NSAIDs, non-steroidal anti-inflammatory drugs, are one of the most commonly prescribed pain medications. It is a highly effective drug class for pain and inflammation; however, NSAIDs are known for ...multiple adverse effects, including gastrointestinal bleeding, cardiovascular side effects, and NSAID induced nephrotoxicity. As our society ages, it is crucial to have comprehensive knowledge of this class of medication in the elderly population. Therefore, we reviewed the pharmacodynamics and pharmacokinetics, current guidelines for NSAIDs use, adverse effect profile, and drug interaction of NSAIDs and commonly used medications in the elderly.
to determine the prevalence of three independent, disability-free and operationally defined frailty phenotypes and the associated risk of mortality in a community-dwelling older people cohort over 74 ...years of age.
observational, prospective and population-based design. Bio-psycho-social variables were assessed using a range of standardised instruments. The physical frailty phenotype (PFP), mental frailty phenotype (MFP) and social frailty phenotype (SFP) were operationally defined using a deficit accumulation model that excluded disability. Logistic regression analyses explored associations of the frailty phenotypes with sex, age and marital status, and a Cox proportional hazard regression analysis was performed to evaluate the association between frailty phenotypes and mortality.
of the eligible individuals, 82% (n = 875) participated. The prevalence of any frailty phenotype in an individual was 38.8%; 17.3% exhibited the PFP, 20.2% exhibited the MFP, and 8.9% exhibited the SPF. Older and female were more likely to exhibit the PFP, and widowhood was associated with the SFP. The hazard ratios of mortality were 3.09 (95% CI = 1.54-6.17) for the PFP and 2.69 (95% CI = 1.01-7.25) for the SFP.
three different disability-free frailty phenotypes were differentially related to the socio-demographical characteristics of sex, age and marital status and independently predicted risk of mortality.
No previous study has investigated fatigue in older patients with Inflammatory Bowel Disease (IBD).
To describe the prevalence of fatigue in older patients and compare it to the prevalence in younger ...patients with IBD, and to determine factors associated with fatigue.
A prospective, multicenter cohort study, including older- (≥ 65 years) and younger patients with IBD (18–64 years). A geriatric assessment was performed in older patients to measure deficits in geriatric assessment (DiG). Fatigue was defined by one item from the short Inflammatory Bowel Disease Questionnaire. Active disease was defined as the presence of clinical or biochemical disease activity.
Fatigue prevalence in the 405 older patients varied between 45.4% (71/155) in active disease to 23.6% (60/250) in remission. Fatigue prevalence in 155 younger patients was 59.5% (47/79) and 57.4% (89/155), respectively. Female sex, clinical disease activity, use of immunomodulators and presence of DiG were associated with fatigue in older patients with IBD.
Fatigue prevalence is lower in older patients with IBD compared to younger patients with IBD, but increases when active disease is present. Clinicians should be aware that fatigue is a relevant symptom in older patients with IBD, as it is associated with DiG.
Abstract
Background
two popular operational definitions of frailty, the frailty phenotype and Frailty index (FI), are based on different theories. Although FI was shown to be superior in predicting ...mortality to the frailty phenotype, no meta-analysis on mortality risk according to FI has been found in the literature.
Methods
an electronic systematic literature search was conducted in August 2016 using four databases (Embase, Medline, CINAHL and PsycINFO) for prospective cohort studies published in 2000 or later, examining the mortality risk according to frailty measured by FI. A meta-analysis was performed to synthesise pooled mortality risk estimates.
Results
of 2,617 studies identified by the systematic review, 18 cohorts from 19 studies were included. Thirteen cohorts showed hazard ratios (HRs) per 0.01 increase in FI, six cohorts showed HRs per 0.1 increase in FI and two cohorts each showed odds ratios (ORs) per 0.01 and 0.1 increase in FI, respectively. All meta-analyses suggested that higher FI was significantly associated with higher mortality risk (pooled HR per 0.01 FI increase = 1.039, 95% CI = 1.033–1.044, P < 0.001; pooled HR per 0.1 FI increase = 1.282, 95% CI = 1.258–1.307, P < 0.001; pooled OR per 0.01 FI increase = 1.054, 95% CI = 1.040–1.068, P < 0.001; pooled OR per 0.1 FI increase = 1.706, 95% CI = 1.547–1.881, P < 0.001). Meta-regression analysis among 13 cohorts with HR per 0.01 increase in FI showed that the studies with shorter follow-up periods and with lower female proportion were associated with higher mortality risks by FI.
