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Danielle Harari

Publications and source records attributed to Danielle Harari.

9 recordsLinked to original sources
PubMed2026

Identifying biomarkers of accelerated ageing in cancer patients from routine clinical data.

INTRODUCTION: Cancer and ageing have a bidirectional relationship: age is the strongest risk factor for cancer, and cancer and treatments can accelerate ageing. Therefore, biological age can differ from chronological age; biomarkers are needed to stratify interventions to minimise accelerated ageing. METHODS: PhenoAge was calculated from routine blood test results of patients attending a Geriatric Oncology clinic. PhenoAgeAccel was the residual from a regression of PhenoAge against age. RESULTS: Data were available for 173 patients (62% male). Mean PhenoAge was higher than age (84.3 (12.6) vs 76.2 (7.24), p&#x202f;<&#x202f;0.001), though the two were correlated (r&#x202f;=&#x202f;0.579, p&#x202f;<&#x202f;0.001). Unlike age, PhenoAge and PhenoAgeAccel were associated with one-year mortality (PhenoAge OR=1.083, 95% CI: 1.038-1.136; PhenoAgeAccel OR=1.096, 95% CI: 1.047-1.155). PhenoAge correlated with Clinical Frailty Score and Timed Up and Go (CFS: Rs=0.31, p&#x202f;<&#x202f;0.001; TUG: Rs=0.25, p&#x202f;<&#x202f;0.005); there were no correlations with age. PhenoAgeAccel correlated with the number of CGA interventions made (Rs=0.17, p&#x202f;<&#x202f;0.05), unlike age and PhenoAge. Patients with diabetes mellitus had a higher PhenoAgeAccel compared to those without (3.40 vs -1.71, p&#x202f;=&#x202f;0.002). In patients receiving systemic anti-cancer treatment, patients with PhenoAgeAccel calculated pre-treatment had less age acceleration than those with PhenoAgeAccel calculated post-treatment, both overall (2.18 vs -2.87; p&#x202f;=&#x202f;0.048) and in matched samples (n&#x202f;=&#x202f;21, 7.76 vs -2.87, p&#x202f;<&#x202f;0.001). CONCLUSIONS: PhenoAgeAccel is a greater predictor of risk than chronological age in older people with cancer. This makes it a promising biomarker to stratify patients for holistic geriatric assessment, dose reductions, or future geroprotective measures which could be integrated within electronic healthcare record systems.

Humans↗
PubMed2007

Development, feasibility and performance of a health risk appraisal questionnaire for older persons.

BACKGROUND: Health risk appraisal is a promising method for health promotion and prevention in older persons. The Health Risk Appraisal for the Elderly (HRA-E) developed in the U.S. has unique features but has not been tested outside the United States. METHODS: Based on the original HRA-E, we developed a scientifically updated and regionally adapted multilingual Health Risk Appraisal for Older Persons (HRA-O) instrument consisting of a self-administered questionnaire and software-generated feed-back reports. We evaluated the practicability and performance of the questionnaire in non-disabled community-dwelling older persons in London (U.K.) (N = 1090), Hamburg (Germany) (N = 804), and Solothurn (Switzerland) (N = 748) in a sub-sample of an international randomised controlled study. RESULTS: Over eighty percent of invited older persons returned the self-administered HRA-O questionnaire. Fair or poor self-perceived health status and older age were correlated with higher rates of non-return of the questionnaire. Older participants and those with lower educational levels reported more difficulty in completing the HRA-O questionnaire as compared to younger and higher educated persons. However, even among older participants and those with low educational level, more than 80% rated the questionnaire as easy to complete. Prevalence rates of risks for functional decline or problems were between 2% and 91% for the 19 HRA-O domains. Participants' intention to change health behaviour suggested that for some risk factors participants were in a pre-contemplation phase, having no short- or medium-term plans for change. Many participants perceived their health behaviour or preventative care uptake as optimal, despite indications of deficits according to the HRA-O based evaluation. CONCLUSION: The HRA-O questionnaire was highly accepted by a broad range of community-dwelling non-disabled persons. It identified a high number of risks and problems, and provided information on participants' intention to change health behaviour.

Aged↗
PubMed2007

The PRO-AGE study: an international randomised controlled study of health risk appraisal for older persons based in general practice.

