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Resumen Introducción: la fragilidad es un indicador del estado de salud en la vejez y un síndrome clínico común en adultos mayores; conlleva un elevado riesgo de resultados deficientes de salud que incluyen caídas, incidentes de discapacidad, hospitalización y mortalidad. Este estudio tuvo como objetivo identificar las diferentes trayectorias de la fragilidad y los factores relacionados con esta entre adultos mayores mexicanos a lo largo del tiempo. Metodología: los datos provienen de un panel de cuatro rondas compuesto por adultos mayores mexicanos y desarrollado de 2001 a 2015 por el Estudio Nacional de Salud y Envejecimiento en México (ENASEM). La fragilidad es la acumulación de déficits a partir de un índice de fragilidad. Se aplicó un análisis multinivel, utilizando modelos jerárquicos para conocer los cambios de trayectorias de fragilidad y qué factores se relacionan con ella. Resultados: ser mujer mayor, viuda y tener un bajo nivel educativo fueron factores de riesgo para un índice de fragilidad alto y una menor satisfacción financiera o realizar actividades en el hogar tienen efectos adversos. Conclusiones: se halló una prevalencia de la fragilidad según la proporción de déficits que poseen los individuos y sus primordiales componentes asociados. Se requiere mejorar las condiciones socioeconómicas de salud en fases previas a la vejez con miras a evitar la presencia de fragilidad en el futuro.
Abstract Introduction: Frailty is an indicator of health status in old age and a common clinical syndrome in older adults that carries an increased risk of poor health outcomes, including falls, incidents of disability, hospitalization, and mortality. This study aimed to identify the different trajectories of frailty and the factors related to frailty among Mexican older adults over time. Methods: Data are from a four-wave panel composed of older Mexican adults from 2001 to 2015 of the Mexican Health and Aging Study (MHAS). Frailty is the accumulation of deficits using a frailty index. A multilevel analysis, using hierarchical models, was applied to know the changes of frailty trajectories and what factors are related to it. Results: Being female, older, being widowhood, and having a lower level of education were risk factors for having a high frailty index and lower financial satisfaction doing activities at home have adverse effects. Conclusion: The findings of this work present information about the prevalence of frailty considering the proportion of deficits that individuals possess and their main associated components in older Mexican adults. It is necessary to improve socioeconomic health conditions in phases before old age to avoid developing frailty in the future.
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Humans , Male , Female , Aged , Aged, 80 and over , Aging , Frailty , Longitudinal Studies , MexicoABSTRACT
Objective:To evaluate the relationship between postoperative delirium and preoperative modified frailty index (mFI) score in elderly patients undergoing colorectal cancer surgery.Methods:The medical records of elderly patients of either sex, aged 65-90 yr, with primary tumor, without radiotherapy and chemotherapy before operation, with the expected operating time ≥ 2 h, undergoing colorectal cancer surgery under general anesthesia, were collected.The patients′ preoperative frailty was assessed using mFI scale.Primary outcome was the incidence of delirium within 7 days after operation, and delirium was assessed using Confusion Assessment Method.The preoperative baseline characteristics, BI score, mFI score and Mini-Mental State Examination were recorded; anesthesia-related information, surgery-related information, intraoperative adverse events, total volume of intraoperative fluid infused, blood loss, and urine output were recorded.The patients were divided into delirium group (D group) and non-delirium group (N group) according to whether delirium occurred or not, and logistic regression analysis was used to screen the risk factors for postoperative delirium in elderly patients with colorectal cancer.Results:A total of 370 patients were enrolled in this study, and the incidence of delirium was 10.8%.There were significant differences in age, ASA grading ratio, mFI score, anesthetic time and total volume of intraoperative fluid infused between group N and group D ( P<0.05). The results of multivariate logistic regression analysis showed that increased age and mFI were independent risk factors for the occurrence of postoperative delirium ( P<0.05). Conclusions:Increased mFI score and age are independent risk factors for postoperative delirium in elderly patients undergoing colorectal cancer.
