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Results for “Frailty”

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PubMed1997

The effects of reproduction on longevity and fertility in male Drosophila melanogaster.

We examined the effect of reproduction on subsequent survival and fecundity of male Drosophila melanogaster by reversing the reproductive status of individuals part-way through life. Reproduction had a much more marked effect on fertility than survival: males with a history of reproduction showed complete sterility at a time when upwards of 80% of their cohort were still alive. Analyses of survival rates alone gave a misleading measure of the impact of ageing. Sterility appeared to be attributable mainly to a reduction in sperm count. Early reproduction caused permanent, irreversible damage to both survival and fecundity, with risk playing an apparently minor role. Individual differences in frailty appeared to be of little consequence for the interpretation of these reversal experiments, although its possible occurrence made definite detection of risk difficult.

Journal Article↗

PubMed2002

Depression and immune function: central pathways to morbidity and mortality.

OBJECTIVE: The increased morbidity and mortality associated with depression is substantial. In this paper, we review evidence suggesting that depression contributes to disease and death through immune dysregulation. METHOD: This review focuses on recent human studies addressing the impact of depression on immune function, and the health consequences of those changes. RESULTS: There is growing evidence that depression can directly stimulate the production of proinflammatory cytokines that influence a spectrum of conditions associated with aging, including cardiovascular disease, osteoporosis, arthritis, type 2 diabetes, certain cancers, periodontal disease, frailty, and functional decline. Additionally, depression can down-regulate the cellular immune response; as a consequence, processes such as prolonged infection and delayed wound healing that fuel sustained proinflammatory cytokine production may be promoted by depression. CONCLUSIONS: These direct and indirect processes pose the greatest health risks for older adults who already show age-related increases in proinflammatory cytokine production. Thus, aging interacts with depression to enhance risks for morbidity and mortality.

Aging↗

PubMed1997

No evidence of hemispheric facilitation following the induction of negative and positive affect.

A dichotomy is thought to exist between the hemispheres whereby the right hemisphere is specialized for the processing of negative emotions and the left hemisphere is specialized for positive emotions. Van Strien and Morpurgo (Neuropsychologia, 1992, 30, 845-848) demonstrated that the activation of negative and positive emotional states resulted in the allocation of attentional resources to the contralateral hemispace. In the present experiment we sought to replicate this effect and improve upon certain methodological features of the experiment. The effect of positive and negative emotions on performance in the left and right visual fields was investigated in 30 dextral students. Positive and negative emotional states were generated by presenting subjects with an emotive word prior to each trial and subsequently requiring them to use that word within a sentence. Performance within the left and right fields was measured using a gap detection task which was neutral in relation to functional asymmetry. No evidence of right or left visual field facilitation was found for the positive or negative conditions, respectively. These results are not interpreted as a refutation of hemispheric specialization for emotional valence. Instead, they are seen to highlight the frailty of hemispheric facilitation effects.

Adolescent↗

PubMed2001

Theory of the age dependence of mortality from congenital defects.

A theory is presented, based on the evidence that the congenital defect of an individual is at one of many different levels. It is supposed that the individual mortality risk from congenital defect is lognormally or normally distributed in the population. The relationship between childhood mortality from seven congenital defects and age is described. It uses data from the US during the period 1979-1991. Mortality from five congenital defects is inversely proportional to age. Mortality from two congenital defects is inversely proportional to the second power of age. The presented theory explains these two observed types of mortality decline with age. Childhood mortality from some infectious diseases is also inversely proportional to age during childhood in different populations. It follows from this theory that the death from these infectious diseases up the age of 10 years may be caused by a hidden congenital frailty.

Aging↗

PubMed2000

Satellite cell numbers in senile rat levator ani muscle.

