Frail Elderly Group Research Articles

The Frail Elderly Patient and the Need for a Video Store on Regional Anaesthesia Blocks

The Frail Elderly Patient and the Need for a Video Store on Regional Anaesthesia Blocks

Frailty prevalence and related factors in older adults from southern Brazil: A cross-sectional observational study

OBJECTIVES:To determine the prevalence of frailty and the association of sociodemographic characteristics, clinical aspects, and functional capacity with the frailty status of community-dwelling older adults from Curitiba, Southern Brazil.METHODS:This cross-sectional observational study included 1,716 participants aged ≥60 years. Frailty was assessed using the Fried phenotype indicators of weakness, exhaustion, low activity, slowness, and weight loss. Sociodemographic characteristics, clinical aspects, and functional capacity and functionality were evaluated and compared between the sexes and the different frailty statuses (non-frail, prefrail, and frail). Multinomial logistic regression models were used to identify associations (p<0.05).RESULTS:A high prevalence of frailty (15.8%) and prefrailty (65.3%) were observed, and both were higher in female than in male individuals. The most predominant frailty criterion was weakness, followed by exhaustion. Compared with the non-frail elderly, the prefrail and frail elderly were older in age and presented more health problems, greater dependency for basic and instrumental activities of daily living, and reduced lower extremity strength performance and functional mobility. The highest proportion of illiterate individuals, individuals with 1-4 years of education, widowed individuals, polypharmacy, and possible cognition problems and diseases were seen in the frail elderly group. Moreover, the risk of being prefrail and frail was higher in those who were older and had more health problems, higher body mass index, and reduced lower extremity strength performance. Greater calf circumference and independence in activities of daily living were protective factors for prefrailty and frailty. Furthermore, lower functional mobility increased the chances of being frail.CONCLUSIONS:The prevalence of frailty was more pronounced in female than in male individuals, mainly because of a decline in force. Prefrailty was 4 times more prevalent than frailty, and the presence of health problems and reduced functional capacity increased the chances of being prefrail and frail.

Prebiotic supplementation in frail older people affects specific gut microbiota taxa but not global diversity

BackgroundThere are complex interactions between aging, frailty, diet, and the gut microbiota; modulation of the gut microbiota by diet could lead to healthier aging. The purpose of this study was to test the effect of diets differing in sugar, fat, and fiber content upon the gut microbiota of mice humanized with microbiota from healthy or frail older people. We also performed a 6-month dietary fiber supplementation in three human cohorts representing three distinct life-stages.MethodsMice were colonized with human microbiota and then underwent an 8-week dietary intervention with either a high-fiber/low-fat diet typical of elderly community dwellers or a low-fiber/high-fat diet typical of long-stay residential care subjects. A cross-over design was used where the diets were switched after 4 weeks to the other diet type to identify responsive taxa and innate immunity changes. In the human intervention, the subjects supplemented their normal diet with a mix of five prebiotics (wheat dextrin, resistant starch, polydextrose, soluble corn fiber, and galactooligo-saccharide) at 10 g/day combined total, for healthy subjects and 20 g/day for frail subjects, or placebo (10 g/day maltodextrin) for 26 weeks. The gut microbiota was profiled and immune responses were assayed by T cell markers in mice, and serum cytokines in humans.ResultsHumanized mice maintained gut microbiota types reflecting the respective healthy or frail human donor. Changes in abundance of specific taxa occurred with the diet switch. In mice with the community type microbiota, the observed differences reflected compositions previously associated with higher frailty. The dominance of Prevotella present initially in community inoculated mice was replaced by Bacteroides, Alistipes, and Oscillibacter. Frail type microbiota showed a differential effect on innate immune markers in both conventional and germ-free mice, but a moderate number of taxonomic changes occurring upon diet switch with an increase in abundance of Parabacteroides, Blautia, Clostridium cluster IV, and Phascolarctobacterium. In the human intervention, prebiotic supplementation did not drive any global changes in alpha- or beta-diversity, but the abundance of certain bacterial taxa, particularly Ruminococcaceae (Clostridium cluster IV), Parabacteroides, Phascolarctobacterium, increased, and levels of the chemokine CXCL11 were significantly lower in the frail elderly group, but increased during the wash-out period.ConclusionsSwitching to a nutritionally poorer diet has a profound effect on the microbiota in mouse models, with changes in the gut microbiota from healthy donors reflecting previously observed differences between elderly frail and non-frail individuals. However, the frailty-associated gut microbiota did not reciprocally switch to a younger healthy-subject like state, and supplementation with prebiotics was associated with fewer detected effects in humans than diet adjustment in animal models.

