Development of a frailty measure for older adults: the frailty index for elders.

BACKGROUND AND PURPOSE: Frailty is a significant challenge for health care. Therefore, it is important to identify frail individuals. Theoretical Framework: The Vulnerability/Risk/Human Response/Care Model. The purpose of this study was to develop and validate a measure to identify frail older adults. METHODS: Instrument development encompassed the following: delineation of content domains, item generation, content validity, quantitative content validity analysis, and psychometric analysis. RESULTS: Findings indicated the following: (a) Frailty is a complex concept, (b) the Frailty Index for Elders (FIFE) is composed of 10 items, (c) FIFE was able to predict depression, and (d) FIFE was able to differentiate differences in demographic profiles by social support environment. CONCLUSIONS: FIFE is a valid instrument. FIFE can be used to study the relationships among frailty determinants, provide standardized measurement, and develop and measure interventional studies.

Evaluación multidimensional de la astenia relacionada con el cáncer / Cancer related fatigue: a multidimensional evaluation

La astenia en el paciente con cáncer es definida como una sensación abrumadora y persistente de cansancio o agotamiento relacionado con el cáncer o el tratamiento de este, que disminuye o impide la capacidad para el trabajo mental o físico en el contexto de su actividad diaria y a pesar de un buen descanso. Es uno de los primeros síntomas que puede presentarse en el paciente con cáncer, afectando de manera importante a la calidad de vida. El objetivo de esta revisión es detallar las diferentes causas que influyen en la astenia y describir las escalas de medida que más frecuentemente se utilizan para estudiarla. La metodología empleada en esta revisión es narrativa. En esta revisión describimos cómo la astenia es un concepto multidimensional, ya que casi siempre está provocada o influenciada por múltiples causas. Esta multidimensionalidad interviene también en la comprensión de la fisiopatología. Por esta razón en esta revisión diferenciaremos entre astenia primaria y secundaria definiendo y detallando cada una de ellas. Por otro lado, también analizamos el tipo de escalas empleadas para medir la astenia diferenciando entren las que miden la astenia de forma primaria o las que la miden desde un punto de vista multidimensional

Fatigue in cancer patients is defined as an unusual, persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning, despite good rest. Fatigue is one of the first symptoms that can appear in patients with cancer and quality of life is severely impacted by it. The main goal of this review is to describe the different causes that influence fatigue and the different ways to asses this symptom. The methodology we have used for this review is narrative. In this work we describe fatigue as a multidimensional concept that it is caused by multiple mechanisms. This multidimensionality is also involved in understanding the pathophysiologyFor that reason we are going to define fatigue as primary and secondary, and we are going to describe each of them. We are also going to analyse the type of scales used to measure fatigue; describing the differences between the ones that measure only fatigue and the ones that are used to asses fatigue from a multidimensional perspective

[Asthenic disorders in children].

The present study comprised two parts. In the first part, authors attempted to work out the systematics of asthenic disorders based on our own observations of 189 children aged 7-14 years. The following clinical variants of asthenic states in children were singled out: cerebrogenic asthenia (14.3%), somatogenic (13.8%), residual (16.4%), dysontogenetic (20.1%) and neurasthenia (35.4%). In the second part, we summarized the results of treatment of neurasthenia with adaptol (32 patients) compared to pantoham (30 patients). The efficacy of adaptol was higher: the improvement was seen in 71.9% of cases compared to pantoham (56.7%). The good tolerability of adaptol which clinical efficacy is confirmed by neurophysiological and psychological studies is discussed.

[The chronic asthenia syndrome: a clinical approach]. / Enfoque del síndrome de astenia crónica.

The term asthenia comes from the Greek (centsqsneia, a: privation, without; esthénos: vigor, force), it means absence of strength, vigor or force. It is a symptom, difficult to define, with a set of vague sensations, different for each patient. It is a frequent cause of consult, almost 30% in ambulatory settings. The chronic fatigue represents up to 10% of these cases, and the 0.2-0.7% belongs to the chronic fatigue syndrome. It is very important to differentiate asthenia from weakness, dizziness or dyspnoea, since patients may confuse them. The factor time in asthenia is very useful for its characterization, it was defined to the prolonged fatigue when it lasts for more than a month and chronic when the duration is greater than 6 months. The depression is the commonest fatigue cause, representing approximately half of the cases. The most effective treatment of the asthenia is to solve the underlying cause, although up to 20% of the patients remain without diagnosis. The diagnosis of the chronic fatigue syndrome is of exclusion and the criteria of the international consensus of year 1994 are due to use. The high frequency of the symptom entails an enormous social and economic cost and it is for that reason so important for physicians to have a correct manage of this symptom.

