Aims
To describe the prevalence, overlap, and prognostic implications of physical and social frailties and cognitive dysfunction in hospitalized elderly patients with heart failure.
Methods and ...results
The FRAGILE‐HF study was a prospective multicentre cohort study enrolling consecutive hospitalized patients with heart failure aged ≥65 years. The study objectives were to examine the prevalence, overlap, and prognostic implications of the coexistence of multiple frailty domains. Physical frailty, social frailty, and cognitive dysfunction were evaluated by the Fried phenotype model, Makizako's 5 items, and Mini‐Cog, respectively. The primary study outcome was the combined endpoint of heart failure rehospitalization and all‐cause death within 1 year. Among 1180 enrolled hospitalized patients (median age, 81 years; 57.4% male), physical frailty, social frailty, and cognitive dysfunction were identified in 56.1%, 66.4%, and 37.1% of the patients, respectively. The number of identified frailty domains was 0, 1, 2, and 3 in 13.5%, 31.4%, 36.9%, and 18.2% of the patients, respectively. During follow‐up, the combined endpoint occurred in 383 patients. Adjusted hazard ratios for 1, 2, and 3 domains, with 0 domains as the reference, were 1.38 95% confidence interval (CI) 0.89–2.13; P = 0.15, 1.60 (95% CI 1.04–2.46; P = 0.034), and 2.04 (95% CI 1.28–3.24; P = 0.003), respectively. Incorporating the number of frailty domains into the pre‐existing risk model yielded a 22.0% (95% CI 0.087–0.352; P = 0.001) net reclassification improvement for the primary outcome.
Conclusions
The coexistence of multiple frailty domains is prevalent in hospitalized elderly patients with heart failure. Holistic assessment of multi‐domain frailty provides additive value to known prognostic factors.
Nasopharyngeal cancer is common in Morocco. It is a clinicobiological and histological entity that differs from other head and neck cancers, notably in its geographical distribution and evolutionary ...profile.
The aim of our work was to evaluate the impact of treatment tolerance and toxicity in nasopharyngeal cancer in elderly (age at diagnosis ≥ 60 years).
This was a retrospective study of patients with nasopharyngeal cancer treated by VMAT technique in the radiotherapy department at the Institute of Oncology RABAT between January 2018 and December 2021.
Patients received radiotherapy with or without concomitant systemic therapy.
We identified 257 patients: 21% elderly and 79% young, with no differences in AJCC stage 8th edition, Tumors were classified as T1 in 11 %, T2 in 33%, T3 in 24 %, and T4 in 32 %.
Median age in elderly group was 66 years, Sex repartition: 79% men and 21% women. Comorbidities were observed in 14% cases.
The predominant histological type was undifferentiated nasopharyngeal carcinoma (UCNT) in 87% of cases.
Median total duration was 45 days, with 3% patient who did not complete the prescribed RT course with no differences across age groups.
31% patient received radiotherapy alone and 69% received concomitant radio-chemotherapy to a total dose of 69.96 Gy, combined with weekly Cisplatin at a dose of 40 mg/m2/week.
Patients underwent weekly clinical and tomographic monitoring. The dominant side effect was radiomucositis: 55% G1, 20% G2, 22% of patients presented G3, and 3% were hospitalized for G4.
In terms of evolution, locoregional control was found in 75% of patients treated, with 11% of recurrence and 4% metastatic progression. 6% of patients died of their cancer and 4% were lost to follow-up.
Nasopharyngeal Cancer presents a particular evolutionary profile, which partly explains the therapeutic failures despite high radiosensitivity. For the age group studied, this evolutionary profile is compounded by a high delay in consultation and a terrain already weakened by age.
Frail older adults are predisposed to multiple comorbidities and adverse events. Recent interventional studies have shown that frailty can be improved and managed. In this study, effective ...individualized home-based exercise and nutrition interventions were developed for reducing frailty in older adults.
This study was a four-arm, single-blind, randomized controlled trial conducted between October 2015 and June 2017 at Miaoli General Hospital in Taiwan. Overall, 319 pre-frail or frail older adults were randomly assigned into one of the four study groups (control, exercise, nutrition, and exercise plus nutrition combination) and followed up during a 3-month intervention period and 3-month self-maintenance period. Improvement in frailty scores was the primary outcome. Secondary outcomes included improvements in physical performance and mental health. The measurements were performed at baseline, 1 month, 3 months, and 6 months.
At the 6-month measurement, the exercise (difference in frailty score change from baseline: - 0.23; 95% confidence interval CI: - 0.41, - 0.05; p = 0.012), nutrition (- 0.28; 95% CI: - 0.46, - 0.11; p = 0.002), and combination (- 0.34; 95% CI: - 0.52, - 0.16; p < 0.001) groups exhibited significantly greater improvements in the frailty scores than the control group. Significant improvements were also observed in several physical performance parameters in the exercise, nutrition, and combination groups, as well as in the 12-Item Short Form Health Survey mental component summary score for the nutrition group.