Reduced Mitochondrial Content, Elevated Reactive Oxygen Species, and Modulation by Denervation in Skeletal Muscle of Prefrail or Frail Elderly Women.

Denervation and mitochondrial impairment are implicated in age-related skeletal muscle atrophy and may play a role in physical frailty. We recently showed that denervation modulates muscle mitochondrial function in octogenarian men, but this has not been examined in elderly women. On this basis, we tested the hypothesis that denervation plays a modulating role in mitochondrial impairment in skeletal muscle from prefrail or frail elderly (FE) women. Mitochondrial respiratory capacity and reactive oxygen species emission were examined in permeabilized myofibers obtained from vastus lateralis muscle biopsies from FE and young inactive women. Muscle respiratory capacity was reduced in proportion to a reduction in a mitochondrial marker protein in FE, and mitochondrial reactive oxygen species emission was elevated in FE versus young inactive group. Consistent with a significant accumulation of neural cell adhesion molecule-positive muscle fibers in FE (indicative of denervation), a 50% reduction in reactive oxygen species production after pharmacologically inhibiting the denervation-mediated reactive oxygen species response in FE women suggests a significant modulation of mitochondrial function by denervation. In conclusion, our data support the hypothesis that denervation plays a modulating role in skeletal muscle mitochondrial function in FE women, suggesting therapeutic strategies in advanced age should focus on the causes and treatment of denervation.

Developing an assessment based on physical fitness age to evaluate motor function in frail and healthy elderly women.

ObjectivesThe purpose of this study was to identify a method for assessing physical fitness age that is easy to use with both frail and healthy elderly women and to examine its validity.MethodsPrincipal component analysis was used to develop a formula of physical fitness age from four motor function variables. The subjects comprised 688 (75.7±6.0 years) elderly women, in order to develop a physical fitness scale. The formula for calculating physical fitness age was expressed as physical fitness age =−0.419× grip strength −0.096× balancing on one leg with eyes open −0.737×30 s chair stand +0.503× figure-of-8 walking test +0.47× chronological age +52.68.ResultsMeasures obtained from subjects in the frail elderly (n=11, 73.0±2.3 years) and exercise (n=10, 70.8±3.1 years) groups were used to examine the validity of the assessment. The mean physical fitness age of the frail elderly group (79.0±3.7 years) was significantly higher than its mean chronological age (73.0±2.3 years, p<0.05). The mean physical fitness age of the exercise group (65.6±3.1 years) was significantly lower than the chronological age (70.8±3.1 years, p<0.05).ConclusionThese findings confirm that physical fitness age scores are applicable to frail and healthy elderly women. Physical fitness age is a valid measure of motor function in elderly women.

Geriatric in Patient Profile at the Department of Internal Medicine at Niamey National Hospital, Niger

Background: The ageing population in developing countries has brought a demographic and an epidemiological transition, with the impact of chronic diseases resulting from life style changes on the health status of the population. Objective: To describ a profile geriatrics patient, specifically to identify epidemiologic, clinical, etiologic and outcome of this group at the department of internal medicine to NNH Patients and method: Medical records of all geriatric patients aged ≥65 years admitted at the department of NNH Between January 2012 and December 2015 were retrieved and reviewed retrospectively. Results: A total of 6074 admissions at the internal medicine department of NNH over three years were reported and 1130 (18, 6%) were geriatrics patients, the average age was 75, 95 years and more than half were men (50,7%). 80 % of patients were in the young old group (65-74 years), 13% in the old group (75-84 years) and 7% in the oldest old group (≥85 years). High blood pressure was the frequent comorbidity (12, 3%) and the most symptoms caused hospitalization were stroke (17, 6%), fevers (16, 5%) and worst health (13, 1%). Frequent illnesses were cardiovascular diseases (38.4%), infections, (19.2%) and endocrine diseases (11%). The average length of hospital stays was 8, 7 days. The mortality rate was 18, 2% and the worst outcomes factors were female sex, frail elderly group in 75 to 84 years and high blood pressure. Conclusion: Chronic diseases were responsible of morbidity and mortality for the majority elderly’s patient.

