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https://www.readbyqxmd.com/read/28441696/declining-blood-pressure-and-intensification-of-blood-pressure-management-among-people-over-80-years-cohort-study-using-electronic-health-records
#1
Rathi Ravindrarajah, Alex Dregan, Nisha C Hazra, Shota Hamada, Stephen H D Jackson, Martin C Gulliford
BACKGROUND: Management of high blood pressure (BP) in people over 80 years is controversial, but there is limited information available concerning the uptake of hypertension treatment at this age. OBJECTIVE: To evaluate use of antihypertensive drugs and changes in SBP and DBP from 2001 to 2014 in men and women aged 80 years and over. METHODS: Cohort study using primary care electronic health records of 265 225 participants from the UK Clinical Practice Research Datalink...
June 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28441324/designing-fit-for-purpose-health-and-social-services-for-ageing-populations
#2
Jean Woo
Population ageing is occurring in all countries, regardless of the level of economic development. While the rising burden of chronic diseases and disabilities as a consequence of this demographic transition is well recognized, the increasing prevalence of geriatric syndromes as a public health issue is not as well recognized. Recently the World Health Organization's World Health and Ageing Report emphasized functional ability as an important outcome for aging populations, highlighting the concept of raising intrinsic capacity throughout the life course...
April 25, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28439398/a-practical-approach-to-the-pharmacological-management-of-hypertension-in-older-people
#3
REVIEW
Nikesh Parekh, Amy Page, Khalid Ali, Kevin Davies, Chakravarthi Rajkumar
Hypertension is the leading cause of cardiovascular (CV) morbidity and mortality in adults over the age of 65. The first part of this paper is an overview, summarizing the current guidelines on the pharmacological management of hypertension in older adults in Europe and the USA, and evidence from key trials that contributed to the guidelines. In the second part of the paper, we will discuss the major challenges of managing hypertension in the context of multimorbidity, including frailty, orthostatic hypotension (OH), falls and cognitive impairment that are associated with ageing...
April 2017: Therapeutic Advances in Drug Safety
https://www.readbyqxmd.com/read/28439147/a-semi-parametric-transformation-frailty-model-for-semi-competing-risks-survival-data
#4
Fei Jiang, Sebastien Haneuse
In the analysis of semi-competing risks data interest lies in estimation and inference with respect to a so-called non-terminal event, the observation of which is subject to a terminal event. Multi-state models are commonly used to analyse such data, with covariate effects on the transition/intensity functions typically specified via the Cox model and dependence between the non-terminal and terminal events specified, in part, by a unit-specific shared frailty term. To ensure identifiability, the frailties are typically assumed to arise from a parametric distribution, specifically a Gamma distribution with mean 1...
March 2017: Scandinavian Journal of Statistics, Theory and Applications
https://www.readbyqxmd.com/read/28437582/modified-frailty-index-predicts-postoperative-outcomes-in-older-gastrointestinal-cancer-patients
#5
Sarah A Vermillion, Fang-Chi Hsu, Robert D Dorrell, Perry Shen, Clancy J Clark
BACKGROUND AND OBJECTIVES: Frailty disproportionately impacts older patients with gastrointestinal cancer, rendering them at increased risk for poor outcomes. A frailty index may aid in preoperative risk stratification. We hypothesized that high modified frailty index (mFI) scores are associated with adverse outcomes after tumor resection in older, gastrointestinal cancer patients. METHODS: Patients (60-90 years old) who underwent gastrointestinal tumor resection were identified in the 2005-2012 NSQIP Participant Use File...
April 24, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28437320/development-of-a-claims-based-frailty-indicator-anchored-to-a-well-established-frailty-phenotype
#6
Jodi B Segal, Hsien-Yen Chang, Yu Du, Jeremy D Walston, Michelle C Carlson, Ravi Varadhan
BACKGROUND: Fried and colleagues described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when ≥3 of the following are present: low grip strength, low energy, slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phenotype using only administrative claims data to enable frailty to be assessed without physical performance measures. STUDY DESIGN: We used the CHS cohort data linked to participants Medicare claims...
