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Results for “Frailty”

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PubMed2003

Effects of exercise training added to ongoing hormone replacement therapy on bone mineral density in frail elderly women.

OBJECTIVES: To determine whether exercise training added to ongoing hormone replacement therapy (HRT) increases bone mineral density (BMD) in physically frail elderly women. DESIGN: Prospective controlled trial. SETTING: University-based research center. PARTICIPANTS: Twenty-eight women on HRT, aged 75 and older with physical frailty. INTERVENTIONS: Participants were assigned to 9 months of supervised (EXER) or home (HOME) exercise. The EXER program started with physical therapy and gradually incorporated resistance and endurance training. The HOME program consisted of flexibility exercises. MEASUREMENTS: Changes in BMD and body composition. RESULTS: There were larger increases in lumbar spine BMD in response to EXER than with HOME (3.5% vs 1.5%, P =.048), with a trend for larger increases in total body BMD (1.5% vs 0.2%, P =.058). There were no significant between-group differences in hip BMD. The EXER group had decreases in weight (-2.2 +/- 0.3 kg, P =.010) and fat mass (-2.7 +/- 0.4 kg, P =.018) and increases in muscle strength (9-30%, P <.05). CONCLUSION: In physically frail elderly women on HRT, relatively vigorous exercise training significantly increased lumbar spine BMD. The improved BMD and strength in response to exercise could reduce fracture risk in frail women already on HRT.

Aged↗

PubMed2003

Low total cholesterol and increased risk of dying: are low levels clinical warning signs in the elderly? Results from the Italian Longitudinal Study on Aging.

OBJECTIVES: To analyze the relationship between serum total cholesterol (TC) and all-cause mortality, taking into account various potential confounders. DESIGN: Population-based prospective cohort study. SETTING: Older Italians residing in the general community. PARTICIPANTS: Four thousand five hundred twenty-one men and women aged 65-84. MEASUREMENTS: Vital status data were available for 1992-95. The hazard ratios of dying for subjects in the second, third, and fourth quartiles compared with the first quartile of TC were computed using Cox proportional hazards, adjusting for lifestyle factors, anthropomorphic and biochemical measures, preexisting medical conditions, and frailty indicators. RESULTS: Blood samples were obtained from 3,295 (73%) of the participants, of whom 399 died during almost 3 years of follow-up. Low TC was associated with a higher risk of death. Those with TC in the second, third, and fourth quartiles (TC>189 mg/dL or 4.90 mmol/L) had lower hazard ratios (HRs) of death than subjects in the first quartile (0.57, 95% confidence interval (CI) = 0.38-0.87; 0.56, 95% CI = 0.36-0.88; and 0.53, 95% CI = 0.33-0.84, respectively). Few subjects taking lipid-lowering drugs (LLDs) were in the lowest quartile of cholesterol, suggesting that these individuals have low TC values for reasons other than LLD use. CONCLUSION: Subjects with low TC levels (<189 mg/dL) are at higher risk of dying even when many related factors have been taken into account. Although more data are needed to clarify the association between TC and all-cause mortality in older individuals, physicians may want to regard very low levels of cholesterol as potential warning signs of occult disease or as signals of rapidly declining health.

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PubMed1998

Frail bodies, courageous voices: older people influencing community care.

Involving frail older users of health and social care services in decision making presents particular challenges for those committed to hearing the voices of service users. Age Concern Scotland initiated a project in Fife, the User Panels project, intended to enable older people who were unable to leave their homes without assistance to meet together to develop a collective voice expressing the needs and experiences of older service users. This paper reports on an evaluation of that project. It considers methodological questions posed by the evaluation of projects which aim to empower users, as well as discussing key findings from the evaluation. Older people were recruited through contacts in service agencies and other local organizations. The largest group was aged between 86 and 90 years and all were experiencing difficulties relating to poor health, physical frailty or disability. The project was based on a belief in the value of meeting together as a means through which people could develop the confidence to express their views. Those who became members of the panels valued this experience and reported intrinsic benefits related to the social contact, opportunities for learning and development of self-esteem. Evidence concerning enhanced capacity to exercise control over key aspects of their lives was less convincing. The work of the panels was generally well received by local social work and health agencies and had influenced local action in some areas. Responses to some issues raised by the panels generated a less positive response and the article considers reasons for this. The model is considered to demonstrate benefits both for the older people who become involved and for officials seeking to improve the sensitivity of services to the needs of older people.

