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frailty and comorbidity

Amrita Aranake-Chrisinger, Jenny Zhao Cheng, Maxwell R Muench, Rose Tang, Angela Mickle, Hannah Maybrier, Nan Lin, Troy Wildes, Eric Lenze, Michael Simon Avidan
INTRODUCTION: Postoperative delirium (POD) is a common complication in elderly patients, characterised by a fluctuating course of altered consciousness, disordered thinking and inattention. Preliminary research has linked POD with persistent cognitive impairment and decreased quality of life. However, these findings maybe confounded by patient comorbidities, postoperative complications and frailty. Our objective is to determine whether POD is an independent risk factor for persistent impairments in attention and executive function after elective surgery...
March 17, 2018: BMJ Open
Xiaosong Meng, Benjamin Press, Audrey Renson, James S Wysock, Samir S Taneja, William C Huang, Marc A Bjurlin
BACKGROUND: The American Society of Anesthesiologists physical status classification system, modified Charlson Comorbidity Index (mCCI), and modified Frailty Index have been associated with complications after urologic surgery. No study has compared the predictive performance of these indexes for postoperative complications after radical cystectomy (RC) for bladder cancer. MATERIALS AND METHODS: Data from 1516 patients undergoing elective RC for bladder cancer were extracted from the 2005 to 2011 American College of Surgeons National Surgical Quality Improvement Program for a retrospective review...
February 26, 2018: Clinical Genitourinary Cancer
Maartje Dijkstra, Rik H W Van Lunsen, Katherine W Kooij, Udi Davidovich, Rosan A Van Zoest, Ferdinand W M N Wit, Maria Prins, Peter Reiss, Maarten F Schim Van Der Loeff
INTRODUCTION: HIV-1-infected men who have sex with men (MSM) more often experience sexual dysfunctions than the general population. We assessed associations between HIV-1 status and decreased sexual functioning among MSM. METHODS: We used cross-sectional data from 399 HIV-1-infected MSM mostly on combination antiretroviral therapy (cART) and 366 HIV-1-uninfected MSM aged ≥45 years participating in the AGEhIV Cohort Study. The study questionnaire included questions on erectile function, sexual satisfaction, and sexual desire...
March 15, 2018: AIDS
Olivia Farrer, Alison Yaxley, Karen Walton, Michelle Miller
AIM: The prevalence of diabetes in older adults in residential aged care (RAC) is twice that of community dwelling older adults. Older adults with diabetes have been highlighted as being at high risk of frailty and malnutrition, particularly when managed on a therapeutic diet. However, assumptions may be based on clinical presentation of our oldest old which may be at conflict with the clinical presentation of younger older adults. The aim of this retrospective audit was to identify the characteristics of aged care residents with diabetes, their comorbidities and malnutrition risk...
March 15, 2018: Nutrition & Dietetics: the Journal of the Dietitians Association of Australia
Daniel W Yokom, Shabbir M H Alibhai, Schroder Sattar, Monika K Krzyzanowska, Martine T E Puts
INTRODUCTION: Screening tools in geriatric oncology have traditionally been studied for their ability to identify patients who have abnormal domains on a comprehensive geriatric assessment (CGA). However, an alternative outcome of identifying patients who would receive CGA-based interventions could improve selection of patients whose management will be altered by a CGA. The objective of this study was to assess the performance of three geriatric oncology screening tools for their ability to predict for CGA-based interventions...
March 12, 2018: Journal of Geriatric Oncology
Albert Ariza-Solé, Carme Guerrero, Francesc Formiga, Jaime Aboal, Emad Abu-Assi, Francisco Marín, Héctor Bueno, Oriol Alegre, Ramón López-Palop, María T Vidán, Manuel Martínez-Sellés, Pablo Díez-Villanueva, Pau Vilardell, Alessandro Sionis, Miquel Vives-Borrás, Juan Sanchís, Jordi Bañeras, Agnès Rafecas, Cinta Llibre, Javier López, Violeta González-Salvado, Àngel Cequier
BACKGROUND:  Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting. METHODS:  The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton-Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization...
March 2018: Thrombosis and Haemostasis
Keenan A Walker, Jeremy Walston, Rebecca F Gottesman, Anna Kucharska-Newton, Priya Palta, B Gwen Windham
Background: Evidence suggests systemic inflammation may have a mechanistic role in age-related frailty, yet prospective data is limited. We examined whether systemic inflammation during midlife was associated with late-life frailty within the community-based Atherosclerosis Risk in Communities Study. Methods: Plasma levels of four inflammatory markers (fibrinogen, von Willebrand factor, and Factor VIII, and white blood cell count) were measured during Visit 1 (1987-89; mean age: 52[5]), standardized into z-scores, and combined to create an inflammation composite score...
