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Sample records for semiparametric frailty selection

  1. Model and Variable Selection Procedures for Semiparametric Time Series Regression

    Directory of Open Access Journals (Sweden)

    Risa Kato

    2009-01-01

    Full Text Available Semiparametric regression models are very useful for time series analysis. They facilitate the detection of features resulting from external interventions. The complexity of semiparametric models poses new challenges for issues of nonparametric and parametric inference and model selection that frequently arise from time series data analysis. In this paper, we propose penalized least squares estimators which can simultaneously select significant variables and estimate unknown parameters. An innovative class of variable selection procedure is proposed to select significant variables and basis functions in a semiparametric model. The asymptotic normality of the resulting estimators is established. Information criteria for model selection are also proposed. We illustrate the effectiveness of the proposed procedures with numerical simulations.

  2. Model selection for semiparametric marginal mean regression accounting for within-cluster subsampling variability and informative cluster size.

    Science.gov (United States)

    Shen, Chung-Wei; Chen, Yi-Hau

    2018-03-13

    We propose a model selection criterion for semiparametric marginal mean regression based on generalized estimating equations. The work is motivated by a longitudinal study on the physical frailty outcome in the elderly, where the cluster size, that is, the number of the observed outcomes in each subject, is "informative" in the sense that it is related to the frailty outcome itself. The new proposal, called Resampling Cluster Information Criterion (RCIC), is based on the resampling idea utilized in the within-cluster resampling method (Hoffman, Sen, and Weinberg, 2001, Biometrika 88, 1121-1134) and accommodates informative cluster size. The implementation of RCIC, however, is free of performing actual resampling of the data and hence is computationally convenient. Compared with the existing model selection methods for marginal mean regression, the RCIC method incorporates an additional component accounting for variability of the model over within-cluster subsampling, and leads to remarkable improvements in selecting the correct model, regardless of whether the cluster size is informative or not. Applying the RCIC method to the longitudinal frailty study, we identify being female, old age, low income and life satisfaction, and chronic health conditions as significant risk factors for physical frailty in the elderly. © 2018, The International Biometric Society.

  3. Frailty

    African Journals Online (AJOL)

    Frailty may be primary or secondary to medical conditions and the challenge in assessing and ..... Maliganancy. Tuberculosis. Renal failure. SIADH, Addison's. Hyperparathyroidism. Malnutrition. Osteomalacia. Anaemia of chronic disorders. Lymphoproliferative disease. Autoimmune. Myeloma. Polymyagia rheumatica. Fig.

  4. Estimation and model selection of semiparametric multivariate survival functions under general censorship.

    Science.gov (United States)

    Chen, Xiaohong; Fan, Yanqin; Pouzo, Demian; Ying, Zhiliang

    2010-07-01

    We study estimation and model selection of semiparametric models of multivariate survival functions for censored data, which are characterized by possibly misspecified parametric copulas and nonparametric marginal survivals. We obtain the consistency and root- n asymptotic normality of a two-step copula estimator to the pseudo-true copula parameter value according to KLIC, and provide a simple consistent estimator of its asymptotic variance, allowing for a first-step nonparametric estimation of the marginal survivals. We establish the asymptotic distribution of the penalized pseudo-likelihood ratio statistic for comparing multiple semiparametric multivariate survival functions subject to copula misspecification and general censorship. An empirical application is provided.

  5. Gender Wage Gap : A Semi-Parametric Approach With Sample Selection Correction

    NARCIS (Netherlands)

    Picchio, M.; Mussida, C.

    2010-01-01

    Sizeable gender differences in employment rates are observed in many countries. Sample selection into the workforce might therefore be a relevant issue when estimating gender wage gaps. This paper proposes a new semi-parametric estimator of densities in the presence of covariates which incorporates

  6. Covariate selection for the semiparametric additive risk model

    DEFF Research Database (Denmark)

    Martinussen, Torben; Scheike, Thomas

    2009-01-01

    This paper considers covariate selection for the additive hazards model. This model is particularly simple to study theoretically and its practical implementation has several major advantages to the similar methodology for the proportional hazards model. One complication compared...... and study their large sample properties for the situation where the number of covariates p is smaller than the number of observations. We also show that the adaptive Lasso has the oracle property. In many practical situations, it is more relevant to tackle the situation with large p compared with the number...... of observations. We do this by studying the properties of the so-called Dantzig selector in the setting of the additive risk model. Specifically, we establish a bound on how close the solution is to a true sparse signal in the case where the number of covariates is large. In a simulation study, we also compare...

  7. Semiparametric efficient and robust estimation of an unknown symmetric population under arbitrary sample selection bias

    KAUST Repository

    Ma, Yanyuan

    2013-09-01

    We propose semiparametric methods to estimate the center and shape of a symmetric population when a representative sample of the population is unavailable due to selection bias. We allow an arbitrary sample selection mechanism determined by the data collection procedure, and we do not impose any parametric form on the population distribution. Under this general framework, we construct a family of consistent estimators of the center that is robust to population model misspecification, and we identify the efficient member that reaches the minimum possible estimation variance. The asymptotic properties and finite sample performance of the estimation and inference procedures are illustrated through theoretical analysis and simulations. A data example is also provided to illustrate the usefulness of the methods in practice. © 2013 American Statistical Association.

  8. Empirical Bayes ranking and selection methods via semiparametric hierarchical mixture models in microarray studies.

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    Noma, Hisashi; Matsui, Shigeyuki

    2013-05-20

    The main purpose of microarray studies is screening of differentially expressed genes as candidates for further investigation. Because of limited resources in this stage, prioritizing genes are relevant statistical tasks in microarray studies. For effective gene selections, parametric empirical Bayes methods for ranking and selection of genes with largest effect sizes have been proposed (Noma et al., 2010; Biostatistics 11: 281-289). The hierarchical mixture model incorporates the differential and non-differential components and allows information borrowing across differential genes with separation from nuisance, non-differential genes. In this article, we develop empirical Bayes ranking methods via a semiparametric hierarchical mixture model. A nonparametric prior distribution, rather than parametric prior distributions, for effect sizes is specified and estimated using the "smoothing by roughening" approach of Laird and Louis (1991; Computational statistics and data analysis 12: 27-37). We present applications to childhood and infant leukemia clinical studies with microarrays for exploring genes related to prognosis or disease progression. Copyright © 2012 John Wiley & Sons, Ltd.

  9. Semiparametric regression for the social sciences

    CERN Document Server

    Keele, Luke John

    2008-01-01

    An introductory guide to smoothing techniques, semiparametric estimators, and their related methods, this book describes the methodology via a selection of carefully explained examples and data sets. It also demonstrates the potential of these techniques using detailed empirical examples drawn from the social and political sciences. Each chapter includes exercises and examples and there is a supplementary website containing all the datasets used, as well as computer code, allowing readers to replicate every analysis reported in the book. Includes software for implementing the methods in S-Plus and R.

  10. Frailty and Technology: A Systematic Review of Gait Analysis in Those with Frailty

    Science.gov (United States)

    Schwenk, Michael; Howe, Carol; Saleh, Ahlam; Mohler, Jane; Grewal, Gurtej; Armstrong, David; Najafi, Bijan

    2014-01-01

    Background New technologies for gait assessment areemerging and have provided new avenues for accurately measuring gait characteristics in home and clinic. However, potential meaningful clinical gait parameters beyond speed have received little attention in frailty research. Objective To study gait characteristics in different frailty status groups for identifying the most useful parameters and assessment protocols for frailty diagnosis. Methods We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and Age Line. Articles were selected according to the following criteria: (1) population: individuals defined as frail, prefrail, or transitioning to frail, and (2) outcome measures: quantitative gait variables as obtained by biomechanical analysis. Effect sizes (d) were calculated for the ability of parameters to discriminate between different frailty status groups. Results Eleven publications met inclusion criteria. Frailty definitions, gait protocols and parameters were inconsistent, which made comparison of outcomes difficult. Effect sizes were calculated only for the three studies which compared at least two different frailty status groups. Gait speed shows the highest effect size to discriminate between frailty subgroups, in particular during habitual walking (d = 0.76–6.17). Gait variability also discriminates between different frailty status groups in particular during fast walking. Prominent parameters related to prefrailty are reduced cadence (d = 1.43) and increased step width variability (d = 0.64), whereas frailty (vs. prefrail status) is characterized by reduced step length during habitual walking (d = 1.32) and increased double support during fast walking (d = 0.78). Interestingly, one study suggested that dual-task walking speed can be used to predict prospective frailty development. Conclusion Gait characteristics in people with frailty are insufficiently analyzed in the literature and represent a major area for innovation

  11. Frailty Across Age Groups.

    Science.gov (United States)

    Pérez-Zepeda, M U; Ávila-Funes, J A; Gutiérrez-Robledo, L M; García-Peña, C

    2016-01-01

    The implementation of an aging biomarker into clinical practice is under debate. The Frailty Index is a model of deficit accumulation and has shown to accurately capture frailty in older adults, thus bridging biological with clinical practice. To describe the association of socio-demographic characteristics and the Frailty Index in different age groups (from 20 to over one hundred years) in a representative sample of Mexican subjects. Cross-sectional analysis. Nationwide and population-representative survey. Adults 20-years and older interviewed during the last Mexican National Health and Nutrition Survey (2012). A 30-item Frailty Index following standard construction was developed. Multi-level regression models were performed to test the associations of the Frailty Index with multiple socio-demographic characteristics across age groups. A total of 29,504 subjects was analyzed. The 30-item Frailty Index showed the highest scores in the older age groups, especially in women. No sociodemographic variable was associated with the Frailty Index in all the studied age groups. However, employment, economic income, and smoking status were more consistently found across age groups. To our knowledge, this is the first report describing the Frailty Index in a representative large sample of a Latin American country. Increasing age and gender were closely associated with a higher score.

  12. Nutrition, frailty, and sarcopenia.

    Science.gov (United States)

    Cruz-Jentoft, Alfonso J; Kiesswetter, Eva; Drey, Michael; Sieber, Cornel C

    2017-02-01

    Frailty and sarcopenia are important concepts in the quest to prevent physical dependence, as geriatrics are shifting towards identifications of early stages of disability. Definitions of both sarcopenia and frailty are still developing, and both concepts clearly overlap in their physical aspects. Malnutrition (both undernutrition and obesity) plays a key role in the pathogenesis of frailty and sarcopenia. The quality of the diet along the lifespan has a close relation with the incidence of both entities, and nutritional interventions may be able to reduce the incidence or revert either of them. This brief review explores the role of energy and protein intake and other key nutrients on muscle function. Nutrition may be a key element of multimodal interventions for frailty and sarcopenia. The results of the "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) trial will offer key insights on the effect of such interventions in frail, sarcopenic older individuals.

  13. Semiparametric regression during 2003–2007

    KAUST Repository

    Ruppert, David

    2009-01-01

    Semiparametric regression is a fusion between parametric regression and nonparametric regression that integrates low-rank penalized splines, mixed model and hierarchical Bayesian methodology – thus allowing more streamlined handling of longitudinal and spatial correlation. We review progress in the field over the five-year period between 2003 and 2007. We find semiparametric regression to be a vibrant field with substantial involvement and activity, continual enhancement and widespread application.

  14. Frailty and Mobility.

    Science.gov (United States)

    Eeles, Eamonn; Low Choy, Nancy

    2015-01-01

    Frailty represents a state of heightened vulnerability. Mobility impairment contributes to the construct of frailty and channels adverse events. While mobility disorder is universal at a high burden of frailty, neither mobility nor balance dysfunction is sufficient to fully define frailty. Frailty represents proximity to complex system failure, with higher-order disturbance, such as mobility and balance disturbance, as a consequence. Impairment of mobility and balance is a common manifestation of illness in the frail individual and is therefore a sensitive marker of acute disease, putatively also in delirium. Clinical measurement of mobility and balance should be prioritized. Consequently, assessment tools, such as the de Morton Mobility Index and the Hierarchical Assessment of Balance and Mobility, are being explored, with the sensitivity of the latter illustrated in the acute hospital setting. Walking with speed and under dual/multi-task conditions better differentiates healthier and frail ambulant adults, providing a basis for screening older adults for pre-emptive interventions. Specific mobility and balance interventions reduce falls risk. However, patients with dementia walk too fast for their level of frailty, creating an ethical dimension to rehabilitation and risk. Overall, there is no need for reduced mobility to reinforce the frailty stereotype; both are potentially modifiable and amenable to intervention strategies. 2015 S. Karger AG, Basel.

  15. Frailty and Transplantation

    NARCIS (Netherlands)

    Exterkate, Leonie; Slegtenhorst, Bendix R.; Kelm, Matthias; Seyda, Midas; Schuitenmaker, Jeroen M.; Quante, Markus; Uehara, Hirofumi; El Khal, Abdala; Tullius, Stefan G.

    Consequences of aging are gaining clinical relevance. In transplantation, aging and immunosenescence impact treatment and outcomes. The impact of aging, however, will critically depend on distinguishing healthy, chronological aging from biological aging that may result into frailty. Approximately

  16. Frailty Intervention Trial (FIT

    Directory of Open Access Journals (Sweden)

    Lockwood Keri

    2008-10-01

    Full Text Available Abstract Background Frailty is a term commonly used to describe the condition of an older person who has chronic health problems, has lost functional abilities and is likely to deteriorate further. However, despite its common use, only a small number of studies have attempted to define the syndrome of frailty and measure its prevalence. The criteria Fried and colleagues used to define the frailty syndrome will be used in this study (i.e. weight loss, fatigue, decreased grip strength, slow gait speed, and low physical activity. Previous studies have shown that clinical outcomes for frail older people can be improved using multi-factorial interventions such as comprehensive geriatric assessment, and single interventions such as exercise programs or nutritional supplementation, but no interventions have been developed to specifically reverse the syndrome of frailty. We have developed a multidisciplinary intervention that specifically targets frailty as defined by Fried et al. We aim to establish the effects of this intervention on frailty, mobility, hospitalisation and institutionalisation in frail older people. Methods and Design A single centre randomised controlled trial comparing a multidisciplinary intervention with usual care. The intervention will target identified characteristics of frailty, functional limitations, nutritional status, falls risk, psychological issues and management of chronic health conditions. Two hundred and thirty people aged 70 and over who meet the Fried definition of frailty will be recruited from clients of the aged care service of a metropolitan hospital. Participants will be followed for a 12-month period. Discussion This research is an important step in the examination of specifically targeted frailty interventions. This project will assess whether an intervention specifically targeting frailty can be implemented, and whether it is effective when compared to usual care. If successful, the study will establish a

  17. [Frailty in the elderly

    NARCIS (Netherlands)

    Iersel, M.B. van; Jansen, D.R.; Olde Rikkert, M.G.M.

    2009-01-01

    Older people differ in their level of multimorbidity, functional dependence and need for assistance. Frailty is a recently constructed syndromatic entity used to characterize vulnerable older people with an increased risk of functional decline, institutionalization and death. This is illustrated by

  18. Explaining frailty by lifestyle

    NARCIS (Netherlands)

    Gobbens, Robbert J J; van Assen, Marcel A L M

    2016-01-01

    Objective: To determine whether the effects of lifestyle factors on frailty can be adequately addressed by asking a single self-report question. Design: Cross-sectional study. Setting: A sample of Dutch citizens completed the web-based questionnaire "Seniorenbarometer". Participants: 610 persons

  19. Frailty in elderly people

    NARCIS (Netherlands)

    Clegg, A.; Young, J.; Iliffe, S.; Olde Rikkert, M.G.M.; Rockwood, K.

    2013-01-01

    Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves

  20. Marginal longitudinal semiparametric regression via penalized splines

    KAUST Repository

    Al Kadiri, M.

    2010-08-01

    We study the marginal longitudinal nonparametric regression problem and some of its semiparametric extensions. We point out that, while several elaborate proposals for efficient estimation have been proposed, a relative simple and straightforward one, based on penalized splines, has not. After describing our approach, we then explain how Gibbs sampling and the BUGS software can be used to achieve quick and effective implementation. Illustrations are provided for nonparametric regression and additive models.

  1. Nonparametric and semiparametric dynamic additive regression models

    DEFF Research Database (Denmark)

    Scheike, Thomas Harder; Martinussen, Torben

    Dynamic additive regression models provide a flexible class of models for analysis of longitudinal data. The approach suggested in this work is suited for measurements obtained at random time points and aims at estimating time-varying effects. Both fully nonparametric and semiparametric models can...... in special cases. We investigate the finite sample properties of the estimators and conclude that the asymptotic results are valid for even samll samples....

  2. A matrix approach to the statistics of longevity in heterogeneous frailty models

    Directory of Open Access Journals (Sweden)

    Hal Caswell

    2014-09-01

    Full Text Available Background: The gamma-Gompertz model is a fixed frailty model in which baseline mortality increasesexponentially with age, frailty has a proportional effect on mortality, and frailty at birth follows a gamma distribution. Mortality selects against the more frail, so the marginal mortality rate decelerates, eventually reaching an asymptote. The gamma-Gompertz is one of a wider class of frailty models, characterized by the choice of baseline mortality, effects of frailty, distributions of frailty, and assumptions about the dynamics of frailty. Objective: To develop a matrix model to compute all the statistical properties of longevity from thegamma-Gompertz and related models. Methods: I use the vec-permutation matrix formulation to develop a model in which individuals are jointly classified by age and frailty. The matrix is used to project the age and frailty dynamicsof a cohort and the fundamental matrix is used to obtain the statistics of longevity. Results: The model permits calculation of the mean, variance, coefficient of variation, skewness and all moments of longevity, the marginal mortality and survivorship functions, the dynamics of the frailty distribution, and other quantities. The matrix formulation extends naturally to other frailty models. I apply the analysis to the gamma-Gompertz model (for humans and laboratory animals, the gamma-Makeham model, and the gamma-Siler model, and to a hypothetical dynamic frailty model characterized by diffusion of frailty with reflecting boundaries.The matrix model permits partitioning the variance in longevity into components due to heterogeneity and to individual stochasticity. In several published human data sets, heterogeneity accounts for less than 10Š of the variance in longevity. In laboratory populations of five invertebrate animal species, heterogeneity accounts for 46Š to 83Š ofthe total variance in longevity.

  3. SEMIPARAMETRIC VERSUS PARAMETRIC CLASSIFICATION MODELS - AN APPLICATION TO DIRECT MARKETING

    NARCIS (Netherlands)

    BULT, [No Value

    In this paper we are concerned with estimation of a classification model using semiparametric and parametric methods. Benefits and limitations of semiparametric models in general, and of Manski's maximum score method in particular, are discussed. The maximum score method yields consistent estimates

  4. A new operational definition of frailty: the Frailty Trait Scale.

    Science.gov (United States)

    García-García, Francisco José; Carcaillon, Laure; Fernandez-Tresguerres, Jesus; Alfaro, Ana; Larrion, Jose L; Castillo, Carmen; Rodriguez-Mañas, Leocadio

    2014-05-01

    To provide a new instrument to diagnose frailty, the Frailty Trait Scale (FTS), that allows a more precise assessment and monitoring of individuals. Prospective population-based cohort study. The Toledo Study for Healthy Aging, Spain. A total of 1972 men and women aged 65 years or older. We identified 7 frailty dimensions (energy balance-nutrition, physical activity, nervous system, vascular system, strength, endurance, and gait speed) represented by 12 items. Each item was pondered based on the quintiles of its distribution in the study population. Validity was evaluated by testing its association with factors related to frailty and its predictive value for adverse events. This predictive capacity was further compared with the capacity of 2 well-established frailty models (the frailty phenotype and the Frailty Index). FTS score was associated with several comorbidities and biomarkers classically associated with frailty. The FTS was associated with the incidence of hospitalization and mortality (hazard ratio associated with a score in the highest quartile [versus the first quartile] = 2.3, 95% confidence interval [CI] 1.6-3.4, and 2.5, 95% CI 1.8-3.6, respectively). Compared with Fried et al's definition, the FTS showed a better predictor for hospitalization in persons younger than 80 (area under the curve [AUC] = 0.65 vs 0.62, P = .01), and for mortality in the oldest group (AUC = 0.77 vs 0.72, P = .02). FTS showed similar predictive value to the Frailty Index. FTS associates with many of the factors linked to frailty and has a similar predictive capacity to that provided by the classical instruments. Its characteristics offer some advantages over them, with potential utility in research and clinical practice. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  5. Efficient estimation of semiparametric copula models for bivariate survival data

    KAUST Repository

    Cheng, Guang

    2014-01-01

    A semiparametric copula model for bivariate survival data is characterized by a parametric copula model of dependence and nonparametric models of two marginal survival functions. Efficient estimation for the semiparametric copula model has been recently studied for the complete data case. When the survival data are censored, semiparametric efficient estimation has only been considered for some specific copula models such as the Gaussian copulas. In this paper, we obtain the semiparametric efficiency bound and efficient estimation for general semiparametric copula models for possibly censored data. We construct an approximate maximum likelihood estimator by approximating the log baseline hazard functions with spline functions. We show that our estimates of the copula dependence parameter and the survival functions are asymptotically normal and efficient. Simple consistent covariance estimators are also provided. Numerical results are used to illustrate the finite sample performance of the proposed estimators. © 2013 Elsevier Inc.

  6. Fecal microbiota composition and frailty

    NARCIS (Netherlands)

    van Tongeren, SP; Slaets, JPJ; Harmsen, HJM; Welling, GW

    2005-01-01

    The relationship between fecal microbiota composition and frailty in the elderly was studied. Fecal samples from volunteers with high frailty scores showed a significant reduction in the number of lactobacilli (26-fold). At much higher population levels, both the Bacteroides/Prevotella (threefold)

  7. Semi-parametric estimation for ARCH models

    Directory of Open Access Journals (Sweden)

    Raed Alzghool

    2018-03-01

    Full Text Available In this paper, we conduct semi-parametric estimation for autoregressive conditional heteroscedasticity (ARCH model with Quasi likelihood (QL and Asymptotic Quasi-likelihood (AQL estimation methods. The QL approach relaxes the distributional assumptions of ARCH processes. The AQL technique is obtained from the QL method when the process conditional variance is unknown. We present an application of the methods to a daily exchange rate series. Keywords: ARCH model, Quasi likelihood (QL, Asymptotic Quasi-likelihood (AQL, Martingale difference, Kernel estimator

  8. Frailty and nutrition: searching for evidence.

    Science.gov (United States)

    Bonnefoy, M; Berrut, G; Lesourd, B; Ferry, M; Gilbert, T; Guérin, O; Hanon, O; Jeandel, C; Paillaud, E; Raynaud-Simon, A; Ruault, G; Rolland, Y

    2015-03-01

    Frailty is a geriatric syndrome that predicts disability, morbidity and mortality in the elderly. Poor nutritional status is one of the main risk factors for frailty. Macronutrients and micronutrients deficiencies are associated with frailty. Recent studies suggest that improving nutritional status for macronutrients and micronutrients may reduce the risk of frailty. Specific diets such as the Mediterranean diet rich in anti-oxidants, is currently investigated in the prevention of frailty. The aim of this paper is to summarize the current body of knowledge on the relations between nutrition and frailty, and provide recommendations for future nutritional research on the field of frailty.

  9. Exercise prescription to reverse frailty.

    Science.gov (United States)

    Bray, Nick W; Smart, Rowan R; Jakobi, Jennifer M; Jones, Gareth R

    2016-10-01

    Frailty is a clinical geriatric syndrome caused by physiological deficits across multiple systems. These deficits make it challenging to sustain homeostasis required for the demands of everyday life. Exercise is likely the best therapy to reverse frailty status. Literature to date suggests that pre-frail older adults, those with 1-2 deficits on the Cardiovascular Health Study-Frailty Phenotype (CHS-frailty phenotype), should exercise 2-3 times a week, for 45-60 min. Aerobic, resistance, flexibility, and balance training components should be incorporated but resistance and balance activities should be emphasized. On the other hand, frail (CHS-frailty phenotype ≥ 3 physical deficits) older adults should exercise 3 times per week, for 30-45 min for each session with an emphasis on aerobic training. During aerobic, balance, and flexibility training, both frail and pre-frail older adults should work at an intensity equivalent to a rating of perceived exertion of 3-4 ("somewhat hard") on the Borg CR10 scale. Resistance-training intensity should be based on a percentage of 1-repetition estimated maximum (1RM). Program onset should occur at 55% of 1RM (endurance) and progress to higher intensities of 80% of 1RM (strength) to maximize functional gains. Exercise is the medicine to reverse or mitigate frailty, preserve quality of life, and restore independent functioning in older adults at risk of frailty.

  10. Frailty among rural elderly adults.

    Science.gov (United States)

    Curcio, Carmen-Lucia; Henao, Guadalupe-Maria; Gomez, Fernando

    2014-01-10

    This study aimed to estimate the prevalence and associated factors related to frailty, by Fried criteria, in the elderly population in a rural area in the Andes Mountains, and to analyze the relationship of these with comorbidity and disability. A cross-sectional study was undertaken involving 1878 participants 60 years of age and older. The frailty syndrome was diagnosed based on the Fried criteria (weakness, low speed, low physical activity, exhaustion, and weight loss). Variables were grouped as theoretical domains and, along with other potential confounders, were placed into five categories: (a) demographic and socioeconomic status, (b) health status, (c) self-reported functional status, (d) physical performance-based measures, and (e) psychosocial factors. Chi-square, ANOVA, and multinomial logistic regression analyses were used to test the prognostic value of frailty for the outcomes of interest. The prevalence of frailty was 12.2%. Factors associated with frailty were age, gender, health status variables that included self-perceived health and number of chronic conditions, functional covariate variables that included disability in activities in daily living (ADL), disabilities in instrumental ADL, chair stand time, and psychosocial variables that included depressive symptoms and cognitive impairment. Higher comorbidity and disability was found in frail elderly people. Only a subset of frail elderly people (10%) reported no disease or disability. A relevant number of elderly persons living in rural areas in the Andes Mountains are frail. The prevalence of frailty is similar to that reported in other populations in the Latin American region. Our results support the use of modified Cardiovascular Health Study criteria to measure frailty in communities other than urban settings. Frailty in this study was strongly associated with comorbidities, and frailty and comorbidity predicted disability.

  11. Management of Frailty at Individual Level - Clinical Management: Systematic Literature Review.

    Science.gov (United States)

    Veninšek, Gregor; Gabrovec, Branko

    2018-06-01

    To deliver quality management of a frail individual, a clinician should understand the concept of frailty, be aware of its epidemiology and be able to screen for frailty and assess it when it is present, and, finally, to recommend successful interventions. A systematic literature search was conducted in the following databases: PubMed, Cochrane, Embase, Cinahl and UpToDate. The criterion in selecting the literature was that articles were published in the period from 2002 to 2017. From 67432 initial hits, 27 publications were selected. Useful interventions to address frailty are supplementation of vitamin D, proper nutrition, multicomponent training, home-based physiotherapy and comprehensive geriatric assessment, particularly when performed in geriatric wards. Comprehensive geriatric assessment is an effective way to decrease frailty status especially when performed in geriatric wards. Multicomponent physical training and multidimensional interventions (physical training, nutrition, vitamin D supplementation and cognitive training) are effective measures to reduce frailty.