Journal Article↗

PubMed2002

Heritability of death from coronary heart disease: a 36-year follow-up of 20 966 Swedish twins.

OBJECTIVE: The aim of the present study was to evaluate and distinguish between environmental and genetic effects for death from coronary heart disease (CHD) as well as to determine whether the importance of genetic influences is changing with age. DESIGN: A cohort study with a follow-up time of 36 years. SUBJECTS: The cohort drawn for the present study includes 20 966 twins born in Sweden between 1886 and 1925 where both twins within a pair still lived within the country in 1961. METHODS: Concordances and correlated gamma-frailty model were used to assess and distinguish between genetic and environmental influences as well as to evaluate age-related changes in genetic influences. RESULTS: A total number of 4007 CHD-deaths (2208 males, and 1799 females) was observed. The probability of dying from CHD given that one's twin partner already has died from CHD decreased with increasing age, particularly amongst males. The genetic variation in susceptibility to death from CHD was moderately large, and decreased slightly across time, particularly amongst males. The heritability was 0.57 (95% CI, 0.45-0.69) amongst male twins, and 0.38 (0.26-0.50) amongst female twins. CONCLUSIONS: The genetic contribution to the variation in CHD-mortality was moderate both in females and males. Furthermore, although genetic effects appeared to be greater at younger ages of death, our findings clearly suggest that genetic factors are in operation throughout the entire life span.

Adult↗

PubMed2002

Side rails as physical restraints in the care of older people: a management issue.

This article explores the use of side rails within the context of physical restraint in gerontological practice. It is debated that side rails can be considered as a form of physical restraint if the individual cannot voluntarily remove/lower the device if he/she wishes to do so. The value of side rails as a protective medium is debated with regard to their association with injuries sustained as a result. Side rails should be used with caution and within a risk management context. Frailty should not be an indicator for the use of side rails, an individualized approach to determine patient's suitability to side rails is advocated.

Aged↗

PubMed2002

Benefits of exercise and dietary measures to optimize shifts in body composition with age.

Ageing is associated with changes in body composition, including an increase and redistribution of adipose tissue and a decrease in muscle and bone mass, beginning as early as the fourth decade of life. These changes have significant implications for the health and functioning of the individual because of their associations with chronic disease expression and severity, as well as geriatric syndromes such as mobility impairment, falls, frailty and functional decline. Therefore, understanding the preventive and therapeutic options for optimizing body composition in old age is central to the care of patients in mid-life and beyond. Pharmacological interventions are currently available for maintaining or improving bone mass, and much current interest is focused on anabolic agents that will preserve or restore muscle mass, as well as those that can potentially limit adipose tissue deposition. However, in this brief review, non-pharmacological modulation of body composition through appropriate dietary intake and physical activity patterns, will be discussed. There is sufficient evidence currently to suggest that a substantial portion of what have been considered 'age-related' changes in muscle, fat and bone are in fact related either to excess energy consumption, decreased energy expenditure in physical activity, or both factors in combination. In addition, selective underconsumption of certain macro- or micronutrients contributes to losses of muscle and bone mass. Each of the three compartments will be considered in turn, with recommendations for optimizing the size of these body tissue stores in early adulthood, and minimizing undesirable changes typically seen in middle and old age.

Adipose Tissue↗

PubMed2002

Aging: a body of resistance.

The present paper explores the language of aging used, often unthinkingly, by nurses and policy makers. Terms so often used when describing aging, such as "frailty" and "dependence", are used in a way that implies a common knowledge, a point of convergence. It will be argued, using data gathered from research, that these terms often are a point of departure and that they may not signify a common understanding at all. From a postmodern perspective, it will be argued that it is at this point that common knowledge comes up against corporeal or embodied knowledge. In conclusion, the author will argue for a clinical encounter in which intersubjective meanings can be elucidated.

Aged↗

PubMedDate not supplied

What is the prognosis of mild normocytic anaemia in older people?