Total hip arthroplasty using a cementless dual-mobility cup provides increased stability and favorable gait parameters at five years follow-up

BackgroundRates of dislocation following primary total hip arthroplasty (THA) vary from 0.5 to 10%. Dual-mobility cups in THA demonstrate increased stability. Clinical outcomes following THA with dual-mobility cups have been reported, but gait has not been assessed. Therefore we performed a retrospective case control study to answer: (1) is gait better in patients following THA with a dual-mobility cup than in frail, elderly patients of the same age? (2) Are clinical outcomes better in patients following THA with a dual-mobility cup than in frail, elderly patients? (3) What is the dislocation rate following THA with a dual-mobility cup? HypothesisWe hypothesized that patients who underwent THA with a dual-mobility cup have a better gait compared to frail, elderly patients of the same age. Patients and methodsTwenty patients (22 hips), mean age 79.9±7.7 (range, 62.3–88.3) years were assessed in this retrospective case-control series 5.6±1.4 (range: 4.1–8.8) years following dual-mobility cup THA. A reference group consisted of 72 “frail elderly” patients in a rehabilitation hospital for health problems unrelated to the lower limb, with no lower limb surgery or neurological conditions. Temporal and spatial gait performance were measured with four miniature gyroscopes, mounted on each thigh and calf, while patients walked freely along a 30m corridor. Harris Hip Score, WOMAC, radiological outcomes, and dislocation rate were determined. ResultsAll gait parameters were better in the dual-mobility group compared to the frail elderly group. The dual-mobility group had a higher cadence (100.3 steps/minute versus 75.6 steps/minute), shorter (relative to gait cycle time) stance (61.6% versus 67.8%), shorter (relative to gait cycle time) double stance (23.3% versus 36.0%), longer stride (1.13m versus 0.80m), and faster walking speed (0.96m/s versus 0.52m/s). Range of motion of the shank, thigh and knee were better in the dual-mobility group. Harris Hip Score was 87.6±13.9 (range 51–100) and WOMAC score was 11.3±12.1 (range 0–34) in the THA group. We observed no dislocations. DiscussionGait patterns five years following THA with the dual-mobility cup were better or comparable to published study populations. Level of evidenceIII, retrospective case-control series.

Pre-Operative nutrition In Neck of femur Trial (POINT)--carbohydrate loading in patients with fragility hip fracture: study protocol for a randomised controlled trial.

BackgroundTrauma such as hip fracture initiates a neurohumoral stress response that changes the balance between anabolism and catabolism resulting in muscle breakdown and reduced mobilisation. Various studies have demonstrated a reduction in catabolism with pre-operative carbohydrate loading but only in an elective setting.Methods/DesignThis is a two-centre, randomised double-blinded trial in the United Kingdom. Sample size will be 30 patients (approximately 15 from each centre).Randomisation will be web based using computer-generated concealed tables. Both participants and investigators will be blinded to group allocation.Participants will be >70 years of age, cognitively intact (Abbreviated Mental Score ≥7), able to give informed consent, and admitted directly through the emergency department with fractured neck of femur requiring hemiarthroplasty.Intervention will consist of two carbohydrate drinks (Nutricia pre-Op) given the night before, and the morning of the surgery. The control will receive two placebo drinks of equal volume.All participants will receive standard hospital care at the discretion of the clinical team. The primary outcome is the difference between groups in insulin resistance calculated by a glucose tolerance test administered pre-operatively and 24 hours postoperatively. Secondary endpoints will be changes in muscle carbohydrate metabolism (biopsy), mobility (Cumulative Ambulation Score) and subjective measures of tolerability.DiscussionThis is a small-scale pilot study, investigating the benefits and tolerability of carbohydrate loading in an emergency setting in a frail elderly group with known high morbidity and mortality. Positive findings will provide the basis for a larger scale study.Trial registrationCurrent Controlled Trials ISRCTN91109766 (7 April 2014); NRES ref: 13/EM/0214Trial Sponsor: University of Nottingham Ref.13036.

