Factores de riesgo para mortalidad en mujeres adultas mayores con síndrome de fragilidad / Risk Factors for Mortality in Older Adult Women with Frailty Syndrome

Introducción: La fragilidad es un síndrome geriátrico de gran prevalencia e impacto en la población adulta mayor, que se asocia con diversos desenlaces negativos en la salud, particularmente en el sexo femenino, pues implica una mayor predisposición de morir. Existen diversos factores asociados a la mortalidad en mujeres frágiles, entre los descritos están los factores sociodemográficos, la presencia de comorbilidades y los síndromes geriátricos. Objetivos: Determinar los factores de riesgo asociados a mortalidad en mujeres adultas mayores con síndrome de fragilidad. Métodos: Estudio observacional, analítico, de tipo cohorte retrospectiva, análisis secundario en una base de datos de una investigación realizada en adultos mayores del Centro Médico Naval Cirujano Mayor Santiago Távara entre los años 2010 y 2015 con seguimiento de supervivencia hasta junio del 2016. La muestra para el presente análisis se constituyó por datos de 341 adultas mayores frágiles, de acuerdo al fenotipo de Fried. Resultados: El estado civil, ser divorciadas o separadas, la multimorbilidad, el número de fármacos, el riesgo de caídas y el Puntaje de la Escala de Gijón se asociaron significativamente con un mayor riesgo de mortalidad en mujeres frágiles, mientras que la educación, la edad, el Puntaje del Índice de Barthel y el Puntaje de Minimental State Examination no fueron factores asociados. Conclusiones: Las mujeres frágiles divorciadas o separadas, con pobre soporte social, mayor consumo de fármacos y multimorbilidad, y con riesgo de caídas tienen mayor riesgo de mortalidad(AU)

Introduction: Frailty is a geriatric syndrome of great prevalence and impact in the older adult population, associated with various negative health outcomes, particularly in the female sex. Among the various factors associated with mortality in frail women, sociodemographic factors, as well the presence of comorbidities and geriatric syndromes have been described. Objective: To determine the risk factors associated with mortality in older women with frailty syndrome. Methods: An observational and analytical study of retrospective-cohort type was carried out, between the years 2010 and 2015, through the secondary analysis in a database of a research conducted with older adults from Cirujano Mayor Santiago Távara Naval Medical Center, with survival follow-up until June 2016. The sample for the present analysis was made up of 341 frail elderly women, according to Fried's phenotype. Results: Marital status, being divorced or separated, multimorbidity, number of drugs, risk of falls and the score based on Gijon's scale were significantly associated with an increased mortality risk in frail women; while education, age, as well as the scores based on Barthel index and the Mini-mental State Examination were not associated factors. Conclusions: Frail women who are divorced or separated, with poor social support, higher drug use, multimorbidity and at risk for falls are at higher risk for mortality(AU)

Social determinants of health and frailty are associated with all-cause mortality in older adults / Los determinantes de la salud y la fragilidad están asociados con la mortalidad por todas las causas en adultos mayores

Abstract: Objective: To examine the longitudinal association between the social determinants of health (SDH) and frailty status with all-cause mortality in older Mexican adults. Materials and methods: Longitudinal study with a sample of adults aged 60 and over of Study on Global AGEing and Adult Health (SAGE) in Mexico. A Cox proportional hazard model was used to estimate the SDH and frailty-related hazard ratios (HR) for mortality over the study period. Results: Overall mortality rate was 16.9%. Higher education, having a higher frequency of inter-personal contacts (HR=0.96;p<0.01) reduced the risk of dying, after adjusting for potential confounders. While, not counting on someone to trust (HR= 1.59;p<0.03) and having a sense a lack of control over important decisions in life increased the mortality risk. Conclusions: Given that frailty and the SDH affect health using independent pathways, public health systems in Mexico could benefit from increasing the capacity of identifying frail and isolated older adults and providing a risk-stratified health care accordingly.

Resumen: Objetivo: Examinar la asociación longitudinal entre los determinantes sociales en salud (DSS) y la fragilidad con la mortalidad por todas las causas en adultos mayores mexicanos. Material y métodos: Estudio longitudinal con una muestra de adultos mayores de 60 años o más del estudio Envejecimiento Global y Salud de los Adultos (SAGE, por sus siglas en inglés) en México. Se utilizó el modelo riesgos proporcionales de Cox para estimar la asociación entre DSS y la fragilidad en la mortalidad. Resultados: La tasa de mortalidad general fue 16.9%. Tener mayor educación y una mayor frecuencia de contactos interpersonales (HR= 0.96,p<0.01) reducen el riesgo de morir, después de ajustar por covariables. Mientras tanto, no contar con alguien en quien confiar (HR= 1.59;p<0.03) y tener una sensación de falta de control sobre las decisiones importantes en la vida aumentan el riesgo de mortalidad. Conclusiones: Dado que la fragilidad y los DSS inciden sobre la salud usando vías independientes, el sistema de salud de México se beneficiaría al incrementar su capacidad para detectar a los adultos mayores frágiles y con aislamiento social, para proveer cuidados a la salud.