BACKGROUND: There is reduced survival for people with all types of anaemia and it has been shown that there is a low yield from investigations for older people with normocytic anaemia. However, the longer-term outcomes of people with mild normocytic anaemia are not known. AIMS: To determine the 5-year prognosis of older people with mild normocytic anaemia, compared with non-anaemic controls. METHODS: This was a prospective cohort study, with some retrospective data collection, comparing 52 people aged > or =65 years (haemoglobin 100-119 g/L; mean cell volume 80-99 fL) without an obvious cause at presentation with 52 non-anaemic controls. The incidence of death, new malignancies and significant illnesses was compared between the two groups, 5 years later. RESULTS: Anaemic patients were less likely to be living at home at baseline. Although survival was lower for the anaemic group at all follow-up times, these differences were not significantly different. Over 5 years, there were no significant differences between groups in the types of problems that developed. CONCLUSIONS: A mild normocytic anaemia in older people, in the absence of an obvious cause, is not associated with significant differences in outcomes but is associated with poorer independence and a trend to lower survival. We suggest it may therefore be a marker of frailty in older people.

Aged↗

PubMed2002

Cognitive functions after transient topographical amnesia.

Twelve consecutive patients having previously experienced one or more episodes of isolated transient topographical amnesia (TTA) underwent neuropsychological examination 6-12 months after the last episode to detect signs of global cognitive decline and to assess, in particular, cognitive functions deemed critical for topographical orientation. The test scores were compared with those of 12 normal subjects matched for age, sex, educational level and place of residence. Both patients and controls showed normal performances in all tasks. The comparison between the two groups revealed a significantly lower performance of the patient group in a task of geographical orientation, namely 'Map of Italy'. We conclude that isolated episodes of TTA in the elderly per se do not represent a sign of mental deterioration, but can be associated with frailty on survey components of spatial orientation. It remains to be explained whether this feature is a pre-existing condition favouring the occurrence of the episodes of topographical amnesia or represents a sequela.

Activities of Daily Living↗

PubMed2002

The demography of slow aging in male and female Drosophila mutant for the insulin-receptor substrate homologue chico.

Hypomorphic mutants affecting the Drosophila insulin/IGF signal pathway are reported to increase longevity in females but not in males. To understand this sex-difference, we conducted a large-scale demographic study with three new isogenic strains of alleles at chico, the insulin-receptor substrate homologue. We verify that female dwarf homozygotes (ch1/ch1) and normal-sized heterozygotes (ch1/+) are long-lived, as originally reported. We find for the first time that male heterozygotes are long-lived relative to wildtype, by about 50%. The life span of male ch1/ch1 is similar to that of wildtype but these dwarf males age at a slow demographic rate. The levels of demographic frailty and of age-independent mortality are elevated in ch1/ch1 males, counteracting the effect of slow aging upon life expectancy. Mortality deceleration occurs amongst the oldest-old wildtype adults, as seen in many organisms. Remarkably, in similarly sized cohorts of male and female ch1/ch1 and of male ch1/+ mortality deceleration is absent. Mortality deceleration is a phenotype of chico.

Aging↗

PubMed2001

Lipoprotein metabolism in Japanese centenarians: effects of apolipoprotein E polymorphism and nutritional status.

