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PubMedDate not supplied

Prediction error variance and expected response to selection, when selection is based on the best predictor - for Gaussian and threshold characters, traits following a Poisson mixed model and survival traits.

In this paper, we consider selection based on the best predictor of animal additive genetic values in Gaussian linear mixed models, threshold models, Poisson mixed models, and log normal frailty models for survival data (including models with time-dependent covariates with associated fixed or random effects). In the different models, expressions are given (when these can be found - otherwise unbiased estimates are given) for prediction error variance, accuracy of selection and expected response to selection on the additive genetic scale and on the observed scale. The expressions given for non Gaussian traits are generalisations of the well-known formulas for Gaussian traits - and reflect, for Poisson mixed models and frailty models for survival data, the hierarchal structure of the models. In general the ratio of the additive genetic variance to the total variance in the Gaussian part of the model (heritability on the normally distributed level of the model) or a generalised version of heritability plays a central role in these formulas.

Analysis of Variance↗

PubMed2026

Exerkine dysregulation links visceral adiposity to skeletal muscle impairment in end-stage heart failure with reduced ejection fraction: proteomic evidence for a cardio-adipose-muscle axis.

BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) is associated with profound alterations in body composition, skeletal muscle dysfunction, and impaired exercise capacity. Exerkines representing exercise-responsive signaling molecules released by skeletal muscle, adipose tissue, and other organs may mediate systemic metabolic communication between tissues. However, their role in advanced HFrEF and their relationship with adiposity and skeletal muscle characteristics remain poorly understood. METHODS: We studied 73 patients with end-stage HFrEF and 16 healthy controls. Body composition was assessed using computed tomography, including visceral (VAT), subcutaneous (SAT), and epicardial adipose tissue (EAT), as well as skeletal muscle quantity (psoas muscle index, PMI) and quality (psoas muscle density, PMD). Functional performance was evaluated using handgrip strength (HGT) and the 6-min walk test (6MWT). Circulating exerkines were quantified using the Olink technology. Associations between proteins and clinical variables were assessed using age- and creatinine-adjusted linear models with false discovery rate correction. RESULTS: Among patients with HFrEF, 36% were obese and 38% exhibited central obesity independent of BMI. Muscle strength and muscle quality were strongly associated with functional capacity. VAT correlated with muscle mass but not with muscle quality or performance. Compared with controls, HFrEF patients demonstrated elevated inflammatory and metabolic stress-related exerkines including CXCL8, CCL2, IL-6, TNF, IL-15, GDF15, FGF21, ANGPTL4, CTSB, DCN, and resistin. In contrast, proteins associated with muscle integrity and regenerative signaling (myostatin, BDNF, IL-7, SPARC) were significantly reduced. In HFrEF patients leptin strongly correlated with adiposity measures. Metabolic stress mediators (GDF15, IL-15, FGF21, CTSB) were inversely associated with muscle quality and functional performance, whereas myostatin positively correlated with muscle quality, strength, and exercise capacity. BDNF was inversely associated with frailty. CONCLUSIONS: Advanced HFrEF is characterized by a dysregulated exerkine network linking adiposity, skeletal muscle quality, and functional performance. Four biologically coherent axes were identified: a leptin-driven adiposity axis, a metabolic stress-muscle quality axis, a myostatin-related muscle function axis, and a neurotrophic frailty axis. These findings support the presence of a systemic cardio-adipose-muscle signaling network in end-stage HFrEF and identify candidate molecular mediators of sarcopenia and functional decline.

Humans↗

PubMed2002

Psychosocial-spiritual correlates of death distress in patients with life-threatening medical conditions.