Ageing in skeletal muscle results in motor frailty and a reduced capacity for self repair after injury. The contractile characteristics of muscle are determined principally by the myosin heavy chain (MHC) composition of its myofibers. During the restorative process, satellite cells play a central role. The present study compares the levator ani muscle of very old (32 months) and young (4 months) male WI/HicksCar rats in terms of structural integrity, MHC and satellite cell content. Myofiber typing was carried out by indirect immunohistochemistry using a panel of anti-MHC antibodies. Single myofibers for nuclear enumeration were isolated by an enzymatic technique while fiber cross-sectional areas and satellite cell frequencies were determined by computerized planimetry and electron microscopy. In both groups of rats, the myofiber population was homogeneously MHC type IIb-reactive. Cross-sectional data reflected a marked degree of atrophy in the muscle of the senile rats (710.05 +/- 63.6 microm2, compared with 1519.98 +/- 79.0 microm2 in young). The myofiber population was reduced by only about 6.7% with ageing and the representation of satellite cells, as a fraction of total sublaminal nuclei, was relatively stable (1.15 versus 1.91% in young; P > 0.05). The results indicate that ageing had a considerable atrophic effect on the levator ani muscle but induced neither MHC isoform transition nor massive depletion of the satellite cell pool. They suggest that the well-documented impairment of the restorative capacity of senile muscle could be due more to alterations in the nature of microenvironmental cues than to quantitative aspects of its cellular capacity to respond.

Aging↗

PubMed2001

The influence of water storage and C-factor on the dentin-resin composite microtensile bond strength and debond pathway utilizing a filled and unfilled adhesive resin.

OBJECTIVE: To test the elastic wall concept utilizing adhesive resins of varying stiffness in a low- and high-C-factor cavity design after short- and long-term water storage. METHODS: A flat and box-shaped cavity was restored on occlusal dentin with a resin composite using a filled and unfilled adhesive resin from which microtensile specimens with a 0.5mm(2) cross-sectional area were formed. After storage for 30- and 150-days the microtensile bond strength (muTBS) was determined in a Zwick materials testing machine and the subsequent debond pathway was examined under scanning electron microscopy. Fisher's exact test was used to determine differences in joint and substrate failure modes and a Weibull regression model with gamma frailties was used to test for differences between failure distributions. Tests for three-way and two-way interactions were also completed for storage time, C-factor and adhesive. All tests were at 95% confidence levels. RESULTS: The characteristic strength (TBS degrees ) for the Optibond FL adhesive applied on a flat cavity was 47.57 and 20.90MPa and a box-shaped cavity was 49.26 and 17.49MPa for short- and long-term storage, respectively, while the corresponding TBS degrees for the unfilled Optibond adhesive on the flat cavity design was 36.93 and 32.68MPa and in a box-shaped cavity was 32.84 and 15.46MPa. Combining all groups according to storage time revealed a three-fold increase in the debond pathway including the bottom of the hybrid layer. SIGNIFICANCE: Evidence suggests that the durability of the bonded joint is threatened by hydrolysis and the most susceptible region is the bottom half of the hybrid layer and in low C-factor cavity designs a more flexible adhesive resin liner was more durable.

Adhesiveness↗

PubMedDate not supplied

Post-hospitalization mortality in the elderly.

The level of disability and polypathology in hospitalized elderly is usually high. Multidimensional and functional assessment allows to identify risk factors for clinical and functional failure of patients. Many studies point out that identifying predictors of high-risk patients is a necessary step in accurate targeting. We evaluated 395 subjects (175 women, 202 men, mean age 77.9 year) during their hospitalization in our Geriatric ward. Baseline data included: demographics variables, medical diagnosis, functional evaluation, and laboratory values. After a 6-month follow up 80 (20.2%) subjects died. In our study, male gender, dependence at the Dependence Medical Index (DMI), low serum albumin (< 2.8 g/dl), impaired score at the Instrumental Activities of Daily Living scale (IADL), score lower than 13.7 at the acute physiology and chronic health evaluation (APACHE II) and neoplasm were independent predictors of 6-month post-hospitalization mortality. The high mortality rate of our sample could be a marker of considerable frailty among elderly patients. Our study shows that a poor functional status is a more reliable prognostic factor than type and number of admitting diagnosis. Clinical evaluation, improved with information about functional status, is a feasible and practical way of detecting risk of short term post-hospitalization mortality of elderly subjects.