  12. Combining parametric, semi-parametric, and non-parametric survival models with stacked survival models.

    Science.gov (United States)

    Wey, Andrew; Connett, John; Rudser, Kyle

    2015-07-01

    For estimating conditional survival functions, non-parametric estimators can be preferred to parametric and semi-parametric estimators due to relaxed assumptions that enable robust estimation. Yet, even when misspecified, parametric and semi-parametric estimators can possess better operating characteristics in small sample sizes due to smaller variance than non-parametric estimators. Fundamentally, this is a bias-variance trade-off situation in that the sample size is not large enough to take advantage of the low bias of non-parametric estimation. Stacked survival models estimate an optimally weighted combination of models that can span parametric, semi-parametric, and non-parametric models by minimizing prediction error. An extensive simulation study demonstrates that stacked survival models consistently perform well across a wide range of scenarios by adaptively balancing the strengths and weaknesses of individual candidate survival models. In addition, stacked survival models perform as well as or better than the model selected through cross-validation. Finally, stacked survival models are applied to a well-known German breast cancer study. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. A multidisciplinary systematic literature review on frailty: Overview of the methodology used by the Canadian Initiative on Frailty and Aging

    Directory of Open Access Journals (Sweden)

    Bergman Howard

    2009-10-01

    Full Text Available Abstract Background Over the past two decades, there has been a substantial growth in the body of literature on frailty in older persons. However, there is no consensus on its definition or the criteria used to identify frailty. In response to this lack of consensus, the Canadian Initiative on Frailty and Aging carried out a set of systematic reviews of the literature in ten areas of frailty research: biological basis; social basis; prevalence; risk factors; impact; identification; prevention and management; environment and technology; health services; health and social policy. This paper describes the methodology that was developed for the systematic reviews. Methods A Central Coordination Group (CCG was responsible for developing the methodology. This involved the development of search strategies and keywords, article selection processes, quality assessment tools, and guidelines for the synthesis of results. Each review was conducted by two experts in the content area, with the assistance of methodologists and statisticians from the CCG. Results Conducting a series of systematic literature reviews involving a range of disciplines on a concept that does not have a universally accepted definition posed several conceptual and methodological challenges. The most important conceptual challenge was determining what would qualify as literature on frailty. The methodological challenges arose from our goal of structuring a consistent methodology for reviewing literature from diverse fields of research. At the outset, certain methodological guidelines were deemed essential to ensure the validity of all the reviews. Nevertheless, it was equally important to permit flexibility in the application of the proposed methodology to capture the essence of frailty research within the given fields. Conclusion The results of these reviews allowed us to establish the status of current knowledge on frailty and promote collaboration between disciplines. Conducting

  14. Frailty and post-operative outcomes in older surgical patients: a systematic review.

    Science.gov (United States)

    Lin, Hui-Shan; Watts, J N; Peel, N M; Hubbard, R E

    2016-08-31

    As the population ages, increasing numbers of older adults are undergoing surgery. Frailty is prevalent in older adults and may be a better predictor of post-operative morbidity and mortality than chronological age. The aim of this review was to examine the impact of frailty on adverse outcomes in the 'older old' and 'oldest old' surgical patients. A systematic review was undertaken. Electronic databases from 2010 to 2015 were searched to identify articles which evaluated the relationship between frailty and post-operative outcomes in surgical populations with a mean age of 75 and older. Articles were excluded if they were in non-English languages or if frailty was measured using a single marker only. Demographic data, type of surgery performed, frailty measure and impact of frailty on adverse outcomes were extracted from the selected studies. Quality of the studies and risk of bias was assessed by the Epidemiological Appraisal Instrument. Twenty-three studies were selected for the review and they were assessed as medium to high quality. The mean age ranged from 75 to 87 years, and included patients undergoing cardiac, oncological, general, vascular and hip fracture surgeries. There were 21 different instruments used to measure frailty. Regardless of how frailty was measured, the strongest evidence in terms of numbers of studies, consistency of results and study quality was for associations between frailty and increased mortality at 30 days, 90 days and one year follow-up, post-operative complications and length of stay. A small number of studies reported on discharge to institutional care, functional decline and lower quality of life after surgery, and also found a significant association with frailty. There was strong evidence that frailty in older-old and oldest-old surgical patients predicts post-operative mortality, complications, and prolonged length of stay. Frailty assessment may be a valuable tool in peri-operative assessment. It is possible that

  15. Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments

    Science.gov (United States)

    Buta, Brian J.; Walston, Jeremy D.; Godino, Job G.; Park, Minsun; Kalyani, Rita R.; Xue, Qian-Li; Bandeen-Roche, Karen; Varadhan, Ravi

    2016-01-01

    The medical syndrome of frailty is widely recognized, yet debate remains over how best to measure it in clinical and research settings. This study reviewed the frailty-related research literature by (a) comprehensively cataloging the wide array of instruments that have been utilized to measure frailty, and (b) systematically categorizing the different purposes and contexts of use for frailty instruments frequently cited in the research literature. We identified 67 frailty instruments total; of these, nine were highly-cited (≥200 citations). We randomly sampled and reviewed 545 English-language articles citing at least one highly-cited instrument. We estimated the total number of uses, and classified use into eight categories: risk assessment for adverse health outcomes (31% of all uses); etiological studies of frailty (22%); methodology studies (14%); biomarker studies (12%); inclusion/exclusion criteria (10%); estimating prevalence as primary goal (5%); clinical decision-making (2%); and interventional targeting (2%). The most common assessment context was observational studies of older community-dwelling adults. Physical Frailty Phenotype was the most used frailty instrument in the research literature, followed by the Deficit Accumulation Index and the Vulnerable Elders Survey. This study provides an empirical evaluation of the current uses of frailty instruments, which may be important to consider when selecting instruments for clinical or research purposes. We recommend careful consideration in the selection of a frailty instrument based on the intended purpose, domains captured, and how the instrument has been used in the past. Continued efforts are needed to study the validity and feasibility of these instruments. PMID:26674984

  16. Testosterone and frailty in elderly men

    NARCIS (Netherlands)

    Emmelot-Vonk, M.H.

    2009-01-01

    With aging, there is an increase of the incidence of frailty. Frailty is associated with adverse health outcomes, like falls and fractures, disabilities, hospitalization, institutionalization and mortality. It is generally accepted that frailty, unlike the aging process, is in part reversible and

  17. Operationalizing frailty among older residents of assisted living facilities

    Directory of Open Access Journals (Sweden)

    Patten Scott B

    2011-05-01

    Full Text Available Abstract Background Frailty in later life is viewed as a state of heightened vulnerability to poor outcomes. The utility of frailty as a measure of vulnerability in the assisted living (AL population remains unexplored. We examined the feasibility and predictive accuracy of two different interpretations of the Cardiovascular Health Study (CHS frailty criteria in a population-based sample of AL residents. Methods CHS frailty criteria were operationalized using two different approaches in 928 AL residents from the Alberta Continuing Care Epidemiological Studies (ACCES. Risks of one-year mortality and hospitalization were estimated for those categorized as frail or pre-frail (compared with non-frail. The prognostic significance of individual criteria was explored, and the area under the ROC curve (AUC was calculated for select models to assess the utility of frailty in predicting one-year outcomes. Results Regarding feasibility, complete CHS criteria could not be assessed for 40% of the initial 1,067 residents. Consideration of supplementary items for select criteria reduced this to 12%. Using absolute (CHS-specified cut-points, 48% of residents were categorized as frail and were at greater risk for death (adjusted risk ratio [RR] 1.75, 95% CI 1.08-2.83 and hospitalization (adjusted RR 1.54, 95% CI 1.20-1.96. Pre-frail residents defined by absolute cut-points (48.6% showed no increased risk for mortality or hospitalization compared with non-frail residents. Using relative cut-points (derived from AL sample, 19% were defined as frail and 55% as pre-frail and the associated risks for mortality and hospitalization varied by sex. Frail (but not pre-frail women were more likely to die (RR 1.58 95% CI 1.02-2.44 and be hospitalized (RR 1.53 95% CI 1.25-1.87. Frail and pre-frail men showed an increased mortality risk (RR 3.21 95% CI 1.71-6.00 and RR 2.61 95% CI 1.40-4.85, respectively while only pre-frail men had an increased risk of hospitalization (RR 1

  18. Operationalizing frailty among older residents of assisted living facilities.

    Science.gov (United States)

    Freiheit, Elizabeth A; Hogan, David B; Strain, Laurel A; Schmaltz, Heidi N; Patten, Scott B; Eliasziw, Misha; Maxwell, Colleen J

    2011-05-13

    Frailty in later life is viewed as a state of heightened vulnerability to poor outcomes. The utility of frailty as a measure of vulnerability in the assisted living (AL) population remains unexplored. We examined the feasibility and predictive accuracy of two different interpretations of the Cardiovascular Health Study (CHS) frailty criteria in a population-based sample of AL residents. CHS frailty criteria were operationalized using two different approaches in 928 AL residents from the Alberta Continuing Care Epidemiological Studies (ACCES). Risks of one-year mortality and hospitalization were estimated for those categorized as frail or pre-frail (compared with non-frail). The prognostic significance of individual criteria was explored, and the area under the ROC curve (AUC) was calculated for select models to assess the utility of frailty in predicting one-year outcomes. Regarding feasibility, complete CHS criteria could not be assessed for 40% of the initial 1,067 residents. Consideration of supplementary items for select criteria reduced this to 12%. Using absolute (CHS-specified) cut-points, 48% of residents were categorized as frail and were at greater risk for death (adjusted risk ratio [RR] 1.75, 95% CI 1.08-2.83) and hospitalization (adjusted RR 1.54, 95% CI 1.20-1.96). Pre-frail residents defined by absolute cut-points (48.6%) showed no increased risk for mortality or hospitalization compared with non-frail residents. Using relative cut-points (derived from AL sample), 19% were defined as frail and 55% as pre-frail and the associated risks for mortality and hospitalization varied by sex. Frail (but not pre-frail) women were more likely to die (RR 1.58 95% CI 1.02-2.44) and be hospitalized (RR 1.53 95% CI 1.25-1.87). Frail and pre-frail men showed an increased mortality risk (RR 3.21 95% CI 1.71-6.00 and RR 2.61 95% CI 1.40-4.85, respectively) while only pre-frail men had an increased risk of hospitalization (RR 1.58 95% CI 1.15-2.17). Although

  19. Semiparametric Mixtures of Regressions with Single-index for Model Based Clustering

    OpenAIRE

    Xiang, Sijia; Yao, Weixin

    2017-01-01

    In this article, we propose two classes of semiparametric mixture regression models with single-index for model based clustering. Unlike many semiparametric/nonparametric mixture regression models that can only be applied to low dimensional predictors, the new semiparametric models can easily incorporate high dimensional predictors into the nonparametric components. The proposed models are very general, and many of the recently proposed semiparametric/nonparametric mixture regression models a...

  20. Investigating international new product diffusion speed: A semiparametric approach

    KAUST Repository

    Hartman, Brian M.

    2012-06-01

    Global marketing managers are interested in understanding the speed of the new product diffusion process and how the speed has changed in our ever more technologically advanced and global marketplace. Understanding the process allows firms to forecast the expected rate of return on their new products and develop effective marketing strategies. The most recent major study on this topic [Marketing Science 21 (2002) 97-114] investigated new product diffusions in the United States.We expand upon that study in three important ways. (1) Van den Bulte notes that a similar study is needed in the international context, especially in developing countries. Our study covers four new product diffusions across 31 developed and developing nations from 1980-2004. Our sample accounts for about 80% of the global economic output and 60% of the global population, allowing us to examine more general phenomena. (2) His model contains the implicit assumption that the diffusion speed parameter is constant throughout the diffusion life cycle of a product. Recognizing the likely effects on the speed parameter of recent changes in the marketplace, we model the parameter as a semiparametric function, allowing it the flexibility to change over time. (3) We perform a variable selection to determine that the number of internet users and the consumer price index are strongly associated with the speed of diffusion. © Institute of Mathematical Statistics, 2012.

  1. Frailty in Community-Dwelling Older People in Abu Dhabi, United Arab Emirates: A Cross-Sectional Study.

    Science.gov (United States)

    Al-Kuwaiti, Saleha Jaber; Aziz, Faisal; Blair, Iain

    2015-01-01

    Frailty describes the aging-associated loss of physiological and psychological reserves, leading to an increased risk of adverse health outcomes. Many developed countries view frailty as a major priority for their health and social care systems. Less is known about frailty in less-developed countries. The purpose of this study was to determine the prevalence of frailty in a sample of community-dwelling older people in the United Arab Emirates (UAE). This was a cross-sectional study of community-dwelling Emirati adults aged 55 years and older (n = 160) in Abu Dhabi, UAE. Data were collected at interview by questionnaire and physical measurements. Frailty was defined according to the criteria of the Fried Frailty Index. The prevalence of frailty and its association with selected independent variables were assessed. The overall prevalence of frailty (95% CI) was 47% (39-55). Higher levels of frailty were seen in older age groups, women, those who were non-married, those with recent hospital admission, those with comorbid conditions, those on more than five medications, and those with lower forced expiratory volume and mini-mental state examination score. After adjustment in a multiple logistic regression model, only age and gender were found to be independently associated with frailty. A high prevalence of frailty was found among older Emiratis. Given that frailty is associated with adverse health outcomes and can be a means of identifying opportunities for intervention in clinical practice and health policy, further attention and consideration within professional and public health policy circles are needed.

  2. Dose-response curve estimation: a semiparametric mixture approach.

    Science.gov (United States)

    Yuan, Ying; Yin, Guosheng

    2011-12-01

    In the estimation of a dose-response curve, parametric models are straightforward and efficient but subject to model misspecifications; nonparametric methods are robust but less efficient. As a compromise, we propose a semiparametric approach that combines the advantages of parametric and nonparametric curve estimates. In a mixture form, our estimator takes a weighted average of the parametric and nonparametric curve estimates, in which a higher weight is assigned to the estimate with a better model fit. When the parametric model assumption holds, the semiparametric curve estimate converges to the parametric estimate and thus achieves high efficiency; when the parametric model is misspecified, the semiparametric estimate converges to the nonparametric estimate and remains consistent. We also consider an adaptive weighting scheme to allow the weight to vary according to the local fit of the models. We conduct extensive simulation studies to investigate the performance of the proposed methods and illustrate them with two real examples. © 2011, The International Biometric Society.

  3. Association between Frailty and Dementia

    DEFF Research Database (Denmark)

    Kulmala, J; Nykänen, I; Mänty, Minna Regina

    2014-01-01

    Background: Frailty is commonly considered as a syndrome with several symptoms, including weight loss, exhaustion, weakness, slow walking speed and physical inactivity. It has been suggested that cognitive impairment should be included in the frailty index, however the association between frailty...... dementia with Lewy bodies and 8 persons (1%) had some other type of dementia. Multivariate logistic regression models showed that frail persons were almost 8 times more likely to have cognitive impairment (OR 7.8, 95% CI 4.0-15.0), 8 times more likely to have some kind of dementia (OR 8.0, 95% CI 4.......0-15.9), almost 6 times more likely to have vascular dementia (OR 5.6, 95% CI 1.2-25.8) and over 4 times more likely to have Alzheimer's disease (OR 4.5, 95% CI 2.1-9.6) than persons who were robust. Conclusion: Frailty is strongly associated with cognitive impairment and clinically diagnosed dementia among...

  4. Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living

    Directory of Open Access Journals (Sweden)

    Hogan David B

    2012-09-01

    Full Text Available Abstract Background Few studies have directly compared the competing approaches to identifying frailty in more vulnerable older populations. We examined the ability of two versions of a frailty index (43 vs. 83 items, the Cardiovascular Health Study (CHS frailty criteria, and the CHESS scale to accurately predict the occurrence of three outcomes among Assisted Living (AL residents followed over one year. Methods The three frailty measures and the CHESS scale were derived from assessment items completed among 1,066 AL residents (aged 65+ participating in the Alberta Continuing Care Epidemiological Studies (ACCES. Adjusted risks of one-year mortality, hospitalization and long-term care placement were estimated for those categorized as frail or pre-frail compared with non-frail (or at high/intermediate vs. low risk on CHESS. The area under the ROC curve (AUC was calculated for select models to assess the predictive accuracy of the different frailty measures and CHESS scale in relation to the three outcomes examined. Results Frail subjects defined by the three approaches and those at high risk for decline on CHESS showed a statistically significant increased risk for death and long-term care placement compared with those categorized as either not frail or at low risk for decline. The risk estimates for hospitalization associated with the frailty measures and CHESS were generally weaker with one of the frailty indices (43 items showing no significant association. For death and long-term care placement, the addition of frailty (however derived or CHESS significantly improved on the AUC obtained with a model including only age, sex and co-morbidity, though the magnitude of improvement was sometimes small. The different frailty/risk models did not differ significantly from each other in predicting mortality or hospitalization; however, one of the frailty indices (83 items showed significantly better performance over the other measures in predicting long

  5. Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living.

    Science.gov (United States)

    Hogan, David B; Freiheit, Elizabeth A; Strain, Laurel A; Patten, Scott B; Schmaltz, Heidi N; Rolfson, Darryl; Maxwell, Colleen J

    2012-09-14

    Few studies have directly compared the competing approaches to identifying frailty in more vulnerable older populations. We examined the ability of two versions of a frailty index (43 vs. 83 items), the Cardiovascular Health Study (CHS) frailty criteria, and the CHESS scale to accurately predict the occurrence of three outcomes among Assisted Living (AL) residents followed over one year. The three frailty measures and the CHESS scale were derived from assessment items completed among 1,066 AL residents (aged 65+) participating in the Alberta Continuing Care Epidemiological Studies (ACCES). Adjusted risks of one-year mortality, hospitalization and long-term care placement were estimated for those categorized as frail or pre-frail compared with non-frail (or at high/intermediate vs. low risk on CHESS). The area under the ROC curve (AUC) was calculated for select models to assess the predictive accuracy of the different frailty measures and CHESS scale in relation to the three outcomes examined. Frail subjects defined by the three approaches and those at high risk for decline on CHESS showed a statistically significant increased risk for death and long-term care placement compared with those categorized as either not frail or at low risk for decline. The risk estimates for hospitalization associated with the frailty measures and CHESS were generally weaker with one of the frailty indices (43 items) showing no significant association. For death and long-term care placement, the addition of frailty (however derived) or CHESS significantly improved on the AUC obtained with a model including only age, sex and co-morbidity, though the magnitude of improvement was sometimes small. The different frailty/risk models did not differ significantly from each other in predicting mortality or hospitalization; however, one of the frailty indices (83 items) showed significantly better performance over the other measures in predicting long-term care placement. Using different

  6. Parametric overdispersed frailty models for current status data.

    Science.gov (United States)

    Abrams, Steven; Aerts, Marc; Molenberghs, Geert; Hens, Niel

    2017-12-01

    Frailty models have a prominent place in survival analysis to model univariate and multivariate time-to-event data, often complicated by the presence of different types of censoring. In recent years, frailty modeling gained popularity in infectious disease epidemiology to quantify unobserved heterogeneity using Type I interval-censored serological data or current status data. In a multivariate setting, frailty models prove useful to assess the association between infection times related to multiple distinct infections acquired by the same individual. In addition to dependence among individual infection times, overdispersion can arise when the observed variability in the data exceeds the one implied by the model. In this article, we discuss parametric overdispersed frailty models for time-to-event data under Type I interval-censoring, building upon the work by Molenberghs et al. (2010) and Hens et al. (2009). The proposed methodology is illustrated using bivariate serological data on hepatitis A and B from Flanders, Belgium anno 1993-1994. Furthermore, the relationship between individual heterogeneity and overdispersion at a stratum-specific level is studied through simulations. Although it is important to account for overdispersion, one should be cautious when modeling both individual heterogeneity and overdispersion based on current status data as model selection is hampered by the loss of information due to censoring. © 2017, The International Biometric Society.

  7. Investigating hospital heterogeneity with a multi-state frailty model: application to nosocomial pneumonia disease in intensive care units

    Directory of Open Access Journals (Sweden)

    Liquet Benoit

    2012-06-01

    Full Text Available Abstract Background Multistate models have become increasingly useful to study the evolution of a patient’s state over time in intensive care units ICU (e.g. admission, infections, alive discharge or death in ICU. In addition, in critically-ill patients, data come from different ICUs, and because observations are clustered into groups (or units, the observed outcomes cannot be considered as independent. Thus a flexible multi-state model with random effects is needed to obtain valid outcome estimates. Methods We show how a simple multi-state frailty model can be used to study semi-competing risks while fully taking into account the clustering (in ICU of the data and the longitudinal aspects of the data, including left truncation and right censoring. We suggest the use of independent frailty models or joint frailty models for the analysis of transition intensities. Two distinct models which differ in the definition of time t in the transition functions have been studied: semi-Markov models where the transitions depend on the waiting times and nonhomogenous Markov models where the transitions depend on the time since inclusion in the study. The parameters in the proposed multi-state model may conveniently be computed using a semi-parametric or parametric approach with an existing R package FrailtyPack for frailty models. The likelihood cross-validation criterion is proposed to guide the choice of a better fitting model. Results We illustrate the use of our approach though the analysis of nosocomial infections (ventilator-associated pneumonia infections: VAP in ICU, with “alive discharge” and “death” in ICU as other endpoints. We show that the analysis of dependent survival data using a multi-state model without frailty terms may underestimate the variance of regression coefficients specific to each group, leading to incorrect inferences. Some factors are wrongly significantly associated based on the model without frailty terms. This

  8. A Derivative Based Estimator for Semiparametric Index Models

    NARCIS (Netherlands)

    Donkers, A.C.D.; Schafgans, M.

    2003-01-01

    This paper proposes a semiparametric estimator for single- and multiple index models.It provides an extension of the average derivative estimator to the multiple index model setting.The estimator uses the average of the outer product of derivatives and is shown to be root-N consistent and

  9. Semiparametric copula models for biometric score level fusion

    NARCIS (Netherlands)

    Susyanto, N.

    2016-01-01

    In biometric recognition, biometric samples (images of faces, fingerprints, voices, gaits, etc.) of people are compared and matchers (classifiers) indicate the level of similarity between any pair of samples by a score. If we model the joint distribution of all scores by a (semiparametric) Gaussian

  10. Bootstrap consistency for general semiparametric M-estimation

    KAUST Repository

    Cheng, Guang

    2010-10-01

    Consider M-estimation in a semiparametric model that is characterized by a Euclidean parameter of interest and an infinite-dimensional nuisance parameter. As a general purpose approach to statistical inferences, the bootstrap has found wide applications in semiparametric M-estimation and, because of its simplicity, provides an attractive alternative to the inference approach based on the asymptotic distribution theory. The purpose of this paper is to provide theoretical justifications for the use of bootstrap as a semiparametric inferential tool. We show that, under general conditions, the bootstrap is asymptotically consistent in estimating the distribution of the M-estimate of Euclidean parameter; that is, the bootstrap distribution asymptotically imitates the distribution of the M-estimate. We also show that the bootstrap confidence set has the asymptotically correct coverage probability. These general onclusions hold, in particular, when the nuisance parameter is not estimable at root-n rate, and apply to a broad class of bootstrap methods with exchangeable ootstrap weights. This paper provides a first general theoretical study of the bootstrap in semiparametric models. © Institute of Mathematical Statistics, 2010.

  11. Semiparametric Power Envelopes for Tests of the Unit Root Hypothesis

    DEFF Research Database (Denmark)

    Jansson, Michael

    This paper derives asymptotic power envelopes for tests of the unit root hypothesis in a zero-mean AR(1) model. The power envelopes are derived using the limits of experiments approach and are semiparametric in the sense that the underlying error distribution is treated as an unknown...

  12. Testing Parametric versus Semiparametric Modelling in Generalized Linear Models

    NARCIS (Netherlands)

    Härdle, W.K.; Mammen, E.; Müller, M.D.

    1996-01-01

    We consider a generalized partially linear model E(Y|X,T) = G{X'b + m(T)} where G is a known function, b is an unknown parameter vector, and m is an unknown function.The paper introduces a test statistic which allows to decide between a parametric and a semiparametric model: (i) m is linear, i.e.

  13. The Semiparametric Normal Variance-Mean Mixture Model

    DEFF Research Database (Denmark)

    Korsholm, Lars

    1997-01-01

    We discuss the normal vairance-mean mixture model from a semi-parametric point of view, i.e. we let the mixing distribution belong to a non parametric family. The main results are consistency of the non parametric maximum likelihood estimat or in this case, and construction of an asymptotically...

  14. Frailty and Lower Urinary Tract Symptoms.

    Science.gov (United States)

    Suskind, Anne M

    2017-09-01

    The incidence of both frailty and lower urinary tract symptoms, including urinary incontinence, overactive bladder, underactive bladder, and benign prostatic hyperplasia, increases with age. However, our understanding of the relationship between frailty and lower urinary tract symptoms, both in terms of pathophysiology and in terms of the evaluation and management of such symptoms, is greatly lacking. This brief review will summarize definitions and measurement tools associated with frailty and will also review the existing state of the literature on frailty and lower urinary tract symptoms in older individuals.

  15. Sarcopenia and frailty in chronic respiratory disease.

    Science.gov (United States)

    Bone, Anna E; Hepgul, Nilay; Kon, Samantha; Maddocks, Matthew

    2017-02-01

    Sarcopenia and frailty are geriatric syndromes characterized by multisystem decline, which are related to and reflected by markers of skeletal muscle dysfunction. In older people, sarcopenia and frailty have been used for risk stratification, to predict adverse outcomes and to prompt intervention aimed at preventing decline in those at greatest risk. In this review, we examine sarcopenia and frailty in the context of chronic respiratory disease, providing an overview of the common assessments tools and studies to date in the field. We contrast assessments of sarcopenia, which consider muscle mass and function, with assessments of frailty, which often additionally consider social, cognitive and psychological domains. Frailty is emerging as an important syndrome in respiratory disease, being strongly associated with poor outcome. We also unpick the relationship between sarcopenia, frailty and skeletal muscle dysfunction in chronic respiratory disease and reveal these as interlinked but distinct clinical phenotypes. Suggested areas for future work include the application of sarcopenia and frailty models to restrictive diseases and population-based samples, prospective prognostic assessments of sarcopenia and frailty in relation to common multidimensional indices, plus the investigation of exercise, nutritional and pharmacological strategies to prevent or treat sarcopenia and frailty in chronic respiratory disease.

  16. Polymorphisms in the mitochondrial DNA control region and frailty in older adults.

    Directory of Open Access Journals (Sweden)

    Ann Z Moore

    2010-06-01

    Full Text Available Mitochondria contribute to the dynamics of cellular metabolism, the production of reactive oxygen species, and apoptotic pathways. Consequently, mitochondrial function has been hypothesized to influence functional decline and vulnerability to disease in later life. Mitochondrial genetic variation may contribute to altered susceptibility to the frailty syndrome in older adults.To assess potential mitochondrial genetic contributions to the likelihood of frailty, mitochondrial DNA (mtDNA variation was compared in frail and non-frail older adults. Associations of selected SNPs with a muscle strength phenotype were also explored. Participants were selected from the Cardiovascular Health Study (CHS, a population-based observational study (1989-1990, 1992-1993. At baseline, frailty was identified as the presence of three or more of five indicators (weakness, slowness, shrinking, low physical activity, and exhaustion. mtDNA variation was assessed in a pilot study, including 315 individuals selected as extremes of the frailty phenotype, using an oligonucleotide sequencing microarray based on the Revised Cambridge Reference Sequence. Three mtDNA SNPs were statistically significantly associated with frailty across all pilot participants or in sex-stratified comparisons: mt146, mt204, and mt228. In addition to pilot participants, 4,459 additional men and women with frailty classifications, and an overlapping subset of 4,453 individuals with grip strength measurements, were included in the study population genotyped at mt204 and mt228. In the study population, the mt204 C allele was associated with greater likelihood of frailty (adjusted odds ratio = 2.04, 95% CI = 1.07-3.60, p = 0.020 and lower grip strength (adjusted coefficient = -2.04, 95% CI = -3.33- -0.74, p = 0.002.This study supports a role for mitochondrial genetic variation in the frailty syndrome and later life muscle strength, demonstrating the importance of the mitochondrial genome in complex

  17. Prevalence of Frailty and Associated Factors in the Community-Dwelling Population of China.

    Science.gov (United States)

    Ma, Lina; Tang, Zhe; Zhang, Li; Sun, Fei; Li, Yun; Chan, Piu

    2018-03-01

    Frailty in older adults predicts dependence and mortality and is a major challenge for healthcare systems in countries with rapidly aging populations. Little is known about frailty in China. We investigated the prevalence and associated risk factors of frailty in older adults in China. Cross-sectional. Data were obtained from the China Comprehensive Geriatric Assessment Study, conducted in 2011-12, which was the first uniform comprehensive assessment system adopted in China. Older adults from 7 cities were selected based on well-established cluster, stratification, and random selection statistical sampling techniques (N = 5,844). The Comprehensive Geriatric Assessment-Frailty Index was measured based on demographic characteristics, physical health, physical function, living behavior and social function, mental health, and cognitive function. The overall weighted prevalence of frailty was 9.9%: 12.7% in southwestern China, 11.0% in northern China, 5.9% in northwestern China, 5.0% in south-central China, 2.5% in eastern China, and 2.3% in northeastern China. The prevalence of frailty increased with age and was significantly higher in women and those living in rural areas. After adjusting for sex, age, area, region, and education, activity of daily living impairment was the strongest risk factor for frailty. Chronic diseases, depression, poor lifestyle, and geriatric syndromes were also independent risk factors. Our study provides epidemiological characteristics and the risk factors of frailty in China; the findings indicate greater regional disparities. Efforts to promote physical, psychological, and social health in older adults are a core objective of health policy, especially in women and those living in rural areas. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  18. Accounting for frailty when treating chronic diseases.

    Science.gov (United States)

    Onder, Graziano; Vetrano, Davide L; Marengoni, Alessandra; Bell, J Simon; Johnell, Kristina; Palmer, Katie

    2018-03-08

    Chronic diseases are considered to be major determinants of frailty and it could be hypothesized that their treatment may counteract the development of frailty. However, the hypothesis that intensive treatment of chronic diseases might reduce the progression of frailty is poorly supported by existing studies. In contrast, some evidence suggests that intensive treatment of chronic diseases may increase negative health outcomes in frail older adults. In particular, if treatment of symptoms related to chronic diseases (i.e. pain in osteoarthritis, dyspnoea in respiratory disease, motor symptoms in Parkinson disease) might potentially reverse frailty, the benefits related to preventive pharmacological treatment of chronic diseases (i.e. antihypertensive treatment) in patients with prevalent frailty is not certain. In particular, several factors might alter the risk/benefit ratio of a given treatment in persons with frailty. These include: exclusion of frail persons from clinical studies, reduced life expectancy in frail persons, increased susceptibility to iatrogenic events, and functional deficits associated with frailty. Therefore, frailty acts as an effect modifier, by modifying the risks and benefits of chronic disease treatments. This hypothesis must be considered and tested in future clinical intervention studies and clinical guidelines should provide specific recommendations for the treatment of frail people, underlining the pros and the cons of pharmacological treatment and possible targets for therapy in this population. Meanwhile, in older patients, the prescribing process should be individualized and flexible. Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  19. Implementation of the mouse frailty index.

    Science.gov (United States)

    Kane, Alice E; Ayaz, Omar; Ghimire, Anjali; Feridooni, Hirad A; Howlett, Susan E

    2017-10-01

    Frailty is considered a state of high vulnerability for adverse health outcomes for people of the same age. Those who are frail have higher mortality, worse health outcomes, and use more health care services than those who are not frail. Despite this, little is known about the biology of frailty, the effect of frailty on pharmacological or surgical outcomes, and potential interventions to attenuate frailty. In humans, frailty can be quantified using a frailty index (FI) based on the principle of deficit accumulation. The recent development of an FI in naturally ageing mice provides an opportunity to conduct frailty research in a validated preclinical model. The mouse FI has been successfully used across a wide range of applications; however, there are some factors that should be considered in implementing this tool. This review summarises the current literature, presents some original data, and suggests areas for future research on the current applications of the mouse FI, inter-rater reliability of the FI, the effect of observer characteristics and environmental factors on mouse FI scores, and the individual items that make up the FI assessment. The implementation of this tool into preclinical frailty research should greatly accelerate translational research in this important field.