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Objective To evaluate frailty in people aged 50 years and above in Shanghai. Methods Cross-sectional data was collected from 2009 to 2010 among people aged 50 and above in Shanghai in the World Health Organization (WHO) study on global AGEing and adult health (SAGE) wave 1. A frailty index (FI) was constructed as the proportion of deficits in 40 variables. A FI of 0.2 or greater was recognized as approaching a frail state. Results A total of 8 632 participants were included, with average age of 63.3 years. The overall weighted prevalence of frailty was 7.8% (95% CI: 5.8-10.4%), the score of FI was 0.08 (95% CI: 0.07-0.09), which were both higher among women, elderly people, the divorced (separated/widowed) and individuals with lower levels of education and wealth. In addition, Ageing, insufficient intake of vegetable and fruit and low level of physical activity were significantly associated with frailty and higher FI. Conclusions Our study provides the epidemiological characteristics of frailty in people aged 50 years and older in Shanghai. It highlights the need for targeted preventive approaches and support programs to promote physical, psychological and social health in elderly people.
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Objective@#To evaluate the relationship between modified Frailty Index (mFI) and development of delirium after artificial joint replacement in elderly patients.@*Methods@#Elderly patients (aged ≥60 yr) who scheduled for elective hip or knee replacement, were enrolled.Preoperative frailty was assessed using the mFI scale.All the patients received surgery under combined spinal-epidural anesthesia.Primary outcome was the incidence of delirium within 5 days after operation, and delirium was assessed by Confusion Assessment Method or Confusion Assessment Method-Intensive Care Unit.The patients were divided into delirium group and non-delirium group according to whether delirium occurred or not.@*Results@#A total of 620 patients were included in the study, the mFI was 0.09 (0.18), and the incidence of delirium within 5 days after surgery was 8.5%.The results of multivariate logistic regression analyses showed that increase in age (OR 1.068, 95% CI 1.018-1.120, P=0.007), higher postoperative consumption of morphine (OR 1.089, 95% CI 1.051-1.128, P<0.01) and higher mFI (OR 2.465, 95% CI 1.636-3.714, P<0.01) were the independent risk factors for postoperative delirium.@*Conclusion@#Higher mFI is the independent risk factor for delirium after artificial joint replacement in elderly patients.
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Objective To evaluate the relationship between modified Frailty Index(mFI)and de-velopment of delirium after artificial joint replacement in elderly patients.Methods Elderly patients(aged≥60 yr)who scheduled for elective hip or knee replacement,were enrolled.Preoperative frailty was assessed using the mFI scale.All the patients received surgery under combined spinal-epidural anesthesia.Primary outcome was the incidence of delirium within 5 days after operation,and delirium was assessed by Confusion Assessment Method or Confusion Assessment Method-Intensive Care Unit.The patients were di-vided into delirium group and non-delirium group according to whether delirium occurred or not.Results A total of 620 patients were included in the study,the mFI was 0.09(0.18),and the incidence of delirium within 5 days after surgery was 8.5％.The results of multivariate logistic regression analyses showed that in-crease in age(OR 1.068,95％CI 1.018-1.120,P＝0.007),higher postoperative consumption of mor-phine(OR 1.089,95％CI 1.051-1.128,P＜0.01)and higher mFI(OR 2.465,95％CI 1.636-3.714,P＜0.01)were the independent risk factors for postoperative delirium.Conclusion Higher mFI is the independent risk factor for delirium after artificial joint replacement in elderly patients.