April 21, 2017: Medical Care
https://www.readbyqxmd.com/read/28436194/impact-of-living-arrangements-on-clinical-outcomes-among-older-patients-with-dementia-or-cognitive-impairment-admitted-to-the-geriatric-evaluation-and-management-unit-in-taiwan
#7
Cheng-Hao Hung, Ting-Ching Tang, Chih-Jen Wang, Li-Kuo Liu, Li-Ning Peng, Liang-Kung Chen
AIM: To evaluate the impact of living arrangements on mortality and functional decline among older patients with dementia or cognitive impairment after discharge from a geriatric evaluation and management unit (GEMU) in Taiwan. METHODS: The present retrospective cohort study used data from the Veteran Affairs Comprehensive Geriatric Assessment from January 2015 to May 2016 for analysis. Data of patients aged 65 years and older with dementia or cognitive impairment at admission to the GEMU of Taipei Veterans General Hospital during the study period were retried for study...
April 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28433120/additional-cost-because-of-pneumonia-in-nursing-home-residents-results-from-the-incidence-of-pneumonia-and-related-consequences-in-nursing-home-resident-study
#8
Nadège Costa, Emiel O Hoogendijk, Michael Mounié, Robert Bourrel, Yves Rolland, Bruno Vellas, Laurent Molinier, Matteo Cesari
OBJECTIVES: Pneumonia is a frequent condition in older people. Our aim was to examine the total healthcare cost related to pneumonia in nursing home (NH) residents over a 1-year follow-up period. DESIGN: This was a prospective, longitudinal, observational, and multicenter study that was a part of the Incidence of Pneumonia and related Consequences in Nursing Home Resident study. SETTING: Thirteen NHs located in Languedoc Roussillon and Midi-Pyrénées regions in France were included...
May 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28432148/systolic-blood-pressure-trajectory-frailty-and-all-cause-mortality-over-80-years-of-age-cohort-study-using-electronic-health-records
#9
Rathi Ravindrarajah, Nisha C Hazra, Shota Hamada, Judith Charlton, Stephen H D Jackson, Alex Dregan, Martin C Gulliford
Background -Clinical trials show benefit from lowering systolic blood pressure in people aged ≥80 years but non-randomised epidemiological studies suggest lower systolic blood pressure may be associated with higher mortality. This study aimed to evaluate associations of SBP with all-cause mortality by frailty category over 80 years of age and to evaluate SBP trajectories before death. Methods -A population-based cohort study was conducted using electronic health records of 144,403 participants aged 80 and older registered with family practices in the United Kingdom from 2001 to 2014...
April 21, 2017: Circulation
https://www.readbyqxmd.com/read/28431912/osteosarcopenic-obesity-prevalence-and-relation-with-frailty-and-physical-performance-in-middle-aged-and-older-women
#10
Claudia Szlejf, Lorena Parra-Rodríguez, Oscar Rosas-Carrasco
OBJECTIVES: The aims of this study were to determine the prevalence of osteosarcopenic obesity (OSO) and to investigate its association with frailty and physical performance in Mexican community-dwelling middle-aged and older women. DESIGN: Cross-sectional analysis of a prospective cohort. SETTING: The FraDySMex study, a 2-round evaluation of community-dwelling adults from 2 municipalities in Mexico City. PARTICIPANTS: Participants were 434 women aged 50 years or older, living in the designated area in Mexico City...
