Frail Elderly 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

A Conversation About the Ethics of Past and Future Memory Care Models: Perspectives from the First Two European Dementia Villages.

Dementia care organizations face a range of daunting environmental changes and challenges. Internationally, there is a long history of efforts to improve quality of care and life for individuals with dementia. In a time of particular attention to the images of older adults confined to a single or shared room in a care facility due to COVID-19, autonomy becomes the overarching problem, not only because in general institutions limit the freedom of frail elders, but because the existential conditions that create the need for long term care such as chronic disease, cognitive decline, and the need for general support with activities of daily living (ADLs) rail against the autonomy of independent self-sufficiency. Additionally, these environments are institutional in design and size, with little access to outdoor spaces and other amenities. This perspective manuscript addresses the ethics of past and future memory care models, looking specifically at the European Dementia Village (DV) model. This model allows for autonomy and continuation of patterns of daily living through housing integrated with exterior walks, gardens, restaurants, and amenities within familiar and normal surroundings. This pioneering health care experiment negotiates rivaling discourses of intimacy, professionalization, and medicalization. In order to get a deeper understanding of the culture and ethics of this integrated care model, the first two dementia village sites were visited which included meetings with care staff and administrators. Those conversations and observations led to a series of aligned themes relating to the ethics of the DV model which include: the strength of the social approach, clinical support, resident/staff collaborations, and advocating for ethical dementia care. Rethinking the ethics of dementia care entails individual perspectives and group discussions on what can keep individuals social connected within their care community, including focusing on strengths of the individual and normalized daily routines.

Decrease Treatment Burden following the Application of ADCES7 and WHOICOPE in a Diabetic Frail Elderly Lady with Multimorbidity

Decrease Treatment Burden following the Application of ADCES7 and WHOICOPE in a Diabetic Frail Elderly Lady with Multimorbidity

The Impact of Frailty and Geriatric Syndromes on the Quality of Life of Older Adults Receiving Home-Based Healthcare: A Cross-Sectional Survey.

Purpose: To identify the effect of frailty and geriatric syndromes on the quality of life (QoL), of older adults receiving home care, taking into consideration their socioeconomic and homebound status, including multi-comorbidities. Patients and Methods: This cross-sectional study enrolled elders aged (≥65) years old, registered members of “Help at Home” programs in the Reference Region of Crete, from March to May 2019. Participants were screened using the WHOQOL-BREF for Quality of Life, geriatric syndromes such as frailty using the SHARE-Frailty Index (SHARE-Fi), the Montreal Cognitive Assessment (MoCA), for cognitive function and the Geriatric Depression Scale (GDS), for the assessment of depression. Results: The mean age of the 301 participants was 78.45 (±7.87) years old. The prevalence of frailty was 38.5%, severe depression 13.6%, cognitive dysfunction 87.8% and severe comorbidity 70.6%. Intriguingly, none of the participants (0%) was identified as free of comorbidity (CCI = 0−1). The overall QoL (ranging from 4−20) of the study participants was 13.24 (±4.09). The bivariate analysis showed that overall QoL significantly differed among older adults with frailty (15.91 vs. 11.56, p < 0.001), cognitive dysfunction (15.42 vs. 12.90, p < 0.001), depression (14.90 vs. 9.31, p < 0.001), and disability in Activities of Daily Living (13.67 vs. 10.67, p = 0.002), compared to non-frail, normal cognition and depression, and independent elders, respectively. Multiple linear regression models revealed that frail and depressive elders reported significantly lower QoL (β = −2.65, p < 0.001 and (β = −5.71, p < 0.001), compared to non-frail and older adults with no depressive symptoms, respectively, despite the fact that this association was not significant for older adults with dementia (β = −2.25, p = 0.159), even after adjusting for potential confounding effects (age, gender, comorbidity, homebound status, etc.). Conclusion: frailty and geriatric syndromes including comorbidities are important risk factors for “poor” QoL among older adults receiving home-based healthcare.

Detection of the Frail Elderly at Risk of Postoperative Sepsis.