The purpose of this study was to identify demographic, disease, health care, and psychosocial-spiritual factors associated with death distress (death-related depression and anxiety). Cross-sectional baseline data from a randomized controlled trial were used. Outpatients (n=70) were recruited from an urban academic medical centre and proprietary hospital. All patients had life-threatening medical conditions, including cancer; pulmonary, cardiac, liver, or kidney disease; HIV/AIDS; or geriatric frailty. Measures of death distress, physical symptom severity, depression and anxiety symptoms, spiritual well-being, social support, patient-perceived physician communication, and patient-perceived quality of health care experiences were administered. In a hierarchical multiple regression model, higher death distress was significantly associated with living alone, greater physical symptom severity, more severe depression symptoms, lower spiritual well-being, and less physician communication as perceived by the patient. Death distress as a unique experiential construct was discriminable among younger patients with specific, diagnosable life-threatening conditions, but less so among geriatric frailty patients. The findings suggest that the experience of death distress among patients with life-threatening medical conditions is associated with the psychosocial-spiritual dimensions of the patient's life. Attention to these dimensions may buffer the negative affects of death distress.

Anxiety↗

PubMed1999

Sarcopenia and decreased muscle strength in the elderly woman: resistance training as a safe and effective intervention.

A principle component of age-related weakness and frailty in women is sarcopenia. This decrease in skeletal muscle mass is a progressive syndrome that will affect the quality of life for elderly women by decreasing the ability to perform many activities of daily living. Strength training is known to be an effective means of increasing muscular strength and size in many populations, and can be utilized successfully to significantly improve muscle strength, muscle mass and functional mobility in elderly women up to the age of 96 years. Such exercise can minimize the syndrome of physical frailty due to decreased muscle mass and strength. Any rehabilitation or exercise program for the elderly woman would benefit from the inclusion of such a training regime.

Activities of Daily Living↗

PubMed2006

Religious attendance and mortality: implications for the black-white mortality crossover.

This study investigates the relationships among religious attendance, mortality, and the black-white mortality crossover. We build on prior research by examining the link between attendance and mortality while testing whether religious involvement captures an important source of population heterogeneity that contributes to a crossover Using data from the Established Populations for Epidemiologic Studies of the Elderly, we find a strong negative association between attendance and mortality. Our results also show evidence of a racial crossover in mortality rates for both men and women. When religious attendance is modeled in terms of differential frailty, clear gender differences emerge. For women, the effect of attendance is race- and age-dependent, modifying the age at crossover by 10 years. For men, however; the effect of attendance is not related to race and does not alter the crossover pattern. When other health risks are modeled in terms of differential frailty, wefind neither race nor age-related effects. Overall, the results highlight the importance of considering religious attendance when examining racial and gender differences in age-specific mortality rates.

Black or African American↗

PubMed2003

[The quest for adequate health care for the elderly: literature review and the application of an instrument for early detection and prediction of diseases].

The increase in the elderly population demands changes in health care models by policymakers to deal with the substantial cost increase This article addresses patient access flow and the definition of priorities in an outpatient unit. A short questionnaire (8 questions) was used to assess enrollment and ranking of the elderly at risk of repeated hospital admissions, considered as a proxy for frailty. In a sample of 360 individuals, 75.8% of the elderly population was classified as "low risk". However, approximately 11% of the sample was considered to be at "medium" or "high" risk of becoming ill and requiring intensive use of health services. Our findings corroborate the usefulness (for promoting an effective health system for the elderly) of the proposed questionnaire as a tool to classify the elderly in different "frailty groups", using a hierarchic definition of vulnerability. The proposed ranking procedure can help adjust the portal of entry into the system, as used thus far in most Brazilian health facilities. The article concludes by suggesting that the validity of the method be tested in a prospective study.

Age Distribution↗

PubMed2005

Artificial environments and an aging population: designing for age-related functional losses.