BACKGROUND: This paper describes the study protocol, the recruitment, and base-line data for evaluating the success of randomisation of the PRO-AGE (PRevention in Older people-Assessment in GEneralists' practices) project. METHODS/DESIGN: A group of general practitioners (GPs) in London (U.K.), Hamburg (Germany) and Solothurn (Switzerland) were trained in risk identification, health promotion, and prevention in older people. Their non-disabled older patients were invited to participate in a randomised controlled study. Participants allocated to the intervention group were offered the Health Risk Appraisal for Older Persons (HRA-O) instrument with a site-specific method for reinforcement (London: physician reminders in electronic medical record; Hamburg: one group session or two preventive home visits; Solothurn: six-monthly preventive home visits over a two-year period). Participants allocated to the control group received usual care. At each site, an additional group of GPs did not receive the training, and their eligible patients were invited to participate in a concurrent comparison group. Primary outcomes are self-reported health behaviour and preventative care use at one-year follow-up. In Solothurn, an additional follow-up was conducted at two years. The number of older persons agreeing to participate (% of eligible persons) in the randomised controlled study was 2503 (66.0%) in London, 2580 (53.6%) in Hamburg, and 2284 (67.5%) in Solothurn. Base-line findings confirm that randomisation of participants was successful, with comparable characteristics between intervention and control groups. The number of persons (% of eligible) enrolled in the concurrent comparison group was 636 (48.8%) in London, 746 (35.7%) in Hamburg, and 1171 (63.0%) in Solothurn. DISCUSSION: PRO-AGE is the first large-scale randomised controlled trial of health risk appraisal for older people in Europe. Its results will inform about the effects of implementing HRA-O with different methods of reinforcement.

Aged↗
PubMed2006

Predicting the risk of hospital admission in older persons--validation of a brief self-administered questionnaire in three European countries.

OBJECTIVES: To validate the Probability of Repeated Admission (Pra) questionnaire, a widely used self-administered tool for predicting future healthcare use in older persons, in three European healthcare systems. DESIGN: Prospective study with 1-year follow-up. SETTING: Hamburg, Germany; London, United Kingdom; Canton of Solothurn, Switzerland. PARTICIPANTS: Nine thousand seven hundred thirteen independently living community-dwelling people aged 65 and older. MEASUREMENTS: Self-administered eight-item Pra questionnaire at baseline. Self-reported number of hospital admissions and physician visits during 1 year of follow-up. RESULTS: In the combined sample, areas under the receiver operating characteristic curves (AUCs) were 0.64 (95% confidence interval (CI)=0.62-0.66) for the prediction of one or more hospital admissions and 0.68 (95% CI=0.66-0.69) for the prediction of more than six physician visits during the following year. AUCs were similar between sites. In comparison, prediction models based on a person's age and sex alone exhibited poor predictive validity (AUC or= 0.5) were 2.3 times as likely (95% CI=2.1-2.6) as low-risk individuals to have a hospital admission, and 2.1 times as likely (95% CI=2.0-2.2) to have more than six physician visits. CONCLUSION: The Pra instrument exhibits good validity for predicting future health service use on a population level in different healthcare settings. Administrative data have shown similar predictive validity, but in practice, such data are often not available. The Pra is likely of high interest to governments and health insurance companies worldwide as a basis for programs aimed at health risk management in older persons.

Aged↗
PubMed2005

Self-reported visual function in healthy older people in Britain: an exploratory study of associations with age, sex, depression, education and income.

BACKGROUND: Tractable but undetected visual impairment in older people may be relatively common, particularly amongst the very old and in more deprived populations. Measurement of visual acuity is unlikely to be helpful in identifying this impairment, but targeted assessment of visual function may be beneficial. There is uncertainty about the defining characteristics of the target group. OBJECTIVE: To explore factors associated with self-reported visual impairment in community dwelling older people. METHODS DESIGN: secondary cross sectional analysis of baseline data from a randomised controlled trial. SETTING: three large group practices in outer London. PARTICIPANTS: older people aged 65 and over enrolled in a study of health risk appraisal. METHOD: postal questionnaire using questions from the National Eye Institute Visual Function questionnaire. RESULTS: Moderate or extreme visual function loss occurred in 4 to 12% of community-dwelling older people in this population reporting less than excellent vision, depending on which aspect of visual function is considered. Visual function loss in this subgroup increases in prevalence with advancing age, but is not associated with female sex, low educational attainment or low income. It is associated with depressed mood. CONCLUSION: Questions about visual function identify a group of older people whose vision and mental state needs further investigation.

Aged↗
PubMed2005

Fear of falling limiting activity in young-old women is associated with reduced functional mobility rather than psychological factors.

