01/2014 journal articles
AGE, OBESITY, SARCOPENIA, AND PROXIMITY TO DEATH EXPLAIN REDUCED MEAN MUSCLE ATTENUATION IN PATIENTS WITH ADVANCED CANCER
N. Esfandiari, S. Ghosh, C.M.M. Prado, L. Martin, V. Mazurak, V.E. Baracos
J Frailty Aging 2014;3(1):3-8Show summaryHide summary
Background: Cancer cachexia is characterized by skeletal muscle loss. A feature of muscle wasting, reduction in the mean muscle attenuation from computed tomography images is believed to reflect pathological infiltration of fat into muscle. It is a reported prognostic indicator in cancer patients. Objectives: To develop an explanatory multivariate model of muscle attenuation of cancer patients incorporating age, sex, disease characteristics, body composition. Time to death ≤92 days was included in the model as the demarcation of end-stage disease. Design: Multivariate general linear model regression analysis of total mean muscle attenuation and change in muscle attenuation. Setting: Regional cancer center (Alberta, Canada). Participants: Patients with gastrointestinal and respiratory tract cancers (mean age 64±11 years, 44% female). Measurements: Total adipose tissue and skeletal muscle cross sectional area, and mean muscle attenuation at the 3rd lumbar vertebra were assessed from baseline computed tomography (n=1719), and a subset with repeated measures (n=246 patients with a total of 871 images). Results: At baseline, muscle attenuation associated with total skeletal muscle (β 0.09; 95% CI 0.07 to 0.11; p<0.001) and adipose tissue (β -0.032; 95% CI -0.035 to -0.029; p<0.001) cross sectional areas, age (β -0.28; 95% CI -0.32 to -0.24; p<0.001), time to death ≤92 days (β -1.9; 95% CI -3.1 to -0.7; p=0.003) and male sex (β -2.3; 95% CI –3.5 to -1.1; p<0.001). Change in muscle attenuation over time associated with total adipose tissue cross sectional area (β -0.008; 95% CI -0.012 to -0.004; p<0.001) and time to death ≤92 days (β -1.6; 95% CI -3.0 to -0.2; p=0.03). Conclusions: The radiation attenuation of skeletal muscle is lowest in individuals who are older, less muscular, have a higher fat mass and are within 92 days of death. Men had lower muscle attenuation than women when controlled for other variables.
N. Esfandiari ; S. Ghosh ; C.M.M. Prado ; L. Martin ; V. Mazurak ; V.E. Baracos (2014): AGE, OBESITY, SARCOPENIA, AND PROXIMITY TO DEATH EXPLAIN REDUCED MEAN MUSCLE ATTENUATION IN PATIENTS WITH ADVANCED CANCER. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.1
ALCOHOL USE AND FRAILTY IN COMMUNITY-DWELLING OLDER PERSONS AGED 65 TO 70 YEARS
L. Seematter-Bagnoud, J. Spagnoli, C. Büla, B. Santos-Eggimann
J Frailty Aging 2014;3(1):9-14Show summaryHide summary
Background: Alcohol use has beneficial as well as adverse consequences on health, but few studies examined its role in the development of age-related frailty. Objectives: To describe the cross-sectional and longitudinal association between alcohol intake and frailty in older persons. Design: The Lausanne cohort 65+ population-based study, launched in 2004. Setting: Community. Participants: One thousand five hundred sixty-four persons aged 65-70 years. Measurements: Annual data collection included demographics, health and functional status, extended by a physical examination every 3 years. Alcohol use (AUDIT-C), and Fried’s frailty criteria were measured at baseline and 3-year follow-up. Participants were categorized into robust (0 frailty criterion) and vulnerable (1+ criteria). Results: Few participants (13.0%) reported no alcohol consumption over the past year, 57.8% were light-to-moderate drinkers, while 29.3% drank above recommended thresholds (18.7% “at risk” and 10.5% “heavy” drinkers). At baseline, vulnerability was most frequent in non-drinkers (43.0%), least frequent in light-to-moderate drinkers (26.2%), and amounted to 31.9% in “heavy” drinkers showing a reverse J-curve pattern. In multivariate analysis, compared to light-to-moderate drinkers, non-drinkers had twice higher odds of prevalent (adjOR: 2.24; 95%CI:1.39-3.59; p=.001), as well as 3-year incident vulnerability (adjOR: 2.00; 95%CI:1.02-3.91; p=.043). No significant association was observed among “at risk” and “heavy” drinkers. Conclusion: Non-drinkers had two-times higher odds of prevalent and 3-year incident vulnerability, even after adjusting for their baseline poorer health status. Although residual confounding is still possible, these results likely reflect a healthy survival effect among drinkers while those who experienced health- or alcohol-related problems stopped drinking earlier.