Over the past century there has been a large and continuing increase in the frequency of persons aged over 65 years; particularly those aged over 100 years. During the 21st century the number of persons over 100 years will continue to increase. This will occur at such a rapid rate that the 21st century may one day be called the century of centenarians. Frailty and disability secondary to senescence, disease, and trauma have accompanied old age (often defined as age 65 and over) as far back as recorded history. However, during the 20th century, age, frailty, disability, and chronic degenerative diseases have been decoupled to some extant in the most long-lived human populations. Until recently, there was little need to design artificial environments for the unique needs of the elderly due to their low representation in most national populations. Today that need is increasing in concert with the number of persons aged 65 and older. The purpose of this review is to suggest areas wherein physiological anthropologists may have an opportunity to contribute to design trends for this rapidly increasing aging population. Major considerations for design of environments for the elderly are based upon altering the environment to accommodate their declining visual, auditory, and kinesthetic senses, thereby enhancing their declining faculties and improving their autonomy, independence, and self perceptions of well-being. To date most design considerations have been directed toward improving environments for those suffering from Alzheimer's disease or residing within assisted living facilities. Many such design improvements also may be effective in improving life satisfaction and functional abilities of the non-institutionalized elderly.

Activities of Daily Living↗

PubMed2005

[Functional status of very old people in urban area: the Itabashi Oldest-Old Study I].

It is predicted that the future increase in the oldest-old (85 years and older) population will have a marked influence on society. However, little is known about the features of various functions in the oldest-old. The purpose of this study was to clarify the functional status of the oldest-old. We surveyed all oldest-old residents in a small area of Itabashi ward in metropolitan Tokyo to clarify their living conditions. The oldest-old themselves and their family members were invited to participate, and 235 out of 311 residents (75.6%) agreed to do so. Forty-two percent of the participants were dependent and needed care from others. The ADL status measured by the Barthel Index showed that 30% of independent participants also had some deterioration of physical function. These results are indicative of increased frailty in the oldest-old. Comparison between independent and dependent (need care from others in daily living) showed that the functional status was lower in dependent group. However, the psychological well-being was the same in this two groups. These results indicate progressive functional deterioation and psychological adaptation to it, in the oldest-old. Further research to elucidate the process of psychological adaptation to frailty is necessary in order to promote the well-being among the oldest-old, in whom functional limitation is evident.

Activities of Daily Living↗

PubMed2002

Heritability, reliability of genetic evaluations and response to selection in proportional hazard models.

The purposes of this study were 1) to investigate the heritability, reliability, and selection response for survival traits following a Weibull frailty proportional hazard model; and 2) to examine the relationship between genetic parameters from a Weibull model, a discrete proportional hazard model, and a binary data analysis using a linear model. Both analytical methods and Monte Carlo simulations were used to achieve these aims. Data were simulated using the Weibull frailty model with two different shapes of the Weibull distribution. Breeding values of 100 unrelated sires with 50 to 100 progeny (with different levels of censoring) were generated from a normal distribution and two different sire variances. For analysis of longevity data on the discrete scale, simulated data were transformed to a discrete scale using arbitrary ends of discrete intervals of 400, 800, or 1200 d. For binary data analysis, an individual's longevity was either 0 (when longevity was less than the end of interval) or 1 (when longevity was equal or greater than the end of interval). Three different statistical models were investigated in this study: a Weibull model, a discrete-time model (a proportional hazard model assuming that the survival data are measured on a discrete scale with few classes), and a linear model based upon binary data. An alternative derivation using basic expressions of reliabilities in sire models suggests a simple equation for the heritability on the original scale (effective heritability) that is not dependent on the Weibull parameters. The predictions of reliabilities using the proposed formulae in this study are in very good agreement with reliabilities observed from simulations. In general, the estimates of reliability from either the discrete model or the binary data analysis were close to estimates from the Weibull model for a given number of uncensored records in this simplified case of a balanced design. Although selection response from the binary data analysis depends on the end of interval point, there is a relatively good agreement between selection responses in the Weibull model and the binary data analysis. In general, when the underlying survival data is from a Weibull distribution, it appears that the method of analyzing data does not greatly affect the results in terms of sire ranking or response to selection, at least for the simplified context considered in this study.

