SEARCH · PubMed Health

Results for “Frailty”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 811 records · Page 45Linked to original sources

PubMed2003

Alternative therapy use by elderly African Americans attending a community clinic.

OBJECTIVES: To describe the use of orally ingested alternative therapies (OAT) by a community-dwelling, primarily African-American sample of elders. DESIGN: Face-to-face survey. SETTING: University-affiliated geriatric medicine primary care clinic. PARTICIPANTS: One hundred two elderly OAT users and 100 nonusers who had an appointment between June and August 2000. MEASUREMENTS: Demographic characteristics, OAT products used, reasons for use, and influencing factors leading to use. RESULTS: Two hundred ninety-two subjects were screened: 102 (35%) OAT users, 100 (34%) nonusers, and 90 (31%) who refused to participate. The OAT users were 78% female and 67% African American, with a mean age+/-standard deviation of 79.7+/-6.2. They were a frail group, with an average of 5.2+/-2.3 medical conditions, 4.5+/-2.3 medications, and 52% with at least one impairment in activities of daily living. Nonusers had more documented medical conditions and medications and a lower median household income. The most popular OAT products were multivitamins (65%), vitamin E (42%), and calcium (31%). Ninety-seven percent of users reported concurrent OAT and prescription medication use. The patients took OATs to supplement their diet (23%) and stay well (15%), as well as for various medical conditions. Influencing factors for OAT use were media advertisements (37%), physicians' advice (36%), and immediate family members (19%). Sixty percent of elders discussed their OAT use with their physicians CONCLUSION: Community-dwelling, primarily African-American, elders are using OATs despite physical frailty and limited financial resources. OAT users are healthier and wealthier than nonusers. More subjects used concurrent OAT and prescription medications and discussed their use with their physicians than would be expected from the literature. A large national survey of OAT use by minority elders could explore these findings.

Activities of Daily Living↗

PubMed2003

Biological interactions of aging and anemia: a focus on cytokines.

Anemia is one of the characteristics of the frailty phenotype and is often observed in elderly patients. Although anemia in people of advancing age can often be attributed to underlying etiologies such as iron deficiency or chronic disease, some cases do not have any identifiable cause. Therefore, it has been suggested that the aging process itself might be an intrinsic factor in the development of anemia, possibly through the age-related dysregulation of certain proinflammatory cytokines such as interleukin-6 (IL-6). Although the mechanism underlying the association between increased IL-6 and anemia has not been fully elucidated, it has been suggested that, like with other cytokines, it involves direct inhibition of erythropoietin production or interaction with the erythropoietin receptor.

Aged↗

PubMed2002

Motor performance deteriorates with simultaneously performed cognitive tasks in geriatric patients.

OBJECTIVE: To investigate whether simultaneous cognitive tasks influence maximal motor performance in frail geriatric patients with a history of injurious falls and different levels of cognitive function. DESIGN: Experimental 3-group design. SETTING: Geriatric rehabilitation hospital. PARTICIPANTS: Twenty-two healthy, young adults (mean age +/- standard deviation, 27.7 +/- 9y) and 23 geriatric patients (mean age, 80.9 +/- 5.4y) with a history of injurious falls with (Mini-Mental State Examination [MMSE] score, 20.5 +/- 1.6) and without (MMSE score, 28.1 +/- 1.2) cognitive impairment. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Motor performance: peak and integral of maximal isometric strength of leg extensors. Cognition: semiautomated calculation steps (serial 2 forward) and nonautomated calculation steps derived from the MMSE (serial 7 retro). Motor and cognitive performances were examined as single and dual tasks. RESULTS: In frail geriatric patients, especially in patients with cognitive impairment, maximal motor performance decreased significantly during all dual tasks. Cognitive performance was reduced, depending on the task and group. CONCLUSION: In frail or cognitively impaired geriatric patients, additional tasks can substantially decrease maximal motor performance. Insufficient resources on dual tasking may thus be a link in connecting the high incidence of falls with frailty and cognitive impairment in geriatric patients with a history of injurious falls.

Accidental Falls↗

PubMed2003

A prehabilitation program for physically frail community-living older persons.