With the increase in the elderly population, surgery in aged patients is seeing an exponential increase. In this population, sepsis is a major concern for perioperative care, especially in older and frail patients. We aim to investigate the incidence of sepsis in elderly patients receiving diverse types of surgical procedures and explore the predictive capacity of the Hospital Frailty Risk Score (HFRS) to identify patients at high risk of incidence of postoperative sepsis. This study relies on information from the Spanish Minimum Basic Data Set, including data from nearly 300 hospitals in Spain. We extracted records of 254,836 patients aged 76 years and older who underwent a series of surgical interventions within three consecutive years (2016-2018). The HFRS and Elixhauser comorbidity index were computed to determine the independent effect on the incidence of sepsis. Overall, the incidence of postoperative sepsis was 2645 (1.04%). The higher risk of sepsis was in major stomach, esophageal, and duodenal (7.62%), followed by major intestinal procedures (5.65%). Frail patients are at high risk of sepsis. HFRS demonstrated a high predictive capacity to identify patients with a risk of postoperative sepsis and can be a valid instrument for risk stratification and vigilant perioperative monitoring for the early identification of patients at high risk of sepsis.

The Role of Age and Comorbidities in Esophagogastric Cancer Chemoradiation of the Frail Elderly (>70 Years): An Analysis from a Tertiary High Volume-Center

Elderly patients > 70 years of age with esophageal cancer (EC) represent a challenging group as frailty and comorbidities need to be considered. The aim of this retrospective study was to evaluate the efficacy and side effects of curative chemoradiation therapy (CRT) with regard to basic geriatric screening in elderly patients in order to elucidate prognostic factors. Thirty-four elderly patients > 70 years with EC treated at our cancer center between May 2014 and October 2018 fulfilled the selection criteria for this retrospective analysis. Treatment consisted of intravenous infusion of carboplatin/paclitaxel or fluorouracil (5-FU)/cisplatin with the intention of neoadjuvant or definite chemoradiation. Clinicopathological data including performance status (ECOG), (age-adjusted) Charlson comorbidity index (CCI), Frailty-scale by Fried, Mini Nutritional Assessment Short Form, body mass index, C-reactive protein to albumin ratio, and treatment-related toxicity (CTCAE) were assessed. Data were analyzed as predictors of overall survival (OS) and progression-free survival (PFS). All patients (ten female, 24 male) received combined CRT (22 patients in neoadjuvant, 12 patients in definite intent). Median age was 75 years and the ECOG index between 0 and 1 (52.9% vs. 35.3%); four patients were rated as ECOG 3 (11.8%). Median follow-up was 24 months. Tumors were mainly located in the lower esophagus or esophagogastric-junction with an T3 stage (n = 25; 75.8%) and N1 stage (n = 28; 90.3%). 15 patients (44.1%) had SCC, 19 patients (55.9%) AC. 26 of the patients (76.5%) were scored as prefrail and 50% were in risk for malnutrition (n = 17). In relation to the BMI, ten patients (29.4%) were ranked as overweight, and 15 patients were presented in a healthy state of weight (44.1%). Grade 3 acute toxicity (or higher) occured in nine cases (26.5%). Most of the patients did not show any late toxicities (66.7%). Trimodal therapy provides a significant prolonged OS (p = 0.049) regardless of age, but without impact on PFS. Our analysis suggests that chemoradiation therapy is feasible for elderly patients (>70 years) with tolerable toxicity. Trimodal therapy of EC shows a positive effect on OS and PFS. Further studies are needed to elucidate benefitting subgroups within the elderly. In addition to age, treatment decisions should be based on performance status, nutritional condition and multidisciplinary validated geriatric screening tools.

Characteristics of frailty phenotype in Chinese nursing home population and significance of motor function indicators in frailty assessment.

The objectives of this study were to analyze the distribution characteristics of frailty phenotypes in older adults of Chinese nursing homes, and to compare some motor function characteristics of older adults in nursing homes between frailty and non-frailty, to determine which motor function and frailty are related. This cross-sectional study included 177 older adults living in nursing homes. Frailty was diagnosed by Fried's phenotype, and motor function assessment characteristics (including muscle tone, ROM, and balance) were also evaluated. Chi-square and logistic regression analyses were performed. Frailty prevalence was 53% in nursing homes in big Chinese cities (average age 82.0 ± 6.1). Low levels of physical activity (90.4% in frail elder), decreased handgrip strength (98.9% in frail elder) and slowed walking speed (100% in frail elder) were the 3 main components of the frailty phenotype of frail adults in nursing homes in China. It is worth noting that 74.7% of the non-frail elders also had reduced handgrip strength. Further analysis showed that balance (P < .001), muscle tone (upper, P = .028, lower, P = .001) and the range of motion (P < .001) were associated with frailty in older adults. The frailty of the elders in Chinese nursing homes was characterized by the decline of motor function. And surprisingly, both frail and non-frail elders were found to have poor strength. Frail nursing home seniors also have body muscle tone, range of motion and balance problems. The elderly of China should focus on strength, stretch and balance training to improve motor function, especially strength training, which is important for prevention frailty.