Animals↗

PubMedDate not supplied

Nutritional product use and practice in nursing and residential homes.

AIM: To review the use of nutritional products in nursing and residential homes in the Northern Health and Social Services Board (NHSSB) area of Northern Ireland. METHOD: Two questionnaires on nutritional product use were sent to all (a total of 131) nursing and residential homes in the NHSSB area. RESULTS: A total of 122 nursing and residential homes completed and returned the questionnaires, giving a response rate of 93 per cent. Of these, 81 homes were administering nutritional products to some patients and residents. There were 3,208 residents in the homes that responded. Of these, 1,800 were residing in nursing homes and 1,390 in residential homes. Of the total of 3,190 people, 218 patients and 81 residents (299 in total) were receiving nutritional products. The findings suggest that oral supplements are the most commonly used means of nutritional support. There was a wide degree of variability between homes with regard to monitoring the use of nutritional products. In 39 per cent of cases (n = 118), the nutritional products was introduced into a person's diet because of frailty. Frailty was also mentioned in a further 15 per cent of cases (n = 45) as part of the reason for giving a nutritional product. CONCLUSION: The authors' findings suggest that guidelines should be developed to promote standardisation across nursing and residential care settings, where appropriate.

Adult↗

PubMed1999

[Mobility in the community-dwelling elderly and its correlates].

OBJECTIVE: To examine mobility level in community-dwelling elderly using a questionnaire of walking ability over a distance of 1 km and its relationship to activities of daily living (ADL) and quality of life (QOL) indices, and to obtain clues to mobility impairment in the elderly. SUBJECTS AND METHODS: A total of 3,266 community-dwelling elderly aged 60 to 84 years were interviewed with questionnaires for assessing mobility, ADL and QOL levels. The mobility was assessed by walking ability over a distance of 1 km, and the ADL levels were by conventional basic ADL, comprehensive mobility index and the Tokyo Metropolitan Institute of Gerontology Index of Competence, and the QOL levels were by self-rated health, Geriatric Depression Scale (GDS) short-version and Life Satisfaction Index-K (LSIK). They were also asked about diseases for which they regularly consult doctors, and about subjective symptoms. RESULTS: Eighty-seven percent of the subjects responded to the interview, with 86.3% of male responders and 77.6% of female responders answering that they could walk on foot over a distance of 1 km without any difficulty. The percentages of subjects who answered that they could walk but with difficulty or could not walk over a distance of 1 km increased with advancing age. The correlation analysis between 1 km-walking ability and other mobility indices showed that 1 km-walking ability was a better index for identifying a slight to moderate mobility impairment, and that the mobility level was closely associated with daily activity levels in the community-dwelling elderly. The elderly with an impaired mobility had lowered self-rated health, GDS and LSIK scores. After controlling for sex and age, it was shown that prevalences of musculoskeltal (knee arthritis, lower back pain, etc.), cerebrovascular and heart diseases, and complaints of subjective symptoms which were associated with physical frailty, were closely associated with impaired mobility. Hearing and visual disturbances also had a significant relation to a lowered mobility. CONCLUSIONS: Walking ability over a distance of 1 km may be a good index for discriminating differing mobility levels which community-dwelling elderly have intrinsically. The possible etiological factors for a lowered mobility in the elderly include musculoskeletal, cerebrovascular and heart diseases; physical frailty; and hearing and visual disturbances.

Activities of Daily Living↗

PubMed2000

Age related testosterone level changes and male andropause syndrome.

