Clinical outcomes of severely frail older patients after deprescription of denosumab

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer

BackgroundThe association between frailty and older patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) is unclear. Therefore, we conducted a systematic review and meta‐analysis to investigate the prevalence of frailty in older patients with AMI following PCI, and determine the relationship between frailty and adverse outcomes in these patients.HypothesisOlder patients with AMI have a higher prevalence of frailty after PCI, and the frailty in these patients increases the risk of adverse outcomes.MethodsA comprehensive search of the PubMed, Cochrane, Ovid (Medline), Ovid (Embase), and Web of Science databases was performed for articles published until October 2021. A meta‐analysis was performed using stata12.0 software. A random‐effects model was used when I2 was greater than 50%; otherwise, a fixed‐effects model was used.ResultsThere were a total of 274,976 older patients in the included studies. Nine studies investigated the prevalence of frailty in older patients with AMI after PCI, with an overall prevalence of 39% (95% confidence interval [CI]: 18%–60%, p < .001). Six studies included adverse outcomes of frailty in older patients with AMI after PCI, including all‐cause mortality (hazard ratio [HR] = 2.29, 95% CI: 1.65–3.16, p = .285), rehospitalization (HR = 2.53, 95% CI: 1.38–4.63), and in‐hospital major bleeding (HR = 1.93, 95% CI: 1.29–2.90, p = .825).ConclusionThe frailty prevalence is increased in older patients with AMI after PCI, especially in ST‐segment elevation myocardial infarction (STEMI). AMI with frailty after PCI is more likely to be associated with worse clinical outcomes, such as death, bleeding, and rehospitalization.

Chronic inflammation plays a pivotal role in the development of frailty in patients with cardiovascular diseases (CVD). Systemic inflammatory response index (SIRI) has been shown to reflect the overall inflammatory status. This study aimed toinvestigate the relationship between SIRI and frailty in older patients with CVD, and to develop a nomogram for predicting the risk of frailty in this population. A total of 234 older patientswith CVD were included. Inflammation markers were derived from routine blood tests, and frailty status was assessed using the FRAIL scale. Clinical and laboratory characteristics were compared between patients with or without frailty. Multivariate logistic regression was employed to identify significant variables for inclusion in the nomogram. The performance of the nomogram, including its discrimination and calibration, was rigorously evaluated. A total of 98 cases were assigned to the frailty group and 136 to the non-frailty group. Patients in the non-frailty group were generally younger, more likely to have normal kidney function, and better blood pressure control. Frail patients exhibited a higher degree of systemic inflammation compared to non-frail patients (P < 0.05). Age, LDL-C and SIRI were identified as three independent risk factors with significant potential for predicting frailty in CVD patients. Therefore, we constructed a clinical nomogram model for frailty based on age, LDL-C and SIRI. The nomogram for frailty had considerable discriminative and calibrating abilities. In summary, our study demonstrated a significant association between elevated levels of inflammation markers, particularly SIRI, and an increased risk of frailty. Furthermore, by integrating age, LDL-C and SIRI, we established a nomogram to predict the risk of frailty in older patients with CVD.

Background and aimsTo systematically evaluate the relevant literature to explore the prevalence and influencing factors of frailty in older patients with diabetes in China.MethodsCochrane Library, PubMed, Embase, Medline, CINAHL, Scopus, Proquest Central, Web of Science, SinoMed, CNKI, VIP and Wan fang Databases were searched to collect Chinese and English literatures about frailty in older diabetic patients. RevMan 5.4 software was used to extract data for systematic review.ResultsSeventeen studies involving 23,070 older patients with diabetes were included. The results showed that the prevalence of frailty in older Chinese diabetic patients was 30%. The main influencing factors were HbA1c level, number of complications, age, depression, exercise, and nutritional status.ConclusionThe prevalence of frailty in Chinese elderly diabetic patients is high and there are many influencing factors. However, the quality of relevant literature is general and the number is limited, so high-quality prospective studies should be carried out in the future to further verify the conclusions.