  20. Frailty Testing Pilot Study: Pros and Pitfalls.

    Science.gov (United States)

    Adlam, Taylor; Ulrich, Elizabeth; Kent, Missy; Malinzak, Lauren

    2018-02-01

    Frailty can be defined as an inflammatory state with a loss of physiologic reserve in multiple systems that manifests as a decreased ability to respond to stressors that ultimately leads to an increased risk of adverse outcomes. The aim of this study was to determine the ease of frailty testing in a pre-kidney transplant clinic and the resources required to do so. A secondary goal was to better understand the utility of frailty testing when evaluating potential kidney transplant recipients. Frailty testing was conducted at a pre-kidney transplant clinic in three phases using Fried's frailty phenotype (shrinking, exhaustion, low physical activity, slowness, and grip strength). A total of 132 frailty tests were completed on 128 patients. Frail patients had significantly higher rates of shrinking (26% vs. 8.5%, P testing was most complete when an examiner dedicated to frailty testing performed the testing. Frailty testing is feasible to complete in a pre-transplant clinic with an appropriate investment in personnel and resources.

  1. Multistate event history analysis with frailty

    Directory of Open Access Journals (Sweden)

    Govert Bijwaard

    2014-05-01

    Full Text Available Background: In survival analysis a large literature using frailty models, or models with unobserved heterogeneity, exists. In the growing literature and modelling on multistate models, this issue is only in its infant phase. Ignoring frailty can, however, produce incorrect results. Objective: This paper presents how frailties can be incorporated into multistate models, with an emphasis on semi-Markov multistate models with a mixed proportional hazard structure. Methods: First, the aspects of frailty modeling in univariate (proportional hazard, Cox and multivariate event history models are addressed. The implications of choosing shared or correlated frailty is highlighted. The relevant differences with recurrent events data are covered next. Multistate models are event history models that can have both multivariate and recurrent events. Incorporating frailty in multistate models, therefore, brings all the previously addressed issues together. Assuming a discrete frailty distribution allows for a very general correlation structure among the transition hazards in a multistate model. Although some estimation procedures are covered the emphasis is on conceptual issues. Results: The importance of multistate frailty modeling is illustrated with data on labour market and migration dynamics of recent immigrants to the Netherlands.

  2. The assessment of frailty in older adults.

    Science.gov (United States)

    Abellan van Kan, Gabor; Rolland, Yves; Houles, Mathieu; Gillette-Guyonnet, Sophie; Soto, Maria; Vellas, Bruno

    2010-05-01

    No clear consensual definition regarding frailty seems to emerge from the literature after 30 years of research in the topic, and a large array of models and criteria has been proposed to define the syndrome. Controversy continues to exist on the choice of the components to be included in the frailty definition. Two main definitions based on clusters of components are found in literature: a physical phenotype of frailty, operationalized in 2001 by providing a list of 5 measurable items of functional impairments, which coexists with a multidomain phenotype, based on a frailty index constructed on the accumulation of identified deficits based on comprehensive geriatric assessment. The physical phenotype considers disability and comorbidities such as dementia as distinct entities and therefore outcomes of the frailty syndrome, whereas comorbidity and disability can be components of the multidomain phenotype. Expanded models of physical frailty (models that included clusters other than the original 5 items such as dementia) increased considerably the predicting capacity of poor clinical outcomes when compared with the predictive capacity of the physical phenotype. The unresolved controversy of the components shapes the clusters of original frailty syndrome, and the components depend very much on how frailty is defined. This update also highlights the growing evidence on gait speed to be considered as a single-item frailty screening tool. The evaluation of gait speed over a short distance emerges from the literature as a tool with the capacity to identify frail older adults, and slow gait speed has been proven to be a strong predictor for frailty-adverse outcomes. Copyright 2010 Elsevier Inc. All rights reserved.

  3. Explicit estimating equations for semiparametric generalized linear latent variable models

    KAUST Repository

    Ma, Yanyuan

    2010-07-05

    We study generalized linear latent variable models without requiring a distributional assumption of the latent variables. Using a geometric approach, we derive consistent semiparametric estimators. We demonstrate that these models have a property which is similar to that of a sufficient complete statistic, which enables us to simplify the estimating procedure and explicitly to formulate the semiparametric estimating equations. We further show that the explicit estimators have the usual root n consistency and asymptotic normality. We explain the computational implementation of our method and illustrate the numerical performance of the estimators in finite sample situations via extensive simulation studies. The advantage of our estimators over the existing likelihood approach is also shown via numerical comparison. We employ the method to analyse a real data example from economics. © 2010 Royal Statistical Society.

  4. Frailty Index Predicts All-Cause Mortality for Middle-Aged and Older Taiwanese: Implications for Active-Aging Programs.

    Science.gov (United States)

    Lin, Shu-Yu; Lee, Wei-Ju; Chou, Ming-Yueh; Peng, Li-Ning; Chiou, Shu-Ti; Chen, Liang-Kung

    2016-01-01

    Frailty Index, defined as an individual's accumulated proportion of listed health-related deficits, is a well-established metric used to assess the health status of old adults; however, it has not yet been developed in Taiwan, and its local related structure factors remain unclear. The objectives were to construct a Taiwan Frailty Index to predict mortality risk, and to explore the structure of its factors. Analytic data on 1,284 participants aged 53 and older were excerpted from the Social Environment and Biomarkers of Aging Study (2006), in Taiwan. A consensus workgroup of geriatricians selected 159 items according to the standard procedure for creating a Frailty Index. Cox proportional hazard modeling was used to explore the association between the Taiwan Frailty Index and mortality. Exploratory factor analysis was used to identify structure factors and produce a shorter version-the Taiwan Frailty Index Short-Form. During an average follow-up of 4.3 ± 0.8 years, 140 (11%) subjects died. Compared to those in the lowest Taiwan Frailty Index tertile ( 0.23) had significantly higher risk of death (Hazard ratio: 3.2; 95% CI 1.9-5.4). Thirty-five items of five structure factors identified by exploratory factor analysis, included: physical activities, life satisfaction and financial status, health status, cognitive function, and stresses. Area under the receiver operating characteristic curves (C-statistics) of the Taiwan Frailty Index and its Short-Form were 0.80 and 0.78, respectively, with no statistically significant difference between them. Although both the Taiwan Frailty Index and Short-Form were associated with mortality, the Short-Form, which had similar accuracy in predicting mortality as the full Taiwan Frailty Index, would be more expedient in clinical practice and community settings to target frailty screening and intervention.

  5. Semiparametric Efficient Adaptive Estimation of the PTTGARCH model

    OpenAIRE

    Ciccarelli, Nicola

    2016-01-01

    Financial data sets exhibit conditional heteroskedasticity and asymmetric volatility. In this paper we derive a semiparametric efficient adaptive estimator of a conditional heteroskedasticity and asymmetric volatility GARCH-type model (i.e., the PTTGARCH(1,1) model). Via kernel density estimation of the unknown density function of the innovation and via the Newton-Raphson technique applied on the root-n-consistent quasi-maximum likelihood estimator, we construct a more efficient estimator tha...

  6. Bayesian non- and semi-parametric methods and applications

    CERN Document Server

    Rossi, Peter

    2014-01-01

    This book reviews and develops Bayesian non-parametric and semi-parametric methods for applications in microeconometrics and quantitative marketing. Most econometric models used in microeconomics and marketing applications involve arbitrary distributional assumptions. As more data becomes available, a natural desire to provide methods that relax these assumptions arises. Peter Rossi advocates a Bayesian approach in which specific distributional assumptions are replaced with more flexible distributions based on mixtures of normals. The Bayesian approach can use either a large but fixed number

  7. Simultaneous confidence bands for Cox regression from semiparametric random censorship.

    Science.gov (United States)

    Mondal, Shoubhik; Subramanian, Sundarraman

    2016-01-01

    Cox regression is combined with semiparametric random censorship models to construct simultaneous confidence bands (SCBs) for subject-specific survival curves. Simulation results are presented to compare the performance of the proposed SCBs with the SCBs that are based only on standard Cox. The new SCBs provide correct empirical coverage and are more informative. The proposed SCBs are illustrated with two real examples. An extension to handle missing censoring indicators is also outlined.

  8. Nonlinearities in productivity growth: a semi-parametric panel analysis

    OpenAIRE

    Azomahou, T.T.; Diene, B.; Diene, M.

    2012-01-01

    We use country panel data spanning over 1998-2008 for both developed and developing countries to study the productivity growth when countries are close to the technology frontier. Relying on a semi-parametric generalized additive model, we estimate both reduced and structural forms for total factor productivity growth. We consider three measurements of frontier: the economy with the highest level of productivity growth, the world productivity growth and the productivity growth of the USA. We ...

  9. How should older adults with cancer be evaluated for frailty?

    Science.gov (United States)

    Huisingh-Scheetz, M; Walston, J

    2016-01-01

    Traditionally used as a descriptive term, frailty is now a recognized medical syndrome identifying individuals with decreased physiologic reserve. Frailty is characterized by diminished strength, endurance, and reduced physiologic function. Several valid frailty screening tools exist in the literature, and these measures have been used to relate frailty to outcomes important to the older patient with cancer. Frail adults are at increased risk of adverse surgical outcomes and early findings suggest that frailty predicts poor chemotherapy tolerance. While much research is needed to explore the biologic relationships between frailty and cancer, there is an urgent need to implement frailty screening and management into the care of the older patient with cancer in order to improve outcomes in this vulnerable subset. The purpose of this paper is to provide an introduction of frailty to oncologists including a review of the definition, frailty screening tools, its clinical relevance to older patients with cancer, and a brief guide to frailty management. PMID:27318797

  10. Frailty in men living with HIV: a cross-sectional comparison of three frailty instruments.

    Science.gov (United States)

    Yeoh, Hui-Ling; Cheng, Allen; Palmer, Clovis; Crowe, Suzanne M; Hoy, Jennifer F

    2017-07-21

    Potent antiretroviral treatment has resulted in near normal life expectancy for people living with HIV. Consequently, there is an increased focus on comorbidities, frailty and quality of life. We assessed and compared the prevalence of frailty, associated factors and relationship with quality of life in older Australian men living with HIV in a cross-sectional study using three frailty measurements. The Frailty Phenotype, Frailty Index and Edmonton Frail Scale were applied to 93 HIV-infected men aged over 50 years, on antiretroviral therapy. Multivariable ordinal logistic regression was used to analyse the associations of frailty with covariates and quality of life. The prevalence of frailty was 10.8% (n=10) using the Frailty Phenotype; 22.6% (n=21) using the Frailty Index and 15.1% (n=14) using the Edmonton Frail Scale. Frailty Phenotype-defined pre-frailty/frailty was associated with pre-1996 ART initiation (OR, 3.56; CI, 1.23, 10.36; P=0.020) and depression (OR, 3.74; CI, 1.24, 11.27; P=0.019). Osteoporosis, serious non-AIDS events and AIDS were associated with Frailty Index-defined frailty (OR, 4.84, CI, 1.27, 18.43, P=0.021; OR, 4.27, CI, 1.25, 14.58, P=0.020; OR, 4.62, CI, 1.30, 16.45, P=0.018, respectively) and Edmonton Frail Scale-defined frailty (OR, 7.51; CI, 1.55, 36.42; P=0.012; OR, 7.71; CI, 1.62, 36.75; P=0.010; OR, 8.53; CI, 1.70, 42.73; P=0.009, respectively), independent of age and current CD4 + T-cell count. Frailty, defined by any of the instruments, was significantly associated with poorer quality of life (Pcontemporary consideration of HIV care related to ageing and quality of life.

  11. Neuropsychological Correlates of Pre-Frailty in Neurocognitive Disorders: A Possible Role for Metacognitive Dysfunction and Mood Changes

    Directory of Open Access Journals (Sweden)

    Martina Amanzio

    2017-11-01

    Full Text Available BackgroundRecent studies have suggested that cognitive functions in patients with neurocognitive disorders have a significant role in the pathogenic mechanisms of frailty. Although pre-frailty is considered an intermediate, preclinical state, epidemiological research has begun to dislodge cognition and frailty into their specific subcomponents to understand the relationship among them. We aim to analyse the possible association between pre-frailty and neuropsychological variables to outline which factors can contribute to minor and major neurocognitive disorders.Methods60 subjects complaining of different cognitive deficits underwent a deep-in-wide frailty and neuropsychological assessment. We conducted three multiple linear regression analyses adjusted for a combination of demographic measures and involving several neuropsychological–behavioural parameters selected by the literature on physical frailty.ResultsWe found a significant association between frailty—as measured by the multidimensional prognostic index (MPI—and action monitoring and monetary gain (cognitive domain, depression and disinhibition (behavioural domain. Moreover, an association between MPI and impaired awareness for instrumental activities disabilities exists.ConclusionWe propose a novel framework for understanding frailty associated with metacognitive–executive dysfunction.

  12. New Inference Procedures for Semiparametric Varying-Coefficient Partially Linear Cox Models

    Directory of Open Access Journals (Sweden)

    Yunbei Ma

    2014-01-01

    Full Text Available In biomedical research, one major objective is to identify risk factors and study their risk impacts, as this identification can help clinicians to both properly make a decision and increase efficiency of treatments and resource allocation. A two-step penalized-based procedure is proposed to select linear regression coefficients for linear components and to identify significant nonparametric varying-coefficient functions for semiparametric varying-coefficient partially linear Cox models. It is shown that the penalized-based resulting estimators of the linear regression coefficients are asymptotically normal and have oracle properties, and the resulting estimators of the varying-coefficient functions have optimal convergence rates. A simulation study and an empirical example are presented for illustration.

  13. Frailty and Depression in Older Adults

    DEFF Research Database (Denmark)

    Brown, Patrick J; Roose, Steven P; Fieo, Robert

    2014-01-01

    OBJECTIVE: To identify salient characteristics of frailty that increase risk of death in depressed elders. METHODS: Data were from the Nordic Research on Ageing Study from research sites in Denmark, Sweden, and Finland. Participants were 1,027 adults aged 75 years (436 men and 591 women). Time...... of death was obtained, providing a maximum survival time of 11.08 years (initial evaluation took place between 1988 and 1991). RESULTS: Depressed elders showed greater baseline impairments in each frailty characteristic (gait speed, grip strength, physical activity levels, and fatigue). Simultaneous models...... including all four frailty characteristics showed slow gait speed (hazard ratio: 1.84; 95% confidence interval: 1.05-3.21) and fatigue (hazard ratio: 1.94; 95% confidence interval: 1.11-3.40) associated with faster progression to death in depressed women; none of the frailty characteristics...

  14. High Prevalence of Physical Frailty Among Community-Dwelling Malnourished Older Adults-A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Verlaan, Sjors; Ligthart-Melis, Gerdien C; Wijers, Sander L J; Cederholm, Tommy; Maier, Andrea B; de van der Schueren, Marian A E

    2017-05-01

    Malnutrition and frailty are two geriatric syndromes that significantly affect independent living and health in community-dwelling older adults. Although the pathophysiology of malnutrition and physical frailty share common pathways, it is unknown to what extent these syndromes overlap and how they relate to each other. A systematic review was performed resulting in a selection of 28 studies that assessed both malnutrition and frailty in community-dwelling older adults. Furthermore, a meta-analysis was performed on 10 studies that used Mini- Nutritional Assessment and the Fried frailty phenotype to estimate the prevalence of malnutrition within physical frailty and vice versa. In the systematic review, 25 of the 28 studies used the Mini-Nutritional Assessment (long or short form) for malnutrition screening. For frailty assessment, 23 of the 28 studies focused on the physical frailty phenotype, of which 19 followed the original Fried phenotype. Fifteen studies analyzed the association between malnutrition and frailty, which was significant in 12 of these. The meta-analysis included 10 studies with a total of 5447 older adults. In this pooled population of community-dwelling older adults [mean (standard deviation) age: 77.2 (6.7) years], 2.3% was characterized as malnourished and 19.1% as physically frail. The prevalence of malnutrition was significantly associated with the prevalence of physical frailty (P dwelling older adults are related, but not interchangeable geriatric syndromes. Two out of 3 malnourished older adults were physically frail, whereas close to 10% of the physically frail older adults was identified as malnourished. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  15. Physical Exercise as Therapy for Frailty.

    Science.gov (United States)

    Aguirre, Lina E; Villareal, Dennis T

    2015-01-01

    Longitudinal studies demonstrate that regular physical exercise extends longevity and reduces the risk of physical disability. Decline in physical activity with aging is associated with a decrease in exercise capacity that predisposes to frailty. The frailty syndrome includes a lowered activity level, poor exercise tolerance, and loss of lean body and muscle mass. Poor exercise tolerance is related to aerobic endurance. Aerobic endurance training can significantly improve peak oxygen consumption by ∼10-15%. Resistance training is the best way to increase muscle strength and mass. Although the increase in muscle mass in response to resistance training may be attenuated in frail older adults, resistance training can significantly improve muscle strength, particularly in institutionalized patients, by ∼110%. Because both aerobic and resistance training target specific components of frailty, studies combining aerobic and resistance training provide the most promising evidence with respect to successfully treating frailty. At the molecular level, exercise reduces frailty by decreasing muscle inflammation, increasing anabolism, and increasing muscle protein synthesis. More studies are needed to determine which exercises are best suited, most effective, and safe for this population. Based on the available studies, an individualized multicomponent exercise program that includes aerobic activity, strength exercises, and flexibility is recommended to treat frailty. © 2015 Michael E. DeBakey VA Medical Center (US Government) Published by S. Karger AG, Basel.

  16. Psychological Frailty in the Aging Patient.

    Science.gov (United States)

    Fitten, L Jaime

    2015-01-01

    There is little written in the geriatric literature about the concept of psychological frailty which encompasses cognitive, mood, and motivational components. The concept is intended to consider brain changes that are beyond normal aging, but not necessarily inclusive of disease, that result in decreased cognitive or mood resilience in the presence of modest stressors, and may eventually lead to negative health outcomes in a manner parallel to physical frailty, an entity well known to clinicians. Most work exploring the interface between cognition, mood, and physical frailty has demonstrated a bidirectional association between the two domains. Psychological symptoms or deficits have been described as either worsening the degree of physical frailty, or physical frailty has been viewed as a risk to a worsening cognition or depression. However, psychological frailty, a consequence of age-altered brain function, has not been studied for itself. By what possible mechanism does the brain reveal its loss of resiliency under modest stress and how can this be visualized? Are there markers that predate a psychological decline that might permit a preventive intervention which could delay the appearance of negative health outcomes such as reduced functional capacity or increased dependency? The present review will explore these concepts and possibilities. © 2015 Nestec Ltd., Vevey/S. Karger AG, Basel.

  17. Multiplicity-adjusted semiparametric benefiting subgroup identification in clinical trials.

    Science.gov (United States)

    Schnell, Patrick M; Müller, Peter; Tang, Qi; Carlin, Bradley P

    2018-02-01

    Background A recent focus in the health sciences has been the development of personalized medicine, which includes determining the population for which a given treatment is effective. Due to limited data, identifying the true benefiting population is a challenging task. To tackle this difficulty, the credible subgroups approach provides a pair of bounding subgroups for the true benefiting subgroup, constructed so that one is contained by the benefiting subgroup while the other contains the benefiting subgroup with high probability. However, the method has so far only been developed for parametric linear models. Methods In this article, we develop the details required to follow the credible subgroups approach in more realistic settings by considering nonlinear and semiparametric regression models, supported for regulatory science by conditional power simulations. We also present an improved multiple testing approach using a step-down procedure. We evaluate our approach via simulations and apply it to data from four trials of Alzheimer's disease treatments carried out by AbbVie. Results Semiparametric modeling yields credible subgroups that are more robust to violations of linear treatment effect assumptions, and careful choice of the population of interest as well as the step-down multiple testing procedure result in a higher rate of detection of benefiting types of patients. The approach allows us to identify types of patients that benefit from treatment in the Alzheimer's disease trials. Conclusion Attempts to identify benefiting subgroups of patients in clinical trials are often met with skepticism due to a lack of multiplicity control and unrealistically restrictive assumptions. Our proposed approach merges two techniques, credible subgroups, and semiparametric regression, which avoids these problems and makes benefiting subgroup identification practical and reliable.

  18. Semiparametric analysis of linear transformation models with covariate measurement errors.

    Science.gov (United States)

    Sinha, Samiran; Ma, Yanyuan

    2014-03-01

    We take a semiparametric approach in fitting a linear transformation model to a right censored data when predictive variables are subject to measurement errors. We construct consistent estimating equations when repeated measurements of a surrogate of the unobserved true predictor are available. The proposed approach applies under minimal assumptions on the distributions of the true covariate or the measurement errors. We derive the asymptotic properties of the estimator and illustrate the characteristics of the estimator in finite sample performance via simulation studies. We apply the method to analyze an AIDS clinical trial data set that motivated the work. © 2013, The International Biometric Society.

  19. Association Between Frailty and Cognitive Impairment: Cross-Sectional Data From Toulouse Frailty Day Hospital.

    Science.gov (United States)

    Fougère, Bertrand; Daumas, Matthieu; Lilamand, Matthieu; Sourdet, Sandrine; Delrieu, Julien; Vellas, Bruno; Abellan van Kan, Gabor

    2017-11-01

    A consensus panel, based on epidemiologic evidence, argued that physical frailty is often associated with cognitive impairment, possibly because of common underlying pathophysiological mechanisms. The concepts of cognitive frailty and motoric cognitive risk were recently proposed in literature and may represent a prodromal stage for neurodegenerative diseases. The purpose of this study was to analyze the relationship between cognition and the components of the physical phenotype of frailty. Participants admitted to the Toulouse frailty day hospital aged 65 years or older were included in this cross-sectional study. Cognitive impairment was identified using the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR). Frailty was assessed using the physical phenotype as defined by Fried's criteria. We divided the participants into 2 groups: participants with normal cognition (CDR = 0) and participants who had cognitive impairment (CDR = 0.5). Participants with CDR >0.5 were excluded. Data from 1620 participants, mean age 82 years and 63% of women were analyzed. Cognitive impairment was identified in 52.5% of the participants. Frailty was identified in 44.7% of the sample. There were more frail subjects in the impaired group than the normal cognitive group (51% vs 38%, P impairment [adjusted odds ratio (OR) 1.66, 95% confidence interval (CI) 1.12-2.46]. Subsequent analysis showed that the association between cognitive impairment and frailty was only observed considering one of the 5 frailty criteria: gait speed (adjusted OR 1.89, 95% CI 1.55-2.32). Physical frailty and in particular slow gait speed were associated with cognitive impairment. Future research including longitudinal studies should exploit the association between cognitive impairment and frailty. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  20. Semiparametric estimation of covariance matrices for longitudinal data.

    Science.gov (United States)

    Fan, Jianqing; Wu, Yichao

    2008-12-01

    Estimation of longitudinal data covariance structure poses significant challenges because the data are usually collected at irregular time points. A viable semiparametric model for covariance matrices was proposed in Fan, Huang and Li (2007) that allows one to estimate the variance function nonparametrically and to estimate the correlation function parametrically via aggregating information from irregular and sparse data points within each subject. However, the asymptotic properties of their quasi-maximum likelihood estimator (QMLE) of parameters in the covariance model are largely unknown. In the current work, we address this problem in the context of more general models for the conditional mean function including parametric, nonparametric, or semi-parametric. We also consider the possibility of rough mean regression function and introduce the difference-based method to reduce biases in the context of varying-coefficient partially linear mean regression models. This provides a more robust estimator of the covariance function under a wider range of situations. Under some technical conditions, consistency and asymptotic normality are obtained for the QMLE of the parameters in the correlation function. Simulation studies and a real data example are used to illustrate the proposed approach.

  1. Life satisfaction and frailty among older adults

    Directory of Open Access Journals (Sweden)

    Katarina Wilhelmson

    2013-09-01

    Full Text Available Functional and physical impairment are factors believed to lead to declined life satisfaction among older adults. This study aimed to examine life satisfaction among older adults and the influence of frailty. Baseline data from two studies addressing frail older adults aged 80+ in Gothenburg, Sweden, (n=577 were used. Frailty was measured through eight indicators. Life satisfaction was measured with Fugl-Meyer’s instrument LiSat-11. Perceived life satisfaction was rather high within the studied population, with 66% being satisfied with life as a whole. Most life satisfaction items were significantly associated with frailty status, with non-frail participants being satisfied to a higher extent for all items with the exception of financial situation, sexual life and partnership relation. The factors significantly explaining life satisfaction were psychological health, partner relationship, leisure and ADL. This study shows that older adults’ satisfaction with life as a whole is almost as high as in younger age groups. Respondents with higher degree of frailty reported significantly lower degrees of life satisfaction, indicating a possibility to maintain life satisfaction by preventing or delaying the development of frailty.

  2. Frailty in elderly people with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Maria Eugenia Portilla Franco

    2016-11-01

    Frailty can be reversed, which is why a study of frailty in patients with chronic kidney disease is of particular interest. This article aims to describe the association between ageing, frailty and chronic kidney disease in light of the most recent and relevant scientific publications.

  3. Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition.

    Science.gov (United States)

    Laur, Celia V; McNicholl, Tara; Valaitis, Renata; Keller, Heather H

    2017-05-01

    There is increasing awareness of the detrimental health impact of frailty on older adults and of the high prevalence of malnutrition in this segment of the population. Experts in these 2 arenas need to be cognizant of the overlap in constructs, diagnosis, and treatment of frailty and malnutrition. There is a lack of consensus regarding the definition of malnutrition and how it should be assessed. While there is consensus on the definition of frailty, there is no agreement on how it should be measured. Separate assessment tools exist for both malnutrition and frailty; however, there is intersection between concepts and measures. This narrative review highlights some of the intersections within these screening/assessment tools, including weight loss/decreased body mass, functional capacity, and weakness (handgrip strength). The potential for identification of a minimal set of objective measures to identify, or at least consider risk for both conditions, is proposed. Frailty and malnutrition have also been shown to result in similar negative health outcomes and consequently common treatment strategies have been studied, including oral nutritional supplements. While many of the outcomes of treatment relate to both concepts of frailty and malnutrition, research questions are typically focused on the frailty concept, leading to possible gaps or missed opportunities in understanding the effect of complementary interventions on malnutrition. A better understanding of how these conditions overlap may improve treatment strategies for frail, malnourished, older adults.

  4. Unobserved Heterogeneity of Frailty in the Analysis of Socioeconomic Differences in Health and Mortality

    DEFF Research Database (Denmark)

    Zarulli, Virginia

    2016-01-01

    The concepts of unobserved frailty and selection have been extensively analyzed with respect to phenomena like mortality deceleration at old ages and mortality convergence or cross overs between populations (for example American black and white populations, men and women). Despite the long-time o...

  5. Can resources moderate the impact of levels of frailty on adverse outcomes among (pre-) frail older people? A longitudinal study.

    Science.gov (United States)

    Op Het Veld, Linda P M; Ament, Bart H L; van Rossum, Erik; Kempen, Gertrudis I J M; de Vet, Henrica C W; Hajema, KlaasJan; Beurskens, Anna J H M

    2017-08-17

    Higher levels of frailty result in higher risks of adverse frailty outcomes such as hospitalisation and mortality. There are, however, indications that more factors than solely frailty play a role in the development of these outcomes. The presence of resources, e.g. sufficient income and good self-management abilities, might slow down the pathway from level of frailty to adverse outcomes (e.g. mortality). In the present paper we studied whether resources (i.e. educational level, income, availability of informal care, living situation, sense of mastery and self-management abilities) moderate the impact of the level of frailty on the adverse outcomes mortality, hospitalisation and the development of disability over a two-year period. Longitudinal data on a sample of 2420 community-dwelling pre-frail and frail older people were collected. Participants filled out a questionnaire every six months, including measures of frailty, resources and outcomes. To study the moderating effects of the selected resources their interaction effects with levels of frailty on outcomes were studied by means of multiple logistics and linear regression models. Frail older participants had increased odds of mortality and hospitalisation, and had more deteriorating disability scores compared to their pre-frail counterparts. No moderating effects of the studied resources were found for the outcomes mortality and hospitalisation. Only for the outcome disability statistically significant moderating effects were present for the resources income and living situation, yet these effects were in the opposite direction to what we expected. Overall, the studied resources showed hardly any statistically significant moderating effects and the directions of the trends were inconsistent. Frail participants were more at risk of mortality, hospitalisation, and an increase in disability. However, we were unable to demonstrate a clear moderating effect of the studied resources on the adverse outcomes

  6. Assessment of frailty in aged dogs.

    Science.gov (United States)

    Hua, Julie; Hoummady, Sara; Muller, Claude; Pouchelon, Jean-Louis; Blondot, Marc; Gilbert, Caroline; Desquilbet, Loic

    2016-12-01

    OBJECTIVE To define a frailty-related phenotype-a clinical syndrome associated with the aging process in humans-in aged dogs and to investigate its association with time to death. ANIMALS 116 aged guide dogs. PROCEDURES Dogs underwent a clinical geriatric assessment (CGA) and were followed to either time of death or the study cutoff date. A 5-component clinical definition of a frailty phenotype was derived from clinical items included in a geriatric health evaluation scoresheet completed by veterinarians during the CGA. Univariate (via Kaplan-Meier curves) and multivariate (via Cox proportional hazards models) survival analyses were used to investigate associations of the 5 CGA components with time to death. RESULTS 76 dogs died, and the median time from CGA to death was 4.4 years. Independent of age at the time of CGA, dogs that had ≥ 2 of the 5 components (n = 10) were more likely to die during the follow-up period, compared with those that had 1 or no components (adjusted hazard ratio, 3.9 [95% confidence interval, 1.4 to 10.9]). After further adjustments for subclinical or clinical diseases and routine biomarkers, the adjusted hazard ratio remained significant. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that signs of frailty appeared to be a risk factor for death in dogs. The concept of frailty in dogs requires further development. IMPACT FOR HUMAN MEDICINE The concept of frailty, as defined for humans, seems transposable to dogs. Given that they share humans' environments and develop several age-related diseases similar to those in humans, dogs may be useful for the study of environmental or age-related risk factors for frailty in humans.