L. Seematter-Bagnoud ; J. Spagnoli ; C. Büla ; B. Santos-Eggimann (2014): ALCOHOL USE AND FRAILTY IN COMMUNITY-DWELLING OLDER PERSONS AGED 65 TO 70 YEARS. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.2
GRIP STRENGTH AND GAIT SPEED OF OLDER WOMEN RECEIVING PHYSICAL THERAPY IN A HOME-CARE SETTING
J Frailty Aging 2014;3(1):15-17Show summaryHide summary
Grip strength and gait speed have both been recommended as “vital signs” for older adults. I, therefore, sought to determine the extent to which grip strength and comfortable gait speed were limited and related in a sample of older women home-care patients. A retrospective analysis was conducted using archived initial therapy records of 33 older women (mean age = 80.7 years) residing in their homes in New England (USA). Demographics, bilateral grip strength and usual gait speed data were extracted from the records. Best grip strength was 80.1% of its reference norm. Usual gait speed was 38.4% of its reference norm. Significantly more patients were below reference norm for gait speed. Both measures were significantly less than functional standards as well. The measures were not correlated significantly. Grip strength and gait speed are sensitive to limitations in older women home-care patients, but not equally so.
R.W. Bohannon (2014): GRIP STRENGTH AND GAIT SPEED OF OLDER WOMEN RECEIVING PHYSICAL THERAPY IN A HOME-CARE SETTING. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.3
REASONING ABOUT FRAILTY IN NEUROLOGY: NEUROBIOLOGICAL CORRELATES AND CLINICAL PERSPECTIVES
M. Canevelli, F. Troili, G. Bruno
J Frailty Aging 2014;3(1):18-20Show summaryHide summary
To date, the frailty syndrome has surprisingly attracted limited attention in the field of neurology and neuroscience. Nevertheless, several concepts closely related to frailty, such as vulnerability, susceptibility, and homeostatic reserves, have been increasingly investigated and documented at level of neuronal cells, brain networks, and functions. Similarly, several aspects commonly assessed in the neurological practice, including cognitive functioning and emotional/affective status, clearly appear to be major determinants of the individual’s vulnerability and resiliency to stressors. Therefore, they should be carefully considered in the clinical approach to frail subjects. Moreover, dysfunctions of these domains, if timely detected, may be suitable to be targeted by interventions providing beneficial effects to the overall health status of the individual. In the present article, we discuss the neurobiological processes potentially contributing to frailty. Moreover, we reason about the clinical manifestations allowing the prompt and easy recognition of frail persons in the neurological practice.
M. Canevelli ; F. Troili ; G. Bruno (2014): REASONING ABOUT FRAILTY IN NEUROLOGY: NEUROBIOLOGICAL CORRELATES AND CLINICAL PERSPECTIVES. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.4
THE ROLE THE FRAILTY SYNDROME CAN PLAY IN ADVOCACY AND RESOURCE ALLOCATION FOR OUR AGEING POPULATION – FINDINGS IN A DUBLIN DAY HOSPITAL
O. Ntlholang, R.E. Kelly, R. Romero-Ortuno, S. Cosgrave, D. Kelly, M. Crowe, O. Collins, J.J. Barry, L. Cogan, G. Hughes, D. O’Shea
J Frailty Aging 2014;3(1):21-24Show summaryHide summary
Frail individuals are at higher risk of adverse outcomes, and need identification and priority access to Comprehensive Geriatric Assessment (CGA). We prospectively collected data on new referrals to our day hospital. Levels of frailty were measured with the SHARE Frailty Instrument for Primary Care (SHARE-FI). Of 257 patients assessed (90 men, 167 women), 110 (43%) were non-frail, 66 (26%) pre-frail and 81 (32%) frail. Mean age was 82 years for the non-frail, 83 for the pre-frail and 84 for the frail. Forty-one percent of the frail reported two or more falls in the preceding year, compared to 38% of the pre-frail and 21% of the non-frail (P for trend = 0.003). Of 27 patients who were referred for ongoing multidisciplinary assessment and rehabilitation, 16 (59%) were frail. The frailty syndrome has the potential to become an advocacy tool for older people and help target effective, but finite, CGA resources.
O. Ntlholang ; R.E. Kelly ; R. Romero-Ortuno ; S. Cosgrave ; D. Kelly ; M. Crowe ; O. Collins ; J.J. Barry ; L. Cogan ; G. Hughes ; D. O’Shea (2014): THE ROLE THE FRAILTY SYNDROME CAN PLAY IN ADVOCACY AND RESOURCE ALLOCATION FOR OUR AGEING POPULATION – FINDINGS IN A DUBLIN DAY HOSPITAL. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.5