Pet Insects May Improve Physical Performance and Sleep in Community-Dwelling Frail Elderly People with Chronic Diseases: A Single-Arm Interventional Pilot Study.

Animal-assisted intervention (AAI) is an effective intervention that improves the mental and physical health. However, few have examined the efficacy of pet insects as a form of AAI for prefrail and frail elderly. This study aimed to ascertain the effects of pet insects on physical performance and psychological health in community-dwelling frail elderly individuals with a chronic disease. This study was an 8 week prospective single-arm interventional pilot study that enrolled prefrail and frail community-dwelling adults aged 70 years and older, all of whom had a chronic disease and attended a daycare facility. Pet insects and appropriate equipment were provided, and supporting programs were used to educate participants about how to rear the insects and how to get close to them. Pre- and post-interventional physical and psychological functions were evaluated. A total of 23 subjects (mean age, 82.78 years) were enrolled in the final analysis. The timed up-and-go-test (TUG) was used to measure functional mobility, and grip strength was used as a measure of muscle strength; both showed significant changes after the 8-week intervention (Δ = -0.35±0.73 sec, P = 0.034; and Δ = 0.73±0.99 kg, P = 0.002, respectively). In addition, the insomnia severity index (ISI) and average sleep duration improved significantly (Δ = -2.91±5.64, P = -0.021; and Δ = 0.87±1.98, P = 0.047, respectively). There were no significant changes in the results of other psychometric tests. Logistic regression analysis using the forward stepwise selection method revealed that the baseline ISI score and the absence of other comorbidities were significantly associated with the probability of positive changes in both the TUG and HS tests after the intervention. Pet insects may be an effective and easily applicable type of AAI, which improves physical function and sleep in prefrail and frail elderly individuals.

Development of a shared decision-making intervention to improve drug safety and to reduce polypharmacy in frail elderly patients living at home.

For patients with geriatric frailty, reducing inappropriate medication is an important goal to improve patient safety in primary care. GP-side barriers include knowledge gaps, legal concerns, and lack of communication between the actors involved. The aim was to develop a multi-faceted intervention to facilitate deprescribing and shared prioritisation among frail elderlies with polypharmacy living at home. Mixed methods study including: 1) scoping review on family conferences, expert panels; 2) group discussions with GPs, mapping of needs and challenges in Primary Care; 3) workshops and expert interviews with GPs, patient advocates, researchers as a basis for a theoretical intervention model; 4) piloting. A major challenge for GPs is to conduct a productive discussion with patients and family cares on deprescribing and drug safety. A guideline for a structured family conference with a medication check and geriatric assessment was developed and proved to be feasible in the pilot study. The intervention developed to facilitate deprescribing and shared prioritisation of drug therapy based on family conferences seems suitable to be tested in a subsequent cRCT. Adapting family conferences to primary care for frail patients with polypharmacy.

The Intergenerational Representation of Old Age in the Transition to Frailty: An Empirical Analysis in Italy

The results presented here are part of the outcome of a research project titled Redesign—Frail Elderly, Intergenerational Solidarity and Age-Friendly Communities (https://redesignanziani.com) funded by Fondazione Cariplo and coordinated by the Università Cattolica del Sacro Cuore in Milan, in collaboration with Università degli studi di Verona and Università degli studi del Molise (2019–2022). The research aims to co-acquire knowledge of the transition to old age in vulnerable situations, to develop and implement new community networks of care, and thus promote health and well-being, active ageing, and intergenerational solidarity in eight Italian municipalities. The analysis of the dyadic interviews, conducted with the NVivo software, will provide the image of ageing and old age emerging from an intergenerational dialogue. By analysing results, it will therefore be possible to identify some specific types of representation of old age in relation to the dyad, the stressful events that occurred to the interviewees and in relation to the ways of living the transition. The representation of old age seems closely connected with the quality and intensity of relationships, the environment of associative and local life that the interviewees relate to, and the stressful events that have recently occurred to them.