  7. An Overview of Modified Semiparametric Memory Estimation Methods

    Directory of Open Access Journals (Sweden)

    Marie Busch

    2018-03-01

    Full Text Available Several modified estimation methods of the memory parameter have been introduced in the past years. They aim to decrease the upward bias of the memory parameter in cases of low frequency contaminations or an additive noise component, especially in situations with a short-memory process being contaminated. In this paper, we provide an overview and compare the performance of nine semiparametric estimation methods. Among them are two standard methods, four modified approaches to account for low frequency contaminations and three procedures developed for perturbed fractional processes. We conduct an extensive Monte Carlo study for a variety of parameter constellations and several DGPs. Furthermore, an empirical application of the log-absolute return series of the S&P 500 shows that the estimation results combined with a long-memory test indicate a spurious long-memory process.

  8. Semiparametric Inference in a GARCH-in-Mean Model

    DEFF Research Database (Denmark)

    Christensen, Bent Jesper; Dahl, Christian Møller; Iglesias, Emma M.

    A new semiparametric estimator for an empirical asset pricing model with general nonpara- metric risk-return tradeoff and a GARCH process for the underlying volatility is introduced. The estimator does not rely on any initial parametric estimator of the conditional mean func- tion, and this feature...... facilitates the derivation of asymptotic theory under possible nonlinearity of unspecified form of the risk-return tradeoff. Besides the nonlinear GARCH-in-mean effect, our specification accommodates exogenous regressors that are typically used as conditioning variables entering linearly in the mean equation...... variance of returns from the literature is misspecified, and this could be the reason for the disagreement on the sign of the relation....

  9. Study on Semi-Parametric Statistical Model of Safety Monitoring of Cracks in Concrete Dams

    OpenAIRE

    Gu, Chongshi; Qin, Dong; Li, Zhanchao; Zheng, Xueqin

    2013-01-01

    Cracks are one of the hidden dangers in concrete dams. The study on safety monitoring models of concrete dam cracks has always been difficult. Using the parametric statistical model of safety monitoring of cracks in concrete dams, with the help of the semi-parametric statistical theory, and considering the abnormal behaviors of these cracks, the semi-parametric statistical model of safety monitoring of concrete dam cracks is established to overcome the limitation of the parametric model in ex...

  10. Oral Frailty as a Risk Factor for Physical Frailty and Mortality in Community-Dwelling Elderly.

    Science.gov (United States)

    Tanaka, Tomoki; Takahashi, Kyo; Hirano, Hirohiko; Kikutani, Takeshi; Watanabe, Yutaka; Ohara, Yuki; Furuya, Hiroyasu; Tsuji, Tetsuo; Akishita, Masahiro; Iijima, Katsuya

    2017-11-17

    Oral health is important for maintaining general health among the elderly. However, a longitudinal association between poor oral health and general health has not been reported. We investigated whether poor oral status can predict physical weakening (physical frailty, sarcopenia, subsequent disability) and identified the longitudinal impact of the accumulated poor oral health (i.e., oral frailty) on adverse health outcomes, including mortality. A total of 2,011 elderly individuals (aged ≥65 years) participated in the baseline survey of the Kashiwa study in 2012. At baseline, 16 oral status measures and covariates such as demographic characteristics were assessed. As outcomes, physical frailty and sarcopenia were assessed at baseline and at follow-up in 2013 and 2014. Physical independence and survival were assessed from 2012 to 2016 at the time of long-term care certification and time of death. Poor oral status as determined by the number of natural teeth, chewing ability, articulatory oral motor skill, tongue pressure, and subjective difficulties in eating and swallowing significantly predicted future physical weakening (new-onsets of physical frailty, sarcopenia, and disability). Oral frailty was defined as co-existing poor status in ≥3 of the 6 measures. Sixteen percent of participants had oral frailty at baseline, which was significantly associated with 2.4-, 2.2-, 2.3-, and 2.2-fold increased risk of physical frailty, sarcopenia, disability, and mortality, respectively. Accumulated poor oral status strongly predicted the onset of adverse health outcomes, including mortality among the community-dwelling elderly. Prevention of oral frailty at an earlier stage is essential for healthy aging. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Nutritional determinants of frailty in older adults: A systematic review.

    Science.gov (United States)

    Lorenzo-López, Laura; Maseda, Ana; de Labra, Carmen; Regueiro-Folgueira, Laura; Rodríguez-Villamil, José L; Millán-Calenti, José C

    2017-05-15

    Frailty is a geriatric syndrome that affects multiple domains of human functioning. A variety of problems contributes to the development of this syndrome; poor nutritional status is an important determinant of this condition. The purpose of this systematic review was to examine recent evidence regarding the association between nutritional status and frailty syndrome in older adults. PubMed, Web of Science, and Scopus electronic databases were searched using specific key words, for observational papers that were published during the period from 2005 to February 2017 and that studied the association or relationship between nutritional status and frailty in older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was followed to assess the quality of the included articles. Of the 2042 studies found, nineteen met the inclusion criteria. Of these studies, five provided data on micronutrients and frailty, and reported that frailty syndrome is associated with low intakes of specific micronutrients. Five studies provided data on macronutrients and frailty, and among those studies, four revealed that a higher protein intake was associated with a lower risk of frailty. Three studies examined the relationship between diet quality and frailty, and showed that the quality of the diet is inversely associated with the risk of being frail. Two studies provided data on the antioxidant capacity of the diet and frailty, and reported that a high dietary antioxidant capacity is associated with a lower risk of developing frailty. Finally, seven studies evaluated the relationship between scores on both the Mini Nutritional Assessment (MNA) and the MNA-SF (Short Form) and frailty, and revealed an association between malnutrition and/or the risk of malnutrition and frailty. This systematic review confirms the importance of both quantitative (energy intake) and qualitative (nutrient quality) factors of nutrition in the development of frailty

  12. A comparison between uni- and multidimensional frailty measures: prevalence, functional status, and relationships with disability

    Directory of Open Access Journals (Sweden)

    Roppolo M

    2015-10-01

    frailty prevalence rate is strictly dependent on the index used (CHS =12.7%; TFI =44.6%. Furthermore, frail individuals presented differences in terms of functional status in all the domains. Frailty measures were significantly correlated with each other (r=0.483, and with disability (CHS: r=0.423; TFI: r=0.475. Finally, the area under the curve of the TFI (0.833 for disability was higher with respect to the one of CHS (0.770.Conclusion: Data reported here confirm that different instruments capture different frail individuals. Clinicians and researchers have to consider the different abilities of the two measures to detect frail individuals. Keywords: functional decline, older adults, health outcomes, active aging, indexes selection 

  13. Charting the Elements of Pedagogic Frailty

    Science.gov (United States)

    Kinchin, I. M.; Alpay, E.; Curtis, K.; Franklin, J.; Rivers, C.; Winstone, N. E.

    2016-01-01

    Background: The concept of pedagogic frailty has been proposed as a unifying concept that may help to integrate institutional efforts to enhance teaching improvement within universities by helping to maintain a simultaneous focus on four key areas that are thought to impede development. Purpose: The variation in internal structure of the four…

  14. Profile local linear estimation of generalized semiparametric regression model for longitudinal data.

    Science.gov (United States)

    Sun, Yanqing; Sun, Liuquan; Zhou, Jie

    2013-07-01

    This paper studies the generalized semiparametric regression model for longitudinal data where the covariate effects are constant for some and time-varying for others. Different link functions can be used to allow more flexible modelling of longitudinal data. The nonparametric components of the model are estimated using a local linear estimating equation and the parametric components are estimated through a profile estimating function. The method automatically adjusts for heterogeneity of sampling times, allowing the sampling strategy to depend on the past sampling history as well as possibly time-dependent covariates without specifically model such dependence. A [Formula: see text]-fold cross-validation bandwidth selection is proposed as a working tool for locating an appropriate bandwidth. A criteria for selecting the link function is proposed to provide better fit of the data. Large sample properties of the proposed estimators are investigated. Large sample pointwise and simultaneous confidence intervals for the regression coefficients are constructed. Formal hypothesis testing procedures are proposed to check for the covariate effects and whether the effects are time-varying. A simulation study is conducted to examine the finite sample performances of the proposed estimation and hypothesis testing procedures. The methods are illustrated with a data example.

  15. Androgen effects on skeletal muscle: implications for the development and management of frailty

    Directory of Open Access Journals (Sweden)

    Matthew DL O'Connell

    2014-04-01

    Full Text Available Androgens have potent anabolic effects on skeletal muscle and decline with age in parallel to losses in muscle mass and strength. This loss of muscle mass and function, known as sarcopenia, is the central event in development of frailty, the vulnerable health status that presages adverse outcomes and rapid functional decline in older adults. The potential role of falling androgen levels in the development of frailty and their utility as function promoting therapies in older men has therefore attracted considerable attention. This review summarizes current concepts and definitions in muscle ageing, sarcopenia and frailty, and evaluates recent developments in the study of androgens and frailty. Current evidence from observational and interventional studies strongly supports an effect of androgens on muscle mass in ageing men, but effects on muscle strength and particularly physical function have been less clear. Androgen treatment has been generally well-tolerated in studies of older men, but concerns remain over higher dose treatments and use in populations with high cardiovascular risk. The first trials of selective androgen receptor modulators (SARMs suggest similar effects on muscle mass and function to traditional androgen therapies in older adults. Important future directions include the use of these agents in combination with exercise training to promote functional ability across different populations of older adults, as well as more focus on the relationships between concurrent changes in hormone levels, body composition and physical function in observational studies.

  16. Androgen effects on skeletal muscle: implications for the development and management of frailty

    Science.gov (United States)

    O’Connell, Matthew DL; Wu, Frederick CW

    2014-01-01

    Androgens have potent anabolic effects on skeletal muscle and decline with age in parallel to losses in muscle mass and strength. This loss of muscle mass and function, known as sarcopenia, is the central event in development of frailty, the vulnerable health status that presages adverse outcomes and rapid functional decline in older adults. The potential role of falling androgen levels in the development of frailty and their utility as function promoting therapies in older men has therefore attracted considerable attention. This review summarizes current concepts and definitions in muscle ageing, sarcopenia and frailty, and evaluates recent developments in the study of androgens and frailty. Current evidence from observational and interventional studies strongly supports an effect of androgens on muscle mass in ageing men, but effects on muscle strength and particularly physical function have been less clear. Androgen treatment has been generally well–tolerated in studies of older men, but concerns remain over higher dose treatments and use in populations with high cardiovascular risk. The first trials of selective androgen receptor modulators (SARMs) suggest similar effects on muscle mass and function to traditional androgen therapies in older adults. Important future directions include the use of these agents in combination with exercise training to promote functional ability across different populations of older adults, as well as more focus on the relationships between concurrent changes in hormone levels, body composition and physical function in observational studies. PMID:24457838

  17. The association between BMI and different frailty domains : A U-shaped curve?

    NARCIS (Netherlands)

    Rietman, M. Liset; van der A, D. L.; van Oostrom, S. H.; Picavet, H. S J; Dollé, M. E T; van Steeg, H.; Verschuren, W. M M; Spijkerman, A. M W

    2018-01-01

    Objectives: Previous studies showed a U-shaped association between BMI and (physical) frailty. We studied the association between BMI and physical, cognitive, psychological, and social frailty. Furthermore, the overlap between and prevalence of these frailty domains was examined. Design:

  18. bspmma: An R Package for Bayesian Semiparametric Models for Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Deborah Burr

    2012-07-01

    Full Text Available We introduce an R package, bspmma, which implements a Dirichlet-based random effects model specific to meta-analysis. In meta-analysis, when combining effect estimates from several heterogeneous studies, it is common to use a random-effects model. The usual frequentist or Bayesian models specify a normal distribution for the true effects. However, in many situations, the effect distribution is not normal, e.g., it can have thick tails, be skewed, or be multi-modal. A Bayesian nonparametric model based on mixtures of Dirichlet process priors has been proposed in the literature, for the purpose of accommodating the non-normality. We review this model and then describe a competitor, a semiparametric version which has the feature that it allows for a well-defined centrality parameter convenient for determining whether the overall effect is significant. This second Bayesian model is based on a different version of the Dirichlet process prior, and we call it the "conditional Dirichlet model". The package contains functions to carry out analyses based on either the ordinary or the conditional Dirichlet model, functions for calculating certain Bayes factors that provide a check on the appropriateness of the conditional Dirichlet model, and functions that enable an empirical Bayes selection of the precision parameter of the Dirichlet process. We illustrate the use of the package on two examples, and give an interpretation of the results in these two different scenarios.

  19. Characteristic function-based semiparametric inference for skew-symmetric models

    KAUST Repository

    Potgieter, Cornelis J.

    2012-12-26

    Skew-symmetric models offer a very flexible class of distributions for modelling data. These distributions can also be viewed as selection models for the symmetric component of the specified skew-symmetric distribution. The estimation of the location and scale parameters corresponding to the symmetric component is considered here, with the symmetric component known. Emphasis is placed on using the empirical characteristic function to estimate these parameters. This is made possible by an invariance property of the skew-symmetric family of distributions, namely that even transformations of random variables that are skew-symmetric have a distribution only depending on the symmetric density. A distance metric between the real components of the empirical and true characteristic functions is minimized to obtain the estimators. The method is semiparametric, in that the symmetric component is specified, but the skewing function is assumed unknown. Furthermore, the methodology is extended to hypothesis testing. Two tests for a hypothesis of specific parameter values are considered, as well as a test for the hypothesis that the symmetric component has a specific parametric form. A resampling algorithm is described for practical implementation of these tests. The outcomes of various numerical experiments are presented. © 2012 Board of the Foundation of the Scandinavian Journal of Statistics.

  20. Study on Semi-Parametric Statistical Model of Safety Monitoring of Cracks in Concrete Dams

    Directory of Open Access Journals (Sweden)

    Chongshi Gu

    2013-01-01

    Full Text Available Cracks are one of the hidden dangers in concrete dams. The study on safety monitoring models of concrete dam cracks has always been difficult. Using the parametric statistical model of safety monitoring of cracks in concrete dams, with the help of the semi-parametric statistical theory, and considering the abnormal behaviors of these cracks, the semi-parametric statistical model of safety monitoring of concrete dam cracks is established to overcome the limitation of the parametric model in expressing the objective model. Previous projects show that the semi-parametric statistical model has a stronger fitting effect and has a better explanation for cracks in concrete dams than the parametric statistical model. However, when used for forecast, the forecast capability of the semi-parametric statistical model is equivalent to that of the parametric statistical model. The modeling of the semi-parametric statistical model is simple, has a reasonable principle, and has a strong practicality, with a good application prospect in the actual project.

  1. A Bayesian semiparametric latent variable approach to causal mediation.

    Science.gov (United States)

    Kim, Chanmin; Daniels, Michael; Li, Yisheng; Milbury, Kathrin; Cohen, Lorenzo

    2018-03-30

    In assessing causal mediation effects in randomized studies, a challenge is that the direct and indirect effects can vary across participants due to different measured and unmeasured characteristics. In that case, the population effect estimated from standard approaches implicitly averages over and does not estimate the heterogeneous direct and indirect effects. We propose a Bayesian semiparametric method to estimate heterogeneous direct and indirect effects via clusters, where the clusters are formed by both individual covariate profiles and individual effects due to unmeasured characteristics. These cluster-specific direct and indirect effects can be estimated through a set of regression models where specific coefficients are clustered by a stick-breaking prior. To let clustering be appropriately informed by individual direct and indirect effects, we specify a data-dependent prior. We conduct simulation studies to assess performance of the proposed method compared to other methods. We use this approach to estimate heterogeneous causal direct and indirect effects of an expressive writing intervention for patients with renal cell carcinoma. Copyright © 2017 John Wiley & Sons, Ltd.

  2. Generalized Functional Linear Models With Semiparametric Single-Index Interactions

    KAUST Repository

    Li, Yehua

    2010-06-01

    We introduce a new class of functional generalized linear models, where the response is a scalar and some of the covariates are functional. We assume that the response depends on multiple covariates, a finite number of latent features in the functional predictor, and interaction between the two. To achieve parsimony, the interaction between the multiple covariates and the functional predictor is modeled semiparametrically with a single-index structure. We propose a two step estimation procedure based on local estimating equations, and investigate two situations: (a) when the basis functions are pre-determined, e.g., Fourier or wavelet basis functions and the functional features of interest are known; and (b) when the basis functions are data driven, such as with functional principal components. Asymptotic properties are developed. Notably, we show that when the functional features are data driven, the parameter estimates have an increased asymptotic variance, due to the estimation error of the basis functions. Our methods are illustrated with a simulation study and applied to an empirical data set, where a previously unknown interaction is detected. Technical proofs of our theoretical results are provided in the online supplemental materials.

  3. Semi-Parametric Bayesian Inference for Phage Display Data

    Science.gov (United States)

    León-Novelo, Luis G.; Müller, Peter; Arap, Wadih; Kolonin, Mikhail; Sun, Jessica; Pasqualini, Renata; Do, Kim-Anh

    2012-01-01

    Summary We discuss inference for a human phage display experiment with three stages. The data are tripeptide counts by tissue and stage. The primary aim of the experiment is to identify ligands that bind with high affinity to a given tissue. We formalize the research question as inference about the monotonicity of mean counts over stages. The inference goal is then to identify a list of peptide-tissue pairs with significant increase over stages. We use a semi-parametric Dirichlet process mixture of Poisson model. The posterior distribution under this model allows the desired inference about the monotonicity of mean counts. However, the desired inference summary as a list of peptide-tissue pairs with significant increase involves a massive multiplicity problem. We consider two alternative approaches to address this multiplicity issue. First we propose an approach based on the control of the posterior expected false discovery rate. We notice that the implied solution ignores the relative size of the increase. This motivates a second approach based on a utility function that includes explicit weights for the size of the increase. PMID:23339534

  4. Testing Homogeneity in a Semiparametric Two-Sample Problem

    Directory of Open Access Journals (Sweden)

    Yukun Liu

    2012-01-01

    Full Text Available We study a two-sample homogeneity testing problem, in which one sample comes from a population with density f(x and the other is from a mixture population with mixture density (1−λf(x+λg(x. This problem arises naturally from many statistical applications such as test for partial differential gene expression in microarray study or genetic studies for gene mutation. Under the semiparametric assumption g(x=f(xeα+βx, a penalized empirical likelihood ratio test could be constructed, but its implementation is hindered by the fact that there is neither feasible algorithm for computing the test statistic nor available research results on its theoretical properties. To circumvent these difficulties, we propose an EM test based on the penalized empirical likelihood. We prove that the EM test has a simple chi-square limiting distribution, and we also demonstrate its competitive testing performances by simulations. A real-data example is used to illustrate the proposed methodology.

  5. Dynamic frailty models based on compound birth-death processes.

    Science.gov (United States)

    Putter, Hein; van Houwelingen, Hans C

    2015-07-01

    Frailty models are used in survival analysis to model unobserved heterogeneity. They accommodate such heterogeneity by the inclusion of a random term, the frailty, which is assumed to multiply the hazard of a subject (individual frailty) or the hazards of all subjects in a cluster (shared frailty). Typically, the frailty term is assumed to be constant over time. This is a restrictive assumption and extensions to allow for time-varying or dynamic frailties are of interest. In this paper, we extend the auto-correlated frailty models of Henderson and Shimakura and of Fiocco, Putter and van Houwelingen, developed for longitudinal count data and discrete survival data, to continuous survival data. We present a rigorous construction of the frailty processes in continuous time based on compound birth-death processes. When the frailty processes are used as mixtures in models for survival data, we derive the marginal hazards and survival functions and the marginal bivariate survival functions and cross-ratio function. We derive distributional properties of the processes, conditional on observed data, and show how to obtain the maximum likelihood estimators of the parameters of the model using a (stochastic) expectation-maximization algorithm. The methods are applied to a publicly available data set. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Oral health conditions and frailty in Mexican community-dwelling elderly: a cross sectional analysis

    Directory of Open Access Journals (Sweden)

    Castrejón-Pérez Roberto

    2012-09-01

    Full Text Available Abstract Background Oral health is an important component of general well-being for the elderly. Oral health-related problems include loss of teeth, nonfunctional removable dental prostheses, lesions of the oral mucosa, periodontitis, and root caries. They affect food selection, speaking ability, mastication, social relations, and quality of life. Frailty is a geriatric syndrome that confers vulnerability to negative health-related outcomes. The association between oral health and frailty has not been explored thoroughly. This study sought to identify associations between the presence of some oral health conditions, and frailty status among Mexican community-dwelling elderly. Methods Analysis of baseline data of the Mexican Study of Nutritional and Psychosocial Markers of Frailty, a cohort study carried out in a representative sample of people aged 70 and older residing in one district of Mexico City. Frailty was defined as the presence of three or more of the following five components: weight loss, exhaustion, slowness, weakness, and low physical activity. Oral health variables included self-perception of oral health compared with others of the same age; utilization of dental services during the last year, number of teeth, dental condition (edentate, partially edentate, or completely dentate, utilization and functionality of removable partial or complete dentures, severe periodontitis, self-reported chewing problems and xerostomia. Covariates included were gender, age, years of education, cognitive performance, smoking status, recent falls, hospitalization, number of drugs, and comorbidity. The association between frailty and dental variables was determined performing a multivariate logistic regression analysis. Final models were adjusted by socio-demographic and health factors Results Of the 838 participants examined, 699 had the information needed to establish the criteria for diagnosis of frailty. Those who had a higher probability of being

  7. Age, frailty, disability, institutionalization, multimorbidity or comorbidity. Which are the main targets in older adults?

    Science.gov (United States)

    Abizanda, P; Romero, L; Sánchez-Jurado, P M; Martínez-Reig, M; Alfonso-Silguero, S A; Rodríguez-Mañas, L

    2014-01-01

    Age, frailty, disability, institutionalization, multimorbidity or comorbidity are main risk factors for serious health adverse outcomes in older adults. However, the adjusted relevance of each of them in order to determine which characteristics must be of importance for health policies in this population group, has not been established. Concurrent population-based cohort study. Albacete city, Spain. 842 participants over age 70 from the FRADEA Study. Age, gender, institutionalization, frailty (Fried's criteria), previous disability in basic activities of daily living (BADL) (Barthel index), comorbidity (Charlson index), and multimorbidity (≥ 2 from 14 selected diseases) were recorded in the basal visit. The combined event of mortality or incident disability in BADL was determined in the follow-up visit. The risk of presenting adverse events was determined by Kaplan-Meier analysis and logistic regression adjusted for age, sex, and institutionalization. Mean follow-up 520 days. 63 participants died (7.5%). Among the remaining 779, 191 lost at least one BADL (24.5%). The combined event of mortality or disability was present in 254 participants (30.2%). Age (OR 1.10, 95%CI 1.06-1.14), frailty (OR 3.07, 95%CI 1.63-5.77), disability (OR 2.19, 95%CI 1.43-3.36) and institutionalization (OR 2.73, 95%CI 1.68-4.44) were independently associated with the combined adverse event, but not comorbidity or multimorbidity. In subjects younger than 80, only frailty, disability and institutionalization were risk factors, and in those aged ≥ 80, only age, disability and institutionalization were. Health policies for older adults must take into account mainly frailty and disability in subjects younger than 80 and disability in those older than 80.

  8. Quality of Life in Sarcopenia and Frailty

    Science.gov (United States)

    Rizzoli, René; Reginster, Jean-Yves; Arnal, Jean-François; Bautmans, Ivan; Beaudart, Charlotte; Bischoff-Ferrari, Heike; Biver, Emmanuel; Boonen, Steven; Brandi, Maria-Luisa; Chines, Arkadi; Cooper, Cyrus; Epstein, Sol; Fielding, Roger A.; Goodpaster, Bret; Kanis, John A.; Kaufman, Jean-Marc; Laslop, Andrea; Malafarina, Vincenzo; Mañas, Leocadio Rodriguez; Mitlak, Bruce H.; Oreffo, Richard O.; Petermans, Jean; Reid, Kieran; Rolland, Yves; Sayer, Avan Aihie; Tsouderos, Yannis; Visser, Marjolein; Bruyère, Olivier

    2013-01-01

    The reduced muscle mass and impaired muscle performance that defines sarcopenia in older individuals is associated with increased risk of physical limitation and a variety of chronic diseases. It may also contribute to clinical frailty. A gradual erosion of quality of life (QoL) has been evidenced in these individuals, although much of this research has been done using generic QoL instruments, particularly the SF-36, which may not be ideal in older populations with significant comorbidities. This review and report of an expert meeting, presents the current definitions of these geriatric syndromes (sarcopenia and frailty). It then briefly summarises QoL concepts and specificities in older populations, examines the relevant domains of QoL and what is known concerning QoL decline with these conditions. It calls for a clearer definition of the construct of disability and argues that a disease-specific QoL instrument for sarcopenia/frailty would be an asset for future research and discusses whether there are available and validated components that could be used to this end and whether the psychometric properties of these instruments are sufficiently tested. It calls also for an approach using utility weighting to provide some cost estimates and suggests that a time trade off study could be appropriate. PMID:23828275

  9. Pre-frailty and frailty of elderly residents in a municipality with a low Human Development Index

    Directory of Open Access Journals (Sweden)

    Wanderley Matos Reis Júnior

    2014-08-01

    Full Text Available OBJECTIVE: to identify the prevalence of the factors associated with pre-frailty and frailty of elderly residents in a municipality with a low Human Development IndexMETHOD: Cross-sectional study with a populational and household framework conducted with 316 elderly people. Frailty was determined from the presence of three or more of the following factors: (i self-reported unintentional weight loss; (ii lack of strength and energy; (iii weakness; (iv slowness; (v low level of physical activity. The association between frailty and socio-demographic, behavioral and health factors was measured using the multinomial logistic regression technique.RESULTS: The prevalence of pre-frailty and frailty was 58.7% and 23.8%, respectively. The adjusted regression model showed that the state of pre-frailty was associated with gender, age group and BMI, and frailty was associated with gender, age group, hospitalization, functional capacity, and self-perceived health.CONCLUSION: The evidence presented in this study demonstrates more variables associated with the frailty condition, reinforcing the concept of a multifactorial clinical syndrome that may result in the loss of functionality.

  10. Modelling asset correlations during the recent financial crisis: A semiparametric approach

    DEFF Research Database (Denmark)

    Aslanidis, Nektarios; Casas, Isabel

    This article proposes alternatives to the Dynamic Conditional Correlation (DCC) model to study assets' correlations during the recent financial crisis. In particular, we adopt a semiparametric and nonparametric approach to estimate the conditional correlations for two interesting portfolios...... multivariate simulations in addition to the bivariate ones. Our simulation results show that the semiparametric and nonparametric models are best in DGPs with gradual changes or structural breaks in correlations. However, in DGPs with rapid changes or constancy in correlations the DCC delivers the best outcome...

  11. Prevalence and Outcomes of Frailty in Korean Elderly Population: Comparisons of a Multidimensional Frailty Index with Two Phenotype Models

    Science.gov (United States)

    Jung, Hee-Won; Kim, Sun-Wook; Ahn, Soyeon; Lim, Jae-Young; Han, Ji-Won; Kim, Tae-Hui; Kim, Ki-Woong; Kim, Kwang-il; Kim, Cheol-Ho

    2014-01-01

    Background Frailty is related to adverse outcomes in the elderly. However, current status and clinical significance of frailty have not been evaluated for the Korean elderly population. We aimed to investigate the usefulness of established frailty criteria for community-dwelling Korean elderly. We also tried to develop and validate a new frailty index based on a multidimensional model. Methods We studied 693 participants of the Korean Longitudinal Study on Health and Aging (KLoSHA). We developed a new frailty index (KLoSHA Frailty Index, KFI) and compared predictability of it with the established frailty indexes from the Cardiovascular Health Study (CHS) and Study of Osteoporotic Fracture (SOF). Mortality, hospitalization, and functional decline were evaluated. Results The prevalence of frailty was 9.2% (SOF index), 13.2% (CHS index), and 15.6% (KFI). The criteria from CHS and KFI correlated with each other, but SOF did not correlate with KFI. During the follow-up period (5.6±0.9 years), 97 participants (14.0%) died. Frailty defined by KFI predicted mortality better than CHS index (c-index: 0.713 and 0.596, respectively; p<0.001, better for KFI). In contrast, frailty by SOF index was not related to mortality. The KFI showed better predictability for following functional decline than CHS index (area under the receiver-operating characteristic curve was 0.937 for KFI and 0.704 for CHS index, p = 0.001). However, the SOF index could not predict subsequent functional decline. Frailty by the KFI (OR = 2.13, 95% CI 1.04–4.35) and CHS index (OR = 2.24, 95% CI 1.05–4.76) were associated with hospitalization. In contrast, frailty by the SOF index was not correlated with hospitalization (OR = 1.43, 95% CI 0.68–3.01). Conclusion Prevalence of frailty was higher in Korea compared to previous studies in other countries. A novel frailty index (KFI), which includes domains of comprehensive geriatric assessment, is a valid criterion for the evaluation and

  12. Prevalence and outcomes of frailty in Korean elderly population: comparisons of a multidimensional frailty index with two phenotype models.