Activities of Daily Living↗

PubMed2002

Testing Gateway Theory: do cigarette prices affect illicit drug use?

We test the causal Gateway Theory of drug use dynamics by way of a natural experiment. We randomize cigarette smoking by birth cohort and cigarette prices. We use data for Israel to show that while cigarette smoking causes cannabis use, the evidence that cannabis use causes hard drug use is much weaker. These results are based on various econometric methodologies including two-stage logit (2SL), bivariate probit, and frailty analysis for survival data.

Adolescent↗

PubMed2001

Radiotherapy for brain metastases: defining palliative response.

BACKGROUND AND PURPOSE: Most patients with brain metastases are treated with palliative whole brain radiotherapy (WBRT). There is no established definition of palliative response. The aim of this study was to develop and test clinically useful criteria for response following palliative WBRT. MATERIALS AND METHODS: A prospective study was conducted of patients with symptomatic brain metastases treated with WBRT (20 Gy/5 fractions) and standardised steroid tapering. Assessments included observer rating of neurological symptoms, patient-completed symptom checklist and performance status (PS). Response criteria were operationally defined based on a combination of neurological symptoms, PS and steroid dose. RESULTS: Seventy-five patients were accrued. At 1 month, presenting neurological symptoms were improved in 14 patients, stable in 17, and worse in 21; 23 patients were not assessed, mainly due to death or frailty. Using response criteria defined a priori, 15% (95% CI 7-23%) of patients were classified as having a response to RT, 25% no response, and 29% progression; 27% were deceased at or soon after 1 month. A revised set of criteria was tested, with less emphasis on complete tapering of steroids: they increased the proportion of patients responding to 39% (95% CI 27-50%) but didn't change the large proportion who did not benefit (44%). CONCLUSIONS: Clinical response to RT of patients with brain metastases is multifactorial, comprising symptoms, PS and other factors. Assessment of degree of palliation depend on the exact definition used. More research is needed in this important area, to help validate criteria for assessing palliation after WBRT.

Adult↗

PubMed1997

Management of geriatric behavior problems.

Agitation has many causes, and we have no way of classifying it that dictates the choice of the right agents or methods of treatment. It is also difficult to judge the effectiveness of any method. Because agitation is an intermittent phenomenon one can seldom be certain if improvement or worsening is merely incidental to the form of treatment instituted. The complexity of behavior disturbances demands an approach that enlists the cooperation of all involved in the care of the patient, and the use of a broad range of remedies. With regard to prevention, we should help people anticipate infirmity and even dementia. If good health is not taken for granted, this encourages that the present be used more purposefully. More than ever before in history, it is important to plan for the last stages of life. A greater percentage of people can expect to live into the years of frailty than ever before. It may not seem like an attractive thing to do, but a periodic mental review of one's future may be prudent. The consequences of a lack of foresight are seen in too many elderly. A small dose of reality now can result in a better old age.

Aged↗

PubMed2003

[Patients with Alzheimer's disease living alone at home in the cohort of REAL.FR].

OBJECTIVE: Despite the French population's growing, we reported an increasing numbers of older adults living alone and an increasing number of older adults with Alzheimer's disease. Social and medical problems may be exacerbated with subjects with both phenomena. The objective is to identify differences in patterns between persons with dementia who live alone versus living with some people at home. METHOD: 700 subjects with mild to moderate Alzheimer's disease from the French Alzheimer network (REAL.FR). We studied social and demographic feature, nutritional and cognitive statute and a comprehensive geriatric assessment. RESULTS: In this study, 28% of subjects with probable or possible Alzheimer's disease live alone. They are more likely to be women (p < 0.001) with few physical impairments (p < 0.02). Subject are more frailty: lower incomes, impairment in the nutritional status and balance, and are more likely to use medical and non medical services (p < 0.0001). They are more likely to be malnourished than the others. On the other hand, there is no association between disability's cognitive levels and living alone. CONCLUSION: We need longitudinal survey to follow up this population to determine predicting factors for keeping them alone at home and to anticipate long-term care placement.