BACKGROUND: Much like the menopause syndrome occurring among older women, a similar condition has been defined among men. Testosterone production increases rapidly at the onset of puberty, then dwindles quickly after age 50 to become 20 to 50% of the peak level by age 80. Many men older than age 50 have experienced frailty syndrome, which includes decrease of libido, easy fatigue, mood disturbance, accelerated osteoporosis, and decreased muscle strength. We investigated serum total testosterone levels and andropause syndrome in men. METHODS: Serum total testosterone levels were measured in 53 symptomatic men older than age 50 and in 48 men younger than age 40 for a control group. We also analyzed andropause symptoms among the 53 men older than age 50. RESULTS: The mean serum total testosterone level in the symptomatic men older than age 50 (mean: 2.68 +/- 0.51 ng/ml, range: 1.21 to 4.13 ng/ml) was significantly lower than that in the control group (mean: 7.01 +/- 0.82 ng/ml, range: 5.53 ng/ml to 8.14 ng/ml). Male frailty syndrome in these men older than 50 included: decreased libido (91%), lack of energy (89%), erection problems (79%), falling asleep after dinner (77%), memory impairment (77%), loss of pubic hair (70%), sad or grumpy mood changes (68%), decrease in endurance (66%), loss of axillary hair (55%), and deterioration in work performance (51%). CONCLUSION: The serum total testosterone level showed a decline with aging, especially in the men older than age 50. Low serum testosterone levels were also associated with the symptoms of male andropause syndrome.

Adult↗

PubMed2002

Endocrine aspects of healthy ageing in men.

Frailty is characterized by generalized weakness, impaired mobility and balance and poor endurance. Loss of muscle strength is an important factor in the process of frailty, and is the limiting factor for an individual's chances of living an independent life until death. In men, several hormonal systems show a decline in activity during ageing. Serum bioavailable testosterone and oestradiol, dehydroepiandrosterone and its sulfate, and growth hormone and insulin-like growth factor 1 concentrations all decrease during ageing in men. Physical changes during ageing have been considered physiologic, but there is evidence that some of these changes are related to this decline in hormonal activity. Studies on hormone administration in the elderly appear to be promising. However, until now, hormone replacement has not yet been proven to be beneficial and safe.

Aging↗

PubMed2002

Unplanned hospital readmission and its predictors in patients with chronic conditions.

BACKGROUND AND PURPOSE: Unplanned hospital readmission is a devastating experience for patients and is costly for society. This study determined the 60-day unplanned readmission rate and its predicting factors in patients with chronic conditions. METHODS: A total of 334 patients discharged from five hospitals were followed for 2 months after discharge. Patients enrolled in the study were disabled and had a diagnosis of progressive chronic disease (congestive heart failure, chronic pulmonary disease, cancer) or chronic impairment following an acute episode (stroke, traumatic brain injury, hip fracture). Patients were assessed before discharge to collect in-hospital variables. Telephone interviews with patients and families were used to collect data on hospital readmission. RESULTS: Of the 334 patients followed, 76 had unplanned readmission (24.4%). Patients with progressive chronic disease had a higher readmission rate (40.9%) than those with chronic impairment following an acute episode (15.1%). Frailty and abnormal respiratory pattern were significant predictors of readmission for patients with progressive chronic disease. The predictors of readmission for patients with chronic impairment following an acute episode included frailty, clinical instability and discharge from a regional hospital. The major reasons for hospital readmission were exacerbation of the initial major disease (33/76, 43.4%) and infection (21/76, 27.7%). CONCLUSIONS: Exacerbation of chronic diseases and infection are the two major reasons for unplanned readmission. Patients with a progressive chronic disease are more likely to be readmitted.

Aged↗

PubMedDate not supplied

[Impact of population aging on the social and the health care system: need for a new model of long-term care].

Population aging is characterized by a marked increase in the number of subjects aged 80 years or more (the oldest old). In this group frailty is extremely common. Frailty is a recently identified condition resulting from a severely impaired homeostatic reserve, that places the elderly at the highest risk for adverse health outcomes, including dependency, institutionalization and death, following even trivial events. Geriatric medicine proposes an original methodology for the management of frail elderly subjects, the so called "comprehensive geriatric assessment", as well as a model of long-term care. These have been shown to reduce the risk of hospitalization and nursing home admission, with a parallel decrease in expenses and an improvement in the patient's quality of life. The effectiveness of the long-term care system depends on: 1) the availability of all the services that are necessary for the frail elderly, both in the hospital and in the community; 2) the presence of a coordinating team, the comprehensive geriatric assessment team, that develops and implements the individualized treatment plans, identifies the most appropriate setting for each patient and verifies the outcomes of the interventions; 3) the use of common comprehensive geriatric assessment instruments in all the settings; 4) the gerontological and geriatric education and training of all the health care and social professionals.