OBJECTIVES: To describe the development and implementation of a preventive, home-based physical therapy program (PREHAB) and to provide evidence for the safety and interrater reliability of the PREHAB protocol. DESIGN: Demonstration study. SETTING: General community. PARTICIPANTS: Ninety-four physically frail, community-living persons, aged 75 years or older, who were randomized to the PREHAB program in a clinical trial. INTERVENTIONS: The PREHAB program built on the physical therapy component of 2 previous home-based protocols. A total of 223 assessment items were linked to 28 possible interventions, including progressive balance and conditioning exercises, by using detailed algorithms and decisions rules that were automated on notebook computers. MAIN OUTCOMES MEASURES: The percentages of participants who were eligible for and who completed each intervention, the extent of progress noted in the balance and conditioning exercises, adherence to the training program, and adverse events. RESULTS: Participants who completed the PREHAB program and those who ended it prematurely received an average of 9.7 and 7.2 interventions during an average of 14.9 and 9.5 home visits, respectively. With few exceptions, the completion rate and interrater reliability for the specific interventions were high. Despite high self-reported adherence to the training program, the majority of participants did not advance beyond the initial Thera-Band level for the upper- and lower-extremity conditioning exercises, and only about a third advanced to the highest 2 levels of the balance exercises. Adverse events were no more common in the PREHAB group than in the educational control group. CONCLUSION: Our results support the feasibility and safety of the PREHAB program, but also show the special challenges and pitfalls of such a strategy when it is implemented among persons of advanced age and physical frailty.

Aged↗

PubMed1999

A pilot study of continuous, hyperfractionated, accelerated radiotherapy in rectal adenocarcinoma.

This pilot study investigated the feasibility, toxicity and effect of continuous, hyperfractionated, accelerated radiotherapy (CHART) in 19 patients with adenocarcinoma of the rectum who were treated at Mount Vernon Hospital between April 1992 and April 1994. A total dose of 54 Gy was given in 36 fractions over 12 consecutive days; three fractions of 1.5 Gy were employed each day with an interfraction interval of 6 hours. Of these 19 patients, 13 had local pelvic recurrence from rectal carcinoma, four had a primary rectal carcinoma (which was unsuitable for abdominoperineal resection because of patient frailty), and two had large, fixed, unresectable tumours and were given radiotherapy preoperatively to a lower dose of 42 Gy in 28 fractions over 10 days to facilitate surgery. However, none of the 19 patients subsequently underwent surgical resection. Treatment compliance with radiotherapy was 95%. Acute bowel toxicity was assessed by means of a daily bowel chart for 6 weeks and then at 8, 12 and 26 weeks after the completion of radiotherapy. Patients were subsequently scored using the World Health Organization (WHO) grading system. No toxic deaths were observed in this study. There were five grade 3 and one grade 4 toxicities (WHO scale) observed in six patients. There has been minimal acute bladder toxicity in two patients and skin reactions have been surprisingly minimal in all but three patients. Small bowel obstruction and late bowel damage, possibly attributable to radiotherapy, occurred in three patients. Complete pain relief was achieved in recurrent rectal cancer in 100% of patients, at a median of 15 days since commencing radiotherapy (range 7-63 days), and has been maintained for mean and median durations of 19 and 18 months respectively (range 1.5-45 months). Five patients have had a recurrence of pain at 3, 4, 8, 9 and 18 months respectively. All four patients with primary rectal adenocarcinoma achieved a complete response, which has been sustained for 4 months (until death), 54 and 57 months, although one patient relapsed locally at 8 months. In summary, CHART appears to be a feasible treatment for pelvic tumours with regard to toxicity. Patients with pain from a locoregional recurrence achieved rapid complete pain relief, which was sustained for many months.

Adenocarcinoma↗

PubMed2004

Breast cancer in older patients.

Breast cancer is a common problem and a major health concern in our growing geriatric population. Older breast cancer patients are at risk for less than standard management, the appropriateness of which is difficult to discern. Breast tumors tend to have less aggressive characteristics. In addition, planning therapy is not always straightforward because older patients may present with comorbid illnesses and frailty that limit therapeutic choices. Standard management approaches should always be considered first. Here, we outline some data supporting standard treatment for breast cancer in older women. We also describe other options that can be considered in circumstances when the standard treatment is not possible. For instance, primary treatment with tamoxifen or an aromatase inhibitor is justifiable in a patient who is unfit for surgery and axillary dissection may be unnecessary in a patient who is obviously unfit for adjuvant chemotherapy. Adjuvant therapies should be considered, weighing risks and benefits for each patient, though the threshold for using chemotherapy may be higher. The goals in treating metastatic breast cancer in an older patient are not different than for younger patients.

Aged↗

PubMed2001

Chemotherapy for advanced breast cancer: what influences oncologists' decision-making?

