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03/2013 journal articles

THE EUROPEAN UNION GERIATRIC MEDICINE SOCIETY (EUGMS) WORKING GROUP ON \"FRAILTY IN OLDER PERSONS\"

M. Cesari, G. Abellan Van Kan, S. Ariogul, J.P. Baeyens, J. Bauer, M. Cankurtaran, T. Cederholm, A. Cherubini, A.J. Cruz-Jentoft, A. Curgunlu, F. Landi, A.A. Sayer, T. Strandberg, E. Topinkova, D. Van Asselt, B. Vellas, D. Zekry, J.P. Michel

J Frailty Aging 2013;2(3):118-120

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CITATION:
M. Cesari ; G. Abellan Van Kan ; S. Ariogul ; J.P. Baeyens ; J. Bauer ; M. Cankurtaran ; T. Cederholm ; A. Cherubini ; A.J. Cruz-Jentoft ; A. Curgunlu ; F. Landi ; A.A. Sayer ; T. Strandberg ; E. Topinkova ; D. Van Asselt ; B. Vellas ; D. Zekry ; J.P. Michel (2013): THE EUROPEAN UNION GERIATRIC MEDICINE SOCIETY (EUGMS) WORKING GROUP ON «FRAILTY IN OLDER PERSONS». The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.15

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RAISING AWARENESS ON THE URGENT NEED TO IMPLEMENT FRAILTY INTO CLINICAL PRACTICE

The Orlando Frailty Conference Group

J Frailty Aging 2013;2(3):121-124

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Frailty has been linked to longer hospital stays and increased mortality in hospitalized patients. Frailty was found at the most common condition leading to death, followed by organ failure, cancer, other causes, advanced dementia, and sudden death. Yet despite evidence linking frailty to poor outcomes, frailty is not implemented clinically in most countries. Since many people are not identified as frail, they frequently are treated inappropriately in health care settings. Participants in the international conference on frailty emphasized the importance of raising awareness about frailty among geriatricians, general practitioners, and other primary care providers in order to implement frailty in clinical practice. The following recommendations were agreed upon: 1. Prioritize the identification of frail older persons in community settings, hospitals, and specialty clinics in order to ensure that people with frailty are treated appropriately and have access to interventional studies; 2. Build frailty clinics as a means of providing optimal management of frail elders; 3. Develop intervention programs incorporating physical and cognitive exercise, social support, and nutrition for people in the earliest stages of frailty in order to slow or reverse frailty; 4. Build stronger basic and clinical research programs in order to better understand the underlying causes of frailty, identify therapeutic targets, and develop new treatment strategies.

CITATION:
The Orlando Frailty Conference Group (2013): Raising awareness on the urgent need to implement frailty into clinical practice . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.16

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INCORPORATING FRAILTY INTO CLINICAL PRACTICE AND CLINICAL RESEARCH

J.W. Rowe, L.P. Fried

J Frailty Aging 2013;2(3):126-127

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CITATION:
J.W. Rowe ; L.P. Fried (2013): Incorporating Frailty into Clinical Practice and Clinical Research. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.17

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HOW TO EMPOWER THE PRIMARY CARE PHYSICIAN IN THE IDENTIFICATION OF THE VULNERABLE OLDER PERSON WITH A VIEW TO PREVENTING FRAILTY AND ALL ITS CONSEQUENCES

I. Philp

J Frailty Aging 2013;2(3):128

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CITATION:
I. Philp (2013): How to empower the primary care physician in the identification of the vulnerable older person with a view to preventing frailty and all its consequences. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.18

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PROCOLLAGEN TYPE III N-TERMINAL PEPTIDE (P3NP) AND LEAN MASS: A CROSS-SECTIONAL STUDY

S.D. Berry, V.S. Ramachandran, P.M. Cawthon, P. Gona, R.R. McLean, L.A. Cupples, D.P. Kiel