Pre-Frailty Increases the Risk of Adverse Events in Older Patients Undergoing Cardiovascular Surgery / Pré-Fragilidade Aumenta o Risco de Eventos Adversos em Idosos Submetidos à Cirurgia Cardiovascular

Abstract Background: Frailty is identified as a major predictor of adverse outcomes in older surgical patients. However, the outcomes in pre-frail patients after cardiovascular surgery remain unknown. Objective: To investigate the main outcomes (length of stay, mechanical ventilation time, stroke and in-hospital death) in pre-frail patients in comparison with no-frail patients after cardiovascular surgery. Methods: 221 patients over 65 years old, with established diagnosis of myocardial infarction or valve disease were enrolled. Patients were evaluated by Clinical Frailty Score (CFS) before surgery and allocated into 2 groups: no-frailty (CFS 1~3) vs. pre-frailty (CFS 4) and followed up for main outcomes. For all analysis, the statistical significance was set at 5% (p < 0.05). Results: No differences were found in anthropometric and demographic data between groups (p > 0.05). Pre-frail patients showed a longer mechanical ventilation time (193 ± 37 vs. 29 ± 7 hours; p<0.05) than no-frail patients; similar results were observed for length of stay at the intensive care unit (5 ± 1 vs. 3 ± 1 days; p < 0.05) and total time of hospitalization (12 ± 5 vs. 9 ± 3 days; p < 0.05). In addition, the pre-frail group had a higher number of adverse events (stroke 8.3% vs. 3.9%; in-hospital death 21.5% vs. 7.8%; p < 0.05) with an increased risk for development stroke (OR: 2.139, 95% CI: 0.622-7.351, p = 0.001; HR: 2.763, 95%CI: 1.206-6.331, p = 0.0001) and in-hospital death (OR: 1.809, 95% CI: 1.286-2.546, p = 0.001; HR: 1.830, 95% CI: 1.476-2.269, p = 0.0001). Moreover, higher number of pre-frail patients required homecare services than no-frail patients (46.5% vs. 0%; p < 0.05). Conclusion: Patients with pre-frailty showed longer mechanical ventilation time and hospital stay with an increased risk for cardiovascular events compared with no-frail patients.

Resumo Fundamentos: A fragilidade é reconhecida como um importante preditor de eventos adversos em pacientes cirúrgicos idosos. Entretanto, os desfechos em pacientes com pré-fragilidade após a cirurgia cardiovascular ainda permanecem desconhecidos. Objetivos: Investigar os principais desfechos (tempo de internação, tempo de ventilação mecânica, incidência de acidente vascular cerebral e óbito intra-hospitalar) após cirurgia cardiovascular em pacientes com pré-fragilidade em comparação a pacientes sem fragilidade. Métodos: 221 pacientes acima de 65 anos de idade, com diagnóstico de infarto do miocárdio ou doença valvar foram recrutados no estudo. Os pacientes foram avaliados pela escala de fragilidade clínica (CFS, Clinical Frailty Score) antes da cirurgia e separados em 2 grupos: sem-fragilidade (CFS 1~3) vs. pré-fragilidade (CFS 4). Para todas as análises, foi considerada diferença significativa quando p < 0,05. Resultados: Não foram observadas diferenças nos dados antropométricos e demográficos entre os grupos. Os pacientes com pré-fragilidade apresentaram maior tempo de ventilação mecânica em comparação a pacientes sem fragilidade (193 ± 37 vs. 29 ± 7 horas; p < 0,05); resultados similares foram observados para tempo de permanência na unidade de terapia intensiva (5 ± 1 vs. 3 ± 1 days; p < 0,05) e tempo total de internação hospitalar (12 ± 5 vs. 9 ± 3 dias; p < 0,05). Além disso, os pacientes com pré-fragilidade apresentaram maior número de eventos adversos (acidente vascular cerebral-AVC 8,3% vs. 3,9%; óbito intra-hospitalar 21,5% vs. 7,8%; p<0,05) com risco aumentado para AVC (OR: 2,139, IC 95%: 0,622-7,351, p = 0,001; HR: 2,763, IC 95%: 1,206-6,331, p = 0,0001) e morte intra-hospitalar (OR: 1,809, IC 95%: 1,286-2,546, p = 0,001; HR: 1,830, IC 95%: 1,476-2,269, p = 0,0001). Além disso, um maior número de pacientes com pré-fragilidade necessitaram de fisioterapia domiciliar que pacientes sem fragilidade (46,5% vs. 0%; p< 0,05). Conclusão: Pacientes com pré-fragilidade apresentaram maior tempo de ventilação mecânica e maior tempo de internação hospitalar, com maior risco de desenvolverem eventos cardiovasculares adversos em comparação a pacientes sem fragilidade.