OBJECTIVES: To assess the complex interaction of apolipoprotein (apo) E polymorphisms and environmental factors on lipoprotein profile in centenarians. DESIGN: Cross-sectional analysis. SETTING: Tokyo metropolitan area. PARTICIPANTS: Seventy-five centenarians and 73 healthy older volunteers (mean age 63.1 +/- 10.0) living in the Tokyo metropolitan area. MEASUREMENTS: Plasma lipids and lipoproteins, cholesteryl ester transfer protein mass, apo E phenotype, body mass index, nutritional indices (serum albumin, prealbumin, transferrin), dietary intake, inflammation markers (C-reactive protein (CRP), interleukin-6 (IL-6)), activities of daily living, and cognitive function. RESULTS: In comparison with older people, the centenarians had low concentrations of total and low-density lipoprotein cholesterol (LDL-C) and a relative predominance of high-density lipoprotein 2 cholesterol. No environmental factor, except the number of apo E epsilon2 alleles, was a significant determinant of LDL-C and apo B, suggesting that the low apo B-containing lipoprotein in centenarians may be attributable to a genetic cause. Centenarians had elevated levels of lipoprotein (a) and decreased high-density lipoprotein cholesterol (HDL-C), which seem to be an unfavorable lipoprotein profile. Lower levels of HDL-C in the centenarians were associated with decreased serum albumin, elevated CRP and IL-6 levels, and cognitive impairment, suggesting that HDL-C could be a sensitive marker for frailty and comorbidity in the oldest old. CONCLUSIONS: Low levels of apo B-containing lipoproteins attributable to a genetic cause may be advantageous for longevity. Lipoprotein profiles in centenarians were consistently related to the subjects' nutritional status, inflammation markers, and apo E polymorphisms. The results provide evidence for the importance of maintaining nutritional status in the very old.

Activities of Daily Living↗

PubMed2001

Clock drawing: analysis in a retirement community.

OBJECTIVE: To test the hypothesis that performance on a clock-drawing test in a mailed survey to an older cohort is associated with known and potential risk and protective factors for Alzheimer's disease. DESIGN: The Leisure World Cohort Study is an ongoing study, begun in 1981, of nearly 14,000 older adults. In November 1992, the 8,406 living cohort members were mailed a follow-up questionnaire. SETTING: Leisure World Laguna Hills, a southern California retirement community. PARTICIPANTS: The study population is a predominantly white, well-educated, upper-middle-class community; approximately two-thirds are women. Data from 4,843 cohort members (mean age 80 years; range 52-101) were analyzed. MEASUREMENTS: The questionnaire included a clock-drawing task: a predrawn circle 3 1/4 inches (8.3 cm) in diameter was provided with instructions "In the circle below, draw in the numbers as on a clock face. Make no erasures." Clocks were scored on 7 items: all numbers 1-12 present without adding extra or omitting numbers, sequencing of numbers, position of numbers, orientation of numbers to circle, consistent number style (either Arabic or Roman), tilt of numbers, and superfluous marks. A total clock score was calculated by summing the number of correct individual items (0-7). We also classified individuals as cognitively impaired by a previously suggested method: individuals were affected if they did not have three numbers drawn in the upper left quadrant of the clock face. RESULTS: Ninety percent or more of the participants across all ages placed the numbers 1 to 12 on their clocks without omissions or additions; 35% completed the clock drawing without error. The mean total clock scores decreased with each successive 5-year age group in both men and women. Regression analysis indicated a significant effect for age (b = -0.15, P <.0001), education (b = 0.05, P =.0001), smoking (b = 0.13, P =.03), and female gender (b = -0.05, P =.05) and a marginally significant effect of nonrheumatoid arthritis (b = 0.05, P =.07) on total clock score. No other measured variable had a significant effect. Cognitively impaired individuals were more likely to be female and older. After adjusting for age and gender, they were also more likely to be hypertensive and to have taken blood pressure medication and less likely to be college graduates, have glaucoma or arthritis, and to have taken vitamin supplements. CONCLUSION: The clock-drawing task is an appealing measure of cognitive function for large epidemiological studies because it is a simple, self-administered test that is easily adapted to mail surveys and correlates with more-detailed and more-time-consuming cognitive screens. Although it is relatively free of influence by language, cultural, or ethnic factors, our study shows that even in a highly educated population, clock drawing is influenced by educational level and other known risk factors for Alzheimer's disease. Thus a clock-drawing task may help predict cognitive frailty and future disability in older people. Such determination can direct high-risk individuals to earlier diagnosis, potential therapies, and better management.

Age Distribution↗

PubMed2002

Prescription drug costs for dually eligible people in a medicaid home- and community-based services program.