Conclusions
this systematic review and meta-analysis was the first to quantitatively demonstrate that frailty measured by the FI is a significant predictor of mortality.
Sarcopenia is an age-related condition that is characterized by progressive and generalized loss of muscle mass and function. Exercise treatment has been the most commonly used intervention among ...elderly populations. We performed a systematic review and meta-analysis to evaluate the available literature related to the effects of exercise interventions/programs on muscle mass, muscle strength and physical performance in older adults with sarcopenia. We searched PubMed, EMBASE, MEDLINE and the Web of Science for randomized controlled trials and controlled clinical trials exploring exercise in older adults with sarcopenia published through July 2019 without any language restrictions. Pooled analyses were conducted using Review Manager 5.3, with standardized mean differences (SMDs) and fixed-effect models. A total of 3898 titles and abstracts were initially identified, and 22 studies (1041 individuals, 80.75% females, mean age ranged from 60.51 to 85.90 years) were included in the meta-analysis. The exercise programs in the studies consisted of 30 to 80 min of training, with 1 to 5 training sessions weekly for 6 to 36 weeks. Muscle strength (grip strength SMD 0.57, 95 % CI 0.42 to 0.73, P <0.00001 and timed five chair stands SMD -0.56, 95 % CI -0.85 to -0.28, P < 0.0001) and physical performance (gait speed SMD 0.44, 95 % CI 0.26 to 0.61, P < 0.00001 and the timed up and go test SMD -0.97, 95 % CI -1.22 to -0.72, P < 0.00001) showed significant improvement following exercise treatment, while no differences in muscle mass (ASM SMD 0.15, 95 % CI -0.05 to 0.36, P = 0.15 and ASM/height (2) SMD 0.21, 95 % CI -0.05 to 0.48, P = 0.12) were detected. Exercise programs showed overall significant positive effects on muscle strength and physical performance but not on muscle mass in sarcopenic older adults. Key words: Sarcopenia, exercise, elderly, meta-analysis, muscle, physical
Most older individuals develop inflammageing, a condition characterized by elevated levels of blood inflammatory markers that carries high susceptibility to chronic morbidity, disability, frailty, ...and premature death. Potential mechanisms of inflammageing include genetic susceptibility, central obesity, increased gut permeability, changes to microbiota composition, cellular senescence, NLRP3 inflammasome activation, oxidative stress caused by dysfunctional mitochondria, immune cell dysregulation, and chronic infections. Inflammageing is a risk factor for cardiovascular diseases (CVDs), and clinical trials suggest that this association is causal. Inflammageing is also a risk factor for chronic kidney disease, diabetes mellitus, cancer, depression, dementia, and sarcopenia, but whether modulating inflammation beneficially affects the clinical course of non-CVD health problems is controversial. This uncertainty is an important issue to address because older patients with CVD are often affected by multimorbidity and frailty - which affect clinical manifestations, prognosis, and response to treatment - and are associated with inflammation by mechanisms similar to those in CVD. The hypothesis that inflammation affects CVD, multimorbidity, and frailty by inhibiting growth factors, increasing catabolism, and interfering with homeostatic signalling is supported by mechanistic studies but requires confirmation in humans. Whether early modulation of inflammageing prevents or delays the onset of cardiovascular frailty should be tested in clinical trials.
Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on ...risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium.
This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes.
Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (
=0.001), increased association with complications (
<0.001), institutionalization (
<0.001), and 6-month mortality (
<0.001). Patients with dementia (N=168) had a higher delirium rate (57.7%,
<0.001) but a shorter hospital stay (
<0.001). There was no significant difference in the 6-month mortality between delirious patients with (34.0%) and without dementia (26.3%).
Elderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent an episode of delirium were at increased risk for adverse outcomes.
Elderly pedestrians often report difficulty completing crossings in the time estimated by traffic lights, and reduced walking speed while commuting may be associated with negative health outcomes. It ...is also worth highlighting the scarcity of Brazilian studies, which reinforces the need for investigations aimed at this topic of interest.
To analyze the gait speed of community-dwelling elderly; to verify the association of socioeconomic, clinical and health factors, considering the regulated crossing time on roads with pedestrian traffic lights and alternative cutoff points for walking speed.
A cross-sectional study was conducted with 411 elderly people (70.15±7.25 years old) from Macapá, Amapá. Socioeconomic, clinical and health variables were collected using a structured form. Walking speed was assessed using the usual walking speed test, which is among the Short Physical Performance Battery (SPPB) tests (time to walk 4 meters). For the analysis of the established time (<1.2 m/s) for crossing roads with traffic lights for pedestrians, data consulted from the city's traffic departments and alternative cutoff points (<1.1 m/s; <1 .0 m/s and 0.9 m/s). Data were analyzed using descriptive and inferential statistics from the binary logistic regression model (p<0.05 and 95%CI).
The mean walking speed time was 0.99±0.29 m/s. A total of 123 traffic lights were recorded in the city of Macapá, of which (56.1%) are pedestrian traffic lights; most roads (87.8%) do not have indications for crossing; 52% do not have a crosswalk demarcated on the road; and 80.5% do not have lowering or adaptation of the track at the crossing point. Most of the elderly (76.4%) presented a walking speed lower than the crossing time established by the regulation of roads with traffic lights for pedestrians (<1.2 m/s); and when considering alternative cutoff points, it remained unfavorable for most elderly people, except for the <0.9m/s classification. The logistic regression model indicated that elderly women, those of advanced age, with dependence for instrumental activities of daily living and with reduced muscle strength probably walk for less time than established by the traffic department (<1.2 m/s) and at alternative cutoff points.
The current weather pattern does not promote safety and exposes the elderly population to risks when crossing roads with traffic lights. The implementation of a time standard that considers the specificities of the elderly population in this city becomes fundamental.
Through the data obtained from this study, it will be possible to suggest a revision of the standards established for carrying out crossings in order to consider the specificities of the elderly population, as well as to favor their insertion safely in the place where they live, providing conditions that allow their autonomy and integration into society.
The increase in life expectancy in recent years has brought a scenario of multimorbidities and the presence of geriatric syndromes, such as frailty, making the elderly vulnerable to decompensation ...and hospitalizations. In addition, nutritional status and muscle strength have a significant association with frailty, so their characterization in the hospitalized elderly population is extremely relevant since such conditions are accompanied by adverse clinical outcomes, increasing the length of hospitalization and mortality. From this, it is possible to program multidisciplinary strategies and outline the best individualized intervention for these patients, aiming at an early discharge and higher quality of life.
To evaluate the presence of frailty, nutritional status, and muscle strength of hospitalized elderly.
This is a prospective, observational, and cross-sectional study in which patients hospitalized in the ward of a University Hospital over 60 years of age were evaluated. Data were collected from medical records and characterization of the sample. Patients were assessed for frailty screening (Fried criteria), nutritional assessment through mini nutritional assessment (MAN) and handgrip strength.
Partial data from 51 study participants were analyzed. Regarding frailty, according to Fried's criteria, 90.2% of the patients were classified as frail, 9.8% as pre-frail, and none as non-frail. The MAN scores reveal that, in relation to nutritional status, 19.6% are at risk of malnutrition and 43.13% are malnourished. Regarding muscle strength, 66.66% of men and 76.9% of women had muscle weakness, with the mean of men of 27.6 ±11.43 (76.66% of predicted) and of women of 19.3 ±5.76 (83.91% of predicted).
Hospitalized elderly are mostly fragile and have nutrition deficits and peripheral muscle weakness.
Faced with the presence of frailty, nutritional deficit, and muscle weakness, future intervention studies deserve attention to minimize damage to the independence and functionality of the elderly.
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