Health-Related Quality of Life for Frail Transplant-Ineligible Patients with Newly Diagnosed Multiple Myeloma Treated with Daratumumab, Lenalidomide and Dexamethasone: Subgroup Analysis of MAIA Trial

Introduction: In the primary analysis of the phase 3 MAIA trial (NCT02252172), daratumumab, lenalidomide and dexamethasone (D-Rd) improved progression-free survival (PFS) in transplant-ineligible (TIE) patients (pts) with newly diagnosed multiple myeloma (NDMM) vs Rd. With longer follow-up (median: 56.2 months [mo]), D-Rd continued to demonstrate PFS benefit, conferred an overall survival benefit, induced deeper responses, and was associated with clinically meaningful improvements in patient-reported outcomes (PROs) vs Rd. The median age of these pts was 73 years with 43.6% of pts aged ≥75 years. Consistent with the overall population, in a frailty subgroup analysis (median age: 77 years), D-Rd also demonstrated deeper responses and PFS benefit vs Rd (not reached [NR] vs 30.4 mo; HR, 0.62; P = 0.003) in frail pts at a median follow-up of 36.4 mo. Although, D-Rd improved clinical outcomes in these elderly frail pts, little is known about health-related quality of life (HRQoL) outcomes. In frail pts, improving HRQoL and minimizing the risk of toxicity is paramount. Here, we assess PROs in the frail pts in the MAIA trial. Methods: Pts were randomized 1:1 to D-Rd or Rd until disease progression (PD) or unacceptable toxicity. Frailty assessment was performed on all randomized pts using age, Charlson Comorbidity Index, and baseline (BL) Eastern Cooperative Oncology Group performance status score. Based on this assessment, pts were categorized into frail and non-frail subgroups. PROs were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30-item (EORTC QLQ-C30). Questionnaires were completed at BL, on day 1 of cycles (Cyc) 3, 6, 9, and 12 for year 1, and every 6 mo thereafter until PD. Analyses were conducted on all pts with a BL and ≥1 post-BL PRO assessment. Meaningful thresholds for improvement and worsening were defined a priori based on published literature (≥10-point change). Treatment effect was assessed by a mixed-effects model for repeated measures. Time to first worsening was estimated using the Kaplan Meier method and Cox proportional hazards regression was used to compute hazard ratio (HR) and associated 95% confidence interval (CI) where worsening was defined using a distribution-based method. Results: In the MAIA trial, 737 pts were randomized (D-Rd, n=368; Rd, n=369). Of these, 341 pts were classified as frail (D-Rd, n=172; Rd, n=169,). At a median follow-up of 64.5 mo, frail pts treated with D-Rd reported greater improvements from BL vs Rd in EORTC QLQ-C30 Global Health Status (GHS) scores (Figure 1A) and physical functioning (LS mean change from BL for D-Rd at Cyc 12: 12.7 [9.0-16.3] vs Rd, 9.8 [5.9-13.7]) at several time points, with 39% of pts treated with D-Rd staying on treatment with PRO assessment at Cyc 48 vs 17% in the Rd group. Additionally, pts treated with D-Rd showed notably large reductions (≥20-point change) in pain symptoms over time and larger than that seen in pts treated with Rd (Figure 1B). No meaningful changes from BL were observed in fatigue symptoms for either treatment group. Results for emotional functioning, social functioning, and nausea and vomiting also numerically favored D-Rd at several time points. The median time to first improvement was numerically shorter with D-Rd vs Rd for GHS (D-Rd: 2.38 mo vs Rd: 4.67 mo), physical functioning (2.60 mo vs 4.65 mo), pain (2.07 mo vs 2.83 mo), and fatigue symptoms (2.04 mo vs 3.09 mo). The median time to first worsening was longest for physical functioning (D-Rd: 68.14 mo vs Rd: 39.62 mo; HR [95%CI] 0.66 [0.45-0.95]; P=0.023) and pain symptoms (D-Rd: NR vs Rd: 60.48 mo; 0.66 [0.44-1.00]; P=0.045). The median time to first worsening was longer with D-Rd vs Rd for GHS (D-Rd: 29.31 mo vs Rd: 21.62 mo; HR 0.91 [0.65-1.26]). The median time to first worsening for the other functional (emotional, social, role) and symptom (nausea and vomiting) scales numerically favored D-Rd vs Rd, except cognitive functioning and fatigue. Conclusions: D-Rd demonstrates clinical benefit in all pts, including frail pts. In addition, frail pts treated with D-Rd reported sustained improvements in global health (overall HRQoL) and physical functioning, with notable reduction in pain through the duration of therapy. Additionally, higher percentage of frail pts continued on D-Rd vs Rd. D-Rd regimen is not only clinically effective but also results in a sustained improvement in HRQoL for TIE frail pts with NDMM. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Ixazomib, Lenalidomide, and Dexamethasone (IRd) Versus Ixazomib, Pegylated Liposomal Adriamycin, and Dexamethasone(IDd) in Elderly Frail Newly Diagnosed Multiple Myeloma with GA Score ≥2: A Prospective Multicenter Study