To summarize the available evidence on risk factors for preoperative frailty in older gastric cancer patients. We comprehensively searched the CNKI, Wanfang, VIP, CBM, PubMed, Embase, The Cochrane Library, Web of Science, and CINAHL databases for preoperative articles on risk factors for frailty in older gastric cancer patients. The search was conducted from the time of construction of the library to January 27, 2024, with no language restrictions. The quality of the included studies was rated by the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Qualitytool. A total of 20 studies were included, including 16 cohort studies and 4 cross-sectional studies, with a total sample size of 51,717 individuals. The results of the meta-analysis showed that age, albumin, hemoglobin, cancer stage III-IV, Charlson Comorbidity Index score ≥ 3, Eastern Cooperative Oncology Group score > 2, American Society of Anesthesiologists score > 2, smoking, nutritional risk, high school degree or above, and sleep disorders are the main influencing factors for the occurrence of preoperative frailty in older gastric cancer patients. Among them, high school degree or above was aprotective factor. Our study provides valid evidence of risk factors for preoperative frailty in older patients with gastric cancer and informs clinical healthcare professionals to make targeted interventions.

Background There is limited research on the factors influencing frailty improvement and on whether exercise therapy is effective in the general population with heart failure. We aimed to examine the factors and interventions that affect the improvement of frailty in older patients with heart failure during hospitalization. Methods This multicentre prospective cohort study included patients with heart failure admitted and treated in the participating hospitals. Cox regression analysis was done to determine factors and interventions that affect improvement of frailty. After the Cox regression analysis, the receiver operating characteristic (ROC) curve was calculated for significant predictors to assess the cut-off point. Results The factors that affect improvement of frailty were the high short physical performance battery (SPPB) chair-stand test and hand grip strength values. The results of the ROC analysis revealed that the cut-off values of the SPPB chair-stand test and hand grip strength were 2 points and 13.7 kg, respectively. Interventions that affect frailty improvement were use of dobutamine, low resting heart rate, early days to start until aerobic exercise, and light intensity or higher of aerobic exercise. Moreover, the cut-off values of the resting heart rate, number of days to start until aerobic exercise, and intensity of aerobic exercise were 80 beats per minute, 7 days, and 31.6%, respectively. Conclusions Our results suggest that pharmacotherapy and exercise will be effective to improve frailty in patients with heart failure. In particular, early exercise therapy, including aerobic exercise, started within 7 days, may be effective to improve frailty in older patients with heart failure with low resting heart rate, depending on their condition on admission.

IS FRAILTY STATUS A TRIGGER FOR GOALS OF CARE DOCUMENTATION IN OLDER PATIENTS ADMITTED TO THE HOSPITAL?

The Lived Experience of Frailty in Patients Aged 60 Years and Older with Heart Failure: A Qualitative Study

BackgroundSleep disturbance, chronic pain and depressive symptoms later in life are modifiable risk factors and may contribute to frailty. However, much less is known about sex differences in the association between these concurrent symptoms and frailty in older patients. Therefore, we conducted this study to explore the associations of poor sleep quality, chronic pain, and depressive symptoms with frailty in older patients, and the sex-specific associations.MethodsIn an observational population-based study, 540 older hospitalized patients from Zhejiang Hospital in China were enrolled. We collected data on poor sleep quality, pain, depressive symptoms and frailty using the Pittsburgh Sleep Quality Index, the Numerical Rating Scale, the 15-item Geriatric Depression Scale, and the Clinical Frailty Scale. Multivariate logistic regression models were used to explore the total sample and sex-specific associations among symptom burdens, symptom combination patterns and symptom counts, and frailty.ResultsAfter adjusting for the potential covariates, concurrent poor sleep quality and depressive symptoms (OR = 4.02, 95% CI 1.57–10.26), concurrent poor sleep quality and chronic pain (OR = 2.05, 95% CI 1.04–4.05), and having three symptoms (OR = 3.52, 95% CI 1.19–10.44) were associated with a higher likelihood of frailty in older inpatients. In addition, older patients with 2 or 3 symptoms (2 and 3 vs. 0 symptoms) had a higher risk of frailty, and the odds ratios were 2.40 and 3.51, respectively. Interaction analysis and sex-stratified associations exhibited conflicting results. The nonsignificant effect of the interaction of sex and symptoms on frailty, but not the sex-stratified associations, showed that individual symptoms, symptom combination patterns, and symptom counts were associated with elevated risks of frailty in older male patients, but not in older female patients.ConclusionsIncreased symptom burdens were associated with a higher risk of frailty in older inpatients, especially in those with poor sleep quality concurrent with at least one of the other two symptoms. Thus, a multidisciplinary program addressing these common symptoms is required to reduce adverse outcomes.

Influencing factors of frailty in older patients with chronic heart failure: Based on Bayesian network.