J Frailty Aging 2013;2(3):129-134

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Background: Procollagen type III N-terminal peptide (P3NP) is released during collagen synthesis in muscle. Increased circulating P3NP is a marker not only of muscle growth, but also of muscle repair and fibrosis. Thus, P3NP may be a potential biomarker for sarcopenia. Objective: To determine the association between plasma P3NP and lean mass and strength. Design, Setting, and Participants: A cross-sectional study of men and women from the Framingham Offspring Study. Participants included a convenience sample of 687 members with a measure of plasma P3NP and lean mass, and 806 members with P3NP and quadriceps strength assessment. Measurements: Linear regression was used to estimate the association between total and appendicular lean mass and plasma P3NP, and quadriceps strength and P3NP. Results: Mean age was 58 years. Median plasma P3NP was similar in men (3.4 mg/L), premenopausal women (3.1 mg/L), and postmenopausal women (3.0 mg/L). In adjusted models, higher P3NP was associated with a modest decrease in total and appendicular lean mass in postmenopausal women [β= -0.13 unit P3NP/kg total lean mass; p=0.003]. A similar trend was found among premenopausal women, although results were not statistically significant [β=-0.10 unit P3NP/kg total lean mass; p=0.41]. No association between P3NP and lean mass was observed in men. P3NP was not associated with strength in men or women. Conclusion: Our results suggest that plasma P3NP might be a useful biomarker of muscle mass in postmenopausal women if longitudinal studies demonstrate that it has adequate sensitivity and specificity to predict muscle loss.

CITATION:
S.D. Berry ; V.S. Ramachandran ; P.M. Cawthon ; P. Gona ; R.R. McLean ; L.A. Cupples ; D.P. Kiel (2013): Procollagen type III N-terminal peptide (P3NP) and lean mass: a cross-sectional study . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.19

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PHYSICAL ACTIVITY AS HEALTHY INTERVENTION AGAINST SEVERE OXIDATIVE STRESS IN ELDERLY POPULATION

C. Tomás-Zapico, E. Iglesias-Gutiérrez, B. Fernández-García, D. de Gonzalo-Calvo

J Frailty Aging 2013;2(3):135-143

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Severe oxidative stress is a relevant risk factor for major deleterious health-related events in older people and is thought to be an important contributor to age-related disease. Literature has suggested oxidative stress as a therapeutic target for mitigating the biological decline and attenuating the occurrence of adverse clinical events in aged individuals. However, definitive treatments are not known. Regular and moderate physical activity has been proposed as possible intervention for slowing age-related decline. This healthy strategy presents a wide range of beneficial aspects for elderly, from the reduction of morbidity, disability, frailty and mortality rates to treatment of many age-related disorders. Importantly, the global benefits on health are not shared by any other strategies. Nevertheless, the physiological basis by which exercise produces its benefits to the organism is not fully understood. This review summarizes the evidence for the role of physical activity as potential healthy intervention for mitigating the negative aspects of aging through the modulation of the oxidative mechanisms.

CITATION:
C. Tomás-Zapico ; E. Iglesias-Gutiérrez ; B. Fernández-García ; D. de Gonzalo-Calvo (2013): PHYSICAL ACTIVITY AS HEALTHY INTERVENTION AGAINST SEVERE OXIDATIVE STRESS IN ELDERLY POPULATION . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.20

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IMPACT OF NUTRITIONAL RISK ON SELF-CARE CAPACITY: SOCIAL SUPPORT AS A SOURCE OF PROTECTION FOR COMMUNITY-DWELLING OLDER ADULTS LIVING IN A RURAL AREA

S.E. Jung, J. R. Hermann, A. Bishop

J Frailty Aging 2013;2(3):145-149

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Background: Loss of independence is a major concern for rural older adults. Older adults living in rural areas are at an increased nutritional risk, which can lead to functional impairments in self-care capacity. Identifying factors, which have a role in sustaining rural older adults’ self-care capacity, could help with maintaining independence as long as possible. Objective: The objective of this study was to examine the effect of social support as a moderator between nutritional risk and self-care capacity. Design: Cross sectional design using convenient sampling. Setting: Rural Oklahoma counties designated as “non-metro” and having populations under 5,000. Participants: Participants included 171 community-dwelling older adults, 65 years of age and older. Measurements: Data were collected using self-report surveys on self-care capacity (using the Duke Older Americans Resources and Services Procedures), social support (using the Social Provisions Scale), and nutritional risk (using the Mini-Nutritional Assessment short form). Using hierarchical linear regression techniques, data were analyzed to explore the moderating influence of social support in the association between nutritional risk and self-care capacity. Results: A significant interaction emerged between nutritional risk, social support, and self-care capacity (β = 0.20 p < 0.05). Thus, the deleterious impact of nutritional risk on self-care capacity was reduced by social support. Conclusions: Results provide further support of the “buffering-hypothesis” and have implications relative to the importance of accessible social provisions to enhance self-care capacity and quality of life among older adults residing in rural settings.