BACKGROUND: many older people experience fear of falling. This is sometimes associated with activity limitation, with potential adverse health implications. The explanatory contributions of physical and psychosocial factors to this syndrome are unclear. OBJECTIVES: to examine the associations between fear of falling limiting activity (FoF-LA) among young-old women with (i) functional capacity and (ii) psychological factors. SUBJECTS AND METHODS: FoF-LA, functional difficulty and dependency, psychological factors, previous falls, visual and hearing handicap, memory, pain, and habitual physical activity were assessed using standard questionnaires in 713 community-dwelling London women, mean age 64.2 years. RESULTS: 70 women (10.1%) reported FoF-LA, of whom 21 had fallen in the previous year. Women reporting FoF-LA had higher prevalence of adverse functional and clinical characteristics. Multiple logistic regression analyses showed that both mild ('changes in the way walk half a mile') and moderate ('difficulty standing from armless chair') reduction in functional capacity were independently associated with FoF-LA (odds ratios 4.02 (95% CI 1.5-10.7) and 5.07 (CI 2.0-13.0) respectively) after adjustment for age, falls and clinical factors. Psychological factors and perceived fair/poor health were bivariately but not independently associated with FoF-LA; after adjustment for them, mild and moderate reductions in functional capacity remained strongly associated with FoF-LA (OR 4.02 (CI 1.5-10.7) and 3.83 (CI 1.4-10.5) respectively), along with visual handicap and increased health service use. CONCLUSIONS: among young-old women, FoF-LA is related to early reduction of mobility function rather than psychological factors. It may identify individuals at risk of subsequent functional decline.

Accidental Falls↗
PubMed2004

Treatment of constipation and fecal incontinence in stroke patients: randomized controlled trial.

BACKGROUND AND PURPOSE: Despite its high prevalence in stroke survivors, there is little clinical research on bowel dysfunction in this population. This is the first randomized controlled trial to evaluate treatment of constipation and fecal incontinence in stroke survivors. METHODS: Stroke patients with constipation or fecal incontinence were identified by screening questionnaire (122 community, 24 stroke rehabilitation inpatients) and randomized to intervention or routine care (73 per group). The intervention consisted of a 1-off structured nurse assessment (history and rectal examination), leading to targeted patient/carer education with booklet and provision of diagnostic summary and treatment recommendations (after consultation with geriatrician) to patient's general practitioner (GP)+/-ward physician. RESULTS: Percentage of bowel movements (BMs) per week graded as "normal" by participants in a prospective 1-week stool diary was significantly higher in intervention versus control patients at 6 months (72% versus 55%; P=0.027), as was mean number of BMs per week (5.2 versus 3.6; P=0.005). There was no significant reduction in fecal incontinence, although numbers were small. At 12 months, intervention patients were more likely to be modifying their diets (odds ratio [OR], 3.1 [1.2 to 8.0]) and fluid intake (OR, 4.2 [1.4 to 12.2]) to control their bowels and to have visited their GP for their bowel problem (OR, 5.0 [1.4 to 17.5]). GP prescribing of laxatives and suppositories was significantly influenced at 12 months. CONCLUSIONS: A single clinical/educational nurse intervention in stroke patients effectively improved symptoms of bowel dysfunction up to 6 months later, changed bowel-modifying lifestyle behaviors up to 12 months later, and influenced patient-GP interaction and physician prescribing patterns.

Aged↗
PubMed2003

New-onset fecal incontinence after stroke: prevalence, natural history, risk factors, and impact.

BACKGROUND AND PURPOSE: Fecal incontinence (FI) is a common complication after stroke, yet epidemiological research into this distressing condition is limited. The purpose of this study was to describe the prevalence, natural history, associations, and impact of new-onset FI after stroke. METHODS: Stroke patients in the community-based South London Stroke Register (January 1995 to 2000) without preexisting FI were characterized regarding bowel continence at 7 to 10 days, 3 months, and 1 and 3 years after stroke. FI was defined as any degree of bowel leakage. RESULTS: Prevalence of poststroke FI was 30% (7 to 10 days), 11% (3 months), 11% (1 year), and 15% (3 years). One third of patients with FI at 3 months were continent by 1 year; conversely, 63% incontinent at 1 year had been continent at 3 months. Characteristics of 91 patients with FI and 755 without FI at 3 months were compared using multiple logistic regression. Acute stroke associations of neglect (adjusted odds ratio [OR], 1.9; 95% CI, 1.0 to 3.5) and initial urinary incontinence (OR, 6.2; 95% CI, 3.2 to 11.9) were no longer significant after adjustment for clinical factors at 3 months. Final independent associations were anticholinergic drug use (OR, 3.1; 95% CI, 1.1 to 10.2) and needing help with toilet use (OR, 3.5; 95% CI, 1.4 to 17.3). FI at 3 months increased the risk of long-term placement (28% vs 6%) and death within 1 year (20% vs 8%). CONCLUSIONS: New-onset FI in stroke survivors is common but may be transient. Modifiable risk factors for FI 3 months after stroke are constipating drug use and difficulty with toilet access, raising implications for developing treatment and prevention strategies.

Aged↗