The designated home-based exercise and nutrition interventions can help pre-frail or frail older adults to improve their frailty score and physical performance.
Retrospectively registered at ClinicalTrials.gov (identifier: NCT03477097); registration date: March 26, 2018.
The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic ...indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.
A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded.
The study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival.
Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: NCT04321265 , registered 19 March 2020.
A study was designed to identify conditions of frailty in relation to social, demographic, health, cognitive, functional, and psychosocial variables in community-dwelling elderly. The article ...presents the methodology and preliminary data. A total of 3,478 elderly (65 years and older) were selected from probabilistic samples of seven Brazilian cities chosen by convenience and participated in a data collection session in a community setting. The following characteristics predominated: women (67.7%), married (48%) or widowed (36.4%), living with a son or daughter and family (52.6%), head of family (64.5%), and 1-4 years of schooling (49%); 28.8% were illiterate and 24.8% presented a cognitive deficit; 9.1% were frail, 51.8% pre-frail, and 39.1% non-frail. There were more frail individuals among women, those 80 years or older, the widowed, the illiterate, those who had never attended school, and those with cognitive deficit. In general, the social and demographic data corroborate Brazilian epidemiological studies, while those on frailty, cognitive status, and schooling corroborate the international literature.
This paper investigates the relationship between medical treatment costs and the length of hospital stays resulting from motorcycle crashes involving the elderly. The World Health Organization ...defines aelderlya as people more than 65 years old. The sample for this study consisted of data for the year 2007 collected by the Bureau of National Health Insurance, Taiwan. We develop models for predicting medical costs and the length of hospital stays based on diagnosis, hospital and user types. The seemingly unrelated regression equation (SURE) model was applied first to investigate the relationship between medical costs and the length of hospital stays. The SURE model shows that the type of injury (e.g. head injury) is statistically significant and has positive effects on medical costs for motorcycle crashes involving the elderly in Taiwan. Due to the statistical insignificance of the dependency between medical costs and length of hospital stays, two separate simple linear regression models were subsequently estimated. For motorcycle crashes, patients over 80 years old had the highest medical costs. The findings reinforce the need for transportation authorities to focus on preventing certain types of injuries that are particularly serious and costly for the elderly in Taiwan.
Sub-optimal thermal conditions influence the health and well-being of elderly people and deteriorate their cognitive functions due to age-induced changes in thermoregulatory mechanisms. Addressing ...the thermal comfort needs of elderly is better aided when a robust predictive thermal sensation (TS) model exists. However, available TS models in the literature are based on physiological and subjective data collected from young subjects, and their use to assess elderly TS is inappropriate.
In this work, a model for predicting elderly TS under steady and transient states was developed from published experimental data under controlled environment. The model predicts the mean TS of elderly people in terms of their average skin temperature, rate of change of skin temperature and core temperature. The model was coupled with a robust elderly bioheat model, enabling the prediction of elderly TS from environmental conditions. The TS model was further extended with a correlation that links the required physiological data for sensation prediction with few segmental skin temperatures that can be measured to enable the development of TS monitoring devices for the elderly. The model and the approach of using segmental temperatures in TS prediction were validated using different experimental measurements and subjective data than those used in the model development. Good agreement between experimental and predicted TS was achieved under varying steady and transient environments. The model predicts the elderly TS in ambient temperatures ranging from 13 °C to 43 °C and in transient settings with up to a 10 °C step rise or drop in ambient temperature.
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•Models for young adults are inadequate for predicting elderly thermal sensation.•An elderly thermal sensation model was derived from published experimental data.•TS model was validated with other published data for steady & transient conditions.•TS model applies to ambient range of 13 °C–43 °C and to step changes up to 10 °C.•A correlation was developed to predict elderly TS from segmental temperatures.
Purpose/Significance Under the background of the rapid development of the new generation of information technology, the policy supports the smart health care industry, and all kinds of smart health ...care products are constantly popularized and applied. Exploring the practical issue of elderly users using smart health care products is of great significance for China to carry out smart actions to help the elderly and build a digital inclusive old-age society. Method/Process Based on the text information data such as news reports, product reviews and in-depth interviews, this paper adopted the grounded theory method, and formed 3 relational categories, 31 preliminary categories and 69 initial concepts through three-stage coding, and constructed a model of influencing factors of elderly users’ use of smart health care products. Result/Conclusion The research showed that the aging degree, product use guidelines and product safety design affect the psychological perception of elderly users, and individual char
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