Aged↗

PubMed1999

The impact of malnutrition on the quality of life in the elderly.

Malnutrition is a frequent condition, both widely represented in geriatric population and underestimated in diagnostic and therapeutic work-up, and is known to affect health status and life expectancy of elderly people. The unexpected weight loss is a pathological condition, recently classified in three different ways (sarcopenia, wasting and cachexia) according to criteria of nutritional intake, functional abilities and age-related body composition modifications, that is caused by social psychological and medical factors. In this review, the authors highlight the ways that, through malnutrition, could lead to an impairment of quality of life in elderly people. Notwithstanding the great impreciseness and confusion that surrounds the term 'quality of life', the authors focus their attention on the correlation existing with the recently occurring changes to patients' health status and life-style, analysing the relationship with frailty, failure to thrive and homeostatic balance failure syndrome. With the latter term, the authors introduce a pathological condition widely represented in the late stages of malnutrition that often evolves in multiple organ failure and lastly in the death.

Aged↗

PubMed1999

Some important issues in the planning of phase III HIV vaccine efficacy trials.

Given that interesting HIV vaccine candidates, including live preparations and DNA plasmids, exist and that the first phase III vaccine (AIDSVAX) testing is due to begin this summer, 1998, in the U.S., adequately addressing trial preparedness is a pressing issue. Despite double-blind randomized controlled clinical trial design, there may be difficulties with interpretation and use of the usual measures of vaccinal efficacy and calculation of sample size. Difficulties arise from vaccine characteristics (e.g. mode of action, time-lag, waning) and population heterogeneities (e.g. differences in susceptibility, sexual behaviour, mixing preferences) causing frailty effects that can exacerbate bias and time-dependent effects already known to exist in simple cases. Since vaccine properties, particularly mode of action, are unlikely to be known before the onset of clinical trials, choosing an efficacy measure and the associated analyses and sample size calculations will be problematic. Interim analyses designed to decide whether a study will be prolonged may be tenuous if based on a time-dependent measure and will influence sample size determination. Despite shortcomings, general recommendations can be made to minimise pernicious effects. The objectives of this paper are principally to review the current state of knowledge of the different stages in the preparation of large phase III HIV vaccine efficacy trials, the methodological difficulties related to their design, and the analysis of data collected from them. Mathematical models and trial simulations are used to demonstrate that further research is necessary to study the behaviour of vaccine efficacy measures under heterogeneous conditions of population, vaccine action, and trial design and identify a time-independent efficacy measure. Alternative methods to validate sample size calculations have to be developed in older to reduce the chances of unnecessary economic and human cost in phase III HIV vaccine trials.

AIDS Vaccines↗

PubMed2000

Compression of morbidity in the elderly.

The Compression of morbidity paradigm envisions reduction in cumulative lifetime morbidity through primary prevention by postponing the age of onset of morbidity to a greater amount than life expectancy is increased, largely by reducing the lifestyle health risks which cause morbidity and disability. Recent data document slowly improving age-specific health status for seniors, indicate that postponement of the onset of disability by at least 10 years is feasible, and prove effectiveness of some lifestyle interventions by randomized controlled trials. Human aging is increasingly represented by frailty, with declining reserve function of many organ systems, including the immune system. Enhancement of immune function in this setting raises medical, ethical, and social issues which are sometimes in conflict.

Aged↗

PubMed1992

Survival differences among older dialysis patients in the southeast.