This study aimed to investigate the effects of glycaemic control and diabetes distress on frailty in older Chinese patients with diabetes, and to explore the mediating role of diabetes distress between glycaemic control and frailty. This is a descriptive, cross-sectional study. A total of 209 older patients with diabetes were recruited from a teaching hospital in Zhejiang Province. Data were collected from February to September 2022. A self-designed questionnaire was used to collect demographic and disease-related data. The Fried Scale and Diabetes Distress Scale were employed to assess frailty and diabetes distress, respectively The bootstrap method was used to examine the mediating effects of diabetes distress on glycaemic control and frailty. The STROBE checklist was adhered to in the reporting of this study (see details in File S1). The findings indicated a positive correlation between the level of glycaemic control and frailty, as well as between diabetes distress and frailty. Furthermore, diabetes distress was found to play a complete mediating role between glycaemic control and frailty. The study findings highlight the relationship between glycaemic control, diabetes distress and frailty offering a valuable reference for enhancing the management of frailty in older patients with diabetes. This study emphasizes the significance of managing glycaemic control and diabetes distress in older patients with diabetes to prevent frailty, and may contribute for healthcare professionals to developing effective measures to improve the frailty of older diabetic patients in clinical settings. This study was conducted with the participation of older patients with diabetes who contributed data by completing study questionnaires and undergoing physical assessments.

Impact of immune-related adverse events on quality of life and physical functioning in older patients with solid tumors treated with immune checkpoint inhibitors.

The incidence of cancer, including myeloproliferative neoplasms (MPNs), is projected to increase significantly due to the growing proportion of people aged > 65years. These older individuals are a heterogeneous population in terms of fitness, comorbidity, and psychological reserve. Therefore, age per se does not always provide an accurate indication of condition in patients with cancer. Frailty has been proposed as an alternative measure of vulnerability that might better indicate which patients can tolerate standard cancer treatment and those who may benefit from treatment adjustment. A number of methods can be used to assess frailty in older patients with hematological malignancies, including the Cardiovascular Health Study Frailty Screening Measure, the FRAIL (Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight) questionnaire, the Clinical Frailty Scale (CFS), and the Gérontopôle Frailty Screening Tool. In addition to physical frailty, comorbidity and quality of life should also be included in the assessment. Prior to the introduction of tyrosine kinase inhibitors (TKIs), age was considered a marker of poor prognosis in patients with MPNs. In contrast, data show that age is not necessarily a contraindication for TKI use. In CML, the efficacy of TKIs has been shown to be independent of age. The JAK1/2 inhibitor ruxolitinib also seems to be effective across a range of patient ages. Available data suggest that chronological age itself should not necessarily be a contraindication for many new therapies in patients with MPNs, and that frailty does provide a better measure of vulnerability. There is a need for specific methods to assess frailty in patients with MPNs, particularly the context of effective new treatment options, such as TKIs and ruxolitinib.

ObjectiveTo analyze potential subtypes and influencing factors of oral frailty in older ischemic stroke patients. To support clinical professionals in precisely identifying high-risk populations and to offer a scientific foundation for the creation of tailored and accurate nursing interventions.MethodA total of 319 older ischemic stroke patients admitted to the Second Affiliated Hospital of the University of South China between December 2024 and February 2025 were selected using a convenience sampling technique. Various assessments were conducted, including the General Information Questionnaire, the Pittsburgh Sleep Quality Index, the National Institutes of Health Stroke Scale, the Geriatric Depression Scale-15, and the Oral Frailty Index-8. Different subtypes of oral frailty were explored using latent profile analysis. Univariate analysis and multinomial logistic regression were performed to investigate the factors influencing the subtypes of oral frailty.ResultsOral frailty in older ischemic stroke patients can be classified into three categories: oral function decline—high oral frailty group (21.32%); medium in all dimensions—moderate oral frailty group (27.27%); and active social participation—low oral frailty group (51.41%). Multifactorial analysis indicated that age, cognitive impairment, depression, illness recurrence, living alone, albumin, total cholesterol, prothrombin time, and homocysteine are significant factors for moderate and high levels of oral frailty.ConclusionThis study delineated three distinct subtypes of oral frailty. It is imperative for healthcare professionals to pay particular attention to moderate and high levels of oral frailty in older patients with ischemic stroke. Tailored care plans should be devised for various patient subgroups to enhance their oral health outcomes.

Frailty-Based Outcomes with Bispecific Antibodies in Older Patients with Multiple Myeloma