Chemotherapy is widely used in the management of patients with advanced breast cancer. However, a considerable proportion of patients experience toxic side effects without gaining benefit. This study aimed to elicit oncologists' views of the goals of chemotherapy for patients with advanced breast cancer and to elicit which factors are important in decisions to recommend chemotherapy to such patients. 30 oncologists underwent a semi-structured interview to examine their views of 5 goals of chemotherapy and of various disease, treatment and patient-related factors that might influence decisions to offer treatment. The clinicians also made decisions regarding treatment in relation to a hypothetical patient scenario under varying clinical conditions. Relief of symptoms and improvement of activity were rated as the most valuable and achievable goals of treatment. The patient's performance status, frailty and their wishes regarding treatment were the most important patient-related factors in determining decision-making. The most important disease/treatment-related factors were pace of the disease, previous poor response to chemotherapy, co-existing symptoms and concurrent medical conditions. The hypothetical scenario revealed that co-existing medical conditions, adverse previous response, increased age and depression would decrease the likelihood of recommending chemotherapy, whereas key symptoms (e.g. breathlessness) and the patient's goals would increase the likelihood. The findings suggest that British oncologists primarily aim to improve patients' physical function, although subjective factors, such as a patient's desire for anti-cancer treatment and their future goals, also influence decisions to offer treatment.

Adult↗

PubMed2000

Physical activity and oxidative stress during aging.

Physical activity and exercise have several beneficial effects for physical and psychological health in young and aged subjects. Exercise may reduce age-related lean body mass loss and risk for several chronic diseases including coronary artery disease, hypertension, non-insulin-dependent diabetes mellitus, anxiety, depression, functional decline, and frailty. Exercise, however, especially when performed strenuously, is associated with increased production of reactive oxygen species, able to consume endogenous antioxidants and eventually to damage biological molecules and key cellular components. Therefore, the balance between beneficial and potentially harmful effects of exercise might be of particular importance in the elderly, in which nutritional deficiencies, sedentary lifestyle, and comorbidity commonly concur to a depletion of the antioxidant reservoir of the organism and increased susceptibility to oxidative stress. The aim of this review is to summarize current experimental, clinical, and epidemiological knowledge regarding known associations and potential links between oxidative stress and physical activity/exercise during aging. Before a final recommendation can be made with respect to the possible preventive and therapeutical role of antioxidant supplementation in aged exercising people, there is a substantial need for further studies to be performed on this topic.

Aged↗

PubMed2001

Sarcopenia.

Sarcopenia is a term utilized to define the loss of muscle mass and strength that occurs with aging. Sarcopenia is believed to play a major role in the pathogenesis of frailty and functional impairment that occurs with old age. Progressive muscle wasting occurs with aging. The prevalence of clinically significant sarcopenia is estimated to range from 8.8% in young old women to 17.5% in old old men. Persons who are obese and sarcopenic (the "fat frail") have worse outcomes than those who are sarcopenic and non-obese. There is a disproportionate atrophy of type IIa muscle fibers with aging. There is also evidence of an age-related decrease in the synthesis rate of myosin heavy chain proteins, the major anabolic protein. Motor units innervating muscle decline with aging, and there is increased irregularity of muscle unit firing. There are indications that cytokines-especially interleukin-1beta, tumor necrosis factor-alpha, and interleukin-6-play a role in the pathogenesis of sarcopenia. Similarly, the decline in anabolic hormones-namely, testosterone, dehydroepiandrosterone growth hormone, and insulin-like growth factor-I-is also implicated in the sarcopenic process. The role of the physiologic anorexia of aging remains to be determined. Decreased physical activity with aging appears to be the key factor involved in producing sarcopenia. An increased research emphasis on the factors involved in the pathogenesis of sarcopenia is needed.

Aging↗

PubMed2003

Chronic stress and age-related increases in the proinflammatory cytokine IL-6.

Overproduction of IL-6, a proinflammatory cytokine, is associated with a spectrum of age-related conditions including cardiovascular disease, osteoporosis, arthritis, type 2 diabetes, certain cancers, periodontal disease, frailty, and functional decline. To describe the pattern of change in IL-6 over 6 years among older adults undergoing a chronic stressor, this longitudinal community study assessed the relationship between chronic stress and IL-6 production in 119 men and women who were caregiving for a spouse with dementia and 106 noncaregivers, with a mean age at study entry of 70.58 (SD = 8.03) for the full sample. On entry into this portion of the longitudinal study, 28 of the caregivers' spouses had already died, and an additional 50 of the 119 spouses died during the 6 years of this study. Levels of IL-6 and health behaviors associated with IL-6 were measured across 6 years. Caregivers' average rate of increase in IL-6 was about four times as large as that of noncaregivers. Moreover, the mean annual changes in IL-6 among former caregivers did not differ from that of current caregivers even several years after the death of the impaired spouse. There were no systematic group differences in chronic health problems, medications, or health-relevant behaviors that might have accounted for caregivers' steeper IL-6 slope. These data provide evidence of a key mechanism through which chronic stressors may accelerate risk of a host of age-related diseases by prematurely aging the immune response.