Introduction Frailty patients with newly diagnosed multiple myeloma (NDMM) have inferior survival and higher rate of treatment discontinuation due to complications, poor tolerance and compliance and lack of effective treatment. The aim of this study was to prospectively investigate the treatment tolerability, clinical outcomes and quality of life of the ixazomib based regimens in frail NDMM patients according to IMWG frailty index. This trail is registered at http://www.chictr.org.cn/index.aspx as chiCTR1900024917. Methods This prospective trail was an investigator initiate, multicenter, non-randomized controlled study which frail NDMM patients received 6-8 four-week induction cycles of ixazomib, lenalidomide and dexamethasone (IRd) and ixazomib, pegylated liposome adriamycin and dexamethasone (IDd), followed by matienance therapy of 4-week with ixazomib and dexamethasone (Id) until progression. Inclusion criteria were aged ≥ 65 years, IMWG GA score ≥ 2 or Mayo geriatric vulnerability scoring system defined as vulnerable. Main exclusion criteria were acute cardiovascular and cerebrovascular events. The primary endpoint was overall response rate (ORR) defined by having at least a partial response (≥PR). The secondary endpoints were progression free survival (PFS), overall survival (OS), adverse events (AE) and health-related quality of life (using the EORTC-QLQ C30). Results From July 2019 to December 2021, a total of 132 patients from 15 hospitals were enrolled of which 12 were excluded because of ineligibility and non-randomized assigned to receive IRd group (n=60) or IDd (n=60) according to doctor's estimated (Figure 1). The median age was 71 years range (65-88). All patients had a GA Index higher than 2 score, in which 27.5% were also defined fragile by Mayo criterion. The ORR was 83%, including 22 (19.6%) patients with a complete response (CR) and 45 (40.2%) with a very good partial response (VGPR). The ORR was 84.2% and 81.8%, CR was 26.3% and 17.2, VGPR was 36.8% and 43.6% of IRd and IAd group, respectively. After a median follow-up time of 22.9m (95% CI 18.9-26.9), the median PFS was 19.5m of all patients, 24.6m and 15.8 of IRd and IDd group, respectively. The median OS of all patients and IRd group was no reach, while 29.2m in IDd group (Figure 1). Four patients died in 60 days post enroll up because of pneumonia caused by bedridden. Twenty-six and thirty-six patients did not process to maintenance therapy in IRd and IAd group, due to PD (14 in IRd and 16 in IDd), AE (6 in IRd and 7 in IDd), incompliance (5 in IRd and 9 in IDd) and early death (1 in IRd and 3 in IDd). Cumulative grade 3 or higher hematological AEs occurred in 10/60 (16.7%) and 13/60 (21.7%), whereas grade ≥3 non-hematological AEs were reported in 25/60 (41.7%) and 46/60 (76.6%) patients. Most common non-hematological grade ≥3 AEs were infections (20.8%) and gastro-intestinal (13.3%). Only 1 patient experiencing PNP grade 3 (0.83%). During induction, patients experienced a statistically and clinically significant improvement in GHS/QoL of both IRd and IAd group (p<0.0001). (Figure 1) Conclusion The results of ORR and safety support the use of IDd or IRd as frontline therapy for fragile elderly MM patients, which also improves QoL. IDd was especially suitable for frail MM patients with renal dysfunction and thrombosis. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

