In the last 100 years, populations in developed countries have experienced an unprecedented addition of 30 years to life expectancy. Developing countries are now experiencing this same phenomenon, ...but over a shorter time frame. With this success comes the challenge of maximizing health and vitality across these added years. The compression of morbidity to the latest point in the human life span could unleash a sustained third demographic dividend that benefits all of society. To accomplish this, society needs to invest in the prevention and treatment of frailty, as well as in the prevention of chronic diseases at every age and stage of life. A model intervention, physical activity, may offer a road map.
Frailty in the clinical scenario Rodriguez-Mañas, Leocadio; Fried, Linda P
The Lancet (British edition),
02/2015, Letnik:
385, Številka:
9968
Journal Article
Recenzirano
Disability is the main result of three concurrent factors in older people (older than 60 years): the ageing process, unhealthy lifestyles, and health disorders. Disability is often preceded by a ...state characterised by reduced capacity to respond to stressors, caused by a decline in functional reserves. This condition--frailty--might precede by several years the development of disability 3 and other clinical outcomes, and is a major risk factor for non-catastrophic disability.
Frailty in aging marks a state of decreased reserves resulting in increased vulnerability to adverse outcomes when exposed to stressors. This Perspective synthesizes the evidence on the aging-related ...pathophysiology underpinning the clinical presentation of physical frailty as a phenotype of a clinical syndrome that is distinct from the cumulative-deficit-based frailty index. We focus on integrating the converging evidence on the conceptualization of physical frailty as a state, largely independent of chronic diseases, that emerges when the dysregulation of multiple interconnected physiological and biological systems crosses a threshold to critical dysfunction, severely compromising homeostasis. Our exegesis posits that the physiology underlying frailty is a critically dysregulated complex dynamical system. This conceptual framework implies that interventions such as physical activity that have multisystem effects are more promising to remedy frailty than interventions targeted at replenishing single systems. We then consider how this framework can drive future research to further understanding, prevention and treatment of frailty, which will likely preserve health and resilience in aging populations.
Frailty as a Predictor of Surgical Outcomes in Older Patients Makary, Martin A., MD, MPH, FACS; Segev, Dorry L., MD, PhD, FACS; Pronovost, Peter J., MD, PhD ...
Journal of the American College of Surgeons,
06/2010, Letnik:
210, Številka:
6
Journal Article
Recenzirano
Background Preoperative risk assessment is important yet inexact in older patients because physiologic reserves are difficult to measure. Frailty is thought to estimate physiologic reserves, although ...its use has not been evaluated in surgical patients. We designed a study to determine if frailty predicts surgical complications and enhances current perioperative risk models. Study Design We prospectively measured frailty in 594 patients (age 65 years or older) presenting to a university hospital for elective surgery between July 2005 and July 2006. Frailty was classified using a validated scale (0 to 5) that included weakness, weight loss, exhaustion, low physical activity, and slowed walking speed. Patients scoring 4 to 5 were classified as frail, 2 to 3 were intermediately frail, and 0 to 1 were nonfrail. Main outcomes measures were 30-day surgical complications, length of stay, and discharge disposition. Multiple logistic regression (complications and discharge) and negative binomial regression (length of stay) were done to analyze frailty and postoperative outcomes associations. Results Preoperative frailty was associated with an increased risk for postoperative complications (intermediately frail: odds ratio OR 2.06; 95% CI 1.18–3.60; frail: OR 2.54; 95% CI 1.12–5.77), length of stay (intermediately frail: incidence rate ratio 1.49; 95% CI 1.24–1.80; frail: incidence rate ratio 1.69; 95% CI 1.28–2.23), and discharge to a skilled or assisted-living facility after previously living at home (intermediately frail: OR 3.16; 95% CI 1.0–9.99; frail: OR 20.48; 95% CI 5.54–75.68). Frailty improved predictive power (p < 0.01) of each risk index (ie, American Society of Anesthesiologists, Lee, and Eagle scores). Conclusions Frailty independently predicts postoperative complications, length of stay, and discharge to a skilled or assisted-living facility in older surgical patients and enhances conventional risk models. Assessing frailty using a standardized definition can help patients and physicians make more informed decisions.
The world is aging as a result of unprecedented successes worldwide adding 30 years of life expectancy and presenting great opportunities for all of society, but only if we invest effectively. This ...article, written as a requested background article for the World Health Organization 2015 World Report on Aging, proposes that creating health into the oldest ages could lay the basis for a third demographic dividend resulting from the societal benefits from the generative social capital of older adults, on top of the second demographic dividend's savings associated with longer lives. The combination would contribute to stronger and wealthier societies, greater success of the young, and increased societal ability to provide the humane supports needed at the end of life, plus a dividend that would endure. We now know that prevention works at every age and into the oldest ages. A life-course approach to prevention and health promotion is the key investment. The creation of geriatrically knowledgeable and integrated public health, medical and social care systems has the potential to amplify capabilities and well-being to the end of life. Healthy older populations bring both desire for engagement and unique talents. Institutions designed to create impactful roles for older adults to contribute to the success of the young can activate the societal benefits and further enhance health at older ages. Creating a new vision for the opportunities of an older age is the first critical step toward experiencing the benefits of our longer lives and creating a sustained third demographic dividend.