CITATION:
S.E. Jung ; J.R. Hermann ; A. Bishop (2013): IMPACT OF NUTRITIONAL RISK ON SELF-CARE CAPACITY: SOCIAL SUPPORT AS A SOURCE OF PROTECTION FOR COMMUNITY-DWELLING OLDER ADULTS LIVING IN A RURAL AREA . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.21

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FRAILTY DETECTION WITH THE GERONTOPOLE FRAILTY SCREENING TOOL (GFST)

L. Demougeot, G. Abellan van Kan, B. Vellas, P. de Souto Barreto

J Frailty Aging 2013;2(3):150-152

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Frailty is commonly regarded as a pre-disability condition of older persons. Its importance in the elderly should be more carefully taken into account in the clinical practice. To implement interventions aimed at preventing disability in frail older adults, screening tools for the early detection of this syndrome are needed. In this context, the Gérontopôle Frailty Screening Tool (GFST) has been recently proposed as an instrument for assisting general practitioners in the detection of non-disabled frail older adults. In the present paper, we briefly discuss about the difficulties of translating knowledge from the frailty research field to the clinical practice. Such difficulties are illustrated by presenting the evolution of the GFST over time. The use of frailty screening tools, such as the GFST, in the clinical practice is necessary to support the identification of older persons at risk of adverse events and promote the implementation of individualized strategies against disability.

CITATION:
L. Demougeot ; G. Abellan van Kan ; B. Vellas ; P. de Souto Barreto (2013): Frailty detection with the Gérontopôle Frailty Screening Tool (GFST) . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.22

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WHAT IS A “NEIGHBORHOOD”? DEFINITION IN STUDIES ABOUT DEPRESSIVE SYMPTOMS IN OLDER PERSONS

C. Siordia, J. Saenz

J Frailty Aging 2013;2(3):153-164

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The almost irrefutable hypothesis that place matters continues to grow in popularity. Epidemiological and public health researchers are studying social and physical environment’s effect on individual health outcomes. Advances in the field are hindered by the lack of consistency in measuring and labeling social contexts. Greater definitional precision is required. In order to give an example of this, “neighborhood” studies between 2000 and 2012 dealing with depression symptomatology in older adults were identified with an exhaustive search. Only those where the terms neighborhood, and mental health, or mental well-being, or CES-D appear were included for the initial review. After additionally selecting for age and the presence of the Center for Epidemiologic Studies Depression (CES-D) measure, from an initial 98 articles, we end up with 11 articles. We focus on how neighborhoods are defined and briefly highlight findings on CES-D. For the most part, the definition of neighborhood is limited, frequently justified, and typically hidden in the methodological details and closing arguments of an article. In general, articles evade the discussion of polygon appropriateness with relation to the term neighborhood. Our review suggests that a good starting point for advancing this field of inquiry would be to increase the definitional precision of the term neighborhood and to offer an upfront disclosure with more appropriate terminology. Doing so may lead place-effect investigations in population aging and frailty down a more productive road.

CITATION:
C. Siordia ; J. Saenz (2013): What is a “Neighborhood”? Definition in studies about depressive symptoms in older persons. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.23

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IMPACT OF POST-ACUTE TRANSITION CARE FOR FRAIL OLDER PEOPLE: A PROSPECTIVE STUDY

N.M. Peel, R.E. Hubbard, L.C. Gray

J Frailty Aging 2013;2(3):165-171

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Objectives: To describe the characteristics and outcomes of frail older people in a post-acute transitional care program and to compare the recovery trajectories of patients with high and low care needs to determine who benefits from transition care. Design: Prospective observational cohort. Participants and Setting: 351 patients admitted to community-based transition care in two Australian states during an 11 month recruitment period. Intervention: Transition care provides a package of services including personal care, physiotherapy and occupational therapy, nursing care and case management post discharge from hospital. It is targeted at frail older people who, in the absence of an alternative, would otherwise be eligible for admission to residential aged care. Measurements: A comprehensive geriatric assessment using the interRAI Home Care instrument was conducted at transition care admission and discharge. Primary outcomes included changes in functional ability during transition care, living status at discharge and six months follow-up, and hospital re-admissions over the follow-up period. For comparison of outcomes, the cohort was divided into two groups based on risk factors for admission to high or low-level residential aged care. Results: There were no significant differences between groups on outcomes, with over 85% of the cohort living in the community at follow-up. More than 80% of the cohort showed functional improvement or maintenance of independence during transition care, with no significant differences between the groups. Conclusions: Post-acute programs should not be targeted solely at fitter older people: those who are frail also have the potential to gain from community-based rehabilitation.

CITATION:
N.M. Peel ; R.E. Hubbard ; L.C. Gray (2013): Impact of post-acute transition care for frail older people: a prospective study . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.24

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