Widening the lens on risk by connecting data, systems and citizens

The need for integrated pathways and shared data across organisations is not in doubt if services are to reduce risk to health and wellbeing, maintain independence and contain escalating health and social care costs. However, there are three challenges in achieving this. The first is how to connect the data that matters across different systems. The second is how to make this useful to front line carers and system planners while staying within the strict boundaries of data protection and confidentiality. The third is securing citizen consent to do this. Where the chancellor has just announced freedoms to manage our own pensions – the NHS still struggles with allowing us to manage and share our personal health data. Care.data has stalled for at least 6 months while NHSE sorts out how to secure citizen consent. With our partners, Northamptonshire County, we have cracked the first challenge and can share data safely and connect data accurately across health and social care to build a single view of individuals’ health, social, welfare and social environment. We are now mining this unique dataset to assess its potential to support service planning and care management. We are also exploring solutions to the third challenge – how to secure citizen consent to share their data. These three areas are outlined further below Challenge 1 We have built an Information Governance framework that exceeds ICO requirements. This was achieved using the Xantura IG Bridge – a unique and patented approach that allows data from multiple sources to be shared, matched and pseudnoymised – while retaining its integrity to be reconstituted by the data owner if required. Borough and further health data will now be added. Challenge 2 Early analysis on just social care and community health data – no health diagnosis or acute provider data included yet – has provided new insights about the drivers of dependency and service use. These are now being explored to understand the potential for risk stratification, predictive modelling and service design and management. Challenge 3 Despite ICO approval, cultural and behavioural barriers are limiting the pace at which health data is being shared. One solution would be a direct local approach to its citizens to seek approval to share data through a simple web-based/mobile option enabling citizens to optout. Kaiser Permanente and Swedish experiences suggest opt-out could be low. If successful we International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116571– http://www.ijic.org/ International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. will have repositioned the relationship between the state and the citizen as a partnership – willing to share and contribute data to improve services, shape future services for themselves and future generations. The County has started with building the new data asset and IG framework for the Frail Elderly group. The next step is to extend this and start to build risk models around priority agendas such as long term residential care and acute dependency. Combined with direct citizen consent “data” will be positioned, valued and managed as a priceless County asset.

Increased Risk of Large Post-Void Residual Urine and Decreased Long-Term Success Rate After Intravesical OnabotulinumtoxinA Injection for Refractory Idiopathic Detrusor Overactivity

Intravesical injection of onabotulinumtoxinA is effective for idiopathic detrusor overactivity refractory to antimuscarinics. However, safety is a major concern, especially in elderly individuals. We investigated the efficacy and safety of intravesical onabotulinumtoxinA injection for refractory idiopathic detrusor overactivity in the frail elderly population. A total of 166 patients with urodynamic idiopathic detrusor overactivity refractory to previous antimuscarinics for more than 3 months received 1 intravesical 100 U onabotulinumtoxinA injection from 2004 to 2009. Frail elderly was defined as age greater than 65 years and 3 or more of certain criteria, including unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and/or low physical activity. Treatment results were assessed by the Patient Perception of Bladder Condition, voiding diary, urodynamic parameters and Kaplan-Meier estimates of survival plots. We evaluated 61 frail elderly patients, 63 who were elderly without frailty and 42 younger than 65 years. Large post-void residual urine volume (greater than 150 ml) after onabotulinumtoxinA injection was significantly higher in the frail elderly group than in the other groups (60.7% vs 39.7% and 35.7%, respectively, p = 0.018). Urinary retention developed in 7 frail elderly patients (11.5%), 4 (6.3%) who were elderly without frailty and 1 younger patient (2.4%) (p = 0.203). Recovery duration was significantly longer in frail elderly patients. The cumulative success rate was significantly lower in the frail elderly group than in the other 2 groups (p = 0.009). Although safety and efficacy were similar between elderly patients without frailty and younger patients, an increased risk of large post-void residual urine volume and a lower long-term success rate in frail elderly patients were noted after intravesical onabotulinumtoxinA injection for refractory idiopathic detrusor overactivity.

The Characteristic of a Simple Exercise Program under the Instruction of Physiotherapists -For General Elderly People and Frail Elderly People-

[Purpose] The purpose of this study was to validate the characteristic of an exercise program consisting of simple exercise methods under the instruction of physiotherapists for general elderly people living in a community (general elderly group) and a frail elderly group. [Subjects] The general elderly group consisted of 44 persons (74.2 ± 4.38 years old: 6 men, 38 women) and the frail elderly group, 30 persons (80.6 ± 6.12 years old: 10 men, 20 women). [Methods] The measurement items were weight, body fat percentage, grip strength, knee extensor strength, sitting trunk flexion, one leg standing, functional reach test, timed up and go test, 10-m walking time, TMIG Index of Competence, MOS Short-Form 36-Item Health Survey, and the Life-Space Assessment. In each group, group and individual exercises were provided by physiotherapists. All the exercises were easy to perform. [Results] Knee extensor strength of the frail elderly group improved to almost the same level of the general elderly group. There were significant improvements in balance, gait ability, social and psychological attitudes in both groups. [Conclusion] We think that muscle strengthening exercises without exercise tools as resistance under the instruction of physiotherapists would be effective for improving the muscle strength of frail elderly persons.