Aged↗

PubMed2004

Involvement of PPAR gamma co-activator-1, nuclear respiratory factors 1 and 2, and PPAR alpha in the adaptive response to endurance exercise.

Endurance exercise training induces an increase in the respiratory capacity of muscle, resulting in an increased capacity to generate ATP as well as improved efficiency of muscle contraction. Such adaptations are largely the result of a coordinated genetic response that increases mitochondrial proteins, fatty acid oxidation enzymes and the exercise- and insulin-stimulated glucose transporter GLUT4, and shifts the contractile and regulatory proteins to their more efficient isoforms. In recent years a number of the transcriptional regulators involved in this genetic response have been identified and these factors can be classified into two different groups. The first group comprises transcription factors such as nuclear respiratory factors (NRF) 1 and 2 and PPAR alpha that bind DNA in a sequence-specific manner. The second group, referred to as transcriptional co-activators, alter transcription without directly binding to DNA. The PPAR gamma co-activator (PGC) family of proteins have been identified as the central family of transcriptional co-activators for induction of mitochondrial biogenesis. PGC-1 alpha is activated by exercise, and is sufficient to produce the endurance phenotype through direct interactions with NRF-1 and PPAR alpha, and potentially NRF-2. Furthering the understanding of the activation of PGC proteins following exercise has implications beyond improving athletic performance, including the possibility of providing targets for the treatment of frailty in the elderly, obesity and diseases such as mitochondrial myopathies and diabetes.

Adaptation, Physiological↗

PubMed2006

Nutritional factors and immunological ageing.

Undernutrition profoundly affects immune responses, particularly at the extremities of life: in infants and in the elderly. The present review focuses on this interrelationship in the elderly. It describes three different stages of ageing: stage 1, healthy ageing, which is observed in very healthy elderly individuals who have no nutritional deficit; stage 2, common ageing, which is observed in most elderly individuals in whom various micronutrient deficits are found; stage 3, pathological ageing, which is observed in patients with protein-energy deficiency. Stage 1, primary immune ageing, is essentially characterized by changes in T-cell subsets but no change in T-cell function; T-cell function is reduced only in the very elderly (>90 years old). Stage 2, secondary immune ageing, is influenced by micronutrient deficits that may be corrected by providing nutritional supplements. Furthermore, immune responses may also be enhanced by supplementation of subjects who have no micronutrient deficits, indicating that the immune system of elderly individuals is highly susceptible to the influence of micronutrients. In stage 3, tertiary immune ageing, the immune responses are strongly related to the decreased nutritional status. In these patients decreased immune responses lead to long-lasting acute-phase responses, which induce greater use of nutritional reserves during disease and lead to increased frailty. As nutritional status has a marked effect on immune responses in elderly individuals, nutritional therapy should be given to elderly individuals who have nutrient deficits, and perhaps also to individuals who do not have nutrient deficits in order to promote healthy ageing and extend the lifespan.

Aged↗

PubMedDate not supplied

Ageing and activity: their effects on the functional reserve capacities of the heart and vascular smooth and skeletal muscles.

During perinatal life striated muscles grow through the acquisition of more contractile cells (myocytes or fibres) followed by their postnatal enlargement (i.e. hypertrophy). In the ageing adult these events are reversed, with a progressive loss of myocytes that cannot be fully compensated despite the presence of cell renewal systems or reactive myocyte hypertrophy. Hence the functional reserve capacities of the heart and skeletal muscles decline with age. This is probably a consequence of physiological ageing and diminished levels of physical activity. As a result daily tasks once taken for granted become progressively more difficult, and eventually impossible, to perform. For example, sufficient coordinated absolute muscle force is required for an individual to rise from a chair or climb stairs, and the reserve capacity of the heart is a major determinant of an individual's ability to remain active and cope with daily stresses and illnesses. Long-term participation in endurance-based activities helps to preserve cardiac reserve, and has both direct and indirect beneficial effects on vascular smooth muscle and health preservation within the cardiovascular system. In contrast, this type of activity does little to protect skeletal muscles against the age-related losses of fast-twitch fibres, small motor units, overall muscle mass and power output. While resistance exercise promotes fibre hypertrophy in skeletal muscles, and to a lesser extent in myocytes of the heart, the explosive power of muscles still declines with age. Hence, while physical activity is important in attenuating age-related changes in muscle function and its reserve capacity, it delays rather than prevents the deleterious effects of ageing per se. Despite this, in a culture where inactivity has become an accepted part of life we still need to explore in greater detail the benefits of habitual physical activity, and use this information as a community-based educational tool to help prevent or delay cardiovascular disease, obesity, arthritis and the frailty associated with old age.