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STUDY DESIGN: Retrospective cohort study. PURPOSE: The aim of this study was to identify features associated with increased mortality risk in traumatic C2 fractures in the elderly, including measures of comorbidity and frailty. OVERVIEW OF LITERATURE: C2 fractures in the elderly are of increasing relevance in the setting of an aging global population and have a high mortality rate. Previous analyzes of risk factors for mortality have not included the measures of comorbidity and/or frailty, and no local data have been reported to date. METHODS: This study comprises a retrospective review of 70 patients of age >65 years at Waikato Hospital, New Zealand with traumatic C2 fractures identified on computed tomography between 2010 and 2016. Demographic details, medical history, laboratory results on admission, mechanism of injury, and neurological status on presentation were recorded. Medical comorbidities were also detailed allowing calculation of the Charlson Comorbidity Index (CCI) and the modified Frailty Index (mFI). RESULTS: The most common mechanism of injury was a fall from standing height (n=52, 74.3%). Mortality rates were 14.3% (n=10) at day 30, and 35.7% (n=25) at 1 year. Bivariate analysis showed that both CCI and mFI correlated with 1-year mortality rates. Reduced albumin and hemoglobin levels were also associated with 30-day and 1-year mortality rates. Forward stepwise logistic regression models determined CCI and low hemoglobin as predictors of mortality within 30 days, whereas CCI, low albumin, increased age, and female gender predicted mortality at 1 year. CONCLUSIONS: The CCI was a useful tool for predicting mortality at 1 year in the patient cohort. Other variables, including common laboratory markers, can also be used for risk stratification, to initiate timely multidisciplinary management, and prognostic counseling for patients and family members.
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STUDY DESIGN: Retrospective cohort study. PURPOSE: To describe our experience in the management and outcomes of vertebral column osteomyelitis (VCO), particularly focusing on the risk factors of early and late mortality. OVERVIEW OF LITERATURE: Previous reports suggest a global increase in spinal column infections highlighting significant morbidity and mortality. To date, there have been no reports from our local population, and no previous report has assessed the potential relationship of frailty with mortality in a cohort of patients with VCO. METHODS: We reviewed 76 consecutive patients with VCO between 2009 and 2016 in Waikato Hospital, New Zealand. Demographic, clinical, microbiological, and treatment data were collected. Comorbidities were noted to calculate the modified Frailty Index (mFI). Mortality at 30 days and 1 year was recorded. Univariate and multivariate analyses were used to identify the predictors of mortality. RESULTS: The mean age of patients was 64.1 years, with 77.6% being male. Most patients presented with axial back pain (71.1%), with the lumbar spine most commonly affected (46%). A mean of 2.1 vertebral bodies was involved. Methicillin-sensitive Staphylococcus aureus was the most common organism of infection (35.5%), and 15.8% of patients exhibited polymicrobial infection. Twenty patients (26.3%) underwent surgical intervention, which was more likely in patients with concomitant spinal epidural abscess (odds ratio [OR], 4.88) or spondylodiscitis (OR, 3.81). Mortality rate was 5.2% at 30 days and 22.3% at 1 year. The presence of frailty (OR, 13.62) and chronic renal failure (OR, 13.40) elevated the 30-day mortality risk only in univariate analysis. An increase in age (OR, 1.07) and the number of vertebral levels (OR, 2.30) elevated the 1-year mortality risk in both univariate and multivariate analyses. CONCLUSIONS: Although the mFI correlated with 30-day mortality in univariate analysis, it was not a significant predictor in multivariate analysis. An increase in age and the number of levels involved elevated the 1-year mortality risk.
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Adult , Humans , Male , Back Pain , Cohort Studies , Coinfection , Comorbidity , Discitis , Epidural Abscess , Kidney Failure, Chronic , Mortality , Multivariate Analysis , New Zealand , Osteomyelitis , Retrospective Studies , Risk Factors , Spine , Staphylococcus aureusABSTRACT
Objective To investigate the frailty status and related determinants among the elderly in China.Methods Frailty index (FI) was applied to evaluate the frailty status of the elderly.Data used in this study was from the China Health and Retirement Longitudinal Study (CHARLS) in 2011-2015.Binary logistic regression analysis was carried out to identify the determinants related to the status on frailty.Results The prevalence rates of frailty in the elderly were 18.7％,20.6％ and 28.4％ in 2011,2013 and 2015,respectively.Being female or elderly under advanced age,were both associated with the higher level of FI.Factors as hip fracture,falls,alcohol intake more than once a month,and less participation in social activities etc.,might serve as the risk factors for frailty.Conclusion Chinese elderly showed relatively high prevalence on frailty and with annual increasing trend.The status of frailty was related to factors as adverse events and unhealthy lifestyles.Comprehensive intervention strategies should be adopted in early life of the elderly to delay the development process of frailty.