"Real-Life" Data of Zanubrutinib in Patients with Waldenström Macroglobulinemia - a Multi-Center Retrospective Study

Background: Waldenström macroglobulinemia (WM) is a rare indolent lymphoma accompanied by the secretion of clonal IgM. While chemo-immunotherapy (CIT) is still a widely adopted approach in treatment-naïve (TN) patients (pts), Bruton's tyrosine kinase (BTK) inhibition has become the new standard of care, especially in pts with relapsed/refractory (RR) disease. Zanubrutinib (ZAN, BGB-3111) is a second-generation BTK inhibitor with high specificity for BTK and reduced off-target inhibition of structurally related kinases. ZAN has recently been approved by the FDA and EMA for the treatment of WM in any line of therapy. This was based on a phase 2 study (Trotman et al, Blood 2020) and a randomized phase 3 study demonstrating non-inferiority to ibrutinib and an improved safety profile (Tam et al, Blood 2020). Between November 2020 and January 2022, an expanded access program of ZAN opened in Israel for the treatment of patients with RR-WM or those ineligible for CIT or ibrutinib in first line. We herein aim to provide real-world data on ZAN in pts with WM in Israel. Methods: This is a multi-center retrospective study of patients with WM who were treated with ZAN within an expanded access program in Israel. Demographic and clinical data were collected from electronic files and coded according to center. ZAN dose, safety, and efficacy measures were recorded. Adverse events (AEs) of interest were specifically investigated. The response was evaluated by investigator-assessment according to the 6th International Workshop on WM (Br J Haematol. 2013). The program was closed by the sponsor for new accrual in January 2022. Active patients gradually transitioned to commercial ZAN once it was reimbursed by the Israeli Health Ministry. The study was approved by local IRB of each participating center. Results: Thirteen pts (12 RR; 1 TN) were enrolled from December 2020 to January 2022 across 8 medical centers in Israel. The median age at ZAN initiation was 71 years (range, 50-85); 6 were males; 12 were Jewish with a representative Ashkenazi-Sepharadi ratio and 1 Arab pt. RR pts had a median of 1 (range, 1-4) prior lines of therapy: mostly with rituximab-cyclophosphamide-dexamethasone (RCd)-like regimens (n=8), bendamustine-rituximab (n=7), and ibrutinib (n=4). One pt underwent an autologous stem cell transplantation. Other than progressive disease after CIT, the most common consideration for choosing ZAN were pts' age and/or comorbidities (n=5), as well as ibrutinib toxicity. In one representative case ibrutinib was associated with complete atrioventricular block; the patient was started on ZAN after AICD implantation. ZAN dose was 160 mg bid (n=8) or 320 mg once daily (n=1), yet 4 pts were given a reduced dose (160 mg per day) due to frailty. The median time on ZAN was 6.4 months (range 2-19.2). Of 12 evaluable pts, the overall response rate (ORR) was 83% with 3 (25%) minor responses, 6 (50%) partial responses, and 1 case of very good partial response (VGPR). Two pts had stable disease (SD). The median time to best response was 120 days. With a median follow up of 196 days (range, 61-585), 9 patients are still on therapy, 2 pts eventually progressed, 1 while on ZAN and 1 after ZAN was stopped due to an AE. The median PFS and OS were not reached (Figure 1). Eight (61%) pts had AEs of any grade, and 3 (23%) had grade 3-4 AEs. One patient died from GI bleeding 2 months after ZAN initiation. AEs of interest are depicted in Table 1. Three pts stopped ZAN due to the following AEs: GI bleeding, congestive heart failure, and extreme fatigue (one each). Conclusion: The results of this real-world expanded access program are consistent with previously published data from trials with ZAN in WM. There were no new safety signals in this elderly frail cohort. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

AIoT-Based Ergometer for Physical Training in Frail Elderly with Cognitive Decline: A Pilot Randomized Control Trial