    Directory of Open Access Journals (Sweden)

    Hee-Won Jung

    Full Text Available BACKGROUND: Frailty is related to adverse outcomes in the elderly. However, current status and clinical significance of frailty have not been evaluated for the Korean elderly population. We aimed to investigate the usefulness of established frailty criteria for community-dwelling Korean elderly. We also tried to develop and validate a new frailty index based on a multidimensional model. METHODS: We studied 693 participants of the Korean Longitudinal Study on Health and Aging (KLoSHA. We developed a new frailty index (KLoSHA Frailty Index, KFI and compared predictability of it with the established frailty indexes from the Cardiovascular Health Study (CHS and Study of Osteoporotic Fracture (SOF. Mortality, hospitalization, and functional decline were evaluated. RESULTS: The prevalence of frailty was 9.2% (SOF index, 13.2% (CHS index, and 15.6% (KFI. The criteria from CHS and KFI correlated with each other, but SOF did not correlate with KFI. During the follow-up period (5.6 ± 0.9 years, 97 participants (14.0% died. Frailty defined by KFI predicted mortality better than CHS index (c-index: 0.713 and 0.596, respectively; p<0.001, better for KFI. In contrast, frailty by SOF index was not related to mortality. The KFI showed better predictability for following functional decline than CHS index (area under the receiver-operating characteristic curve was 0.937 for KFI and 0.704 for CHS index, p = 0.001. However, the SOF index could not predict subsequent functional decline. Frailty by the KFI (OR = 2.13, 95% CI 1.04-4.35 and CHS index (OR = 2.24, 95% CI 1.05-4.76 were associated with hospitalization. In contrast, frailty by the SOF index was not correlated with hospitalization (OR = 1.43, 95% CI 0.68-3.01. CONCLUSION: Prevalence of frailty was higher in Korea compared to previous studies in other countries. A novel frailty index (KFI, which includes domains of comprehensive geriatric assessment, is a valid criterion for the evaluation and prediction of

  13. Application Of Shared Gamma And Inverse-Gaussian Frailty Models ...

    African Journals Online (AJOL)

    Shared Gamma and Inverse-Gaussian Frailty models are used to analyze the survival times of patients who are clustered according to cancer/tumor types under Parametric Proportional Hazard framework. The result of the ... However, no evidence is strong enough for preference of either Gamma or Inverse Gaussian Frailty.

  14. Frailty and Neurodegenerative Disease: Anticipating the Future, Expanding the Framework.

    Science.gov (United States)

    Lyreskog, D M

    2018-01-01

    An array of technologies for preventing and treating age-related neural decline and disease are currently under development. A clear framework for how to identify groups in need of such inventions is needed. An encompassing concept of frailty could provide a solid basis for such purposes. Concepts of frailty, including physical and cognitive frailty, are currently applied in clinical settings, and in research and development. The terminology facilitates identifying processes of age-related physical and cognitive decline. However, age-related neurodegenerative diseases do not fit the conceptual framework of frailty. A terminology of frailty can and should be developed that connects aging, cognitive decline, and neurodegenerative disease. Such a framework needs to (a) adequately account for the effects that the processes of aging have on neural decline and disease, and (b) be helpful in identifying relevant groups of users and patients.

  15. Risk factors and protective factors associated with incident or increase of frailty among community-dwelling older adults: A systematic review of longitudinal studies.

    Directory of Open Access Journals (Sweden)

    Zeyun Feng

    Full Text Available Frailty is one of the greatest challenges facing our aging population, as it can lead to adverse outcomes such as institutionalization, hospitalization, and mortality. However, the factors that are associated with frailty are poorly understood. We performed a systematic review of longitudinal studies in order to identify the sociodemographic, physical, biological, lifestyle-related, and psychological risk or protective factors that are associated with frailty among community-dwelling older adults.A systematic literature search was conducted in the following databases in order to identify studies that assessed the factors associated with of frailty among community-dwelling older adults: Embase, Medline Ovid, Web of Science, Cochrane, PsychINFO Ovid, CINAHL EBSCOhost, and Google Scholar. Studies were selected if they included a longitudinal design, focused on community-dwelling older adults aged 60 years and older, and used a tool to assess frailty. The methodological quality of each study was assessed using the Quality of Reporting of Observational Longitudinal Research checklist.Twenty-three studies were included. Significant associations were reported between the following types of factors and frailty: sociodemographic factors (7/7 studies, physical factors (5/6 studies, biological factors (5/7 studies, lifestyle factors (11/13 studies, and psychological factors (7/8 studies. Significant sociodemographic factors included older age, ethnic background, neighborhood, and access to private insurance or Medicare; significant physical factors included obesity and activities of daily living (ADL functional status; significant biological factors included serum uric acid; significant lifestyle factors included a higher Diet Quality Index International (DQI score, higher fruit/vegetable consumption and higher tertile of all measures of habitual dietary resveratrol exposure; significant psychological factors included depressive symptoms.A broad range of

  16. The Association between BMI and Different Frailty Domains: A U-Shaped Curve?

    Science.gov (United States)

    Rietman, M L; van der A, D L; van Oostrom, S H; Picavet, H S J; Dollé, M E T; van Steeg, H; Verschuren, W M M; Spijkerman, A M W

    2018-01-01

    Previous studies showed a U-shaped association between BMI and (physical) frailty. We studied the association between BMI and physical, cognitive, psychological, and social frailty. Furthermore, the overlap between and prevalence of these frailty domains was examined. Cross-sectional study. The Doetinchem Cohort Study is a longitudinal population-based study starting in 1987-1991 examining men and women aged 20-59 with follow-up examinations every 5 yrs. For the current analyses, we used data from round 5 (2008-2012) with 4019 participants aged 41-81 yrs. Physical frailty was defined as having ≥ 2 of 4 frailty criteria from the Frailty Phenotype (unintentional weight loss, exhaustion, physical activity, handgrip strength). Cognitive frailty was defined as the BMI was divided into four classes. Analyses were adjusted for sex, age, level of education, and smoking. A U-shaped association was observed between BMI and physical frailty, a small linear association for BMI and cognitive frailty and no association between BMI and psychological and social frailty. The four frailty domains showed only a small proportion of overlap. The prevalence of physical, cognitive and social frailty increased with age, whereas psychological frailty did not. We confirm that not only underweight but also obesity is associated with physical frailty. Obesity also seems to be associated with cognitive frailty. Further, frailty prevention should focus on multiple domains and target individuals at a younger age (<65yrs).

  17. Pharmacological intervention in frailty and sarcopenia: report by the International Conference on Frailty and Sarcopenia Research Task Force

    Science.gov (United States)

    Sarcopenia and frailty often co-exist and both have physical function impairment as a core component. Yet despite the urgency of the problem, the development of pharmaceutical therapies for sarcopenia and frailty has lagged, in part because of the lack of consensus definitions for the two conditions...

  18. A new frailty syndrome: central obesity and frailty in older adults with the human immunodeficiency virus.

    Science.gov (United States)

    Shah, Krupa; Hilton, Tiffany N; Myers, Lauren; Pinto, Jonathan F; Luque, Amneris E; Hall, William J

    2012-03-01

    To evaluate the relationships between body composition and physical frailty in community-dwelling older adults with the human immunodeficiency virus (HIV) (HOA). Cross-sectional. Academic hospital-based infectious disease clinic in Rochester, New York. Forty community-dwelling HOA aged 50 and older undergoing antiretroviral therapy who were able to ambulate without assistive devices with a mean age of 58, a mean BMI of 29.0 kg/m(2), mean CD4 count of 569 cells/mL, and a mean duration since HIV diagnosis of 17 years; 28% were female and 57% Caucasian. Subjective and objective measures of functional status were evaluated using the Physical Performance Test (PPT), the graded treadmill test, knee strength, gait speed, balance, and the Functional Status Questionnaire (FSQ). Body composition was evaluated using dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). Sixty percent (25/40) of the participants met standard criteria for physical frailty. Frail (FR) and nonfrail (NF) participants were comparable in age, sex, CD4 count, and viral load. FR HOA had greater impairments in PPT, peak oxygen uptake, FSQ, walking speed, balance, and muscle quality than NF HOA. FR HOA had a greater body mass index (BMI), fat mass, and truncal fat with lipodystrophy. Moreover, PPT score was inversely related to trunk fat (correlation coefficient (r) = -0.34; P = .04) and ratio of intermuscular fat to total fat (r = -0.60; P = .02) after adjusting for covariates. HOA represent an emerging cohort of older adults who frequently experience frailty at a much younger age than the general older population. Central obesity and fat redistribution are important predictors of frailty in community-dwelling HOA. These findings suggest that physical frailty in HOA may be amenable to lifestyle interventions, especially exercise and diet therapy. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  19. Cervical cancer precursors and hormonal contraceptive use in HIV-positive women: application of a causal model and semi-parametric estimation methods.

    Directory of Open Access Journals (Sweden)

    Hannah H Leslie

    Full Text Available OBJECTIVE: To demonstrate the application of causal inference methods to observational data in the obstetrics and gynecology field, particularly causal modeling and semi-parametric estimation. BACKGROUND: Human immunodeficiency virus (HIV-positive women are at increased risk for cervical cancer and its treatable precursors. Determining whether potential risk factors such as hormonal contraception are true causes is critical for informing public health strategies as longevity increases among HIV-positive women in developing countries. METHODS: We developed a causal model of the factors related to combined oral contraceptive (COC use and cervical intraepithelial neoplasia 2 or greater (CIN2+ and modified the model to fit the observed data, drawn from women in a cervical cancer screening program at HIV clinics in Kenya. Assumptions required for substantiation of a causal relationship were assessed. We estimated the population-level association using semi-parametric methods: g-computation, inverse probability of treatment weighting, and targeted maximum likelihood estimation. RESULTS: We identified 2 plausible causal paths from COC use to CIN2+: via HPV infection and via increased disease progression. Study data enabled estimation of the latter only with strong assumptions of no unmeasured confounding. Of 2,519 women under 50 screened per protocol, 219 (8.7% were diagnosed with CIN2+. Marginal modeling suggested a 2.9% (95% confidence interval 0.1%, 6.9% increase in prevalence of CIN2+ if all women under 50 were exposed to COC; the significance of this association was sensitive to method of estimation and exposure misclassification. CONCLUSION: Use of causal modeling enabled clear representation of the causal relationship of interest and the assumptions required to estimate that relationship from the observed data. Semi-parametric estimation methods provided flexibility and reduced reliance on correct model form. Although selected results suggest an

  20. Confidence Intervals for a Semiparametric Approach to Modeling Nonlinear Relations among Latent Variables

    Science.gov (United States)

    Pek, Jolynn; Losardo, Diane; Bauer, Daniel J.

    2011-01-01

    Compared to parametric models, nonparametric and semiparametric approaches to modeling nonlinearity between latent variables have the advantage of recovering global relationships of unknown functional form. Bauer (2005) proposed an indirect application of finite mixtures of structural equation models where latent components are estimated in the…

  1. Visualizing Confidence Bands for Semiparametrically Estimated Nonlinear Relations among Latent Variables

    Science.gov (United States)

    Pek, Jolynn; Chalmers, R. Philip; Kok, Bethany E.; Losardo, Diane

    2015-01-01

    Structural equation mixture models (SEMMs), when applied as a semiparametric model (SPM), can adequately recover potentially nonlinear latent relationships without their specification. This SPM is useful for exploratory analysis when the form of the latent regression is unknown. The purpose of this article is to help users familiar with structural…

  2. Semiparametric inference on the fractal index of Gaussian and conditionally Gaussian time series data

    DEFF Research Database (Denmark)

    Bennedsen, Mikkel

    Using theory on (conditionally) Gaussian processes with stationary increments developed in Barndorff-Nielsen et al. (2009, 2011), this paper presents a general semiparametric approach to conducting inference on the fractal index, α, of a time series. Our setup encompasses a large class of Gaussian...

  3. Commuters’ preferences for fast and reliable travel: A semi-parametric estimation approach

    NARCIS (Netherlands)

    Koster, P.R.; Koster, H.R.A.

    2015-01-01

    We employ a semi-parametric estimation approach to analyse observed and unobserved heterogeneity in the value of savings in travel time and schedule delay. Our econometric approach allows for the estimation of unobserved and observed heterogeneity in preferences in a flexible way, meaning that we do

  4. Semi-parametric modelling of investments in heating installations: The case of the Dutch glasshouse industry

    NARCIS (Netherlands)

    Oude Lansink, A.G.J.M.; Pietola, K.

    2005-01-01

    This paper applies a semi-parametric approach to estimating a generalised model of investments in heating installations. The results suggest that marginal costs of investments in heating installations increase quickly at small investment levels, whereas the increase slows down at higher investment

  5. Evaluating Portfolio Value-At-Risk Using Semi-Parametric GARCH Models

    NARCIS (Netherlands)

    J.V.K. Rombouts; M.J.C.M. Verbeek (Marno)

    2009-01-01

    textabstractIn this paper we examine the usefulness of multivariate semi-parametric GARCH models for evaluating the Value-at-Risk (VaR) of a portfolio with arbitrary weights. We specify and estimate several alternative multivariate GARCH models for daily returns on the S&P 500 and Nasdaq indexes.

  6. Application of Semiparametric Spline Regression Model in Analyzing Factors that In uence Population Density in Central Java

    Science.gov (United States)

    Sumantari, Y. D.; Slamet, I.; Sugiyanto

    2017-06-01

    Semiparametric regression is a statistical analysis method that consists of parametric and nonparametric regression. There are various approach techniques in nonparametric regression. One of the approach techniques is spline. Central Java is one of the most densely populated province in Indonesia. Population density in this province can be modeled by semiparametric regression because it consists of parametric and nonparametric component. Therefore, the purpose of this paper is to determine the factors that in uence population density in Central Java using the semiparametric spline regression model. The result shows that the factors which in uence population density in Central Java is Family Planning (FP) active participants and district minimum wage.

  7. Mixed Estimator of Kernel and Fourier Series in Semiparametric Regression

    Science.gov (United States)

    Afifah, Ngizatul; Nyoman Budiantara, I.; Nyoman Latra, I.

    2017-06-01

    Given paired observation (x i , v 1i , v 2i , …, v pi , t 1i , t 2i , …, t qi , y i ), i = 1, 2, …, n, follow the additive semiparametric regression model y i = μ(x i , v i , t i ) + ɛ i , where μ(xi,vt,ti)=f(xi)+∑j=1pgj(νji)+∑s=1qhs(tsi) v i = (v 1i , v 2i , …, v pi )‧, and t i = (t 1i , t 2i , …, t qi )‧. Random errors ɛ i is a normal distribution with mean 0 and variance σ 2. To obtain a mixed estimator μ(x i , v i , t i ), the regression curve f(x i ) is approached by linier parametric, g j (v ji ) is kernel with bandwidths Φ = (φ 1, φ 2, …, φ p )‧ and the regression curve component fourier series h s (t si ) is approached by {H}s({t}si)={b}s{t}si+\\frac{1}{2}{a}0s+\\displaystyle \\sum k=1N{a}ks \\cos k{t}si with oscillation paremeter N. The estimator \\displaystyle \\sum j=1p{g}j({ν }ji) is \\displaystyle \\sum j=1p{\\hat{{g}}}j{\\varphi j}({ν }ji) where \\displaystyle \\sum j=1p{\\hat{{g}}}j{\\varphi j}({ν }ji)={V}({\\boldsymbol{Φ }}){y}. Penalized Least Squares (PLS) method give Minc,β{ L(c)+L(β)+∑s=1qθsS(Hs(tsi)) } with smoothing parameter θ = (θ 1, θ 2, …, θ q )‧, the estimator f(x) is \\hat{{f}}(x) and \\displaystyle \\sum s=1q{h}s({t}si) is \\displaystyle \\sum s=1q{\\hat{{h}}}{θ s}({t}si), where \\hat{{f}}(x)={X}\\hat{{\\boldsymbol{β }}} and \\displaystyle \\sum s=1q{\\hat{{h}}}{θ s}({t}si)={X}\\hat{{c}}(θ ). So that, μ^Φ,θ,N(vi,ti)=Z(Φ,θ,N)y is the mixed estimator of μ(v i , t i ) where Z(Φ, θ, N) = C(Φ, θ, N) + V(Φ) + E(Φ, θ, N) Matrix C(Φ, θ, N), V(Φ) and E(Φ, θ, N) are depended on Φ, θ and N. Optimal Φ, θ and N can be obtained by the smallest Generalized Cross Validation (GCV).

  8. A Bayesian goodness of fit test and semiparametric generalization of logistic regression with measurement data.

    Science.gov (United States)

    Schörgendorfer, Angela; Branscum, Adam J; Hanson, Timothy E

    2013-06-01

    Logistic regression is a popular tool for risk analysis in medical and population health science. With continuous response data, it is common to create a dichotomous outcome for logistic regression analysis by specifying a threshold for positivity. Fitting a linear regression to the nondichotomized response variable assuming a logistic sampling model for the data has been empirically shown to yield more efficient estimates of odds ratios than ordinary logistic regression of the dichotomized endpoint. We illustrate that risk inference is not robust to departures from the parametric logistic distribution. Moreover, the model assumption of proportional odds is generally not satisfied when the condition of a logistic distribution for the data is violated, leading to biased inference from a parametric logistic analysis. We develop novel Bayesian semiparametric methodology for testing goodness of fit of parametric logistic regression with continuous measurement data. The testing procedures hold for any cutoff threshold and our approach simultaneously provides the ability to perform semiparametric risk estimation. Bayes factors are calculated using the Savage-Dickey ratio for testing the null hypothesis of logistic regression versus a semiparametric generalization. We propose a fully Bayesian and a computationally efficient empirical Bayesian approach to testing, and we present methods for semiparametric estimation of risks, relative risks, and odds ratios when parametric logistic regression fails. Theoretical results establish the consistency of the empirical Bayes test. Results from simulated data show that the proposed approach provides accurate inference irrespective of whether parametric assumptions hold or not. Evaluation of risk factors for obesity shows that different inferences are derived from an analysis of a real data set when deviations from a logistic distribution are permissible in a flexible semiparametric framework. © 2013, The International Biometric

  9. Frailty syndrome and socioeconomic and health characteristics among older adults.

    Science.gov (United States)

    Dos Santos Tavares, Darlene Mara; de Freitas Corrêa, Thais Aline; Dias, Flavia Aparecida; Dos Santos Ferreira, Pollyana Cristina; Sousa Pegorari, Maycon

    2017-09-30

    To investigate the association of frailty syndrome with socioeconomic and health variables among older adults. This is a cross-sectional, observational and analytical household research conducted with a sample of 1,609 urban elderly. We used: semi-structured questionnaire, scales (Katz, Lawton and shortened version of Geriatric Depression Scale) and Fragility Phenotype proposed by Fried. Descriptive analysis was performed along with a bivariate and multinomial logistic regression model ( p <0.05). The prevalence of pre-frailty condition was 52.0% and the fragility corresponded to 13.6%. Pre-frailty and frailty associated factors were, respectively: age range between 70-79 years and ≥80 years; one to four morbidities and five or more morbidities categories; functional disability for basic and instrumental activities of daily life and depression indicative; whilst lack of a companion or income and female gender were only associated to pre-frailty. The conditions of pre-frailty and frailty levels were elevated with negative effects on the health of the elderly.

  10. Sarcopenia and frailty in elderly trauma patients.

    Science.gov (United States)

    Fairchild, Berry; Webb, Travis P; Xiang, Qun; Tarima, Sergey; Brasel, Karen J

    2015-02-01

    Sarcopenia describes a loss of muscle mass and resultant decrease in strength, mobility, and function that can be quantified by CT. We hypothesized that sarcopenia and related frailty characteristics are related to discharge disposition after blunt traumatic injury in the elderly. We reviewed charts of 252 elderly blunt trauma patients who underwent abdominal CT prior to hospital admission. Data for thirteen frailty characteristics were abstracted. Sarcopenia was measured by obtaining skeletal muscle cross-sectional area (CSA) from each patient's psoas major muscle using Slice-O-Matic(®) software. Dispositions were grouped as dependent and independent based on discharge location. χ (2), Fisher's exact, and logistic regression were used to determine factors associated with discharge dependence. Mean age 76 years, 49 % male, median ISS 9.0 (IQR = 8.0-17.0). Discharge destination was independent in 61.5 %, dependent in 29 %, and 9.5 % of patients died. Each 1 cm(2) increase in psoas muscle CSA was associated with a 20 % decrease in dependent living (p psoas major muscle CSA is related to discharge destination in elderly trauma patients and can be obtained from the admission CT. Lower psoas muscle CSA is related to loss of independence upon discharge in the elderly. The early availability of this variable during the hospitalization of elderly trauma patients may aid in discharge planning and the transition to dependent living.

  11. Health-related and socio-demographic factors associated with frailty in the elderly: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Amanda de Carvalho Mello

    2014-06-01

    Full Text Available Frailty is a syndrome that leads to practical harm in the lives of elders, since it is related to increased risk of dependency, falls, hospitalization, institutionalization, and death. The objective of this systematic review was to identify the socio-demographic, psycho-behavioral, health-related, nutritional, and lifestyle factors associated with frailty in the elderly. A total of 4,183 studies published from 2001 to 2013 were detected in the databases, and 182 complete articles were selected. After a comprehensive reading and application of selection criteria, 35 eligible articles remained for analysis. The main factors associated with frailty were: age, female gender, black race/color, schooling, income, cardiovascular diseases, number of comorbidities/diseases, functional incapacity, poor self-rated health, depressive symptoms, cognitive function, body mass index, smoking, and alcohol use. Knowledge of the complexity of determinants of frailty can assist the formulation of measures for prevention and early intervention, thereby contributing to better quality of life for the elderly.

  12. Common Ground? The Concordance of Sarcopenia and Frailty Definitions.

    Science.gov (United States)

    Reijnierse, Esmee M; Trappenburg, Marijke C; Blauw, Gerard Jan; Verlaan, Sjors; de van der Schueren, Marian A E; Meskers, Carel G M; Maier, Andrea B

    2016-04-01

    This study aimed to explore the concordance between definitions of sarcopenia and frailty in a clinically relevant population of geriatric outpatients. Data were retrieved from a cross-sectional study. The study was performed in a geriatric outpatient clinic of a middle-sized teaching hospital. The study included 299 geriatric outpatients (mean age 82.4, SD 7.1) who were consecutively referred to the outpatient clinic. Prevalence rates and subsequent concordance evolving from 3 definitions of sarcopenia and 2 definitions of frailty were compared. Definitions of sarcopenia included the European Working Group on Sarcopenia in Older People (gait speed, handgrip strength, muscle mass), International Working Group on Sarcopenia (gait speed, muscle mass) and the definition by Janssen (muscle mass). Definitions of frailty included the Fried frailty phenotype (weight loss, exhaustion, physical inactivity, handgrip strength, walk time) and the definition of Rockwood (use of walking aid, activities of daily living, incontinence, and cognitive impairment). Prevalence rates for sarcopenia varied between 17% and 22% and between 29% and 33% for frailty. There was little concordance in intraindividual prevalence rates of sarcopenia and frailty using different definitions. None of the outpatients was classified as having sarcopenia and frailty according to all applied definitions. Outpatients with sarcopenia were more likely to be frail than frail outpatients to be sarcopenic. This study clearly indicates that sarcopenia and frailty are 2 separate conditions based on the current definitions. It is important to diagnose sarcopenia and frailty as separate entities, as each may require specific treatment. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  13. Prevalence and risk factors of frailty among home care clients.

    Science.gov (United States)

    Miettinen, Minna; Tiihonen, Miia; Hartikainen, Sirpa; Nykänen, Irma

    2017-11-17

    Frailty is a common problem among older people and it is associated with an increased risk of death and long-term institutional care. Early identification of frailty is necessary to prevent a further decline in the health status of home care clients. The aims of the present study were to determine the prevalence of frailty and associated factors among 75-year-old or older home care clients. The study participants were 75-year-old or older home care clients living in three cities in Eastern and Central Finland. Home care clients who had completed the abbreviated Comprehensive Geriatric Assessment (aCGA) for frailty (n = 257) were included in the present study. Baseline data were obtained on functional status, cognitive status, depressive symptoms, self-rated health, ability to walk 400 m, nutritional status, drug use and comorbidities. Most of the home care clients (90%) were screened for frailty using the aCGA. Multivariate analysis showed that the risk of malnutrition or malnutrition (OR = 4.27, 95% CI = 1.56, 11.68) and a low level of education (OR = 1.14, 95% CI = 1.07, 1.23) were associated with frailty. Frailty is a prevalent problem among home care clients. The risk of malnutrition or malnourishment and a lower level of education increase the risk of frailty. Screening for frailty should be done to detect the most vulnerable older people for further intervention to prevent adverse health problems. ClinicalTrials.gov: NCT02214758 .

  14. Prospective association between added sugars and frailty in older adults.

    Science.gov (United States)

    Laclaustra, Martin; Rodriguez-Artalejo, Fernando; Guallar-Castillon, Pilar; Banegas, Jose R; Graciani, Auxiliadora; Garcia-Esquinas, Esther; Ordovas, Jose; Lopez-Garcia, Esther

    2018-04-09

    Sugar-sweetened beverages and added sugars (monosaccharides and disaccharides) in the diet are associated with obesity, diabetes, and cardiovascular disease, which are all risk factors for decline in physical function among older adults. The aim of this study was to examine the association between added sugars in the diet and incidence of frailty in older people. Data were taken from 1973 Spanish adults ≥60 y old from the Seniors-ENRICA cohort. In 2008-2010 (baseline), consumption of added sugars (including those in fruit juices) was obtained using a validated diet history. Study participants were followed up until 2012-2013 to assess frailty based on Fried's criteria. Statistical analyses were performed with logistic regression adjusted for age, sex, education, smoking status, body mass index, energy intake, self-reported comorbidities, Mediterranean Diet Adherence Score (excluding sweetened drinks and pastries), TV watching time, and leisure-time physical activity. Compared with participants consuming added sugars (lowest tertile), those consuming ≥36 g/d (highest tertile) were more likely to develop frailty (OR: 2.27; 95% CI: 1.34, 3.90; P-trend = 0.003). The frailty components "low physical activity" and "unintentional weight loss" increased dose dependently with added sugars. Association with frailty was strongest for sugars added during food production. Intake of sugars naturally appearing in foods was not associated with frailty. The consumption of added sugars in the diet of older people was associated with frailty, mainly when present in processed foods. The frailty components that were most closely associated with added sugars were low level of physical activity and unintentional weight loss. Future research should determine whether there is a causal relation between added sugars and frailty.

  15. Efficacy of L-carnitine supplementation on frailty status and its biomarkers, nutritional status, and physical and cognitive function among prefrail older adults: a double-blind, randomized, placebo-controlled clinical trial.

    Science.gov (United States)

    Badrasawi, M; Shahar, Suzana; Zahara, A M; Nor Fadilah, R; Singh, Devinder Kaur Ajit

    2016-01-01

    Frailty is a biological syndrome of decreased reserve and resistance to stressors due to decline in multiple physiological systems. Amino acid deficiency, including L-carnitine, has been proposed to be associated with its pathophysiology. Nevertheless, the efficacy of L-carnitine supplementation on frailty status has not been documented. Thus, this study aimed to determine the effect of 10-week L-carnitine supplement (1.5 g/day) on frailty status and its biomarkers and also physical function, cognition, and nutritional status among prefrail older adults in Klang Valley, Malaysia. This study is a randomized, double-blind, placebo-controlled clinical trial conducted among 50 prefrail subjects randomized into two groups (26 in L-carnitine group and 24 in placebo group). Outcome measures include frailty status using Fried criteria and Frailty Index accumulation of deficit, selected frailty biomarkers (interleukin-6, tumor necrosis factor-alpha, and insulin-like growth factor-1), physical function, cognitive function, nutritional status and biochemical profile. The results indicated that the mean scores of Frailty Index score and hand grip test were significantly improved in subjects supplemented with L-carnitine ( P <0.05 for both parameters) as compared to no change in the placebo group. Based on Fried criteria, four subjects (three from the L-carnitine group and one from the control group) transited from prefrail status to robust after the intervention. L-carnitine supplementation has a favorable effect on the functional status and fatigue in prefrail older adults.

  16. Efficacy of L-carnitine supplementation on frailty status and its biomarkers, nutritional status, and physical and cognitive function among prefrail older adults: a double-blind, randomized, placebo-controlled clinical trial

    Science.gov (United States)

    Badrasawi, M; Shahar, Suzana; Zahara, AM; Nor Fadilah, R; Singh, Devinder Kaur Ajit

    2016-01-01

    Background Frailty is a biological syndrome of decreased reserve and resistance to stressors due to decline in multiple physiological systems. Amino acid deficiency, including L-carnitine, has been proposed to be associated with its pathophysiology. Nevertheless, the efficacy of L-carnitine supplementation on frailty status has not been documented. Thus, this study aimed to determine the effect of 10-week L-carnitine supplement (1.5 g/day) on frailty status and its biomarkers and also physical function, cognition, and nutritional status among prefrail older adults in Klang Valley, Malaysia. Methodology This study is a randomized, double-blind, placebo-controlled clinical trial conducted among 50 prefrail subjects randomized into two groups (26 in L-carnitine group and 24 in placebo group). Outcome measures include frailty status using Fried criteria and Frailty Index accumulation of deficit, selected frailty biomarkers (interleukin-6, tumor necrosis factor-alpha, and insulin-like growth factor-1), physical function, cognitive function, nutritional status and biochemical profile. Results The results indicated that the mean scores of Frailty Index score and hand grip test were significantly improved in subjects supplemented with L-carnitine (Pfunctional status and fatigue in prefrail older adults. PMID:27895474

  17. Frailty Assessment in Heart Failure: an Overview of the Multi-domain Approach.

    Science.gov (United States)

    McDonagh, Julee; Ferguson, Caleb; Newton, Phillip J

    2018-02-01

    The study aims (1) to provide a contemporary description of frailty assessment in heart failure and (2) to provide an overview of multi-domain frailty assessment in heart failure. Frailty assessment is an important predictive measure for mortality and hospitalisation in individuals with heart failure. To date, there are no frailty assessment instruments validated for use in heart failure. This has resulted in significant heterogeneity between studies regarding the assessment of frailty. The most common frailty assessment instrument used in heart failure is the Frailty Phenotype which focuses on five physical domains of frailty; the appropriateness a purely physical measure of frailty in individuals with heart failure who frequently experience decreased exercise tolerance and shortness of breath is yet to be determined. A limited number of studies have approached frailty assessment using a multi-domain view which may be more clinically relevant in heart failure. There remains a lack of consensus regarding frailty assessment and an absence of a validated instrument in heart failure. Despite this, frailty continues to be assessed frequently, primarily for research purposes, using predominantly physical frailty measures. A more multidimensional view of frailty assessment using a multi-domain approach will likely be more sensitive to identifying at risk patients.