Older end-stage renal disease (ESRD) patients treated by chronic dialysis have higher mortality in the United States than in many other countries. While increasing age, white race, male sex, and/or diabetes are considered risk factors for survival, few studies of older dialysis patients have simultaneously considered multiple predictor variables and their interactions. Using information contained in the 1982 to 1986 ESRD Network 20 database for Georgia and South Carolina, we studied hospitalizations and survival of 1,354 blacks and 965 whites who were age 60 years or older when they began dialysis therapy. Survival time was modeled using the Cox life-table regression method. Older blacks' median age at dialysis initiation was 67.4, compared with 68.7 for older whites (P = 0.001). Blacks were more likely than whites (P < 0.001) to have hypertension-related or diabetes-related ESRD. White patients experienced approximately 25% more hospitalization when adjustment was made for patient-days at risk. Separate multivariate survival models were required for patients with diabetes-related versus non-diabetes-related ESRD. Among diabetics, mortality was higher among whites and among patients who were older when they began dialysis. Among patients with non-diabetes-related ESRD, mortality was higher among patients who were older when they began dialysis, but the age effect was much stronger for white males. Our hospitalization and mortality data support the view that unmeasured severity (or frailty) differences characterize white as compared with black dialysis patients. Among non-diabetes-related ESRD patients, the age effect on survival was more severe in white males than in blacks or in white females. The high mortality we observed among older dialysis patients in Georgia and South Carolina warrants further study; the data may in part reflect patients' lower socioeconomic status compared with age, race, and sex-matched controls.

Aged↗

PubMed1999

Costs of formal care for frail older people in England: the resource implications study of the MRC cognitive function and ageing study (RIS MRC CFAS).

The aim of this paper is to quantify service use and costs of supporting frail older people at home in the community, using data collected in a longitudinal multicentre stratified randomised study for 1055 mentally frail, physically frail, and mentally and physically frail subjects. Average costs per person per week were found to total 64.45 Pounds Sterling, with a small number of services accounting for a large proportion of the total costs. The level of services offered by the nonstatutory voluntary and private sectors was found to be small. To highlight issues for policy makers, the extent of cost variations between a number of different subgroups were calculated. These bivariate analyses revealed substantial variation in costs, especially according to household structure, type of frailty, whether admission to continuing care accommodation occurred and survival. Multiple regression analysis demonstrated that 26% of the variation in log average weekly costs could be explained by a number of socio-demographic and health status variables. A particularly close relationship was observed between costs and whether admission to continuing care accommodation occurred, highlighting a need for policy-makers to examine the nature and scale of provision of alternative community based care packages. The results demonstrate that descriptive cost data such as those presented can provide information useful to the planning process, enabling more informed choices to be made over the provision of services for particular groups of people.

Aged↗

PubMed2002

Malarial anaemia: a crossroad?

Despite the apparent frailty of a complex cycle, Plasmodium falciparum seems remarkably fit in its ability to escape human interventions. The red blood cell is central in a number of aspects of the cycle. Hence, hematocrit reduction is of paramount importance in vector survival and reproduction, gametocyte induction and infectiousness, and host pathology. Here, in the light of recent observations, the importance of anemia for P. falciparum is emphasized, suggesting that among populations at risk for malaria, the subgroup of anemic patients may be preferential amplifiers of the plasmodial cycle.

Anemia↗

PubMed2000

Commentary on the Women's Health Initiative.

The Women's Health Initiative (WHI), established by the National Institutes of Health in 1991, is a long-term national health study that focuses on strategies for preventing heart disease, breast and colorectal cancer and osteoporosis in postmenopausal women. These chronic diseases are the major causes of death, disability and frailty in older women of all races and socioeconomic backgrounds. The WHI a 15-year multi-million dollar endeavor, and one of the largest U.S. prevention studies of its kind. The study involves over 161,000 women aged 50-79, and is one of the most definitive, far reaching clinical trials of women's health ever undertaken in the U.S. The WHI Clinical Trial and Observational Study will attempt to address many of the inequities in women's health research and provide practical information to women and their physicians about hormone replacement therapy, dietary patterns and calcium/vitamin D supplements, and their effects on the prevention of heart disease, cancer and osteoporosis. Emerging information from the NIH Women's Health Initiative and other studies of women's health begun in the 1990's should be changing the landscape of options for older women in the years to come.

Aged↗