March 9, 2018: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
William King, Arron Lacey, James White, Daniel Farewell, Frank Dunstan, David Fone
BACKGROUND: Coronary heart disease (CHD) mortality in England fell by 36% between 2000 and 2007 and it is estimated that approximately 50% of the fall was due to improved treatment uptake. Marked socio-economic inequalities in CHD mortality in the United Kingdom (UK) remain, with higher age-adjusted rates in more deprived groups. Inequalities in the persistence of medication for primary and secondary prevention of CHD may contribute to the observed social gradient and we investigated this possibility in the population of Wales (UK)...
2018: PloS One
Victoria C Ewan, William D K Reid, Mark Shirley, A John Simpson, Steven P Rushton, William G Wade
Respiratory tract infections are the commonest nosocomial infections, and occur predominantly in frailer, older patients with multiple comorbidities. The oropharyngeal microbiota is the major reservoir of infection. This study explored the relative contributions of time in hospital and patient demographics to the community structure of the oropharyngeal microbiota in older patients with lower limb fracture. We collected 167 throat swabs from 53 patients (mean age 83) over 14 days after hospitalization, and analyzed these using 16S rRNA gene sequencing...
2018: Frontiers in Cellular and Infection Microbiology
Atish Chopra, Amir F Azarbal, Enjae Jung, Cherrie Z Abraham, Timothy K Liem, Gregory J Landry, Gregory L Moneta, Erica L Mitchell
OBJECTIVE: Major lower extremity amputations (MLEAs) remain a significant source of disability. It is unknown whether postamputation functional outcomes and outcome predictability have changed with a population of increasingly aging and obese patients. Accordingly, we sought to evaluate contemporary trends. METHODS: A retrospective chart review was performed to identify patients undergoing MLEA using Current Procedural Terminology codes in a university hospital...
March 1, 2018: Journal of Vascular Surgery
Tammy T Hshieh, Wooram F Jung, Laura J Grande, Jiaying Chen, Richard M Stone, Robert J Soiffer, Jane A Driver, Gregory A Abel
Importance: As the population ages, cognitive impairment has promised to become increasingly common among patients with cancer. Little is known about how specific domains of cognitive impairment may be associated with survival among older patients with hematologic cancers. Objective: To determine the prevalence of domain-specific cognitive impairment and its association with overall survival among older patients with blood cancer. Design, Setting, and Participants: This prospective observational cohort study included all patients 75 years and older who presented for initial consultation in the leukemia, myeloma, or lymphoma clinics of a large tertiary hospital in Boston, Massachusetts, from February 1, 2015, to March 31, 2017...
March 1, 2018: JAMA Oncology
Shang-Jui Wang, Lara Hathout, Usha Malhotra, Nell Maloney-Patel, Sarah Kilic, Elizabeth Poplin, Salma K Jabbour
Rectal cancer predominantly affects patients older than 70 years, with peak incidence at age 80 to 85 years. However, the standard treatment paradigm for rectal cancer oftentimes cannot be feasibly applied to these patients owing to frailty or comorbid conditions. There are currently little information and no treatment guidelines to help direct therapy for patients who are elderly and/or have significant comorbidities, because most are not included or specifically studied in clinical trials. More recently various alternative treatment options have been brought to light that may potentially be utilized in this group of patients...
March 15, 2018: International Journal of Radiation Oncology, Biology, Physics
Catalina Mosquera, Juan M Bermudez, Jessica L Evans, Konstantinos Spaniolas, Dougald C MacGillivary, Timothy L Fitzgerald
BACKGROUND: An association between frailty and mortality exists; we hypothesized this is secondary to failure to rescue (F2R). STUDY DESIGN: Data were obtained from the National Surgical Quality Improvement Program (2005-2012) for patients undergoing thoracoabdominal surgery. Using the modified frailty index (MFI), patients were classified as not (0 points), mildly (1 point), moderately (2 points), and severely (=/>3) frail. RESULTS: 962,913 patients were included; a majority were non-frail (52...
February 23, 2018: Journal of the American College of Surgeons
Mitsuru Yagi, Nobuyuki Fujita, Eijiro Okada, Osahiko Tsuji, Narihito Nagoshi, Takashi Tsuji, Takashi Asazuma, Masaya Nakamura, Morio Matsumoto, Kota Watanabe
STUDY DESIGN: Retrospective review of surgically treated 481 adult patients with spinal disorders OBJECTIVE.: To elucidate the effect of frailty and comorbidities on postoperative health-related quality of life (HRQoL) and complication rates. SUMMARY OF BACKGROUND DATA: Elective surgeries for spinal disorders improve clinical outcomes but also have high complication rates. METHODS: We retrospectively reviewed the results of consecutive elective spine surgeries for 156 adult spinal deformity (ASDs:65±9yrs), 152 degenerative spondylolisthesis (DSs:64 ± 10yrs), or 173 lumbar spinal canal stenosis (LSCSs:71 ± 9yrs) with followed at least 2 years...
