1,721,076 research outputs found
Frailty, multimorbidity patterns and mortality in institutionalized older adults in Italy
No full textBACKGROUND: Little is known on how frailty influences clinical outcomes in persons with specific multimorbidity patterns. AIMS: To investigate the interplay between multimorbidity and frailty in the association with mortality in older individuals living in nursing homes (NH). METHODS: We considered 4,131 NH residents aged 60 years and over, assessed through the interRAI LTCF instrument between 2014 and 2018. Follow-up was until 2019. Considering four multimorbidity patterns identified via principal component analysis, subjects were stratified in tertiles (T) with respect to their loading values. Frailty Index (FI) considered 23 variables and a cut-off of 0.24 distinguished between high and low frailty levels. For each pattern, all possible combinations of tertiles and FI were evaluated. Their association (Hazard Ratio [HR] and 95% confidence interval) with mortality was tested in Cox regression models. RESULTS: In the heart diseases and dementia and sensory impairments patterns, the hazard of death increases progressively with patterns expression and frailty severity (being HR T3 vs. T1 = 2.36 [2.01–2.78]; HR T3 vs. T1 = 2.12 [1.83–2.47], respectively). In heart, respiratory and psychiatric diseases and diabetes, musculoskeletal and vascular diseases patterns, frailty seems to have a stronger impact on mortality than patterns’ expression. DISCUSSION: Frailty increases mortality risk in all the patterns and provides additional prognostic information in NH residents with different multimorbidity patterns. CONCLUSIONS: These findings support the need to routinely assess frailty. Older people affected by specific groups of chronic diseases need a specific care approach and have high risk of negative health outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40520-022-02269-8
Health trajectories in Swedish centenarians
No full textLongitudinal studies describing centenarians' health trajectories are currently lacking. We compared health trajectories of older adults becoming centenarians and their shorter-living counterparts in terms of chronic diseases, disability and cognitive decline
Associations between multimorbidity and kidney function decline in old age: A population-based cohort study
No full textBackground: Individual chronic conditions have been linked to kidney function decline; however, the role of multimorbidity (the presence of ≥2 conditions) and multimorbidity patterns remains unclear. Methods: A total of 3094 individuals from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were followed for 15 years. Multimorbidity was operationalized as the number of chronic conditions and multimorbidity patterns identified using latent class analysis (LCA). Joint models and Cox regression models were used to explore the associations between multimorbidity, and subsequent absolute and relative (≥25% decline from baseline) changes, respectively, in the estimated glomerular filtration rate (eGFR) calculated using the creatinine-based Berlin Initiative Study equation. Results: Mean age of the sample was 73.9, and 87% had multimorbidity. There was an independent dose–response relationship between the number of chronic conditions, and absolute (β [95% confidence interval, CI] = −0.05 [−0.07; −0.03]) and relative (hazard ratio, HR [95% CI] = 1.23 [1.17; 1.29]) declines in eGFR. Five patterns of multimorbidity were identified. The Unspecific, low burden pattern had the lowest morbidity burden and was used as the reference category. The Unspecific, high burden, and Cardiometabolic patterns showed accelerated absolute (β [95% CI] = −0.15 [−0.26; −0.05] and −0.77 [−0.98; −0.55], respectively) and relative (HR [95% CI] = 1.45 [1.09; 1.92] and 3.45 [2.27; 5.23], respectively) declines. Additionally, the Cognitive and Sensory pattern showed accelerated relative decline (HR [95% CI] = 1.53 [1.02; 2.31]). No associations were found for the Psychiatric and Respiratory pattern. Conclusion: Multimorbidity is strongly associated with accelerated kidney function decline in older age. Individuals with cardiometabolic multimorbidity exhibit a particularly increased risk. Increased monitoring and timely interventions may preserve kidney function and reduce cardiovascular risks in individuals presenting with conditions that are characteristic of high-risk multimorbidity patterns
Hypertension and frailty: A systematic review and meta-analysis
No full textObjective To review the association between hypertension and frailty in observational studies. Design A systematic review of the PubMed, Web of Science and Embase databases was performed. A meta-analysis was performed if at least three studies used the same definition of frailty and a dichotomous definition of hypertension. Setting, participants and measures Studies providing information on the association between frailty and hypertension in adult persons, regardless of the study setting, study design or definition of hypertension and frailty were included. Results Among the initial 964 articles identified, 27 were included in the review. Four longitudinal studies examined the incidence of frailty according to baseline hypertension status, providing conflicting results. Twenty-three studies assessed the cross-sectional association between frailty and hypertension: 13 of them reported a significantly higher prevalence of frailty in hypertensive participants and 10 found no significant association. The pooled prevalence of hypertension in frail individuals was 72% (95% CI 66% to 79%) and the pooled prevalence of frailty in individuals with hypertension was 14% (95% CI 12% to 17%). Five studies, including a total of 7656 participants, reported estimates for the association between frailty and hypertension (pooled OR 1.33; 95% CI 0.94 to 1.89). Conclusions Frailty is common in persons with hypertension. Given the possible influence of frailty on the risk-benefit ratio of treatment for hypertension and its high prevalence, it is important to assess the presence of this condition in persons with hypertension.</p