PurposeReduced physical activity is reported in the elderly, especially in institutional residents. Institutionalized older adults exhibit a high prevalence of frailty. In this work, we developed an artificial intelligence of things (AIoT)-based feedback assistive strengthening ergometer (AIFASE), for the physical strengthening of the elderly with intelligent assistance.MethodsWe conducted a 12-week intervention in a long-term care facility. In total, 16 participants (84.38 ± 6.0 years; 4 males and 12 females) were recruited with 1:1 randomization of exercise to control groups. The muscle strength of the lower extremities, timed up and go test (TUG), and Short-form Physical Performance Battery (SPPB) of the participants were measured. The AIFASE system allows the clinical staff to record the personal physical performance of the elderly and generates personalized exercise prescriptions accordingly. AIFASE also displays the current usage status of all ergometers and the users’ physiological conditions. The algorithms were developed to generate warning alerts when the training workload was too large by personal physiological detection. AIFASE automatically customized the exercise prescription according to the user’s exercise performance.ResultsAfter a 12-week AIFASE intervention, the intervention group exhibited significant improvements in the strength of the hip flexor, Semi-Tandem Stand, and Tandem Stand.ConclusionIn this study, we developed an AIoT ergometer that delivered customized physical training prescriptions to improve the physical performance of long-term care facility residents. We believe that the application of AIFASE will help improve the quality of institutional care.

Development and external validation of a risk prediction model for falls in patients with an indication for antihypertensive treatment: retrospective cohort study

ObjectiveTo develop and externally validate the STRAtifying Treatments In the multi-morbid Frail elderlY (STRATIFY)-Falls clinical prediction model to identify the risk of hospital admission or death from a fall in...

Factors Associated With PIM use in the Frail Elderly: A Cross-sectional Study

Background: The use of potentially inappropriate medications (PIM) by the elderly is commonly studied, but studies evaluating the use of PIM by frail elderly covered by prepaid health plans are still lacking. Objective: To identify the prevalence of use and the factors associated with the use of PIM by the elderly patients with high and moderate risk of clinical-functional vulnerability, according to the Beers criteria 2019. Methods: A cross-sectional study was developed with elderly people from a private health plan in Vitória-ES, Brazil. Socioeconomic, demographic and clinical data were collected through a digital platform and a structured questionnaire through an interview, from October 2018 to June 2019. The association between the use of PIM and independent variables was verified by univariate logistic regression with their respective confidence intervals (CI) 95%. The Multiple Model included the variables with P ≤ .20. Results: 332 elderly patients were interviewed (mean age 81.5 years, gender 237 female, 95 male). A 65% prevalence of PIM use was identified. In the multiple logistic regression model, the variables associated with the use of PIM were self-medication (P = .004), high risk of clinical-functional vulnerability (P = .022), use of psychotropic medications (P = .000001), musculoskeletal medications (P = .04) and alimentary tract medications (P = .03). Physical exercises were considered a protection factor (P = .02). Conclusion: The high prevalence of PIM use indicates the need for improvement in elderly private health care, to increase pharmacotherapy safety for this population.

LBODP062 SGLT2 Inhibition Ameliorates Cognitive And Physical Impairment In Patients With HFpEF And Diabetes

Abstract Aim The aim of this study was to assess whether the inhibitor of sodium-glucose cotransporter-2 (SGLT2) empagliflozin improves cognitive impairment in frail older adults with diabetes mellitus (DM) and Heart Failure with Preserved Ejection Fraction (HFpEF). Methods We designed a prospective study to assess cognitive and physical function in consecutive frail older adults with DM and HFpEF, comparing the effects of empagliflozin, metformin, and insulin. Results A total of 162 frail elders with HFpEF and DM successfully completed the study. The Montreal Cognitive Assessment (MoCA) score was measured at baseline and after 1-month: 19.80±3.77 vs. 22.25±3.27 (p&amp;lt;0. 001) in the empagliflozin group; 19.95±3.81 vs. 20.71±3.56 (p: 0.26) in the metformin group; 19. 00±3.71 vs. 19.1±3.56 (p: 0.81) in the insulin group. A multivariate regression analysis confirmed the beneficial effects of empagliflozin. Additionally, we observed a marked amelioration of physical impairment, assessed by the 5-meter gait speed test, in the empagliflozin and in the metformin arms, but not in patients receiving insulin. Conclusions To the best of our knowledge, this is the first study to show significant beneficial effects of empagliflozin treatment on cognitive and physical impairment in frail subjects with HFpEF and DM. Presentation: No date and time listed

Toward an Integrated Strategy for Care in the Home for Frail Elders.