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Objective To investigate the frailty status and related determinants among the elderly in China.Methods Frailty index (FI) was applied to evaluate the frailty status of the elderly.Data used in this study was from the China Health and Retirement Longitudinal Study (CHARLS) in 2011-2015.Binary logistic regression analysis was carried out to identify the determinants related to the status on frailty.Results The prevalence rates of frailty in the elderly were 18.7％,20.6％ and 28.4％ in 2011,2013 and 2015,respectively.Being female or elderly under advanced age,were both associated with the higher level of FI.Factors as hip fracture,falls,alcohol intake more than once a month,and less participation in social activities etc.,might serve as the risk factors for frailty.Conclusion Chinese elderly showed relatively high prevalence on frailty and with annual increasing trend.The status of frailty was related to factors as adverse events and unhealthy lifestyles.Comprehensive intervention strategies should be adopted in early life of the elderly to delay the development process of frailty.
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Objective To apply the Chinese version of Care Partner-Frailty Index-Comprehensive Geriatric Assessment (CP-FI-CGA) in Taiyuan part of elderly patients and study theirs frailty conditions. Methods To Choose the Chinese version of CP-FI-CGA questionnaire, patients′ general information questionnaire and Clinical Frailty Scale to evaluate 385 patients and analyze the results statistically. Results Of 385 patients, female patients were 166 cases (43.12%);the frailty index score was (0.318 ± 0.165) points, the CFS was 5.044 ± 1.483. Single factor analysis showed that age, marital status, the kinds of medication which the patients used, how much help the patient required, the condition of social support, and the sleep state, these six factors had statistical significance (Z=-7.292, Z=-1.994, χ2=27.726, Z=-9.688,χ2=8.117,χ2=53.477, all P<0.01). Multiple linear regression analysis showed that age, the kinds of medication which the patients used, how much help the patient required and the sleep state, these four factors were independent factors (model R=0.610, R2=0.372; adjusted R2=0.362, F=37.241, P< 0.01). Conclusions CP-FI-CGA questionnaire can accurately estimate the frailty degree by evaluating patients′each system and can be promoted in the clinical geriatric ward and nursing home, etc.
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Frailty syndrome is the core of the comprehensive geriatric assessment of the elderly, which affects the prognosis of elderly critical illness patients and becomes the hotspot of the current geriatric medical research of elderly patients. In critically ill elderly patients, the incidence rate of frailty syndrome is 21％-59％. Frailty syndrome is an independent risk factor in elderly patients with complications, short-term and long-term mortality. Moreover frailty is always accompanied by poor state and affects the health quality of these patients. In the field of critical care medicine in our country, the study of the frailty syndrome is still in its infancy. This article focuses on the research progress of frailty syndrome, and the assessment of the frailty critical illness elderly patients is helpful for the clinical doctors to determine the prognosis and treatment decision.
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Objective To apply the Chinese version of Care Partner-Frailty Index-Comprehensive Geriatric Assessment (CP-FI-CGA) in Taiyuan part of elderly patients and study theirs frailty conditions. Methods To Choose the Chinese version of CP-FI-CGA questionnaire, patients′ general information questionnaire and Clinical Frailty Scale to evaluate 385 patients and analyze the results statistically. Results Of 385 patients, female patients were 166 cases (43.12%);the frailty index score was (0.318 ± 0.165) points, the CFS was 5.044 ± 1.483. Single factor analysis showed that age, marital status, the kinds of medication which the patients used, how much help the patient required, the condition of social support, and the sleep state, these six factors had statistical significance (Z=-7.292, Z=-1.994, χ2=27.726, Z=-9.688,χ2=8.117,χ2=53.477, all P<0.01). Multiple linear regression analysis showed that age, the kinds of medication which the patients used, how much help the patient required and the sleep state, these four factors were independent factors (model R=0.610, R2=0.372; adjusted R2=0.362, F=37.241, P< 0.01). Conclusions CP-FI-CGA questionnaire can accurately estimate the frailty degree by evaluating patients′each system and can be promoted in the clinical geriatric ward and nursing home, etc.