February 22, 2018: Spine
Roman Mayr, Michael Gierth, Florian Zeman, Marieke Reiffen, Philipp Seeger, Felix Wezel, Armin Pycha, Evi Comploj, Matteo Bonatti, Manuel Ritter, Bas W G van Rhijn, Maximilian Burger, Christian Bolenz, Hans-Martin Fritsche, Thomas Martini
OBJECTIVE: A multicentre study was conducted to investigate the impact of sarcopenia as an independent predictor of oncological outcome after radical cystectomy for bladder cancer. METHODS: In total, 500 patients with available digital computed tomography scans of the abdomen obtained within 90 days before surgery were identified. The lumbar skeletal muscle index was measured using pre-operative computed tomography. Cancer-specific survival (CSS) and overall survival (OS) were estimated using Kaplan-Meier curves...
February 25, 2018: Journal of Cachexia, Sarcopenia and Muscle
Mohamed Macki, Mohamed Fakih, Pridvi Kandagatla, Ilan Rubinfeld, Victor Chang
OBJECTIVE: Because of the healthcare initiative on quality improvement projects in academic healthcare, this study explores the impact of different postgraduate years (PGYs) on unexpected re-operation rates. METHODS: Using National Surgical Quality Improvement Program 2005-2014, adult neurosurgical cases were divided into subspecialties: spine, open-vascular, cranial, and functional. Comparison groups: cases involving junior residents [PGY 1-PGY 3], mid-level residents [PGY 4+PGY 5], and senior residents [PGY 6+PGY 7]...
February 21, 2018: World Neurosurgery
Rodrigo Z Megale, Manuela L Ferreira, Paulo H Ferreira, Vasi Naganathan, Robert Cumming, Vasant Hirani, Louise M Waite, Markus J Seibel, David G Le Couteur, David J Handelsman, Fiona M Blyth
Objectives: to determine whether pain increases the risk of developing the frailty phenotype and whether frailty increases the risk of developing chronic or intrusive pain, using longitudinal data. Design/Setting: longitudinal data from the Concord Health and Ageing in Men Project (CHAMP), a prospective population based cohort study. Participants: a total of 1,705 men aged 70 years or older, living in an urban area of New South Wales, Australia...
February 21, 2018: Age and Ageing
Dirk Müller-Wieland
Diabetes in older adults has a high prevalence and is frequently associated with comorbidities of the cardiovascular system, dysfunction of cognition as well as depression and impaired mobility or increased frailty. Furthermore, impaired renal function, heart failure, risk for hypoglycemia and polypharmacy has to be considered in the decision about the diabetes treatment strategy. The goal of blood glucose management is driven by patient relevant issues and patient self-esteem, quality of life defined by the patient, preservation of physical and social mobility rather than potential long-term effects on reduction of cardio- and microvascular events in the future, which is limited by patient-inherent reduced life expectancy of the aged individual...
February 2018: Deutsche Medizinische Wochenschrift
Massimo Breccia, Francesca Palandri, Luigiana Luciano, Giulia Benevolo, Massimiliano Bonifacio, Giovanni Caocci, Fausto Castagnetti, Giuseppe A Palumbo, Alessandra Iurlo, Francesco Landi
The incidence of cancer, including myeloproliferative neoplasms (MPNs), is projected to increase significantly due to the growing proportion of people aged > 65 years. These older individuals are a heterogeneous population in terms of fitness, comorbidity, and psychological reserve. Therefore, age per se does not always provide an accurate indication of condition in patients with cancer. Frailty has been proposed as an alternative measure of vulnerability that might better indicate which patients can tolerate standard cancer treatment and those who may benefit from treatment adjustment...
February 22, 2018: Annals of Hematology
Maria B Ospina, Marta Michas, Lesly Deuchar, Richard Leigh, Mohit Bhutani, Brian H Rowe, Darcy Marciniuk, Donna Goodridge, Gail Dechman, Jean Bourbeau, Meyer Balter, Pat Camp, Paul Hernandez, Roger S Goldstein, Michael K Stickland
Introduction: Hospital and emergency department discharge for patients with chronic obstructive pulmonary disease (COPD) is often poorly organised. We developed a patient-centred, evidence-based and consensus-based discharge care bundle for patients with acute exacerbations of COPD. Methods: A purposeful sample of clinicians and patients were invited to participate in a two-round Delphi study (July-November 2015). In round 1, participants rated on a seven-point Likert scale (1=not at all important; 7=extremely important) the importance of 29 unique COPD care actions...
2018: BMJ Open Respiratory Research
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