Canada requires a strategic plan to care for frail elders in the home. The nation needs a holistic system that addresses the multiple, often unique and dynamic needs of seniors, caregivers and families. This essay introduces ethical, technological and stakeholder engagement considerations that may help Canada move forward with a strategy that offers the capacity to better understand the perspectives of different stakeholders and champions high-quality homecare services. Stakeholder engagement can draw on the concept of brokered dialogue (Parsons and Lavery 2012) as a way to study and ethically design a high-quality national homecare strategy.

Personal budget: integration of social and health resources of frail elderly in supported discharge

Abstract During COVID-19 pandemic, health and social condition of frail elderly got worse at worldwide level. This aggravation was due both to isolation and higher mortality rate for COVID-19, influenced by the widespread condition of comorbidity in this segment of population. The progressive change of needs in this target weren't matched with a prompt and adequate response, which could guarantee the taking charge of frail elderly. Personal budget is a tool for integrating public health, social assistance and family efforts on the international scene. In the Italian context, it is emerging as means to program and coordinate economic and professional, institutional, and personal resources, finalising them to provide a personalised pathway. Research aims to value the contribution of personal budget association to effectiveness and efficacy of personalised pathway for frail elderlies in early supported discharges. A research-intervention approach was done. Personal budget was applied to a significant sample of cases of personalised pathways for frail elderly in supported discharge in the Local Health District of Teramo. The study compared used resources and obtained health outcomes between the sample and a control group. The application of the personal budget permits the immediate maximisation of resources use and the quantification of the deviation between the available and the needed resources for provision of personalised pathway. Moreover, this tool supported the planning of services, the integration of health and social actions, the monitoring of adherence to planned programmes and the application of corrective mechanisms, if these are necessary, improving the health outcomes. Personal budget contributes to increase the integrated and continued taking charge of frail elderly in supported discharges in the short-medium term. Globally, this tool could be an organisational and economic answer for responding in a sustainable way to international increasing of life expectancy. Key messages • Personal budget manages and controls both health and social activities and resources. • Personal budget supports the establishment of an integrated and continuous taking charge system of the frail elderly.

Impact of age and comorbidities on short- and long-term outcomes of patients undergoing surgery for colorectal cancer

As the world population is progressively ageing, more and more elderly patients will require cancer surgery. Although curative surgery is the treatment of choice for resectable colorectal cancer (CRC), it is still debated whether elderly frail patients should undergo major cancer surgery due to the increased risk of postoperative and long-term mortality. The aim of this retrospective study was to evaluate the impact of age and comorbidities on postoperative mortality/morbidity and long-term outcomes, looking for potential age-related survival differences. A total of 1,482 patients operated for CRC at our institution between January 2005 and October 2020 were analysed. The independent effect of age and comorbidities on postoperative complications was assessed by a logistic model, while the effect on overall survival (OS) and cancer-related survival (CRS) was estimated by a Cox regression model. The median age in the cohort was 67.8 years. Postoperative mortality was very low in the whole cohort (0.8%) and contained even in older age groups (3.2% in patients aged 80-84 years, 4% in the 85-90-year age group). The cumulative incidence of postoperative complications was doubled in patients with comorbidities (32.8% vs. 15.1%, p = 0.002). With regard to OS, as expected, it exponentially decreased with advancing age. Conversely, differences in CRS were less pronounced between age groups and absent in patients with stage 0-I CRC. Analysis of all causes and cancer-related mortality revealed a peak within 2 years from surgery, suggesting a prolonged impact of surgery. In patients aged 75 years and above, all-cause mortality showed a steep increase 1 year after surgery, while cancer-related mortality plateaued at about 4 years after surgery. On multivariable analysis, OS, but not CRS, was significantly influenced by age. Although acceptable results of surgery in elderly patients, OS is strongly dependent on age: older people die more from competing causes than cancer-related treatments compared to younger age classes. The preoperative identification of risk factors for low OS may help the selection of those elderly patients who would benefit from curative CRC surgery.