This study examined the prescription drug costs of Medicare beneficiaries participating in a Medicaid home- and community-based services (HCBS) program and discussed possible implications of providing a prescription drug benefit under Medicare. The study examined Medicaid pharmaceutical claims data using two random samples (n=766) of dually eligible Medicare beneficiaries in a HCBS program from four regions in Georgia. The average total monthly Medicaid prescription drug expenditure was determined. Annual prescription expenditures for this group averaged more than 1,500 dollars per person. Prescription drugs intended for the treatment of cancer and circulatory disorders combined to account for 61% of total program drug expenditures. Multivariate analysis found that drug expenditures were higher for those who died during the observation period, the young-old, Caucasians, and those who self-selected into the program. Higher drug expenditures for the self-selected group, even after frailty adjustments, suggest the presence of adverse selection. Medicare prescription drug benefit proposals that rely on voluntary enrollment may also experience adverse selection from frail, low-income beneficiaries.

Aged↗

PubMed2002

Dying of old age: an examination of death certificates of Minnesota centenarians.

OBJECTIVES: To compare how causes of death are recorded on the death certificates of centenarians with those who die in their 70s, 80s, and 90s. We also examined direct and indirect acknowledgment of age as a cause of death. DESIGN: Retrospective review of death certificates. SETTING: State of Minnesota. PARTICIPANTS: The death certificates of 26,415 individuals aged 70 and over who died in Minnesota in 1998 were examined for underlying causes of death. Of these, 449 were for individuals who were aged 100 and older at the time of their death. MEASUREMENTS: Causes of death. RESULTS: Diabetes mellitus, chronic obstructive pulmonary disease, cirrhosis, myocardial infarction, and most cancers decreased in frequency as reported causes of death with advancing age. Conversely, congestive heart failure, atherosclerosis, and neurological/mental and poorly defined conditions increased in frequency with age. CONCLUSIONS: Centenarians appear to "outlive" the risks for many of the conditions that are common causes of death for those who die in their 70s, 80s, and 90s, such as cancer and myocardial infarction. Conditions associated with aging, such as congestive heart failure and degenerative neurological conditions become more prominent as reported causes of death in the oldest individuals. The guidelines for the completion of death certificates should be modified to facilitate direct acknowledgment of age-related frailty as a contributing cause of death.

Aged↗

PubMed2002

Is there a relationship between fat-free soft tissue mass and low cognitive function? Results from a study of 7,105 women.

OBJECTIVES: To test the hypothesis that low fat-free soft tissue mass and cognitive impairment are independently associated. DESIGN: Cross-sectional study. SETTING: Five geographic areas of France. PARTICIPANTS: Seven thousand one hundred five community-dwelling women aged 75 and older recruited from electoral rolls between 1992 and 1994. MEASUREMENTS: Fat-free soft tissue mass, body fat mass, and bone mineral density were measured using dual-energy x-ray absorptiometry. Study participants were assessed for cognitive impairment using the Short Portable Mental Status Questionnaire and divided into two groups according to their scores. Logistic regression models were used to calculate multivariate-adjusted differences in body composition between two groups of subjects according to their cognitive function. RESULTS: After adjustment for confounders, compared with women in the highest quartile of fat-free soft tissue mass, women in the lowest quartile had an odds ratio of 1.43 (95% confidence interval (CI) = 1.07-1.91) for cognitive impairment. Low fat mass was also associated with lower cognitive function, with an odds ratio of 1.35 (95% CI = 1.01-1.79) for the lower quartile of fat mass compared with the highest quartile. There was no association between cognitive impairment and bone mineral density. CONCLUSIONS: This finding supports the hypothesis that low muscle mass is associated with cognitive impairment in older women. These two components represent major causes of frailty and functional decline in older people and could have some common mechanisms. Nevertheless, these results do not predict the causal variable.

Adipose Tissue↗

PubMed2002

Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA).