Multimorbidity Patterns and Unplanned Hospitalisation in a Cohort of Older Adults
Full text linkThe presence of multiple chronic conditions (i.e., multimorbidity) increases the risk of hospitalisation in older adults. We aimed to examine the association between different multimorbidity patterns and unplanned hospitalisations over 5 years. To that end, 2,250 community-dwelling individuals aged 60 years and older from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) were studied. Participants were grouped into six multimorbidity patterns using a fuzzy c-means cluster analysis. The associations between patterns and outcomes were tested using Cox models and negative binomial models. After 5 years, 937 (41.6%) participants experienced at least one unplanned hospitalisation. Compared to participants in the unspecific multimorbidity pattern, those in the cardiovascular diseases, anaemia and dementia pattern, the psychiatric disorders pattern and the metabolic and sleep disorders pattern presented with a higher hazard of first unplanned hospitalisation (hazard ratio range: 1.49-2.05; p < 0.05 for all), number of unplanned hospitalisations (incidence rate ratio (IRR) range: 1.89-2.44; p < 0.05 for all), in-hospital days (IRR range: 1.91-3.61; p < 0.05 for all), and 30-day unplanned readmissions (IRR range: 2.94-3.65; p < 0.05 for all). Different multimorbidity patterns displayed a differential association with unplanned hospital care utilisation. These findings call for a careful primary care follow-up of older adults with complex multimorbidity patterns
Fostering healthy aging:the interdependency of infections, immunity and frailty
Full text linkUntangling the interdependency of infections, immunity and frailty may help to clarify their roles in the maintenance of health in aging individuals, and the recent COVID-19 pandemic has further highlighted such priority. In this scoping review we aimed to systematically collect the evidence on 1) the impact of common infections such as influenza, pneumonia and varicella zoster on frailty development, and 2) the role played by frailty in the response to immunization of older adults. Findings are discussed under a unifying framework to identify knowledge gaps and outline their clinical and public health implications to foster a healthier aging. Twenty-nine studies (113,863 participants) selected to answer the first question provided a moderately strong evidence of an association between infections and physical as well as cognitive decline - two essential dimensions of frailty. Thirteen studies (34,520 participants) investigating the second aim, showed that frailty was associated with an impaired immune response in older ages, likely due to immunosenescence. However, the paucity of studies, the absence of tools to predict vaccine efficacy, and the lack of studies investigating the efficacy of newer vaccines in presence of frailty, strongly limit the formulation of more personalized immunization strategies for older adults. The current evidence suggests that infections and frailty repeatedly cross each other pathophysiological paths and accelerate the aging process in a vicious circle. Such evidence opens to several considerations. First, the prevention of both conditions pass through a life course approach, which includes several individual and societal aspects. Second, the maintenance of a well-functioning immune system may be accomplished by preventing frailty, and vice versa. Third, increasing the adherence to immunization may delay the onset of frailty and maintain the immune system homeostasis, beyond preventing infections.</p
Accounting for frailty when treating chronic diseases
No full textChronic diseases are considered to be major determinants of frailty and it could be hypothesized that their treatment may counteract the development of frailty. However, the hypothesis that intensive treatment of chronic diseases might reduce the progression of frailty is poorly supported by existing studies. In contrast, some evidence suggests that intensive treatment of chronic diseases may increase negative health outcomes in frail older adults. In particular, if treatment of symptoms related to chronic diseases (i.e. pain in osteoarthritis, dyspnoea in respiratory disease, motor symptoms in Parkinson disease) might potentially reverse frailty, the benefits related to preventive pharmacological treatment of chronic diseases (i.e. antihypertensive treatment) in patients with prevalent frailty is not certain. In particular, several factors might alter the risk/benefit ratio of a given treatment in persons with frailty. These include: exclusion of frail persons from clinical studies, reduced life expectancy in frail persons, increased susceptibility to iatrogenic events, and functional deficits associated with frailty. Therefore, frailty acts as an effect modifier, by modifying the risks and benefits of chronic disease treatments. This hypothesis must be considered and tested in future clinical intervention studies and clinical guidelines should provide specific recommendations for the treatment of frail people, underlining the pros and the cons of pharmacological treatment and possible targets for therapy in this population. Meanwhile, in older patients, the prescribing process should be individualized and flexible
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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