Inflammation and Frailty in Older Women Leng, Sean X.; Xue, Qian-Li; Tian, Jing ...
Journal of the American Geriatrics Society (JAGS),
June 2007, Letnik:
55, Številka:
6
Journal Article
Recenzirano
OBJECTIVES: To evaluate relationships between white blood cell (WBC) count and interleukin‐6 (IL‐6) and prevalent frailty.
DESIGN: Cross‐sectional study.
SETTING: Two population‐based studies, the ...Women's Health and Aging Studies (WHAS) I and II, Baltimore, Maryland.
PARTICIPANTS: Five hundred fifty‐eight women aged 65 to 101 from WHAS I and 548 women aged 70 to 79 from the merged WHAS I and II cohorts.
MEASUREMENTS: Frailty was determined using validated screening criteria. WBC counts and IL‐6 levels were measured using standard laboratory methods. Odds ratios (ORs) for frailty were evaluated across tertiles of baseline WBC counts and IL‐6 levels, adjusting for age, race, education, body mass index, and smoking status.
RESULTS: In WHAS I, those in the top tertile of WBC count and IL‐6 had ORs of 4.25 (95% confidence interval (CI)=1.89–9.58) and 3.98 (95% CI=1.76–9.00), respectively, for frailty (both P<.001). In the combined models, participants in the top tertile of WBC count had an OR of 3.15 (95% CI=1.34–7.41), adjusting for IL‐6 (P<.01), and those in the top tertile of IL‐6 had an OR of 2.81 (95% CI=1.19–6.64), adjusting for WBC count (P<.05). Furthermore, participants in the top tertiles of WBC count and IL‐6 had an OR of 9.85 (95% CI=3.04–31.99), and those in the middle/top tertiles had an OR of 5.40 (95% CI=1.83–15.92) (P<.001, trend test) for frailty. These results were validated in the merged WHAS I and II.
CONCLUSION: Higher WBC counts and IL‐6 levels were independently associated with prevalent frailty in community‐dwelling older women.
Many studies of aging examine biomarkers one at a time, but complex systems theory and network theory suggest that interpretations of individual markers may be context-dependent. Here, we attempted ...to detect underlying processes governing the levels of many biomarkers simultaneously by applying principal components analysis to 43 common clinical biomarkers measured longitudinally in 3694 humans from three longitudinal cohort studies on two continents (Women's Health and Aging I & II, InCHIANTI, and the Baltimore Longitudinal Study on Aging). The first axis was associated with anemia, inflammation, and low levels of calcium and albumin. The axis structure was precisely reproduced in all three populations and in all demographic sub-populations (by sex, race, etc.); we call the process represented by the axis "integrated albunemia." Integrated albunemia increases and accelerates with age in all populations, and predicts mortality and frailty--but not chronic disease--even after controlling for age. This suggests a role in the aging process, though causality is not yet clear. Integrated albunemia behaves more stably across populations than its component biomarkers, and thus appears to represent a higher-order physiological process emerging from the structure of underlying regulatory networks. If this is correct, detection of this process has substantial implications for physiological organization more generally.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Increases in life expectancy necessitate new scientific understanding of how to both extend and enhance health over the course of our longer lives. Accumulated evidence has laid the groundwork for a ...new era of prevention and health promotion for an extended health span.
Background. Understanding points of onset of the frailty syndrome is vital to early identification of at-risk individuals and to targeting intervention efforts to those components that are first ...affected, when reversal may be most possible. This study aims to characterize natural history by which commonly used frailty criteria manifest and to assess whether the rate of progression to frailty depends on initial manifestations. Methods. The investigation was based on a 7.5-year observational study of 420 community-dwelling women aged 70–79 years who were not frail at baseline, with frailty defined as meeting ≥3 of 5 criteria: weight loss, slow walking speed, weakness, exhaustion, and low physical activity level. Results. The 7.5-year incidence of frailty was 9% among women who were nonfrail at baseline. Despite significant heterogeneity, weakness was the most common first manifestation, and occurrence of weakness, slowness, and low physical activity preceded exhaustion and weight loss in 76% of the women who were nonfrail at baseline. Women with exhaustion or weight loss as initial presenting symptoms were 3–5 times more likely to become frail than were women without any criterion (p <.05). Conclusions. Our findings suggest that weakness may serve as a warning sign of increasing vulnerability in early frailty development, and weight loss and exhaustion may help to identify women most at risk for rapid adverse progression.
Apr 22, 2017, was the date of the 132nd annual meeting of the Association of American Physicians (AAP). April 22nd was also the date of the March for Science, which was held in 600 cities globally. ...AAP was a formal sponsor of the march, with 84% of its members endorsing it. Apart from the march, the trisociety AAP-ASCI and American Physician Scientists Association (APSA) meeting offered its usual evidence of why the March for Science is relevant: that science both represents some of the best of the human condition -- of curiosity, knowledge, and exploration of the meaning of being human -- and is a basis for securing a better future. The founders' vision for AAP was to foster discourse and advances in understanding through an annual meeting that would span the full breadth of physician-led science and to generate exchange across disciplines and between science and practice. There were to be original communications and demonstrations of gross and microscopic preparations and of apparati and instruments.
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