the Four-test balance scale. All six physical frailty indicators were associated with ADL and IADL disability. After controlling for previous disability, sociodemographic characteristics, self-perceived lifestyle, and chronic diseases, only gait speed was predictive of both ADL and IADL disability, whereas there was a small effect of fatigue on IADL disability. Hence, these physical frailty indicators should be included in frailty assessment when predicting future disability.
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Bennett JA, Winters-Stone KM, Dobek J, Nail LM. Frailty in older breast cancer survivors: age, prevalence, and associated factors. Oncol Nurs Forum 2013; 40:E126-34. [PMID: 23615146 PMCID: PMC3988495 DOI: 10.1188/13.onf.e126-e134] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe frailty and associated factors in breast cancer survivors (BCSs) and evaluate whether BCSs are frail at an earlier age than female participants from in two large epidemiological studies. DESIGN Descriptive, cross-sectional. SETTING School of Nursing at Oregon Health and Science University. SAMPLE 216 BCSs aged 53-87 years who were a mean 5-7 years post-treatment and not currently participating in exercise. METHODS Performance tests, clinical measures, and self-reported questionnaires provided baseline data on five criteria for frailty. MAIN RESEARCH VARIABLES Frailty was defined as meeting three of the five criteria of the frailty phenotype: shrinking, exhaustion, low activity, slowness, and weakness. Data were compared to published data from women in the Cardiovascular Health Study (CHS) and Women's Health and Aging Study (WHAS). FINDINGS Eighteen percent of BCSs aged 70-79 years were frail compared to 11% of women of the same age in the CHS and WHAS. Frailty was more common at a younger age in BCSs, and more BCSs were frail in all age groups compared to women in the CHS study until about age 80 years, when prevalence of frailty was similar in the two groups. Fifty percent of BCSs were classified as prefrail because they met one or two of the five frailty criteria. Higher body mass index increased the odds of frailty, and higher physical activity decreased the odds of frailty (odds ratio [OR] = 1.12, p = 0.003, and OR = 0.99, p = 0.000, respectively). CONCLUSIONS Frailty and prefrailty may be common in BCSs and may occur at an earlier age than in adults without a history of breast cancer. IMPLICATIONS FOR NURSING Nurses should be alert to prefrailty or frailty at a younger age in BCSs. Awareness and early intervention may delay or prevent frailty. KNOWLEDGE TRANSLATION BCSs may be frail even when they are not yet considered older adults. Prefrailty in BCSs is important to recognize because it suggests impending frailty that could lead to reduced physical functioning or poor health. Prefrailty and frailty could be assessed in BCSs aged 50 years and older in a clinical setting using a few questions about weight, fatigue, and activity levels, in addition to simple tests of walking speed and grip strength, if warranted.
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Affiliation(s)
- Jill A Bennett
- School of Nursing, Oregon Health and Science University, Portland, USA.
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