  18. Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us

    Directory of Open Access Journals (Sweden)

    Erik Fung

    2018-04-01

    Full Text Available Heart failure and frailty are clinical syndromes that present with overlapping phenotypic characteristics. Importantly, their co-presence is associated with increased mortality and morbidity. While mechanical and electrical device therapies for heart failure are vital for select patients with advanced stage disease, the majority of patients and especially those with undiagnosed heart failure would benefit from early disease detection and prompt initiation of guideline-directed medical therapies. In this article, we review the problematic interactions between heart failure and frailty, introduce a focused cardiac screening program for community-living elderly initiated by a mobile communication device app leading to the Undiagnosed heart Failure in frail Older individuals (UFO study, and discuss how the knowledge of pre-frailty and frailty status could be exploited for the detection of previously undiagnosed heart failure or advanced cardiac disease. The widespread use of mobile devices coupled with increasing availability of novel, effective medical and minimally invasive therapies have incentivized new approaches to heart failure case finding and disease management.

  19. Depression and frailty in later life: a systematic review

    Directory of Open Access Journals (Sweden)

    Vaughan L

    2015-12-01

    Full Text Available Leslie Vaughan,1 Akeesha L Corbin,1 Joseph S Goveas2 1Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA; 2Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, MI, USA Abstract: Frailty and depression are important issues affecting older adults. Depressive syndrome may be difficult to clinically disambiguate from frailty in advanced old age. Current reviews on the topic include studies with wide methodological variation. This review examined the published literature on cross-sectional and longitudinal associations between frailty and depressive symptomatology with either syndrome as the outcome, moderators of this relationship, construct overlap, and related medical and behavioral interventions. Prevalence of both was reported. A systematic review of studies published from 2000 to 2015 was conducted in PubMed, the Cochrane Database of Systematic Reviews, and PsychInfo. Key search terms were “frailty”, “frail”, “frail elderly”, “depressive”, “depressive disorder”, and “depression”. Participants of included studies were ≥55 years old and community dwelling. Included studies used an explicit biological definition of frailty based on Fried et al’s criteria and a screening measure to identify depressive symptomatology. Fourteen studies met the inclusion/exclusion criteria. The prevalence of depressive symptomatology, frailty, or their co-occurrence was greater than 10% in older adults ≥55 years old, and these rates varied widely, but less in large epidemiological studies of incident frailty. The prospective relationship between depressive symptomatology and increased risk of incident frailty was robust, while the opposite relationship was less conclusive. The presence of comorbidities that interact with depressive symptomatology increased incident frailty risk. Measurement variability of depressive symptomatology and inclusion of older adults

  20. Macronutrients, diet quality, and frailty in older men.

    Science.gov (United States)

    Shikany, James M; Barrett-Connor, Elizabeth; Ensrud, Kristine E; Cawthon, Peggy M; Lewis, Cora E; Dam, Thuy-Tien L; Shannon, Jackilen; Redden, David T

    2014-06-01

    Frailty, a phenotype of multisystem impairment and expanding vulnerability, is associated with higher risk of adverse health outcomes not entirely explained by advancing age. We investigated associations of macronutrients, dietary fiber, and overall diet quality with frailty status in older community-dwelling men. Participants were 5,925 men aged ≥ 65 years enrolled in the Osteoporotic Fractures in Men (MrOS) study at six U.S. centers. Diet was assessed at baseline with a food frequency questionnaire. We assessed frailty status (robust, intermediate, or frail) at baseline and at a second clinic visit (a mean of 4.6 years later) using a slightly modified Cardiovascular Health Study frailty index. We used multinomial logistic regression to assess associations between macronutrient intake, dietary fiber, and the Diet Quality Index Revised with frailty status at baseline and at the second clinic visit. At baseline, 2,748 (46.4%) participants were robust, 2,681 (45.2%) were intermediate, and 496 (8.4%) were frail. Carbohydrate, fat, protein, and dietary fiber showed no consistent associations with frailty status. Overall diet quality exhibited fairly consistent associations with frailty status. The Diet Quality Index Revised was inversely associated with frail status relative to robust status at the baseline visit (odds ratio for Q5 vs Q1 = 0.44, 95% confidence interval: 0.30, 0.63; p for trend clinic visit (odds ratio for Q5 vs Q1 = 0.18, 95% confidence interval: 0.03, 0.97; p for trend = .0180). Overall diet quality was inversely associated with prevalent and future frailty status in this cohort of older men. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Validity of the Kihon Checklist for assessing frailty status.

    Science.gov (United States)

    Satake, Shosuke; Senda, Kazuyoshi; Hong, Young-Jae; Miura, Hisayuki; Endo, Hidetoshi; Sakurai, Takashi; Kondo, Izumi; Toba, Kenji

    2016-06-01

    The Kihon Checklist is extensively used in Japan to identify elderly persons who are at risk of requiring support/care. We aimed to determine whether or not the Kihon Checklist can estimate frailty status defined by the Cardiovascular Health Study criteria. This cross-sectional study evaluated the Kihon Checklist and activities of daily living based on self-records maintained with the assistance of nurses in a convenience sample of 164 elderly outpatients who lived without care or support. Body composition was measured using dual energy X-ray absorptiometry. Physical functions, nutritional status, cognitive function and depressive mood were assessed using standardized evaluations. Frailty status was evaluated using the Cardiovascular Health Study frailty criteria. The total Kihon Checklist score closely correlated with validated assessments of physical functions, nutritional state, cognitive function, depressive mood and the number of frailty phenotypes defined by the Cardiovascular Health Study criteria (ρ = 0.655, P < 0.001). The area under the receiver operating characteristics curves for the evaluation of frailty status was 0.81 for prefrailty and 0.92 for frailty. The sensitivity and the specificity were 70.3% and 78.3% for prefrailty, and 89.5% and 80.7% for frailty at total Kihon Checklist scores of 3/4 and 7/8, respectively. The Kihon Checklist is a useful tool for frailty screening. Analyzing the results of this self-reporting questionnaire, together with other more high-tech screening modalities, will cost-effectively improve the quality of life for many elderly individuals in a timely manner. Geriatr Gerontol Int 2015; ●●: ●●-●●. © 2015 Japan Geriatrics Society.

  2. The relevance of nutrition for the concept of cognitive frailty.

    Science.gov (United States)

    Dominguez, Ligia J; Barbagallo, Mario

    2017-01-01

    Physical and cognitive frailty are interrelated and synergistic syndromes more frequently seen in old age, which represent intermediate stages between aging successfully and disability. Poor nutrition is a fundamental determinant for both conditions, while various dietary components are proposed to prevent and/or improve them. This updated review discusses the possible influence of nutritional factors on cognitive frailty and its potential mediators. Oxidative stress, low-grade systemic inflammation, neuroinflammation, and altered autophagy, all associated with obesity, metabolic syndrome and insulin resistance, are proposed mechanisms to explain the influence of nutrition on cognitive health. Even if no single food or supplement has definitively demonstrated to affect physical frailty and cognitive impairment, combining various dietary and lifestyle components in the Mediterranean dietary pattern has shown benefit. Cognitive frailty is a potential useful construct for the early detection of cognitive impairment and physical frailty, in order to implement timely interventions. Validation of this construct is eagerly needed. Nutritional status is a fundamental part of physical frailty, and potentially important in the prevention of cognitive decline. Identifying and treating protein/calorie and individual nutrients insufficiency is mandatory in all older adults. Conversely, overeating in middle age has been associated with cognitive decline in older age. A lifelong balance diet, such as the Mediterranean diet, combined with regular physical and mental exercise, is perhaps the best preventive strategy against cognitive decline in old age.

  3. Social frailty in older adults: a scoping review.

    Science.gov (United States)

    Bunt, S; Steverink, N; Olthof, J; van der Schans, C P; Hobbelen, J S M

    2017-09-01

    Social frailty is a rather unexplored concept. In this paper, the concept of social frailty among older people is explored utilizing a scoping review. In the first stage, 42 studies related to social frailty of older people were compiled from scientific databases and analyzed. In the second stage, the findings of this literature were structured using the social needs concept of Social Production Function theory. As a result, it was concluded that social frailty can be defined as a continuum of being at risk of losing, or having lost, resources that are important for fulfilling one or more basic social needs during the life span. Moreover, the results of this scoping review indicate that not only the (threat of) absence of social resources to fulfill basic social needs should be a component of the concept of social frailty, but also the (threat of) absence of social behaviors and social activities, as well as (threat of) the absence of self-management abilities. This conception of social frailty provides opportunities for future research, and guidelines for practice and policy.

  4. Frailty phenotypes in the elderly based on cluster analysis

    DEFF Research Database (Denmark)

    Dato, Serena; Montesanto, Alberto; Lagani, Vincenzo

    2012-01-01

    Frailty is a physiological state characterized by the deregulation of multiple physiologic systems of an aging organism determining the loss of homeostatic capacity, which exposes the elderly to disability, diseases, and finally death. An operative definition of frailty, useful for the classifica......Frailty is a physiological state characterized by the deregulation of multiple physiologic systems of an aging organism determining the loss of homeostatic capacity, which exposes the elderly to disability, diseases, and finally death. An operative definition of frailty, useful...... genetic background on the frailty status is still questioned. We investigated the applicability of a cluster analysis approach based on specific geriatric parameters, previously set up and validated in a southern Italian population, to two large longitudinal Danish samples. In both cohorts, we identified...... groups of subjects homogeneous for their frailty status and characterized by different survival patterns. A subsequent survival analysis availing of Accelerated Failure Time models allowed us to formulate an operative index able to correlate classification variables with survival probability. From...

  5. Finite Sample Comparison of Parametric, Semiparametric, and Wavelet Estimators of Fractional Integration

    DEFF Research Database (Denmark)

    Nielsen, Morten Ø.; Frederiksen, Per Houmann

    2005-01-01

    In this paper we compare through Monte Carlo simulations the finite sample properties of estimators of the fractional differencing parameter, d. This involves frequency domain, time domain, and wavelet based approaches, and we consider both parametric and semiparametric estimation methods. The es...... the time domain parametric methods, and (4) without sufficient trimming of scales the wavelet-based estimators are heavily biased.......In this paper we compare through Monte Carlo simulations the finite sample properties of estimators of the fractional differencing parameter, d. This involves frequency domain, time domain, and wavelet based approaches, and we consider both parametric and semiparametric estimation methods....... The estimators are briefly introduced and compared, and the criteria adopted for measuring finite sample performance are bias and root mean squared error. Most importantly, the simulations reveal that (1) the frequency domain maximum likelihood procedure is superior to the time domain parametric methods, (2) all...

  6. Using Spline Regression in Semi-Parametric Stochastic Frontier Analysis: An Application to Polish Dairy Farms

    DEFF Research Database (Denmark)

    Czekaj, Tomasz Gerard; Henningsen, Arne

    The estimation of the technical efficiency comprises a vast literature in the field of applied production economics. There are two predominant approaches: the non-parametric and non-stochastic Data Envelopment Analysis (DEA) and the parametric Stochastic Frontier Analysis (SFA). The DEA...... of specifying an unsuitable functional form and thus, model misspecification and biased parameter estimates. Given these problems of the DEA and the SFA, Fan, Li and Weersink (1996) proposed a semi-parametric stochastic frontier model that estimates the production function (frontier) by non-parametric......), Kumbhakar et al. (2007), and Henningsen and Kumbhakar (2009). The aim of this paper and its main contribution to the existing literature is the estimation semi-parametric stochastic frontier models using a different non-parametric estimation technique: spline regression (Ma et al. 2011). We apply...

  7. Semiparametric mixed-effects analysis of PK/PD models using differential equations.

    Science.gov (United States)

    Wang, Yi; Eskridge, Kent M; Zhang, Shunpu

    2008-08-01

    Motivated by the use of semiparametric nonlinear mixed-effects modeling on longitudinal data, we develop a new semiparametric modeling approach to address potential structural model misspecification for population pharmacokinetic/pharmacodynamic (PK/PD) analysis. Specifically, we use a set of ordinary differential equations (ODEs) with form dx/dt = A(t)x + B(t) where B(t) is a nonparametric function that is estimated using penalized splines. The inclusion of a nonparametric function in the ODEs makes identification of structural model misspecification feasible by quantifying the model uncertainty and provides flexibility for accommodating possible structural model deficiencies. The resulting model will be implemented in a nonlinear mixed-effects modeling setup for population analysis. We illustrate the method with an application to cefamandole data and evaluate its performance through simulations.

  8. Hidden Parameter Markov Decision Processes: A Semiparametric Regression Approach for Discovering Latent Task Parametrizations.

    Science.gov (United States)

    Doshi-Velez, Finale; Konidaris, George

    2016-07-01

    Control applications often feature tasks with similar, but not identical, dynamics. We introduce the Hidden Parameter Markov Decision Process (HiP-MDP), a framework that parametrizes a family of related dynamical systems with a low-dimensional set of latent factors, and introduce a semiparametric regression approach for learning its structure from data. We show that a learned HiP-MDP rapidly identifies the dynamics of new task instances in several settings, flexibly adapting to task variation.

  9. Parametric and semiparametric models with applications to reliability, survival analysis, and quality of life

    CERN Document Server

    Nikulin, M; Mesbah, M; Limnios, N

    2004-01-01

    Parametric and semiparametric models are tools with a wide range of applications to reliability, survival analysis, and quality of life. This self-contained volume examines these tools in survey articles written by experts currently working on the development and evaluation of models and methods. While a number of chapters deal with general theory, several explore more specific connections and recent results in "real-world" reliability theory, survival analysis, and related fields.

  10. Semi-parametric detection of multiple changes in long-range dependent processes

    OpenAIRE

    Bardet, Jean-Marc; Guenaizi, Abdellatif

    2018-01-01

    This paper is devoted to the offline multiple changes detection for long memory processes. The observations are supposed to satisfy a semi-parametric long memory assumption with distinct memory parameters on each stage. A penalized local Whittle contrast is considered for estimating all the parameters. The consistency as well as convergence rates are obtained. Monte-Carlo experiments exhibit the accuracy of the estimators. They also show that the estimation of the number of breaks is improved...

  11. A simple GMM estimator for the semi-parametric mixed proportional hazard model

    OpenAIRE

    Bijwaard, G.E.; Ridder, G.; Woutersen, T.

    2012-01-01

    Ridder and Woutersen (Ridder, G., and T. Woutersen. 2003. “The Singularity of the Efficiency Bound of the Mixed Proportional Hazard Model.” Econometrica 71: 1579–1589) have shown that under a weak condition on the baseline hazard, there exist root-N consistent estimators of the parameters in a semiparametric Mixed Proportional Hazard model with a parametric baseline hazard and unspecified distribution of the unobserved heterogeneity. We extend the linear rank estimator (LRE) of Tsiatis (Tsiat...

  12. Maximum likelihood estimation of semiparametric mixture component models for competing risks data.

    Science.gov (United States)

    Choi, Sangbum; Huang, Xuelin

    2014-09-01

    In the analysis of competing risks data, the cumulative incidence function is a useful quantity to characterize the crude risk of failure from a specific event type. In this article, we consider an efficient semiparametric analysis of mixture component models on cumulative incidence functions. Under the proposed mixture model, latency survival regressions given the event type are performed through a class of semiparametric models that encompasses the proportional hazards model and the proportional odds model, allowing for time-dependent covariates. The marginal proportions of the occurrences of cause-specific events are assessed by a multinomial logistic model. Our mixture modeling approach is advantageous in that it makes a joint estimation of model parameters associated with all competing risks under consideration, satisfying the constraint that the cumulative probability of failing from any cause adds up to one given any covariates. We develop a novel maximum likelihood scheme based on semiparametric regression analysis that facilitates efficient and reliable estimation. Statistical inferences can be conveniently made from the inverse of the observed information matrix. We establish the consistency and asymptotic normality of the proposed estimators. We validate small sample properties with simulations and demonstrate the methodology with a data set from a study of follicular lymphoma. © 2014, The International Biometric Society.

  13. Semiparametric modeling: Correcting low-dimensional model error in parametric models

    International Nuclear Information System (INIS)

    Berry, Tyrus; Harlim, John

    2016-01-01

    In this paper, a semiparametric modeling approach is introduced as a paradigm for addressing model error arising from unresolved physical phenomena. Our approach compensates for model error by learning an auxiliary dynamical model for the unknown parameters. Practically, the proposed approach consists of the following steps. Given a physics-based model and a noisy data set of historical observations, a Bayesian filtering algorithm is used to extract a time-series of the parameter values. Subsequently, the diffusion forecast algorithm is applied to the retrieved time-series in order to construct the auxiliary model for the time evolving parameters. The semiparametric forecasting algorithm consists of integrating the existing physics-based model with an ensemble of parameters sampled from the probability density function of the diffusion forecast. To specify initial conditions for the diffusion forecast, a Bayesian semiparametric filtering method that extends the Kalman-based filtering framework is introduced. In difficult test examples, which introduce chaotically and stochastically evolving hidden parameters into the Lorenz-96 model, we show that our approach can effectively compensate for model error, with forecasting skill comparable to that of the perfect model.

  14. Semiparametric Bayesian Analysis of Nutritional Epidemiology Data in the Presence of Measurement Error

    KAUST Repository

    Sinha, Samiran

    2009-08-10

    We propose a semiparametric Bayesian method for handling measurement error in nutritional epidemiological data. Our goal is to estimate nonparametrically the form of association between a disease and exposure variable while the true values of the exposure are never observed. Motivated by nutritional epidemiological data, we consider the setting where a surrogate covariate is recorded in the primary data, and a calibration data set contains information on the surrogate variable and repeated measurements of an unbiased instrumental variable of the true exposure. We develop a flexible Bayesian method where not only is the relationship between the disease and exposure variable treated semiparametrically, but also the relationship between the surrogate and the true exposure is modeled semiparametrically. The two nonparametric functions are modeled simultaneously via B-splines. In addition, we model the distribution of the exposure variable as a Dirichlet process mixture of normal distributions, thus making its modeling essentially nonparametric and placing this work into the context of functional measurement error modeling. We apply our method to the NIH-AARP Diet and Health Study and examine its performance in a simulation study.

  15. The Lausanne cohort Lc65+: a population-based prospective study of the manifestations, determinants and outcomes of frailty

    Directory of Open Access Journals (Sweden)

    Rodondi Nicolas

    2008-08-01

    Full Text Available Abstract Background Frailty is a relatively new geriatric concept referring to an increased vulnerability to stressors. Various definitions have been proposed, as well as a range of multidimensional instruments for its measurement. More recently, a frailty phenotype that predicts a range of adverse outcomes has been described. Understanding frailty is a particular challenge both from a clinical and a public health perspective because it may be a reversible precursor of functional dependence. The Lausanne cohort Lc65+ is a longitudinal study specifically designed to investigate the manifestations of frailty from its first signs in the youngest old, identify medical and psychosocial determinants, and describe its evolution and related outcomes. Methods/Design The Lc65+ cohort was launched in 2004 with the random selection of 3054 eligible individuals aged 65 to 70 (birth year 1934–1938 in the non-institutionalized population of Lausanne (Switzerland. The baseline data collection was completed among 1422 participants in 2004–2005 through questionnaires, examination and performance tests. It comprised a wide range of medical and psychosocial dimensions, including a life course history of adverse events. Outcomes measures comprise subjective health, limitations in activities of daily living, mobility impairments, development of medical conditions or chronic health problems, falls, institutionalization, health services utilization, and death. Two additional random samples of 65–70 years old subjects will be surveyed in 2009 (birth year 1939–1943 and in 2014 (birth year 1944–1948. Discussion The Lc65+ study focuses on the sequence "Determinants → Components → Consequences" of frailty. It currently provides information on health in the youngest old and will allow comparisons to be made between the profiles of aging individuals born before, during and at the end of the Second World War.

  16. Conceptualizations of frailty in relation to older adults.

    Science.gov (United States)

    Markle-Reid, Maureen; Browne, Gina

    2003-10-01

    The aim of this article is to discuss the concept of frailty and its adequacy in identifying and describing older adults as frail. Despite the dramatic increase in use of the term 'frailty' over the past two decades, there is a lack of consensus in the literature about its meaning and use, and no clear conceptual guidelines for identifying and describing older adults as frail. Differences in theoretical perspectives will influence policy decisions regarding eligibility for, and allocation of, scarce health care resources among older adults. The article presents a literature review and synthesis of definitions and conceptual models of frailty in relation to older adults. The first part of the paper is a summary of the synonyms, antonyms and definitions of the term frailty. The second part is a critical evaluation of conceptual models of frailty. Six conceptual models are analysed on the basis of four main categories of assumptions about: (1) the nature of scientific knowledge; (2) the level of analysis; (3) the ageing process; (4) the stability of frailty. The implications of these are discussed in relation to clinical practice, policy and research. The review gives guidelines for a new theoretical approach to the concept of frailty in older adults: (1) it must be a multidimensional concept that considers the complex interplay of physical, psychological, social and environmental factors; (2) the concept must not be age-related, suggesting a negative and stereotypical view of ageing; (3) the concept must take into account an individual's context and incorporate subjective perceptions; (4) the concept must take into account the contribution of both individual and environmental factors.

  17. Frailty among elderly adults in a rural area of Turkey.

    Science.gov (United States)

    Çakmur, Hülya

    2015-04-30

    The elderly population is growing in Turkey, as it is worldwide. The average age of residents in rural areas of Turkey is relatively high and is gradually increasing. The purpose of this study is to summarize the fitness and frailty of elderly adults living in a rural area of Turkey characterized by a relatively low level of socioeconomic development. This study was designed as a prospective, cross-sectional study, and was conducted in a rural area of Kars Province. A total of 168 elderly adults (≥65 years old) from 12 central villages were included in the study. The Fried Frailty Criteria was used to assess the frailty of the participants. In addition to frailty, the physical, social, and mental status of elderly adults was examined. The prevalence of frailty in this rural area of Turkey was 7.1%.The study group ranged in age from 65 to 96 years (mean 72.70±7.73 years), and 53.6% were female. Among the elderly adult group, 84.3% had not completed elementary school, and 43.29% had a monthly income of ≤500 Turkish liras ($200). No significant relationship was identified between gender and frailty. There was a statistically significant relationship between frailty and older age, lower education level, lower economic level, co-morbidities, polypharmacy, diabetes, chronic obstructive pulmonary disease, gastric disease, arthritis, generalized pain, benign prostatic hyperplasia, urinary incontinence, auditory impairment, impaired oral care, caregiver burden, impaired cognitive function, depression, or a lack of social support (social isolation). It is believed that this study will contribute considerably to understanding the health status and needs of elderly adults in Turkey and the health problems of this population as well as to planning the development of public health and geriatric services based on regional needs.

  18. Frailty as a Predictor of Nursing Home Placement Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Kojima, Gotaro

    Frailty has been recognized as a medical syndrome characterized by decreased physiological reserve and vulnerability to poor resolution of homeostasis. Frailty is common in nursing homes and as many as 90% of nursing home patients are frail or prefrail. Previous studies have examined frailty as a risk factor for nursing home placement and yielded inconsistent results. The current study aims to systematically review the literature and to conduct a meta-analysis to combine the risk measures to provide the evidence on frailty as a predictor of nursing home placement among community-dwelling older adults. A systematic literature search was performed in July 2015 using 6 databases (Scopus, Embase, CINAHL Plus, MEDLINE, PsycINFO, and the Cochrane Library). Any cohort studies examining associations between frailty and risk of subsequent nursing home placement among community-dwelling older adults published from 2000 to July 2015 were potentially eligible. The numbers of those who were admitted to nursing homes and who were not, according to frailty categories, were used to calculate pooled odds ratio (OR) using fixed-effect models. The included studies were assessed for heterogeneity, methodological quality, and publication bias. The systematic literature search and hand-search identified 885 potentially relevant studies, among which 5 studies including 3528 community-dwelling older adults were selected for this review. Meta-analyses were performed using data from these studies and showed that both frailty and prefrailty significantly predicted nursing home placement (5 studies: pooled OR = 5.58, 95% confidence interval [CI] = 2.94-10.60, P dwelling older adults. It is noteworthy that adherence to the exercise programs was high and adverse events were not reported in most of the trials. These findings suggest that physical exercise can potentially prevent or reverse frailty and may lead to decreased risks of nursing home placement in older adults. This systematic review

  19. Tumor dormancy and frailty models: A novel approach.

    Science.gov (United States)

    Rancoita, Paola M V; Valberg, Morten; Demicheli, Romano; Biganzoli, Elia; Di Serio, Clelia

    2017-03-01

    Frailty models are here proposed in the tumor dormancy framework, in order to account for possible unobservable dependence mechanisms in cancer studies where a non-negligible proportion of cancer patients relapses years or decades after surgical removal of the primary tumor. Relapses do not seem to follow a memory-less process, since their timing distribution leads to multimodal hazards. From a biomedical perspective, this behavior may be explained by tumor dormancy, i.e., for some patients microscopic tumor foci may remain asymptomatic for a prolonged time interval and, when they escape from dormancy, micrometastatic growth results in a clinical disease appearance. The activation of the growth phase at different metastatic states would explain the occurrence of metastatic recurrences and mortality at different times (multimodal hazard). We propose a new frailty model which includes in the risk function a random source of heterogeneity (frailty variable) affecting the components of the hazard function. Thus, the individual hazard rate results as the product of a random frailty variable and the sum of basic hazard rates. In tumor dormancy, the basic hazard rates correspond to micrometastatic developments starting from different initial states. The frailty variable represents the heterogeneity among patients with respect to relapse, which might be related to unknown mechanisms that regulate tumor dormancy. We use our model to estimate the overall survival in a large breast cancer dataset, showing how this improves the understanding of the underlying biological process. © 2016, The International Biometric Society.

  20. Frailty measurements and dysphagia in the outpatient setting.

    Science.gov (United States)

    Hathaway, Bridget; Vaezi, Alec; Egloff, Ann Marie; Smith, Libby; Wasserman-Wincko, Tamara; Johnson, Jonas T

    2014-09-01

    Deconditioning and frailty may contribute to dysphagia and aspiration. Early identification of patients at risk of aspiration is important. Aspiration prevention would lead to reduced morbidity and health care costs. We therefore wondered whether objective measurements of frailty could help identify patients at risk for dysphagia and aspiration. Consecutive patients (n = 183) were enrolled. Patient characteristics and objective measures of frailty were recorded prospectively. Variables tested included age, body mass index, grip strength, and 5 meter walk pace. Statistical analysis tested for association between these parameters and dysphagia or aspiration, diagnosed by instrumental swallowing examination. Of variables tested for association with grip strength, only age category (P = .003) and ambulatory status (P dysphagia or aspiration, ambulatory status was significantly associated with dysphagia and aspiration in multivariable model building. Nonambulatory status is a predictor of aspiration and should be included in risk assessments for dysphagia. The relationship between frailty and dysphagia deserves further investigation. Frailty assessments may help identify those at risk for complications of dysphagia. © The Author(s) 2014.

  1. Physical Activity across Frailty Phenotypes in Females with Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Kaitlyn P. Roland

    2012-01-01

    Full Text Available Females with Parkinson’s disease (PD are vulnerable to frailty. PD eventually leads to decreased physical activity, an indicator of frailty. We speculate PD results in frailty through reduced physical activity. Objective. Determine the contribution of physical activity on frailty in PD (n=15, 65 ± 9 years and non-PD (n=15, 73 ± 14 years females. Methods. Frailty phenotype (nonfrail/prefrail/frail was categorized and 8 hours of physical activity was measured using accelerometer, global positioning system, and self-report. Two-way ANCOVA (age as covariate was used to compare physical activity between disease and frailty phenotypes. Spearman correlation assessed relationships, and linear regression determined associations with frailty. Results. Nonfrail recorded more physical activity (intensity, counts, self-report compared with frail. Self-reported physical activity was greater in PD than non-PD. In non-PD, step counts, light physical activity time, sedentary time, and self-reported physical activity were related to frailty (R=0.91. In PD, only carbidopa-levodopa dose was related to frailty (r=0.61. Conclusion. Physical activity influences frailty in females without PD. In PD females, disease management may be a better indicator of frailty than physical activity. Further investigation into how PD associated factors contribute to frailty is warranted.

  2. Measurement Properties of the Groningen Frailty Indicator in Home-Dwelling and Institutionalized Elderly People

    NARCIS (Netherlands)

    Peters, Lilian L.; Boter, Han; Buskens, Erik; Slaets, Joris P. J.