Adult↗

PubMed2003

Did mothers begin with an advantage? A study of childbirth and maternal health in England and Wales, 1778-1929.

This paper contributes to two ongoing debates among demographers. One deals with the immediate and deferred health effects of childbearing in the past, and the other with competing explanations--the frailty and insult accumulation hypotheses--for differences in individual health later in life. The study population consists of working women who lived at four locales in England and Wales in parts of the period 1778-1929 and who were under observation for incapacitating sickness during and after their childbearing years. Mothers within the study population are contrasted with a comparison group made up principally of non-mothers. The mothers began their reproductive careers with an advantage in health that was especially evident in the duration of sickness episodes. Even though individual births were less hazardous than individual sicknesses at the same ages, the cumulative effect of childbearing appears to have eroded the mothers' advantage. By ages 50-74 the mothers resembled the comparison group in health.

Adult↗

PubMed1988

Falls in the elderly. Is prevention possible?

Many elderly persons who fall have multiple problems, which often present in a nonspecific manner. Identification of the cause of the falls is not always possible but is well worth attempting in view of the often disastrous consequences. Because the home is the most common site of falls, various safety measures are recommended to help compensate for the normal frailties of aging.

Accident Prevention↗

PubMed2003

The many dimensions of group process. A discussion of the treatment of Sandy.

What is presented is a summary of the study group's discussion of Dr. Olesker's work with her patient Sandy. A spotlight was thrown on the group process with an emphasis on the organic nature of how this group of psychoanalysts came to grips with the nature of Sandy's inner world. One central issue which challenged the group was how to conceptualize the structure of her mind: Was she a child whose mental life could best be described as compromised by a fundamental biological frailty so that a primary emptiness or inchoate quality of mental contents reigned? If so, technical interventions which turned on narrative building were viewed as the principal therapeutic action. On the other hand, if her difficulties were perceived as stemming primarily from primitive psychological anxieties of annihilation and separateness, a dynamic approach was agreed upon as the preferred mode of treatment. Other issues regarding the transformational potentialities in the developmental process and the use of the analyst as a transformational object were also highlighted. Lastly, I offered my own perspective as to what I imagined occurred between Dr. Olesker and Sandy over the course of her treatment which enabled Sandy to change.

Child↗

PubMedDate not supplied

Urinary free cortisol is similar in older and younger women.

The increased cortisol secretion that occurs with aging is associated with characteristics of frailty. In this study we investigated whether healthy elderly women excrete increased amounts of urinary free cortisol (UFC) when compared to younger women. Twenty-four-hour UFC levels were measured in 25 elderly (70 to 87 years of age; median: 74) and 24 younger (19 to 59 years of age; median: 46) community-living women. All subjects were healthy and cognition was unimpaired. No differences in 24-hr UFC were observed between elderly and younger women (54.2 +/- 28.0 and 45.1 +/- 15.6 micrograms/24 hr, respectively) and no correlation was found between 24-hr UFC and age. Also, elderly and younger women had similar 24-hr urinary volumes (1366 +/- 531 and 1514 +/- 412 ml 24 hr, respectively) that did not correlate with UFC. In conclusion, older and younger healthy women have similar 24-hr UFC levels, possibly reflecting a comparable adrenocortical secretion of cortisol.

Adult↗

PubMedDate not supplied

Harm avoidance and disability in old age.

The relation of personality to disability in old age is not well understood. The authors examined the relation of harm avoidance, a trait indicating a tendency to worry, fear uncertainty, be shy, and tire easily, to disability in a group of 474 older persons without dementia. Participants completed the 35-item Harm Avoidance scale. Disability was assessed with the Rosow-Breslau scale, a self-report measure of physical mobility. Performance-based tests of lower limb functions were also administered from which composite measures of gait, balance, and strength were derived. In a logistic regression model controlled for age, sex, education, and lower limb function, persons with high levels of harm avoidance were nearly three times as likely to report mobility limitations as persons with low levels, and these effects largely reflected fatigability and fear of uncertainty. The association of harm avoidance with disability was not explained or modified by frailty, physical activity, depressive symptoms, neuroticism, extraversion, or cognition. The results suggest that harm avoidance is associated with disability in old age.

Activities of Daily Living↗