April 18, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28431425/the-association-of-frailty-with-outcomes-and-resource-use-after-emergency-general-surgery-a-population-based-cohort-study
#11
Daniel I McIsaac, Husein Moloo, Gregory L Bryson, Carl van Walraven
BACKGROUND: Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. METHODS: We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28429426/age-related-health-care-disparities-in-multiple-myeloma
#12
Mathieu Puyade, Gautier Defossez, François Guilhot, Xavier Leleu, Pierre Ingrand
Age is a well-known factor in solid tumours linked to lower adherence to guidelines. Scarce data exist for haematologic malignancies such as multiple myeloma (MM). The aim of the study was to investigate the relationships among age, adherence to guidelines in MM, and overall survival (OS).The Poitou-Charentes cancer registry has exhaustively registered incident cases of MM from 2008 to 2010. Diagnosis, staging, prognosis, and first-line treatment were compared to the international guidelines. Three hundred and sixty-seven patients aged 36 to 93 years were included...
April 21, 2017: Hematological Oncology
https://www.readbyqxmd.com/read/28428142/increased-rate-of-adenoma-detection-associates-with-reduced-risk-of-colorectal-cancer-and-death
#13
M F Kaminski, P Wieszczy, M Rupinski, U Wojciechowska, J Didkowska, E Kraszewska, J Kobiela, R Franczyk, M Rupinska, B Kocot, A Chaber-Ciopinska, J Pachlewski, M Polkowski, J Regula
BACKGROUND & AIMS: Quality of endoscopists' performance of colonoscopy is measured by adenoma detection rate (ADR). Although ADR is inversely associated with interval colorectal cancer and colorectal cancer death, the effects of increasing ADR have not been demonstrated. We investigated whether increasing ADRs from individual endoscopists associates with reduced risks of interval colorectal cancer and subsequent death METHODS: We performed a prospective cohort study of individuals who underwent screening colonoscopy within the National Colorectal Cancer Screening Program in Poland, from January 1, 2004 through December 31, 2008...
April 17, 2017: Gastroenterology
https://www.readbyqxmd.com/read/28427345/variation-in-gp-decisions-on-antihypertensive-treatment-in-oldest-old-and-frail-individuals-across-29-countries
#14
Sven Streit, Marjolein Verschoor, Nicolas Rodondi, Daiana Bonfim, Robert A Burman, Claire Collins, Gerasimovska Kitanovska Biljana, Sandra Gintere, Raquel Gómez Bravo, Kathryn Hoffmann, Claudia Iftode, Kasper L Johansen, Ngaire Kerse, Tuomas H Koskela, Sanda Kreitmayer Peštić, Donata Kurpas, Christian D Mallen, Hubert Maisoneuve, Christoph Merlo, Yolanda Mueller, Christiane Muth, Marija Petek Šter, Ferdinando Petrazzuoli, Thomas Rosemann, Martin Sattler, Zuzana Švadlenková, Athina Tatsioni, Hans Thulesius, Victoria Tkachenko, Peter Torzsa, Rosy Tsopra, Tuz Canan, Rita P A Viegas, Shlomo Vinker, Margot W M de Waal, Andreas Zeller, Jacobijn Gussekloo, Rosalinde K E Poortvliet
BACKGROUND: In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision...
April 20, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28427049/predictive-validity-of-two-physical-frailty-phenotype-specifications-developed-for-investigation-of-frailty-pathways-in-older-people
#15
Yew Yoong Ding
BACKGROUND: For investigating the relationship of frailty with physical, psychological, and social conditions on pathways, the frailty definition should ideally exclude these conditions. Based on the frailty phenotype, 2 candidate physical frailty specifications or instruments with 3 indicators, namely slowness, weakness, and exhaustion, and 4 indicators with addition of weight loss were previously developed, and had their construct and concurrent validity demonstrated. OBJECTIVE: This study seeks to evaluate the predictive validity of 2 candidate physical frailty specifications with respect to death, functional impairment, and poor quality of life in older people...