OBJECTIVES: To determine the prevalence of adverse drug reaction (ADR)-related hospital admissions in an older population, to describe the most common clinical manifestations and drugs most frequently responsible for ADR-related hospital admissions, and to identify independent factors predictive of these ADRs. DESIGN: Multicenter pharmacoepidemiology survey conducted between 1988 and 1997. SETTING: Eighty-one academic hospitals throughout Italy. PARTICIPANTS: Twenty-eight thousand four hundred eleven patients consecutively admitted to participating centers during the survey periods. MEASUREMENTS: For each suspected ADR at admission, a physician, who coded description, severity, and potentially responsible drugs, completed a questionnaire. RESULTS: Mean age +/- standard deviation of the patients was 70 +/- 16. One thousand seven hundred four ADRs were identified upon hospital admission. In 964 cases (3.4% of all admissions), ADRs were considered to be the cause of these hospital admissions. Of these, 187 ADRs were coded as severe. Gastrointestinal complaints (19%) represented the most common events, followed by metabolic and hemorrhagic complications (9%). The drugs most frequently responsible for these ADRs were diuretics, calcium channel blockers, nonsteroidal antiinflammatory drugs, and digoxin. Female sex (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.10-1.54), alcohol use (OR = 1.39, 95% CI = 1.20-1.60), and number of drugs (OR = 1.24, 95% CI = 1.20-1.27 for each drug increase) were independent predictors of ADR-related hospital admissions. For severe ADRs, age (OR = 1.50, 95% CI = 1.01-2.23 for age 65-79 and OR = 1.53, 95% CI = 1.00-2.33 for age > or =80, respectively), comorbidity (OR = 1.12, 95% CI = 1.05-1.20 for each point in the Charlson Comorbidity Index), and number of drugs (OR = 1.18, 95% CI = 1.11-1.25 for each drug increase) were the only predisposing factors. CONCLUSIONS: The most important determinant of risk for ADR-related hospital admissions in older patients is number of drugs being taken. When considering only severe ADRs, risk is also related to age and frailty.

Aged↗

PubMed2002

Cognitive and functional decline in adults aged 75 and older.

OBJECTIVES: To simultaneously examine the influence of functional disability on the development of cognitive impairment and the influence of cognitive status on the development of functional disability over time and compare findings across ethnic groups. DESIGN: A population-based longitudinal study. SETTING: Galveston County, Texas. PARTICIPANTS: Three hundred sixty-five community-dwelling Hispanic Americans, African Americans, and non-Hispanic whites, aged 75 and older. MEASUREMENTS: Baseline measures included demographics, self-reported chronic medical conditions, functional disability, and cognitive status. Longitudinal measures included functional decline and cognitive decline. RESULTS: Substantial functional decline was associated with each additional error on the mental status measure; substantial cognitive decline was associated with each additional antecedent disability. These findings were evident across all three ethnic groups, even when taking into account the effects of demographic factors and chronic health conditions, although the specific chronic health conditions that influenced cognitive and functional decline were found to vary across the three ethnic groups. CONCLUSION: Our findings suggest that, rather than simply being correlated markers of increasing frailty, cognitive and functional decline appear to influence the development of one another. Clinicians need to be aware of these associations, which may affect the direction of preventive care and rehabilitation in the oldest old. Appropriate intervention may result in the prevention or delay of functional disability and cognitive decline. Awareness of the specific chronic health conditions that increase the risk for cognitive or functional decline in various ethnic groups, and the effect of comorbid disease, may also help efforts to prevent decline in older adults.

Activities of Daily Living↗

PubMed2003

Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial.

OBJECTIVES: To determine whether an intense tai chi (TC) exercise program could reduce the risk of falls more than a wellness education (WE) program in older adults meeting criteria for transitioning to frailty. DESIGN: Randomized, controlled trial of 48 weeks duration. SETTING: Twenty congregate living facilities in the greater Atlanta area. PARTICIPANTS: Sample of 291 women and 20 men aged 70 to 97. MEASUREMENTS: Demographics, time to first fall and all subsequent falls, functional measures, Sickness Impact Profile, Centers for Epidemiologic Studies-Depression Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scales, and adherence to interventions. RESULTS: The risk ratio (RR) of falling was not statistically different in the TC group and the WE group (RR=0.75, 95% confidence interval (CI)=0.52-1.08), P=.13). Over the 48 weeks of intervention, 46% (n=132) of the participants did not fall; the percentage of participants that fell at least once was 47.6% for the TC group and 60.3% for the WE group. CONCLUSION: TC did not reduce the RR of falling in transitionally frail, older adults, but the direction of effect observed in this study, together with positive findings seen previously in more-robust older adults, suggests that TC may be clinically important and should be evaluated further in this high-risk population.

Accidental Falls↗