Aged↗

PubMed2003

Is low back pain in youth associated with weight at birth? A cohort study of 8000 Danish adolescents.

INTRODUCTION: Low back pain has been associated with an increased risk of several diseases and with poor general health. Also low birth weight has been associated with an increased susceptibility to various diseases as well as with poor general health. Thus, low birth weight could be a common factor--indicating a general frailty with an increased risk of both low back pain and overall morbidity. To our knowledge, the association between low back pain and birth weight has not previously been investigated. This study investigates the correlation between birth characteristics and low back pain in adolescence. MATERIAL AND METHODS: Analyses are based on data from The Danish Twin Registry. Information about low back pain is from a postal survey, and information about birth characteristics are from The Danish Medical Birth Register. Analyses include 8278 individuals aged 12-22 years--an age at which they are still largely unaffected by the influence of working life. Possible associations between low back pain, birth weight, birth length, ponderal index, gestational age and Apgar scores are investigated by the use of logistic regression analysis. RESULTS: The odds ratio for the lifetime prevalence of low back pain increases from 1.21 (0.94-1.56) for a birth weight of 2000-2500 g to 1.97 (1.35-2.88) for a birth weight of > 3500 g compared to the smallest weight group (< 2000 g) in males, whereas there is a small statistically insignificant, positive association for females. The same pattern is seen for the one-year prevalence of low back pain. No associations are documented between low back pain and other birth factors. The positive association between low back pain and birth weight is independent of other birth factors and of anthropometric measures in adolescence. CONCLUSION: There is a statistically significant association between high birth weight and the risk of developing low back pain in males but not in females. Our results do not indicate that frailty at birth increases the risk of low back pain in adolescence.

Adolescent↗

PubMedDate not supplied

Measuring the quality of life of the elderly in health promotion intervention clinical trials.

The Multicenter Trials of Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) is a series of clinical trials of biomedical, behavioral, and environmental interventions to reduce the risks of frailty and injury among the elderly. Reliable assessment of the quality of life reported by the subjects is a central issue in evaluating the interventions. An intervention may have a significant impact on an elderly person's sense of well-being, even though significant improvement is not observed in selected physical outcome measures. Elderly persons' compliance with particular intervention regimens may be influenced by the quality of life effects that they perceive in relation to the intervention. The researchers review the definition and measurement of quality of life in the trials, with particular attention to issues in determining common measures used at all study locations. Practical considerations in the selection and use of quality of life measures in both community and institutional populations are addressed. Topics discussed include the interrelation of aging, functional capacities, and quality of life; the multi-dimensionality of quality of life in relation to differential intervention effects; and age-related issues in the collection of quality of life data. Preliminary observations are reviewed, and potential contributions of FICSIT to intervention-sensitive quality of life assessments among the elderly are noted.

Activities of Daily Living↗

PubMed2004

Older age underwriting: frisky vs frail.

The speed of the aging process is variable. Some individuals remain exceptionally fit beyond age 90, while others become frail and fragile early. Survival is better predicted by biological age (state of health, status of reserves) rather than chronological age (age in years since date of birth). The frail group shows a higher mortality compared to the robust group. When assessing the elderly in underwriting, it is important to note the usual chronic diseases such as cardiovascular disease, COPD, cancer risk, and so on. But because of its strong impact on prognosis, it is also important to assess frailty. Key features of frailty are social isolation, dependency in managing life activities and self-care, cognitive decline, shrinking of bone and muscle mass, and slow weight loss.

Activities of Daily Living↗