    Objectives: To enable prevention of poor outcome in elderly people, a valid instrument is required to detect individuals at high risk. The concept of frailty is a better predictor than age alone. The Groningen Frailty Indicator (GFI) has been developed to identify frailty. We assessed feasibility,

  3. Risk Factors of Frailty Among Multi-Ethnic Malaysian Older Adults

    Directory of Open Access Journals (Sweden)

    Manal Badrasawi

    2017-09-01

    Conclusion: Frailty affected about one tenth of the respondents, but almost two thirds were pre-frail. In addition to gender, other modifiable factors including abdominal obesity and poor physical function were identified as risk factors for frailty and pre-frailty among Malaysian older adults.

  4. Frailty and the relationship between blood pressure and mortality in elderly patients with type 2 diabetes (Zwolle Outpatient Diabetes project Integrating Available Care-34)

    NARCIS (Netherlands)

    van Hateren, Kornelis J. J.; Hendriks, Steven H.; Groenier, Klaas H.; Bakker, Stephan J. L.; Bilo, Henk J. G.; Kleefstra, Nanne; Landman, Gijs W. D.

    Objective: We aimed to investigate whether adjustment for frailty influences the relationship of blood pressure with mortality in elderly patients with type 2 diabetes mellitus (T2DM). Methods: Patients aged 60 years and older (n = 858) were selected from a prospective observational cohort study of

  5. Diseases AND or IN frailty, an important conceptual difference.

    Science.gov (United States)

    Borda, Miguel Germán; Patino-Hernandez, Daniela

    2017-11-01

    Frailty is a clinical state that increases an individual's vulnerability. It is an outcome marker in several medical scenarios. However, there is a lack of recognition in the medical field. Frailty should not be regarded as a condition superimposed to disease. Contrarily, it should be noticed as a state frequently found either as a component of diseases themselves or as their outcome. The work of a geriatrician is focused on the best possible approximation to the medical and psychosocial issues that an elder has, and must join the treatment team when the person has a considerable number of conditions that makes him/her frail. Traditionally medicine has focused mainly on illnesses, but the state of frailty requires a change of mindset, through a multidimensional person centered approach. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Body composition as a frailty marker for the elderly community.

    Science.gov (United States)

    Falsarella, Gláucia Regina; Gasparotto, Lívia Pimenta Renó; Barcelos, Caroline Coutinho; Coimbra, Ibsen Bellini; Moretto, Maria Clara; Pascoa, Mauro Alexandre; Ferreira, Talita C B Rezende; Coimbra, Arlete Maria Valente

    2015-01-01

    Body composition (BC) in the elderly has been associated with diseases and mortality; however, there is a shortage of data on frailty in the elderly. To investigate the association between BC and frailty, and identify BC profiles in nonfrail, prefrail, and frail elderly people. A cross-sectional study comprising 235 elderly (142 females and 93 males) aged ≥65 years, from the city of Amparo, State of São Paulo, Brazil, was undertaken. Sociodemographic and cognitive features, comorbidities, medication, frailty, body mass index (BMI), muscle mass, fat mass, bone mass, and fat percent (%) data were evaluated. Aiming to examine the relationship between BC and frailty, the Mann-Whitney and Kruskal-Wallis nonparametric tests were applied. The statistical significance level was P<0.05. The nonfrail elderly showed greater muscle mass and greater bone mass compared with the prefrail and frail ones. The frail elderly had greater fat % than the nonfrail elderly. There was a positive association between grip strength and muscle mass with bone mass (P<0.001), and a negative association between grip strength and fat % (P<0.001). Gait speed was positively associated with fat mass (P=0.038) and fat % (P=0.002). The physical activity level was negatively associated with fat % (P=0.022). The weight loss criterion was positively related to muscle mass (P<0.001), bone mass (P=0.009), fat mass (P=0.018), and BMI (P=0.003). There was a negative association between fatigue and bone mass (P=0.008). Frailty in the elderly was characterized by a BC profile/phenotype with lower muscle mass and lower bone mass and with a higher fat %. The BMI was not effective in evaluating the relationship between BC and frailty. The importance of evaluating the fat % was verified when considering the tissue distribution in the elderly BC.

  7. Secondary prevention in cognitive frailty: the Treviso Dementia Registry

    Directory of Open Access Journals (Sweden)

    Maurizio Gallucci

    2016-09-01

    Full Text Available Dementia is one of the most disabling health conditions for older people. Increasing attention is paid to the preclinical phase such as cognitive frailty and mild cognitive impairment, and to the prevention programs designed to reduce the number of patients in the future. The aims of this brief report are therefore: i to illustrate an action plan currently active in Treviso and that is aimed at secondary prevention in cognitive frailty subjects on the Treviso Dementia (TREDEM Registry; ii to highlight the results achieved by the TREDEM Registry up to now and how these can be used in future research.

  8. Exploring the efficiency of the Tilburg Frailty Indicator: a review

    Directory of Open Access Journals (Sweden)

    Gobbens RJJ

    2017-10-01

    Full Text Available Robbert JJ Gobbens,1–3 Jos MGA Schols,4 Marcel ALM van Assen5,6 1Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 2Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; 3Department of General Practice, University of Antwerp, Antwerp, Belgium; 4Department of Health Services Research and Department of Family Medicine, CAPHRI-Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; 5Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; 6Department of Sociology, Utrecht University, Utrecht, the Netherlands Abstract: Due to rapidly aging human populations, frailty has become an essential concept, as it identifies older people who have higher risk of adverse outcomes, such as disability, institutionalization, lower quality of life, and premature death. The Tilburg Frailty Indicator (TFI is a user-friendly questionnaire based on a multidimensional approach to frailty, assessing physical, psychologic, and social aspects of human functioning. This review aims to explore the efficiency of the TFI in assessing frailty as a means to carry out research into the antecedents and consequences of frailty, and its use both in daily practice and for future intervention studies. Using a multidimensional approach to frailty, in contexts where health care professionals or researchers may have no time to interview or examine the client, we recommend employing the TFI because there is robust evidence of its reliability and validity and it is easy and quick to administer. More studies are needed to establish whether the TFI is suitable for intervention studies not only in the community, but also for specific groups such as patients in the hospital or admitted to an emergency department. We conclude that it is important to not only determine the deficits that frail older people may

  9. An Application for Measuring Frailty of Myeloma Cancer Patients

    DEFF Research Database (Denmark)

    Corradini, Andrea; Bøgelund Hansen, Martin; Savic, Toma

    2016-01-01

    In this paper, we report on a responsive web-based application that we have been developing for the cancer hospital in the city of Vejle, Denmark. The application administers and handles systematic frailty scoring of patients with multiple myeloma (bone marrow cancer) and thereby helps the doctor...... make a more efficient and more effective treatment choice. The application is currently being tested with a small number of patients and is to replace the frailty measurement system used until now, which is usually done by the doctor on a per patient basis....

  10. Development of the interRAI home care frailty scale

    Directory of Open Access Journals (Sweden)

    John N. Morris

    2016-11-01

    Full Text Available Abstract Background The concept of frailty, a relative state of weakness reflecting multiple functional and health domains, continues to receive attention within the geriatrics field. It offers a summary of key personal characteristics, providing perspective on an individual’s life course. There have been multiple attempts to measure frailty, some focusing on physiologic losses, others on specific diseases, disabilities or health deficits. Recently, multidimensional approaches to measuring frailty have included cognition, mood and social components. The purpose of this project was to develop and evaluate a Home Care Frailty Scale and provide a grounded basis for assessing a person’s risk for decline that included functional and cognitive health, social deficits and troubling diagnostic and clinical conditions. Methods A secondary analysis design was used to develop the Home Care Frailty Scale. The data set consisted of client level home care data from service agencies around the world. The baseline sample included 967,865 assessments while the 6-month follow-up sample of persons still being served by the home care agencies consisted of 464,788 assessments. A pool of 70 candidate independent variables were screened for possible inclusion and 16 problem outcomes referencing accumulating declines and clinical complications served as the dependent variables. Multiple regression techniques were used to analyze the data. Results The resulting Home Care Frailty Scale consisted of a final set of 29 items. The items fall across 6 categories of function, movement, cognition and communication, social life, nutrition, and clinical symptoms. The prevalence of the items ranged from a high of 87% for persons requiring help with meal preparation to 3.7% for persons who have experienced a recent decline in the amount of food eaten. Conclusions The interRAI Home Care Frailty Scale is based on a strong conceptual foundation and in our analysis, performed as

  11. The prevalence of frailty and related factors in community-dwelling Turkish elderly according to modified Fried Frailty Index and FRAIL scales.

    Science.gov (United States)

    Akın, Sibel; Mazıcıoglu, Mumtaz M; Mucuk, Salime; Gocer, Semsinnur; Deniz Şafak, Elif; Arguvanlı, Sibel; Ozturk, Ahmet

    2015-10-01

    The purpose of this study is to determine the prevalence of frailty with the Fried Frailty Index (FFI) and FRAIL scales (Fatigue, Resistance, Ambulation, Illness, Low weight) and also its associated factors in the community-dwelling Turkish elderly. This is a cross-sectional population-based study in an urban area with a population of over 1,200,000. We sampled 1/100 of the elderly population. Frailty prevalence was assessed with a modified version of the FFI and FRAIL scale. Nutritional status was assessed by Mini Nutritional Assessment. Cognitive function was assessed by Mini-Mental State Examination. Depressive mood was assessed by GDS. Functional capacity was assessed by the instrumental activities of daily living scale. Falls and fear of falling were noted. Uni- and multivariate analyses were done to determine associated factors for frailty. A total of 906 community-dwelling elderly were included, in whom the mean age and standard deviation (SD) of age were 71.5 (5.6) years (50.6 % female). We detected frailty (female 30.4 %, male 25.2 %), pre-frailty and non-frailty prevalence with FFI as 27.8, 34.8, and 37.4 %, respectively. The prevalence of frailty (female 14.5 %, male 5.4 %), pre-frailty and non-frailty with the FRAIL scale was detected as 10, 45.6, and 44.4 %. Coexisting associated factors related with frailty in both models were found as depressive mood, cognitive impairment, and malnutrition in multivariate analysis. According to both scales, frailty was strongly associated with cognitive impairment, depressive mood, and malnutrition in the community-dwelling Turkish elderly population.

  12. Semi-parametric estimation of the area under the precision-recall curve

    Science.gov (United States)

    Sahiner, Berkman; Chen, Weijie; Pezeshk, Aria; Petrick, Nicholas

    2016-03-01

    Precision and recall are two common metrics used in the evaluation of information retrieval systems. By changing the number of retrieved documents, one can obtain a precision-recall curve. The area under the precision-recall curve (AUCPR) has been suggested as a performance measure for information retrieval systems, in a manner similar to the use of the area under the receiver operating characteristic curve in binary classification. Limited work has been performed in the literature to investigate the bias and variance of AUCPR estimators. The goal of our study was to investigate the bias and variability of a semi-parametric binormal method for estimating the AUCPR, and to compare it to other techniques, such as average precision (AP) and lower trapezoid (LT) approximation. We show how AUCPR can be obtained given the binormal model parameters, and how its variance can be estimated using the delta method. We performed simulation experiments with normal and non-normal data, and investigated the effect of sample size and prevalence. Our results indicated that the semi-parametric binormal approach provided AUCPR estimates with small bias and confidence intervals with acceptable coverage when the sample size was large, and the performance of the binormal model was comparable to or better than alternative methods evaluated in this study when the sample size was small. We conclude that the semi-parametric binormal model can be used to accurately estimate the AUCPR, and that the confidence intervals derived from the model can be at least as accurate as from other alternatives, even for non-normal decision variable distributions.

  13. Spectral Mixture Analysis: Linear and Semi-parametric Full and Iterated Partial Unmixing in Multi- and Hyperspectral Image Data

    DEFF Research Database (Denmark)

    Nielsen, Allan Aasbjerg

    2001-01-01

    As a supplement or an alternative to classification of hyperspectral image data linear and semi-parametric mixture models are considered in order to obtain estimates of abundance of each class or end-member in pixels with mixed membership. Full unmixing based on both ordinary least squares (OLS...... to suggest an iterated CEM scheme. Also the target constrained interference minimized filter (TCIMF) is described. Spectral angle mapping (SAM) is briefly described. Finally, semi-parametric unmixing (SPU) based on a combined linear and additive model with a non-linear, smooth function to represent end...... gives better estimates of end-member abundances than the linear model....

  14. An empirical test of reference price theories using a semiparametric approach

    DEFF Research Database (Denmark)

    Boztug, Yasemin; Hildebrandt, Lutz

      In this paper we estimate and empirically test different behavioral theories of consumer reference price formation. Two major theories are proposed to model the reference price reaction: assimilation contrast theory and prospect theory. We assume that different consumer segments will use...... different reference prices. The study builds on earlier research by Kalyanaram and Little (1994); however, in contrast to their work, we use parametric and semiparametric approaches to detect the structure of the underlying data sets. The different models are tested using a program module in GAUSS...

  15. Semiparametric Bayesian analysis of accelerated failure time models with cluster structures.

    Science.gov (United States)

    Li, Zhaonan; Xu, Xinyi; Shen, Junshan

    2017-11-10

    In this paper, we develop a Bayesian semiparametric accelerated failure time model for survival data with cluster structures. Our model allows distributional heterogeneity across clusters and accommodates their relationships through a density ratio approach. Moreover, a nonparametric mixture of Dirichlet processes prior is placed on the baseline distribution to yield full distributional flexibility. We illustrate through simulations that our model can greatly improve estimation accuracy by effectively pooling information from multiple clusters, while taking into account the heterogeneity in their random error distributions. We also demonstrate the implementation of our method using analysis of Mayo Clinic Trial in Primary Biliary Cirrhosis. Copyright © 2017 John Wiley & Sons, Ltd.

  16. Separating risk in education from heterogeneity: a semiparametric approach

    NARCIS (Netherlands)

    Mazza, J.; van Ophem, H.

    2010-01-01

    Returns to education are variable within the same educational group. If uncertain payoffs are a concern for individuals when selecting education, wage variance is the resultant of unobserved heterogeneity and pure uncertainty. The first element is known to the individual, but unknown to the

  17. Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients

    OpenAIRE

    Joosten, Etienne; Demuynck, Mathias; Detroyer, Elke; Milisen, Koen

    2014-01-01

    Background The prevalence and significance of frailty are seldom studied in hospitalized patients. Aim of this study is to evaluate the prevalence of frailty and to determine the extent that frailty predicts delirium, falls and mortality in hospitalized older patients. Methods In a prospective study of 220 older patients, frailty was determined using the Cardiovascular Health Study (CHS) and the Study of Osteoporotic Fracture (SOF) frailty index. Patients were classified as nonfrail, prefrail...

  18. Frailty, HIV infection, and mortality in an aging cohort of injection drug users.

    Directory of Open Access Journals (Sweden)

    Damani A Piggott

    Full Text Available Frailty is associated with morbidity and premature mortality among elderly HIV-uninfected adults, but the determinants and consequences of frailty in HIV-infected populations remain unclear. We evaluated the correlates of frailty, and the impact of frailty on mortality in a cohort of aging injection drug users (IDUs.Frailty was assessed using standard criteria among HIV-infected and uninfected IDUs in 6-month intervals from 2005 to 2008. Generalized linear mixed-model analyses assessed correlates of frailty. Cox proportional hazards models estimated risk for all-cause mortality.Of 1230 participants at baseline, the median age was 48 years and 29% were HIV-infected; the frailty prevalence was 12.3%. In multivariable analysis of 3,365 frailty measures, HIV-infected IDUs had an increased likelihood of frailty (OR, 1.66; 95% CI, 1.24-2.21 compared to HIV-uninfected IDUs; the association was strongest (OR, 2.37; 95% CI, 1.62-3.48 among HIV-infected IDUs with advanced HIV disease (CD4<350 cells/mm3 and detectable HIV RNA. No significant association was seen with less advanced disease. Sociodemographic factors, comorbidity, depressive symptoms, and prescription drug abuse were also independently associated with frailty. Mortality risk was increased with frailty alone (HR 2.63, 95% CI, 1.23-5.66, HIV infection alone (HR 3.29, 95% CI, 1.85-5.88, and being both HIV-infected and frail (HR, 7.06; 95%CI 3.49-14.3.Frailty was strongly associated with advanced HIV disease, but IDUs with well-controlled HIV had a similar prevalence to HIV-uninfected IDUs. Frailty was independently associated with mortality, with a marked increase in mortality risk for IDUs with both frailty and HIV infection.

  19. Online gaming and training platform against frailty in elderly people

    NARCIS (Netherlands)

    de Vette, Anna Frederiek Alberdien; Tabak, Monique; Hermens, Hermanus J.; Vollenbroek-Hutten, Miriam Marie Rosé

    2016-01-01

    Frailty, a condition associated with functional decline caused by insufficient mental stimulation, physical activity and healthy nutrition (Gomez et al., 2013), is a common occurrence among older adults. To counter this effect and decrease the risks for disability, dementia and hospitalisation, we

  20. Measuring the Frailty Index of Multiple Myeloma Cancer Patients

    DEFF Research Database (Denmark)

    Corradini, Andrea; Hansen, Martin; Savic, Toma

    2016-01-01

    We report on a responsive web-based application that we have been developing for the cancer hospital in Vejle, Denmark. The application administers and handles systematic frailty scoring of patients with multiple myeloma and helps doctors make a more efficient and effective treatment choice...

  1. Common Ground? The Concordance of Sarcopenia and Frailty Definitions

    NARCIS (Netherlands)

    Reijnierse, Esmee M.; Trappenburg, Marijke C.; Blauw, Gerard Jan; Verlaan, Sjors; de van der Schueren, Marian A.E.; Meskers, Carel G.M.; Maier, Andrea B.

    2016-01-01

    Objectives: This study aimed to explore the concordance between definitions of sarcopenia and frailty in a clinically relevant population of geriatric outpatients. Design: Data were retrieved from a cross-sectional study. Setting: The study was performed in a geriatric outpatient clinic of a

  2. Water homeostasis, frailty and congnitive function in the nursing home

    Science.gov (United States)

    The goal of this study is to develop and test a practical clinical method to assess frailty in nursing homes and to investigate the relationship between cognitive status of the elderly and the balance between water compartments of their body composition. This is a cross-sectional study, conducted a...

  3. [Frequency of successful aging and frailty. Associated risk factors].

    Science.gov (United States)

    Carrazco-Peña, Karla Berenice; Farías-Moreno, Katia; Trujillo-Hernández, Benjamín

    To determine the frequency of successful aging (SA) and its relationship with frailty in an elderly population. An analytical cross-sectional study of subjects ≥60 years of age seen as outpatients in a general hospital. Successful aging was defined as scores of ≥ 90 in the Barthel index and ≤ 2 in the Pfeiffer test. Frailty was determined using the Fried criteria. The study included 400 subjects (272 women and 128 men), with a mean age of 71.6±8.2 years. The SA frequency was 40.4%. frail status was statistically higher in non-successful aging subjects than in SA subjects (161.7 versus 7.9%; P<.001). Women were more frequently frail, while being a pensioner/retired and married were associated less frequently with frailty. Successful aging is associated with a lower level of frailty. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Some notes on unobserved parameters (frailties) in reliability modeling

    International Nuclear Information System (INIS)

    Cha, Ji Hwan; Finkelstein, Maxim

    2014-01-01

    Unobserved random quantities (frailties) often appear in various reliability problems especially when dealing with the failure rates of items from heterogeneous populations. As the failure rate is a conditional characteristic, the distributions of these random quantities, similar to Bayesian approaches, are updated in accordance with the corresponding survival information. At some instances, apart from a statistical meaning, frailties can have also useful interpretations describing the underlying lifetime model. We discuss and clarify these issues in reliability context and present and analyze several meaningful examples. We consider the proportional hazards model with a random factor; the stress–strength model, where the unobserved strength of a system can be viewed as frailty; a parallel system with a random number of components and, finally, the first passage time problem for the Wiener process with random parameters. - Highlights: • We discuss and clarify the notion of frailty in reliability context and present and analyze several meaningful examples. • The paper provides a new insight and general perspective on reliability models with unobserved parameters. • The main message of the paper is well illustrated by several meaningful examples and emphasized by detailed discussion

  5. Body composition as a frailty marker for the elderly community

    Directory of Open Access Journals (Sweden)

    Falsarella GR

    2015-10-01

    Full Text Available Gláucia Regina Falsarella,1 Lívia Pimenta Renó Gasparotto,1 Caroline Coutinho Barcelos,2 Ibsen Bellini Coimbra,1,2 Maria Clara Moretto,1 Mauro Alexandre Pascoa,3 Talita C B Rezende Ferreira,1 Arlete Maria Valente Coimbra1,41Gerontology Program, Faculty of Medical Sciences, 2Department of Medical Clinics, Faculty of Medical Sciences, 3Department Biodynamics of Movement, Faculty of Physical Education, 4Family Health Program, Gerontology Program, Faculty of Medical Sciences, State University of Campinas (Unicamp, Campinas, São Paulo, BrazilBackground: Body composition (BC in the elderly has been associated with diseases and mortality; however, there is a shortage of data on frailty in the elderly.Objective: To investigate the association between BC and frailty, and identify BC profiles in nonfrail, prefrail, and frail elderly people.Methods: A cross-sectional study comprising 235 elderly (142 females and 93 males aged ≥65 years, from the city of Amparo, State of São Paulo, Brazil, was undertaken. Sociodemographic and cognitive features, comorbidities, medication, frailty, body mass index (BMI, muscle mass, fat mass, bone mass, and fat percent (% data were evaluated. Aiming to examine the relationship between BC and frailty, the Mann–Whitney and Kruskal–Wallis nonparametric tests were applied. The statistical significance level was P<0.05.Results: The nonfrail elderly showed greater muscle mass and greater bone mass compared with the prefrail and frail ones. The frail elderly had greater fat % than the nonfrail elderly. There was a positive association between grip strength and muscle mass with bone mass (P<0.001, and a negative association between grip strength and fat % (P<0.001. Gait speed was positively associated with fat mass (P=0.038 and fat % (P=0.002. The physical activity level was negatively associated with fat % (P=0.022. The weight loss criterion was positively related to muscle mass (P<0.001, bone mass (P=0.009, fat mass

  6. Efficient semiparametric estimation in generalized partially linear additive models for longitudinal/clustered data

    KAUST Repository

    Cheng, Guang

    2014-02-01

    We consider efficient estimation of the Euclidean parameters in a generalized partially linear additive models for longitudinal/clustered data when multiple covariates need to be modeled nonparametrically, and propose an estimation procedure based on a spline approximation of the nonparametric part of the model and the generalized estimating equations (GEE). Although the model in consideration is natural and useful in many practical applications, the literature on this model is very limited because of challenges in dealing with dependent data for nonparametric additive models. We show that the proposed estimators are consistent and asymptotically normal even if the covariance structure is misspecified. An explicit consistent estimate of the asymptotic variance is also provided. Moreover, we derive the semiparametric efficiency score and information bound under general moment conditions. By showing that our estimators achieve the semiparametric information bound, we effectively establish their efficiency in a stronger sense than what is typically considered for GEE. The derivation of our asymptotic results relies heavily on the empirical processes tools that we develop for the longitudinal/clustered data. Numerical results are used to illustrate the finite sample performance of the proposed estimators. © 2014 ISI/BS.

  7. Semiparametric probit models with univariate and bivariate current-status data.

    Science.gov (United States)

    Liu, Hao; Qin, Jing

    2018-03-01

    Multivariate current-status data are frequently encountered in biomedical and public health studies. Semiparametric regression models have been extensively studied for univariate current-status data, but most existing estimation procedures are computationally intensive, involving either penalization or smoothing techniques. It becomes more challenging for the analysis of multivariate current-status data. In this article, we study the maximum likelihood estimations for univariate and bivariate current-status data under the semiparametric probit regression models. We present a simple computational procedure combining the expectation-maximization algorithm with the pool-adjacent-violators algorithm for solving the monotone constraint on the baseline function. Asymptotic properties of the maximum likelihood estimators are investigated, including the calculation of the explicit information bound for univariate current-status data, as well as the asymptotic consistency and convergence rate for bivariate current-status data. Extensive simulation studies showed that the proposed computational procedures performed well under small or moderate sample sizes. We demonstrate the estimation procedure with two real data examples in the areas of diabetic and HIV research. © 2017, The International Biometric Society.

  8. Distributed Nonparametric and Semiparametric Regression on SPARK for Big Data Forecasting

    Directory of Open Access Journals (Sweden)

    Jelena Fiosina

    2017-01-01

    Full Text Available Forecasting in big datasets is a common but complicated task, which cannot be executed using the well-known parametric linear regression. However, nonparametric and semiparametric methods, which enable forecasting by building nonlinear data models, are computationally intensive and lack sufficient scalability to cope with big datasets to extract successful results in a reasonable time. We present distributed parallel versions of some nonparametric and semiparametric regression models. We used MapReduce paradigm and describe the algorithms in terms of SPARK data structures to parallelize the calculations. The forecasting accuracy of the proposed algorithms is compared with the linear regression model, which is the only forecasting model currently having parallel distributed realization within the SPARK framework to address big data problems. The advantages of the parallelization of the algorithm are also provided. We validate our models conducting various numerical experiments: evaluating the goodness of fit, analyzing how increasing dataset size influences time consumption, and analyzing time consumption by varying the degree of parallelism (number of workers in the distributed realization.

  9. Vulnerable Elderly Survey 13 as a screening method for frailty in Polish elderly surgical patient--prospective study.

    Science.gov (United States)

    Kenig, Jakub; Richter, Piotr; Zychiewicz, Beata; Olszewska, Urszula

    2014-03-01

    The Vulnerable Elders Survey (VES-13) is a simple function based frailty screening tool that can be also administered by the nonclinical personnel within 5 minutes and has been validated in the out- and in patient clinic and acute medical care settings. The aim of the study was to validate the accuracy of the VES-13 screening method for predicting the frailty syndrome based on a CGA in polish surgical patients. We included prospectively 106 consecutive patients ≥65, that qualify for abdominal surgery (both due to oncological and benign reasons), at the tertiary referral hospital.We evaluated the diagnostic performance of VES-13 score comparing to the results from the CGA, accepted as the gold standard for identifying at risk frail elderly patients. The prevalence of frailty as diagnosed by CGA was 59.4%. There was significantly higher number of frail patients in the oncological group (78% vs. 31%; ppatients cannot replace the comprehensive geriatric assessment; this is due to the insufficient discriminative power to select patients for further assessment. It might be helpful in a busy clinical practice and in facilities that do not have trained personal for geriatric assessment.

  10. [Detection of the largest population susceptible to prescription of a program of exercises in Primary Care to prevent frailty].

    Science.gov (United States)

    Rosas Hernández, Ana María; Alejandre Carmona, Sergio; Rodríguez Sánchez, Javier Enrique; Castell Alcalá, Maria Victoria; Otero Puime, Ángel

    2018-03-16

    Identify the population over 70 year's old treated in primary care who should participate in a physical exercise program to prevent frailty. Analyze the concordance among 2criteria to select the beneficiary population of the program. Population-based cross-sectional study. Primary Care. Elderly over 70 years old, living in the Peñagrande neighborhood (Fuencarral district of Madrid) from the Peñagrande cohort, who accepted to participate in 2015 (n = 332). The main variable of the study is the need for exercise prescription in people over 70 years old at the Primary Care setting. It was identified through 2different definitions: Prefrail (1-2 of 5 Fried criteria) and Independent individuals with physical performance limited, defined by Consensus on frailty and falls prevention among the elderly (independent and with a total SPPB score <10). The 63,8% of participants (n = 196) need exercise prescription based on criteria defined by Fried and/or the consensus for prevention of frailty and falls in the elderly. In 82 cases the 2criteria were met, 80 were prefrail with normal physical performance and 34 were robust with a limited physical performance. The concordance among both criteria is weak (kappa index 0, 27). Almost 2thirds of the elderly have some kind of functional limitation. The criteria of the consensus document to prevent frailty detect half of the pre-frail individuals in the community. Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Measuring frailty in Dutch community-dwelling older people : Reference values of the Tilburg Frailty Indicator (TFI)

    NARCIS (Netherlands)

    van Assen, M.A.L.M.; Pallast, Esther; El Fakiri, Fatima; Gobbens, R.J.J.

    2016-01-01

    Objectives: The objectives of this study were to provide reference values of the Tilburg Frailty Indicator (TFI) for community-dwelling older people by age, sex, marital status, ethnicity, education, income, and residence, and examine the effects of these seven socio-demographic variables on

  12. Spectral Mixture Analysis: Linear and Semi-parametric Full and Iterated Partial Unmixing in Multi- and Hyperspectral Image Data

    DEFF Research Database (Denmark)

    Nielsen, Allan Aasbjerg

    2001-01-01

    As a supplement or an alternative to classification of hyperspectral image data linear and semi-parametric mixture models are considered in order to obtain estimates of abundance of each class or end-member in pixels with mixed membership. Full unmixing based on both ordinary least squares (OLS...

  13. Predicting factors associated with frailty in aged patients with bone-arthrosis pain in the clinic.

    Science.gov (United States)

    Li, Bao-Lin; Li, Wei; Bi, Jia-Qi; Meng, Qing-Gang; Fei, Jian-Feng

    2016-11-01

    To identify frail and pre-frail patients in a group of patients older than 60 years. The phenotype model of Fried's method was used to identify frailty and pre-frailty in total of 78 participants. Cognitive ability and psychosocial function tests were also given to 59 of the 78 patients. Prevalence of frailty and pre-frailty was 14.1% (11/78) and 46.2% (36/78), respectively. Of the 5 phenotype variables, weak grip strength was the most commonly seen variable with 53.8% of all participants and 100% in the frail group. Low energy expenditure, however, was not self-reported by any participant in the current study (0%). Prevalence of frailty in the present study is associated with chronological age. The current study indicates that 4 phenotypic variables (unintentional weight loss, self-reported exhaustion, gait speed and grip strength) contribute to the development to frailty, and that cognitive impairment and psychosocial frailty also predict frailty or pre-frailty in the patients older than 60 years old irrespective of chronic pain or osteoarthritis. The findings of the current study suggest frailty and pre-frailty are common in senior Chinese patients with chronic diseases. Recognition and identification of frailty in a rehabilitation clinic or hospital might help physicians to provide appropriate counseling to patients and families about adverse outcomes of certain treatments such as surgery, and could optimize management of coexisting chronic diseases that might contribute to or be affected by frailty.