Redefining cancer-related asthenia-fatigue syndrome.

BACKGROUND: Asthenia fatigue syndrome (AFS) is a common symptom perceived by patients with cancer and consists of reported pathologic fatigue, poor endurance, and impaired motor and cognitive function. OBJECTIVE: The purpose of this study was to examine the relationship between a traditional measure of AFS, visual analogue scale (VAS) fatigue ratings, and a set of more objective functional and physiologic measures (Dietz oncology classification, C-reactive protein, serum albumin, hemoglobin, body mass index [BMI]), Motor Functional Independence Measure (FIM) Score, Cognitive FIM Score. We hypothesized a relationship could suggest the utility of alternative means of assessing and addressing AFS. METHODS: We retrospectively examined the records of 131 patients admitted to our facility for inpatient rehabilitation because of disability-causing cancer or its treatment. RESULTS: Of our sample, 94.7% (124 cases) indicated at least mild fatigue and 97.7% (128 cases) showed abnormal serum albumin, C-reactive protein, hemoglobin, or BMI. We used multiple regression analysis to examine the relationship between VAS fatigue ratings and the aforementioned set of functional and physiologic variables. The regression explained a significant proportion of the variability in VAS fatigue ratings (F = 2.25, df = 7,123, p = 0.03, R = 0.34, R(2) = 0.11). However, only Motor FIM Score accounted for a significant independent contribution to the variability in VAS fatigue ratings. CONCLUSION: The data indicate physiologic and functional variables may provide an alternative, objective, and reliable operational definition of AFS. Specifically, using Motor FIM Score, as a surrogate for VAS fatigue ratings may be used to measure the efficacy of AFS treatment.

Conceptualizations of frailty in relation to older adults.

AIM: The aim of this article is to discuss the concept of frailty and its adequacy in identifying and describing older adults as frail. BACKGROUND: Despite the dramatic increase in use of the term 'frailty' over the past two decades, there is a lack of consensus in the literature about its meaning and use, and no clear conceptual guidelines for identifying and describing older adults as frail. Differences in theoretical perspectives will influence policy decisions regarding eligibility for, and allocation of, scarce health care resources among older adults. METHOD: The article presents a literature review and synthesis of definitions and conceptual models of frailty in relation to older adults. The first part of the paper is a summary of the synonyms, antonyms and definitions of the term frailty. The second part is a critical evaluation of conceptual models of frailty. Six conceptual models are analysed on the basis of four main categories of assumptions about: (1) the nature of scientific knowledge; (2) the level of analysis; (3) the ageing process; (4) the stability of frailty. The implications of these are discussed in relation to clinical practice, policy and research. CONCLUSION: The review gives guidelines for a new theoretical approach to the concept of frailty in older adults: (1) it must be a multidimensional concept that considers the complex interplay of physical, psychological, social and environmental factors; (2) the concept must not be age-related, suggesting a negative and stereotypical view of ageing; (3) the concept must take into account an individual's context and incorporate subjective perceptions; (4) the concept must take into account the contribution of both individual and environmental factors.

Adjuvant role of vitamin B analogue (sulbutiamine) with anti-infective treatment in infection associated asthenia.

AIMS OF THE STUDY: Asthenic symptoms such as weakness accompany illness. This study investigates whether the centrally acting cholinergic agent, vitamin B analogue (sulbutiamine), is effective and acceptable in relieving these symptoms in infectious disease when combined with specific anti-infective treatment. METHODOLOGY: In a prospective uncontrolled, non-randomised, commercial, observational study, 1772 patients with an infectious disease and asthenic symptoms, drawn from the practice of 350 randomly selected physicians throughout India, received vitamin B analogue (sulbutiamine) in addition to specific anti-infective treatment for 15 days. The primary outcome variable was complete resolution of asthenic symptoms with treatment. RESULTS: The number (%, 95% confidence interval) of patients with complete resolution of all asthenic symptoms was 916 (51.7, 49.4-54). In the remaining patients, severe asthenia was reduced but persisted in 11 (0.6, 0-26); and moderate asthenia in 94 (5.3, 0-17.6). The response was greater in patients with acute infection and symptoms more related to cerebral function. Side effects occurred in 10 (0.6%), patients and well being improved significantly. CONCLUSIONS: Vitamin B analogue (sulbutiamine) may be a useful adjunct to specific anti-infective treatment.

