Avances en el manejo de la fragilidad en personas mayores. Implicaciones para atención primaria / Advances in management of frailty in the elderly. Implications for primary health care

El concepto teórico de fragilidad está ampliamente aceptado, pero su aplicación a la práctica presenta algunas limitaciones debido a la existencia de múltiples herramientas para su detección precoz y propuestas de intervención. En esta breve revisión de situación, se pretende resumir las últimas evidencias respecto a la detección precoz y el abordaje de la fragilidad en Atención Primaria. El cribado se basa en la detección oportunista de casos mediante búsqueda activa a partir de los 70 años, usando como herramientas una prueba de ejecución y la escala FRAIL. Se aconseja confirmación con el Frailty Index. Su abordaje debe ser multidimensional centrado en el entrenamiento de fuerza muscular, suplementos proteicos y la revisión de la medicación. La fragilidad es evitable, y se necesita poner el foco en la detección precoz. A pesar de los avances en los últimos años, es necesaria más investigación en busca del modelo de atención más eficaz. (AU)

Although the theoretical concept of frailty is widely accepted, its practical application is somehow limited due to the existence of multiple tools related to its early detection and intervention proposals. In this brief review of the situation, the aim is to summarize the latest evidence regarding early detection and management of frailty in Primary Health Care. The screening is based on opportunistic case detection by active search from the age of 70, using a performance test and the FRAIL scale as tools. Confirmation using the Frailty Index is recommended. Its approach should be multidimensional and focusing on muscle strength training, protein supplementation and medication review. Frailty is preventable, and emphasis should be placed on early detection. Despite advances in recent years, more research is needed in order to find the most effective healthcare model. (AU)

The intersections of industrialization: Variation in skeletal indicators of frailty by age, sex, and socioeconomic status in 18th- and 19th-century England.

OBJECTIVES: Intersectionality theory argues that various categories of identity and forms of systemic oppression interact and produce inequalities in resource access, economic opportunities, and health outcomes. However, there has been little explicit engagement with this theory by bioarchaeologists examining disparate health outcomes in the past. This study examines the associations among frailty, age at death, sex, and socioeconomic status (SES) in 18th- and 19th-century England. MATERIALS AND METHODS: The sample for this study comes from four industrial-era cemeteries from England, ca. 1711-1857. The associations among adult age (18+ years), SES, sex, and three skeletal indicators of stress (dental enamel hypoplasia [DEH, n = 293], cribra orbitalia [CO, n = 457], periosteal lesions [PNB, n = 436]) are examined using hierarchical log-linear analysis. RESULTS: Significant interactions existed among the variables examined for two skeletal indicators: high SES females had lower frequencies of CO relative to other groups and males between ages 30-45 years exhibited higher frequencies of PNB compared to females or males of older or younger ages, regardless of SES. Additionally, sex and SES were consistently associated with age at death. CONCLUSIONS: These results suggest that patterns of stress indicators cannot be examined solely across unilateral axes of age, SES, or sex. Intersecting axes of privilege, marginalization, and structural oppression may have buffered high SES females from some negative health outcomes (CO) while predisposing them to others (risk of maternal mortality). Likewise, the hazardous working conditions relegated to adult males may have heightened the risk of injury, infection, and death for middle-aged men in industrial-era England.

The Skiles Mummy: Care of a debilitated hunter-gatherer evidenced by coprolite studies and stable isotopic analysis of hair.

The Skiles Mummy (SMM), a naturally mummified adult male from the late archaic period of Lower Pecos Canyonlands of South Texas, represents a unique case of care. SMM is an exceptional mummy within this region due to both the retention of a full head of hair, and having a diagnosed case of megacolon, a complication commonly associated with Chagas disease caused by Trypanosoma cruzi. Stable isotopic analysis of his hair is consistent with a diet incorporating of C4/CAM plants with some C3 plants, freshwater resources, and higher trophic level animals. However, the segments of hair most proximal to the scalp exhibited elevated δ15N values. Data from previous research indicate starvation and malnutrition can cause δ15N values to rise. The presence of large fecal boluses in the digestive tract suggest peristalsis ceased in the last four to five months of life, and this, together with results from coprolite analysis, indicate he would not have been able to adequately absorb protein and nutrients during this time. His condition would have rendered him immobile. Following Tilley's index of care, someone would have had to bring him food resources, as well as attending to his daily needs.

Patterns of frailty in non-adults from medieval London.

Famine has the potential to target frail individuals who are at greater risk of mortality than their peers. Although children have been at elevated risk of mortality during recent famines, little is known about the risks posed to children during the medieval period. This study uses burials from the St. Mary Spital cemetery (SRP98), London (c. 1120-1540) to examine the relationships among non-adult age at death, burial type (attritional or famine), and four skeletal lesions (porotic hyperostosis, cribra orbitalia, linear enamel hypoplasia [LEH], and periosteal new bone formation). Hierarchical log-linear analysis reveals significant associations between famine burials and LEH, independent of age. Significant associations also exist between age and the presence of cribra orbitalia, porotic hyperostosis, and periosteal lesions, with all three lesions present in greater frequencies among older children and adolescents, independent of burial type. The LEH results suggest that early exposure to stressors increased frailty among non-adults in the context of famine. The associations between age and the other skeletal indicators suggest that, in both famine and non-famine conditions, frailer individuals died at younger ages and before skeletal lesions could manifest, while their less frail peers survived multiple physiological insults before succumbing to death at older ages.