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Frailty syndrome is the core of the comprehensive geriatric assessment of the elderly, which affects the prognosis of elderly critical illness patients and becomes the hotspot of the current geriatric medical research of elderly patients. In critically ill elderly patients, the incidence rate of frailty syndrome is 21％-59％. Frailty syndrome is an independent risk factor in elderly patients with complications, short-term and long-term mortality. Moreover frailty is always accompanied by poor state and affects the health quality of these patients. In the field of critical care medicine in our country, the study of the frailty syndrome is still in its infancy. This article focuses on the research progress of frailty syndrome, and the assessment of the frailty critical illness elderly patients is helpful for the clinical doctors to determine the prognosis and treatment decision.
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BACKGROUND: This study was done to evaluate the validity and reliability of the Kaigo-Yobo (K-Y) checklist in the Korean elderly population. METHODS: The study population included 283 men and women over 65 years who visited the three community senior's welfare centers located in Seoul and Gyeonggi province from March 29, 2011 to May 26, 2011. The Korean frailty index (FI), Japanese K-Y checklist, Cardiovascular Health Study frailty index (CHSFI), activities of daily living, and Korean Mini-Mental Status Examination were completed for each participant. Reliability was tested by internal consistency (Cronbach's alpha), as was the test-retest reliability, at a 2-week interval. Validity was tested by the area under the curve (AUC) from the receiver operating characteristics curve as a predictor of frailty according to the CHS criteria and the validity index estimated by the reliability index. RESULTS: The correlation coefficients between Korean FI and K-Y checklist, Korean FI and CHSFI, and K-Y checklist and CHSFI were 0.61, 0.43, and 0.44 respectively. The range of Kappa value for each item on the Korean FI was 0.28 to 0.60 and 0.19 to 0.65 for the K-Y checklist. Cronbach's alpha for the Korean FI was 0.58 and 0.64 for the K-Y checklist. The AUC for the Korean FI was 0.79, and 0.64 for the K-Y checklist. The validity index for the items on the Korean FI ranged from 0.28-0.53 to 0.60-0.78 and 0.19-0.44 to 0.65-0.81 for the K-Y checklist. CONCLUSION: The K-Y checklist is a valid and reliable instrument to measure frailty in the Korean elderly population. Follow-up studies are needed.
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Aged , Female , Humans , Male , Activities of Daily Living , Area Under Curve , Asian People , Checklist , Reproducibility of Results , ROC CurveABSTRACT
BACKGROUND: Frailty is a syndrome that involves decreased reserve capacity and loss of physiological function caused by aging. This study was done to develop a frailty index for the Korean elderly. METHODS: The Korean frailty index 8-item questionnaire was established by a panel of experts from the Korean Geriatrics Society. Demographic characteristics, the cardiovascular health study (CHS) frailty index and the Korean frailty index were completed for 240 men and women over 65 years visiting three selected community senior's welfare centers from June 2009 to August 2009. Reliability was tested by internal consistency (Cronbach's alpha) and the test-retest reliability at a 2-week interval. Validity was tested by a criterion validity comparison between the CHS frailty index and the validity index estimated by the reliability index. RESULTS: Cronbach's alpha was 0.65. The range of Kappa value for each item was 0.27-0.65. The Kappa value of the criterion validity comparison with the CHS index for the Korean frailty index was 0.5. The validity indexes for the items estimated by the reliability index ranged from 0.27-0.52 to 0.65-0.81. CONCLUSION: The Korean frailty index is a valid and reliable instrument. However, fine-tuning such as item-revision is needed prior to use in the practical setting.