[Diagnosis of depressive disorder and so-called exhaustion depression. Self-esteem--a central concept]. / Diagnostik av egentlig depression och så kallad utmattningsdepression. Självaktning--ett centralt begrepp.

Depressive disorders can be recognized by the loss of self-esteem; this contrasts with mourning and neurasthenic reactions, in which self-esteem remains intact. Just as depression can result from the gradual reduction and eventual loss of self-esteem, mourning and neurasthenic reactions can evolve into true depressive states. "Exhaustion depression", a new diagnostic category connected to "burnout" situations, should be applied only when criteria for depressive disorder are fulfilled, including loss of self-esteem. When these criteria are lacking we should refer only to an exhaustion state provoked by stress. Neurotic mechanisms may represent a special class of relevant stress factors, but are not seen in manifest neurasthenic reactions and exhaustion depression.

Subsyndromes of chronic schizophrenia: a phenomenological study.

Statistical grouping of clinical symptoms and signs is one method of classifying schizophrenia. This study attempted to find factors of symptoms generated through clinical ratings on three scales, namely the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS) and the Comprehensive Psychopathological Rating Scale (CPRS) in a sample of 80 stable chronic schizophrenics diagnosed by DSM-III-R. It was found that the positive-negative dichotomy could not be replicated. Inappropriate affect was found to be a clear misfit in the cluster of negative symptoms. Inclusion of CPRS led to the generation of a factor loading high on depressive and asthenic items, and this could be clearly distinguished from the factor of negative symptoms. This factor had not hitherto been identified.

Asthenic symptoms in a rural family practice. Epidemiologic characteristics and a proposed classification.

Asthenic symptoms (eg, fatigue, lassitude, weakness) are of major concern in family practice setting, yet relatively little research has addressed this issue. A retrospective chart review over a 10-year period was conducted to better characterize these symptoms in a rural family practice providing health care to 508 adult patients. Asthenic complaints were recorded at least once in the medical charts of 164 patients (32%) with a preponderance of female patients. Peak prevalence occurred in the third decade of age and during the summer months. Associated symptoms, mainly pain and dizziness, were reported in 75% of the cases. A cause or diagnosis was not identified by the practicing physician in nearly 50% of the encounters; nevertheless, most episodes resolved spontaneously. Patients could be subclassified into three categories according to the recurrence pattern of their asthenic symptoms during the study period. The largest category (64%) included patients who had a single or two episodes and was thus termed "episodic asthenia." Forty-five patients (27%) with recurrent episodes (mean 4.4, range 3 to 10) were classified as having "recurrent episodic asthenia." A third small group (14 patients, 9%) with persistent complaints over the years but no evidence of the chronic fatigue syndrome were classified as having "chronic persistent asthenia." The proposed classification may help future research of asthenic symptoms in the family practice setting.

[Torpid schizophrenia with a predominance of asthenic disorders]. / Vialotekushchaia shizofreniia s preobladaniem astenicheskikh rasstroistv.

The article deals with the typology of asthenic disturbances that determine for a long time the clinical picture of slowly progressive schizophrenia. Two types of asthenia (extensive and limited) have been identified as a result. With regard to clinical peculiarities these manifestations can be collated respectively with "pseudoneurasthenia" and "autochtonous asthenia". The author has analyzed the dynamics of these variants of the asthenic symptom complex to which, with the progression of the process, disturbances of the non-delirious hypochondria type are added. The author has established the relationship between clinical features of asthenia and the degree of progression of the process and a differing structure of negative changes formed at late stages of the disease. The first type (extensive asthenia) is observed in the framework of slowly progressive neurosis-like schizophrenia with manifestations of a moderate asthenic defect. The second type (limited asthenia) is noted in psychopathy-like slowly progressive schizophrenia associated with signs of greater progression and psychopathy-like changes of the "verschoben-type" with intellectual reduction.