Visual impairment in elderly patients with hip fracture: causes and associations.

To evaluate the current visual status and ophthalmic history of a sample of elderly patients with fractured neck of femur and to study the relationship between visual status and demographic factors. A four-centre study of all patients admitted to hospital with fractured neck of femur. The setting was two district (Ayr, Dunfermline) and two teaching (Glasgow, Dundee) hospitals in Scotland. The study examined 537 patients aged 65 years and over admitted with acute fractured neck of femur to hospital. Bilateral visual impairment (binocular visual acuity worse than 6/12) was found in 239 of 518 patients (46%). Of this group, the principal causes for visual deficit were untreated cataract (49%), macular degeneration (21%), uncorrected refractive error (17%), and glaucoma (3%). The visually impaired group were more likely to have symptomatic visual complaints (58 vs 26%), however, were less likely to be under optometric care (71 vs 85%). A higher proportion of the group with visual impairment lived in areas of social deprivation (40 vs 26%). Patients with fractured neck of femur represent a frail elderly group that have poorer vision than that documented in any other elderly population. The visual defect was potentially remediable in the majority of cases but this group of individuals are not generally in touch with the ophthalmic services. Social deprivation appears to be associated with this groups' inability to access ophthalmic care.

The Discharge of Elderly Patients from an Accident and Emergency Department: Functional Changes and Risk of Readmission

Four hundred and fifty patients aged 75 years or older were followed up after discharge from an accident and emergency department. Forty-three per cent of all patients experienced some loss of functional independence. A small number, 5.6%, were readmitted to hospital within 14 days. This group were significantly less able to perform certain activities of daily living than those not readmitted. Attention to functional assessment by casualty staff may help to prevent readmission to hospital of this frail elderly group of patients.

Plasma Aspirin Esterase: the Influence of Old Age and Frailty

Plasma aspirin esterase activity, expressed as nmol salicylate formed/ml plasma/min, was found to be similar in a group of healthy elderly adults, a group of young adults and a group of frail young adults, but was lower in a sample of frail elderly subjects. This was associated with reduced plasma albumin levels in healthy elderly subjects compared with young subjects and levels were lower still in the frail elderly group. Plasma cholinesterase also showed a trend towards reduced activity in the frail elderly subjects. As plasma aspirin esterase activity may influence the amount of circulating aspirin, these changes may have implications for the use of aspirin in frail elderly people.

1 - Diagnostic Strategy in a Suspected Red Cell Enzymopathy

To determine the prevalence of frailty and the association of sociodemographic characteristics, clinical aspects, and functional capacity with the frailty status of community-dwelling older adults from Curitiba, Southern Brazil.This cross-sectional observational study included 1,716 participants aged ≥60 years. Frailty was assessed using the Fried phenotype indicators of weakness, exhaustion, low activity, slowness, and weight loss. Sociodemographic characteristics, clinical aspects, and functional capacity and functionality were evaluated and compared between the sexes and the different frailty statuses (non-frail, prefrail, and frail). Multinomial logistic regression models were used to identify associations (p<0.05).A high prevalence of frailty (15.8%) and prefrailty (65.3%) were observed, and both were higher in female than in male individuals. The most predominant frailty criterion was weakness, followed by exhaustion. Compared with the non-frail elderly, the prefrail and frail elderly were older in age and presented more health problems, greater dependency for basic and instrumental activities of daily living, and reduced lower extremity strength performance and functional mobility. The highest proportion of illiterate individuals, individuals with 1-4 years of education, widowed individuals, polypharmacy, and possible cognition problems and diseases were seen in the frail elderly group. Moreover, the risk of being prefrail and frail was higher in those who were older and had more health problems, higher body mass index, and reduced lower extremity strength performance. Greater calf circumference and independence in activities of daily living were protective factors for prefrailty and frailty. Furthermore, lower functional mobility increased the chances of being frail.The prevalence of frailty was more pronounced in female than in male individuals, mainly because of a decline in force. Prefrailty was 4 times more prevalent than frailty, and the presence of health problems and reduced functional capacity increased the chances of being prefrail and frail.