April 21, 2017: Gerontology
https://www.readbyqxmd.com/read/28426535/frailty-in-hiv-infected-people-a-new-risk-factor-for-bone-mineral-density-loss
#16
Sylvie Bregigeon, Anne Galinier, Olivia Zaegel-Faucher, Carla E Cano, Véronique Obry, Hélène Laroche, Sophie Trijau, Armelle Saout, Isabelle Poizot-Martin
OBJECTIVE: This study aims to assess the association between bone mineral density (BMD) and frailty in a cohort of HIV-infected patients. DESIGN: A cross-sectional study in an HIV outpatient unit where nearly 1,000 patients are monitored. METHODS: Subjects undergoing bone densitometry were proposed an evaluation of frailty using criteria of the Cardiovascular Health Study (CHS) and the Study of Osteoporotic Fractures (SOF). Frailty markers (FM) were weight-loss, self-reported exhaustion, physical activity, grip strength, chair stands, and slow gait...
April 19, 2017: AIDS
https://www.readbyqxmd.com/read/28425315/caring-in-nursing-homes-to-promote-autonomy-and-participation
#17
Maria Hedman, Elisabeth Häggström, Anna-Greta Mamhidir, Ulrika Pöder
BACKGROUND: Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care. OBJECTIVE: The purpose was to describe registered nurses' experience of caring for older people in nursing homes to promote autonomy and participation. RESEARCH DESIGN: A descriptive design with a phenomenological approach was used...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28424183/biomarker-calibrated-nutrient-intake-and-healthy-diet-index-associations-with-mortality-risks-among-older-and-frail-women-from-the-women-s-health-initiative
#18
Oleg Zaslavsky, Shira Zelber-Sagi, James R Hebert, Susan E Steck, Nitin Shivappa, Fred K Tabung, Michael D Wirth, Yunqi Bu, James M Shikany, Tonya Orchard, Robert B Wallace, Linda Snetselaar, Lesley F Tinker
Background: Although studies to date have confirmed the association between nutrition and frailty, the impact of dietary intake and dietary patterns on survivorship in those with frailty is yet to be examined in a well-powered cohort with validated frailty status. Moreover, previous studies were limited by measurement error from dietary self-reports.Objective: We derived biomarker-calibrated dietary energy and protein intakes to address dietary self-report error. Using these data, we then evaluated the association of mortality in older women with frailty and dietary intake and healthy diet indexes, such as the alternate Mediterranean Diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) score, and the Dietary Inflammatory Index (DII)...
April 19, 2017: American Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28423084/immune-system-dysfunction-in-the-elderly
#19
Eduardo Fuentes, Manuel Fuentes, Marcelo Alarcón, Iván Palomo
Human aging is characterized by both physical and physiological frailty that profoundly affects the immune system. In this context aging is associated with declines in adaptive and innate immunity established as immunosenescence. Immunosenescence is a new concept that reflects the age-associated restructuring changes of innate and adaptive immune functions. Thus elderly individuals usually present chronic low-level inflammation, higher infection rates and chronic diseases. A study of alterations in the immune system during aging could provide a potentially useful biomarker for the evaluation of immune senescence treatment...
January 2017: Anais da Academia Brasileira de Ciências
https://www.readbyqxmd.com/read/28422306/development-of-a-novel-frailty-index-to-predict-mortality-in-patients-with-end-stage-liver-disease
#20
Jennifer C Lai, Kenneth E Covinsky, Jennifer L Dodge, W John Boscardin, Dorry L Segev, John P Roberts, Sandy Feng
BACKGROUND: Cirrhosis is characterized by muscle wasting, malnutrition, and functional decline that confer excess mortality not well quantified by the MELDNa score. We aimed to develop a frailty index to capture these extrahepatic complications of cirrhosis and enhance mortality prediction in cirrhotics. METHODS: Consecutive outpatients listed for LT at a single transplant center without MELD exceptions were assessed with candidate frailty measures. Best subset selection analyses with Cox regression identified subsets of frailty measures that predicted waitlist mortality (=death or delisting due to sickness)...
April 19, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
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