  14. Frailty syndrome and self-care ability in elderly patients with heart failure

    Science.gov (United States)

    Uchmanowicz, Izabella; Wleklik, Marta; Gobbens, Robbert JJ

    2015-01-01

    Background Chronic heart failure is a serious medical condition. Recently, there has been an increasing interest in frailty syndrome and self-care levels among patients with cardiovascular conditions. Demonstrating the influence of frailty syndrome on self-care could improve the quality of self-care and prevent the adverse effects of frailty syndrome. The purpose of this study was to assess the influence of frailty syndrome on the self-care capabilities of patients with chronic heart failure, and to identify factors associated with frailty. Methods The data were collected between January and July 2014. The study included 110 patients with chronic heart failure who were hospitalized in the cardiology clinic. Frailty syndrome was assessed using the Tilburg Frailty Indicator, a self-report questionnaire, and self-care behavior was assessed using the European Heart Failure Self-Care Behavior Scale. Results Fifty-four percent of the study patients were male and 46% were female. The mean age was 66±11 years, the mean Tilburg Frailty Indicator score was 7.45±3.02 points, and the mean self-care level was 27.6±7.13 points. Correlation analyses showed that patients with higher scores in the social components of the frailty scale had better self-care capabilities. Frailty was associated with age, education, duration of heart failure, number of hospitalizations, and New York Heart Association class. The effects of these patient characteristics differed across components of frailty (physical, psychological, social). Conclusion The social components of frailty syndrome adversely affect the ability to self-care in elderly patients with heart failure. It is relevant to use a multidimensional measurement of frailty. PMID:26028966

  15. Frailty and postoperative outcomes in patients undergoing surgery for degenerative spine disease.

    Science.gov (United States)

    Flexman, Alana M; Charest-Morin, Raphaële; Stobart, Liam; Street, John; Ryerson, Christopher J

    2016-11-01

    Frailty is defined as a state of decreased reserve and susceptibility to stressors. The relationship between frailty and postoperative outcomes after degenerative spine surgery has not been studied. This study aimed to (1) determine prevalence of frailty in the degenerative spine population; (2) describe patient characteristics associated with frailty; and (3) determine the association between frailty and postoperative complications, mortality, length of stay, and discharge disposition. This is a retrospective analysis on a prospectively collected cohort from the National Surgical Quality Improvement Program (NSQIP). A total of 53,080 patients who underwent degenerative spine surgery between 2006 and 2012 were included in the study. A modified frailty index (mFI) with 11 variables derived from the NSQIP dataset was used to determine prevalence of frailty and its correlation with a composite outcome of perioperative complications as well as hospital length of stay, mortality, and discharge disposition. After calculating the mFI for each patient, the prevalence and predictors of frailty were determined for our cohort. The association of frailty with postoperative outcomes was determined after adjusting for known and suspected confounders using multivariate logistic regression. Frailty was present in 2,041 patients within the total population (4%) and in 8% of patients older than 65 years. Frailty severity increased with increasing age, male sex, African American race, higher body mass index, recent weight loss, paraplegia or quadriplegia, American Society of Anesthesiologists (ASA) score, and preadmission residence in a care facility. Frailty severity was an independent predictor of major complication (OR 1.15 for every 0.10 increase in mFI, 95%CI 1.09-1.21, pdegenerative spine surgery. Preoperative recognition of frailty may be useful for perioperative optimization, risk stratification, and patient counseling. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. A Bayesian semiparametric Markov regression model for juvenile dermatomyositis.

    Science.gov (United States)

    De Iorio, Maria; Gallot, Natacha; Valcarcel, Beatriz; Wedderburn, Lucy

    2018-02-20

    Juvenile dermatomyositis (JDM) is a rare autoimmune disease that may lead to serious complications, even to death. We develop a 2-state Markov regression model in a Bayesian framework to characterise disease progression in JDM over time and gain a better understanding of the factors influencing disease risk. The transition probabilities between disease and remission state (and vice versa) are a function of time-homogeneous and time-varying covariates. These latter types of covariates are introduced in the model through a latent health state function, which describes patient-specific health over time and accounts for variability among patients. We assume a nonparametric prior based on the Dirichlet process to model the health state function and the baseline transition intensities between disease and remission state and vice versa. The Dirichlet process induces a clustering of the patients in homogeneous risk groups. To highlight clinical variables that most affect the transition probabilities, we perform variable selection using spike and slab prior distributions. Posterior inference is performed through Markov chain Monte Carlo methods. Data were made available from the UK JDM Cohort and Biomarker Study and Repository, hosted at the UCL Institute of Child Health. Copyright © 2018 John Wiley & Sons, Ltd.

  17. Frailty and incident depression in community-dwelling older people: results from the ELSA study.

    Science.gov (United States)

    Veronese, Nicola; Solmi, Marco; Maggi, Stefania; Noale, Marianna; Sergi, Giuseppe; Manzato, Enzo; Prina, A Matthew; Fornaro, Michele; Carvalho, André F; Stubbs, Brendon

    2017-12-01

    Frailty and pre-frailty are two common conditions in the older people, but whether these conditions could predict depression is still limited to a few longitudinal studies. In this paper, we aimed to investigate whether frailty and pre-frailty are associated with an increased risk of depression in a prospective cohort of community-dwelling older people. Four thousand seventy-seven community-dwelling men and women over 60 years without depression at baseline were included from the English Longitudinal Study of Ageing. Frailty status was defined according to modified Fried's criteria (weakness, weight loss, slow gait speed, low physical activity and exhaustion) and categorized as frailty (≥3 criteria), pre-frailty (1-2 criteria) or robustness (0 criterion). Depression was diagnosed as ≥4 out of 8 points of Center for Epidemiologic Studies Depression Scale, after 2 years of follow-up. Over a 2-year follow-up, 360 individuals developed depression. In a logistic regression analysis, adjusted for 18 potential baseline confounders, pre-frailty (odds ratio (OR) = 0.89; 95% confidence interval (CI), 0.54-1.46; p = 0.64) and frailty (OR = 1.22; 95% CI, 0.90-1.64; p = 0.21) did not predict the onset of depression at follow-up. Among the criteria included in the frailty definition, only slow gait speed (OR = 1.82; 95% CI, 1.00-3.32; p = 0.05) appeared to predict a higher risk of depression. Among older community dwellers, frailty and pre-frailty did not predict the onset of depression during 2 years of follow-up, when accounting for potential confounders, whilst slow gait speed considered alone may predict depression in the older people. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  18. Frailty and life satisfaction in Shanghai older adults: The roles of age and social vulnerability.

    Science.gov (United States)

    Yang, Fang; Gu, Danan; Mitnitski, Arnold

    2016-01-01

    This study aims to examine the relationship between frailty and life satisfaction and the roles of age and social vulnerability underlying the links in Chinese older adults. Using a cross-sectional sample of 1970 adults aged 65 and older in 2013 in Shanghai, we employed regression analyses to investigate the interaction between frailty and age on life satisfaction in the whole sample and in different social vulnerability groups. Life satisfaction was measured using a sum score of satisfaction with thirteen domains. Using a cumulative deficit approach, frailty was constructed from fifty-two variables and social vulnerability was derived from thirty-five variables. Frailty was negatively associated with life satisfaction. The interaction between frailty and age was significant for life satisfaction, such that the negative association between frailty and life satisfaction was stronger among the young-old aged 65-79 than among the old-old aged 80+. Moreover, frailty's stronger association with life satisfaction in the young-old than in the old-old was only found among those in the 2nd and 3rd tertiles of social vulnerability, but not for those in the 1st tertile of social vulnerability. Relation between frailty and life satisfaction likely weakens with age. A higher level of social vulnerability enlarges the negative impact of frailty on life satisfaction with a greater extent in the young-old. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. A Study of relationship between frailty and physical performance in elderly women.

    Science.gov (United States)

    Jeoung, Bog Ja; Lee, Yang Chool

    2015-08-01

    Frailty is a disorder of multiple inter-related physiological systems. It is unclear whether the level of physical performance factors can serve as markers of frailty and a sign. The purpose of this study was to examine the relationship between frailty and physical performance in elderly women. One hundred fourteen elderly women participated in this study, their aged was from 65 to 80. We were measured 6-min walk test, grip-strength, 30-sec arm curl test, 30-sec chair stand test, 8 foot Up- and Go, Back scratch, chair sit and reach, unipedal stance, BMI, and the frailty with questionnaire. The collected data were analyzed by descriptive statistics, frequencies, correlation analysis, ANOVA, and simple liner regression using the IBM 21. SPSS program. In results, statistic tests showed that there were significant differences between frailty and 6-min walk test, 30-sec arm curl test, 30-sec chair stand test, grip-strength, Back scratch, and BMI. However, we did not find significant differences between frailty and 8 foot Up- and Go, unipedal stance. When the subjects were divided into five groups according to physical performance level, subjects with high 6-min walk, 30-sec arm curl test, chair sit and reach test, and high grip strength had low score frailty. Physical performance factors were strongly associated with decreased frailty, suggesting that physical performance improvements play an important role in preventing or reducing the frailty.

  20. [Frailty in older population: a brief position paper from the French society of geriatrics and gerontology].

    Science.gov (United States)

    Rolland, Yves; Benetos, Athanase; Gentric, Armelle; Ankri, Joël; Blanchard, François; Bonnefoy, Marc; de Decker, Laure; Ferry, Monique; Gonthier, Régis; Hanon, Olivier; Jeandel, Claude; Nourhashemi, Fathi; Perret-Guillaume, Christine; Retornaz, Frédérique; Bouvier, Hélène; Ruault, Geneviève; Berrut, Gilles

    2011-12-01

    Frailty in the older population is a clinical syndrome which evaluate a risk level. The Frailty syndrome defines a reduction of the adaptation capacity to a stress. It can be modulated by physical, psychological and social factors. The screening of the frailty syndrome is relevant for older people without disability for basic activities of daily living. The clinical criteria of frailty must be predictive of the risk of functional decline and adverse outcomes, consensual at the international level, and easy to perform in primary care as well as in the clinical researches.

  1. Life satisfaction and frailty in community-based older adults: cross-sectional and prospective analyses.

    Science.gov (United States)

    St John, Philip D; Tyas, Suzanne L; Montgomery, Patrick R

    2013-10-01

    Frailty may be associated with reduced life satisfaction (LS). The objectives of this paper are to determine if (1) frailty is associated with LS in community-dwelling older adults in cross-sectional analyses; (2) frailty predicts LS five years later; and (3) specific domains of LS are preferentially associated with frailty. This paper presents analysis of an existing population-based cohort study of 1,751 persons aged 65+ who were assessed in 1991, with follow-up five years later. LS was measured using the terrible-delightful scale, which measures overall LS and LS in specific domains. Frailty was measured using the Brief Frailty Instrument. Analyses were adjusted for age, gender, education, and marital status. Frailty was associated with overall LS at time 1 and predicted overall LS at time 2. This was seen in unadjusted analyses and after adjusting for confounding factors. Frailty was associated with all domains of LS at time 1, and predicted LS at time 2 in all domains except housing and self-esteem. However, the effect was stronger for LS with health than with other domains for both times 1 and 2. Frailty is associated with LS, and the effect is strongest for LS with health.

  2. Factors Influencing Transitions Between Frailty States in Elderly Adults: The Progetto Veneto Anziani Longitudinal Study.

    Science.gov (United States)

    Trevisan, Caterina; Veronese, Nicola; Maggi, Stefania; Baggio, Giovannella; Toffanello, Elena Debora; Zambon, Sabina; Sartori, Leonardo; Musacchio, Estella; Perissinotto, Egle; Crepaldi, Gaetano; Manzato, Enzo; Sergi, Giuseppe

    2017-01-01

    To investigate frailty state transitions in a cohort of older Italian adults to identify factors exacerbating or improving frailty conditions. Population-based longitudinal study with mean follow-up of 4.4 years. Community. Individuals enrolled in the Progetto Veneto Anziani (Pro.V.A.) (N = 2,925; n = 1,179 male, n = 1,746 female; mean age 74.4 ± 7.3). Frailty was identified at baseline and follow-up based on the presence of at least three Fried criteria; prefrailty was defined as the presence of one or two Fried criteria. Anthropometric, socioeconomic, and clinical characteristics were assessed at baseline in a personal interview and clinical examination using validated scales and medical history. During the study period, 1,114 (38.1%) subjects retained their baseline frailty status, 1,066 (36.4%) had a transition in frailty status, and the remainder of the sample died. Older age, female sex, obesity, cardiovascular disease, osteoarthritis, smoking, loss of vision, low levels of self-sufficiency and physical performance, cognitive impairment, hypovitaminosis D, hyperuricemia, and polypharmacy were associated with increasing frailty and greater mortality. Conversely, overweight, low to moderate drinking, high educational level, and living alone were associated with decreasing frailty. Frailty was confirmed as a dynamic syndrome, with socioeconomic and clinical factors that could be targets of preventive actions influencing transitions to better or worse frailty status. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  3. Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient.

    Science.gov (United States)

    Robinson, Thomas N; Wallace, Jeffrey I; Wu, Daniel S; Wiktor, Arek; Pointer, Lauren F; Pfister, Shirley M; Sharp, Terra J; Buckley, Mary J; Moss, Marc

    2011-07-01

    Frailty is a state of increased vulnerability to health-related stressors and can be measured by summing the number of frailty characteristics present in an individual. Discharge institutionalization (rather than discharge to home) represents disease burden and functional dependence after hospitalization. Our aim was to determine the relationship between frailty and need for postoperative discharge institutionalization. Subjects ≥ 65 years undergoing major elective operations requiring postoperative ICU admission were enrolled. Discharge institutionalization was defined as need for institutionalized care at hospital discharge. Fourteen preoperative frailty characteristics were measured in 6 domains: comorbidity burden, function, nutrition, cognition, geriatric syndromes, and extrinsic frailty. A total of 223 subjects (mean age 73 ± 6 years) were studied. Discharge institutionalization occurred in 30% (n = 66). Frailty characteristics related to need for postoperative discharge institutionalization included: older age, Charlson index ≥ 3, hematocrit institutionalization. An increased number of frailty characteristics present in any one subject resulted in increased rate of discharge institutionalization. Nearly 1 in 3 geriatric patients required discharge to an institutional care facility after major surgery. The frailty characteristics of prolonged up-and-go and any functional dependence were most closely related to the need for discharge institutionalization. Accumulation of a higher number of frailty characteristics in any one geriatric patient increased their risk of discharge institutionalization. Published by Elsevier Inc.

  4. Physiological Aging: Links Among Adipose Tissue Dysfunction, Diabetes, and Frailty.

    Science.gov (United States)

    Stout, Michael B; Justice, Jamie N; Nicklas, Barbara J; Kirkland, James L

    2017-01-01

    Advancing age is associated with progressive declines in physiological function that lead to overt chronic disease, frailty, and eventual mortality. Importantly, age-related physiological changes occur in cellularity, insulin-responsiveness, secretory profiles, and inflammatory status of adipose tissue, leading to adipose tissue dysfunction. Although the mechanisms underlying adipose tissue dysfunction are multifactorial, the consequences result in secretion of proinflammatory cytokines and chemokines, immune cell infiltration, an accumulation of senescent cells, and an increase in senescence-associated secretory phenotype (SASP). These processes synergistically promote chronic sterile inflammation, insulin resistance, and lipid redistribution away from subcutaneous adipose tissue. Without intervention, these effects contribute to age-related systemic metabolic dysfunction, physical limitations, and frailty. Thus adipose tissue dysfunction may be a fundamental contributor to the elevated risk of chronic disease, disability, and adverse health outcomes with advancing age. ©2017 Int. Union Physiol. Sci./Am. Physiol. Soc.

  5. Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ Study

    Directory of Open Access Journals (Sweden)

    Virgílio Garcia Moreira

    2013-07-01

    Full Text Available OBJECTIVE: Frailty syndrome can be defined as a state of vulnerability to stressors resulting from a decrease in functional reserve across multiple systems and compromising an individual's capacity to maintain homeostasis. The purpose of this study was to determine the prevalence of frailty and its association with social and demographic factors, functional capacity, cognitive status and self-reported comorbidities in a sample of community-dwelling older individuals who are clients of a healthcare plan. METHODS: We evaluated 847 individuals aged 65 years or older who lived in the northern area of the city of Rio de Janeiro, Brazil. The subjects were selected by inverse random sampling and stratified by gender and age. To diagnose frailty, we used the scale proposed by the Cardiovascular Health Study, which consisted of the following items: low gait speed, grip strength reduction, feeling of exhaustion, low physical activity and weight loss. The data were collected between 2009 and 2010, and the frailty prevalence was calculated as the proportion of individuals who scored positive for three or more of the five items listed above. To verify the association between frailty and risk factors, we applied a logistic regression analysis. RESULTS: The prevalence of frailty syndrome was 9.1% (95% confidence interval [CI], 7.3-11.3; 43.6% (95% CI, 40.3-47 of the individuals were considered robust, and 47.3% (95% CI 43.8-50.8 were considered pre-frail (p<0.001. The frail individuals tended to be older (odds ratio [OR] 13.2, 95% CI, 8.7-20 and have lower education levels (OR 2.1, 95% CI, 1-4.6, lower cognitive performance (OR 0.76, 95% CI, 0.73-0.79 and reduced health perception (OR 65.8, 95% CI, 39.1-110.8. Frail individuals also had a greater number of comorbidities (OR 6.6, 95% CI, 4.4-9.9 and worse functional capacity (OR 3.8, 95% CI, 2.9-5. CONCLUSION: The prevalence of frailty was similar to that seen in other international studies and was

  6. Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ Study.

    Science.gov (United States)

    Moreira, Virgílio Garcia; Lourenço, Roberto Alves

    2013-07-01

    Frailty syndrome can be defined as a state of vulnerability to stressors resulting from a decrease in functional reserve across multiple systems and compromising an individual's capacity to maintain homeostasis. The purpose of this study was to determine the prevalence of frailty and its association with social and demographic factors, functional capacity, cognitive status and self-reported comorbidities in a sample of community-dwelling older individuals who are clients of a healthcare plan. We evaluated 847 individuals aged 65 years or older who lived in the northern area of the city of Rio de Janeiro, Brazil. The subjects were selected by inverse random sampling and stratified by gender and age. To diagnose frailty, we used the scale proposed by the Cardiovascular Health Study, which consisted of the following items: low gait speed, grip strength reduction, feeling of exhaustion, low physical activity and weight loss. The data were collected between 2009 and 2010, and the frailty prevalence was calculated as the proportion of individuals who scored positive for three or more of the five items listed above. To verify the association between frailty and risk factors, we applied a logistic regression analysis. The prevalence of frailty syndrome was 9.1% (95% confidence interval [CI], 7.3-11.3); 43.6% (95% CI, 40.3-47) of the individuals were considered robust, and 47.3% (95% CI 43.8-50.8) were considered pre-frail (p<0.001). The frail individuals tended to be older (odds ratio [OR] 13.2, 95% CI, 8.7-20) and have lower education levels (OR 2.1, 95% CI, 1-4.6), lower cognitive performance (OR 0.76, 95% CI, 0.73-0.79) and reduced health perception (OR 65.8, 95% CI, 39.1-110.8). Frail individuals also had a greater number of comorbidities (OR 6.6, 95% CI, 4.4-9.9) and worse functional capacity (OR 3.8, 95% CI, 2.9-5). The prevalence of frailty was similar to that seen in other international studies and was significantly associated with educational level, cognition

  7. Using Spline Regression in Semi-Parametric Stochastic Frontier Analysis: An Application to Polish Dairy Farms

    DEFF Research Database (Denmark)

    Czekaj, Tomasz Gerard; Henningsen, Arne

    -parametric regression based on kernel estimators. This approach combines the virtues of the DEA and the SFA, while avoiding their drawbacks: it avoids the specification of a functional form and at the same time accounts for statistical noise. More recently, this approach was used by Henderson and Simar (2005...... is criticised, because it cannot account for statistical noise such as random production shocks and measurement errors, which are inherent in more or less all production data sets. In contrast, the SFA is criticised, because it requires the specification of a functional form, which involves the risk......), Kumbhakar et al. (2007), and Henningsen and Kumbhakar (2009). The aim of this paper and its main contribution to the existing literature is the estimation semi-parametric stochastic frontier models using a different non-parametric estimation technique: spline regression (Ma et al. 2011). We apply...

  8. Health Care Expenditure and GDP in African Countries: Evidence from Semiparametric Estimation with Panel Data

    Directory of Open Access Journals (Sweden)

    Zhike Lv

    2014-01-01

    Full Text Available A large body of literature studies on the relationship between health care expenditure (HCE and GDP have been analyzed using data intensively from developed countries, but little is known for other regions. This paper considers a semiparametric panel data analysis for the study of the relationship between per capita HCE and per capita GDP for 42 African countries over the period 1995–2009. We found that infant mortality rate per 1,000 live births has a negative effect on per capita HCE, while the proportion of the population aged 65 is statistically insignificant in African countries. Furthermore, we found that the income elasticity is not constant but varies with income level, and health care is a necessity rather than a luxury for African countries.

  9. truncSP: An R Package for Estimation of Semi-Parametric Truncated Linear Regression Models

    Directory of Open Access Journals (Sweden)

    Maria Karlsson

    2014-05-01

    Full Text Available Problems with truncated data occur in many areas, complicating estimation and inference. Regarding linear regression models, the ordinary least squares estimator is inconsistent and biased for these types of data and is therefore unsuitable for use. Alternative estimators, designed for the estimation of truncated regression models, have been developed. This paper presents the R package truncSP. The package contains functions for the estimation of semi-parametric truncated linear regression models using three different estimators: the symmetrically trimmed least squares, quadratic mode, and left truncated estimators, all of which have been shown to have good asymptotic and ?nite sample properties. The package also provides functions for the analysis of the estimated models. Data from the environmental sciences are used to illustrate the functions in the package.

  10. Systematic error mitigation in multi-GNSS positioning based on semiparametric estimation

    Science.gov (United States)

    Yu, Wenkun; Ding, Xiaoli; Dai, Wujiao; Chen, Wu

    2017-12-01

    Joint use of observations from multiple global navigation satellite systems (GNSS) is advantageous in high-accuracy positioning. However, systematic errors in the observations can significantly impact on the positioning accuracy if such errors cannot be properly mitigated. The errors can distort least squares estimations and also affect the results of variance component estimation that is frequently used to determine the stochastic model when observations from multiple GNSS are used. We present an approach that is based on the concept of semiparametric estimation for mitigating the effects of the systematic errors. Experimental results based on both simulated and real GNSS datasets show that the approach is effective, especially when applied before carrying out variance component estimation.

  11. Predicting Clustered Dental Implant Survival Using Frailty Methods

    OpenAIRE

    Chuang, S.-K.; Cai, T.

    2006-01-01

    The purpose of this study was to predict future implant survival using information on risk factors and on the survival status of an individual’s existing implant(s). We considered a retrospective cohort study with 677 individuals having 2349 implants placed. We proposed to predict the survival probabilities using the Cox proportional hazards frailty model, with three important risk factors: smoking status, timing of placement, and implant staging. For a non-smoking individual with 2 implants ...

  12. Bayesian spatial semi-parametric modeling of HIV variation in Kenya.

    Directory of Open Access Journals (Sweden)

    Oscar Ngesa

    Full Text Available Spatial statistics has seen rapid application in many fields, especially epidemiology and public health. Many studies, nonetheless, make limited use of the geographical location information and also usually assume that the covariates, which are related to the response variable, have linear effects. We develop a Bayesian semi-parametric regression model for HIV prevalence data. Model estimation and inference is based on fully Bayesian approach via Markov Chain Monte Carlo (McMC. The model is applied to HIV prevalence data among men in Kenya, derived from the Kenya AIDS indicator survey, with n = 3,662. Past studies have concluded that HIV infection has a nonlinear association with age. In this study a smooth function based on penalized regression splines is used to estimate this nonlinear effect. Other covariates were assumed to have a linear effect. Spatial references to the counties were modeled as both structured and unstructured spatial effects. We observe that circumcision reduces the risk of HIV infection. The results also indicate that men in the urban areas were more likely to be infected by HIV as compared to their rural counterpart. Men with higher education had the lowest risk of HIV infection. A nonlinear relationship between HIV infection and age was established. Risk of HIV infection increases with age up to the age of 40 then declines with increase in age. Men who had STI in the last 12 months were more likely to be infected with HIV. Also men who had ever used a condom were found to have higher likelihood to be infected by HIV. A significant spatial variation of HIV infection in Kenya was also established. The study shows the practicality and flexibility of Bayesian semi-parametric regression model in analyzing epidemiological data.

  13. Low Urinary Creatinine Excretion Is Associated With Self-Reported Frailty in Patients With Advanced Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Harmke A. Polinder-Bos

    2017-07-01

    Discussion: Lower kidney function is a strong correlate of low UCrE and self-reported frailty, and the individual frailty components are associated with low UCrE as well, independent of comorbidities.

  14. Frailty in Older Adults: A Nationally Representative Profile in the United States.

    Science.gov (United States)

    Bandeen-Roche, Karen; Seplaki, Christopher L; Huang, Jin; Buta, Brian; Kalyani, Rita R; Varadhan, Ravi; Xue, Qian-Li; Walston, Jeremy D; Kasper, Judith D

    2015-11-01

    Frailty assessment provides a means of identifying older adults most vulnerable to adverse outcomes. Attention to frailty in clinical practice is more likely with better understanding of its prevalence and associations with patient characteristics. We sought to provide national estimates of frailty in older people. A popular, validated frailty phenotype proposed by Fried and colleagues was applied to 7,439 participants in the 2011 baseline of the National Health and Aging Trends Study, a national longitudinal study of persons aged 65 and older. All measures drew on a 2-hour in-person interview. Weighted estimates of frailty prevalence were obtained. Fifteen percent (95% CI: 14%, 16%) of the older non-nursing home population is frail, and 45% is prefrail (95% CI: 44%, 47%). Frailty is more prevalent at older ages, among women, racial and ethnic minorities, those in supportive residential settings, and persons of lower income. Independently of these characteristics, frailty prevalence varies substantially across geographic regions. Chronic disease and disability prevalence increase steeply with frailty. Among the frail, 42% were hospitalized in the previous year, compared to 22% of the prefrail and 11% of persons considered robust. Hip, back, and heart surgery in the last year were associated with frailty. Over half of frail persons had a fall in the previous year. Our findings support the importance of frailty in late-life health etiology and potential value of frailty as a marker of risk for adverse health outcomes and as a means of identifying opportunities for intervention in clinical practice and public health policy. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Incorporating Persistent Pain in Phenotypic Frailty Measurement and Prediction of Adverse Health Outcomes.

    Science.gov (United States)

    Lohman, Matthew C; Whiteman, Karen L; Greenberg, Rebecca L; Bruce, Martha L

    2017-02-01

    Frailty, a syndrome of physiological deficits, is prevalent among older adults and predicts elevated risk of adverse health outcomes. Although persistent pain predicts similar risk, it is seldom considered in frailty measurement. This article evaluated the construct and predictive validity of including persistent pain in phenotypic frailty measurement. Frailty and persistent pain were operationalized using data from the Health and Retirement Study (2006-2012 waves). Among a subset of adults aged 65 and older (n = 3,652), we used latent class analysis to categorize frailty status and to evaluate construct validity. Using Cox proportional hazards models, we compared time to incident adverse outcomes (death, fall, hospitalization, institutionalization, and functional disability) between frailty classes determined by either including or excluding persistent pain as a frailty component. In latent class models, persistent pain occurred with other frailty components in patterns consistent with a medical syndrome. Frail and intermediately frail classes determined by including persistent pain were more strongly associated with all adverse outcomes compared with frail and intermediately frail classes determined excluding persistent pain. Frail respondents had significantly greater risk of death compared with nonfrail respondents when frailty models included rather than excluded persistent pain (respectively, hazard ratio [HR] = 3.87, 95% confidence interval [CI] = 2.99-5.00 (including pain); HR = 2.10, 95% CI = 1.71-2.59 (excluding pain). Findings support consideration of persistent pain as a component of the frailty phenotype. Persistent pain assessment may provide an expedient method to enhance frailty measurement and improve prediction of adverse outcomes. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. Low Urinary Creatinine Excretion Is Associated With Self-Reported Frailty in Patients With Advanced Chronic Kidney Disease

    NARCIS (Netherlands)

    Polinder-Bos, Harmke A; Nacak, Hakan; Dekker, Friedo W; Bakker, Stephan J L; Gaillard, Carlo A J M; Gansevoort, Ron T

    Introduction: Frailty and muscle wasting, a component of frailty, are common in advanced stage chronic kidney disease (CKD). Whether frailty is associated with low urinary creatinine excretion (UCrE) as a measure of muscle mass in this population is unknown. Furthermore, reference values of UCrE are

  17. Density prediction and dimensionality reduction of mid-term electricity demand in China: A new semiparametric-based additive model

    International Nuclear Information System (INIS)

    Shao, Zhen; Yang, Shan-Lin; Gao, Fei

    2014-01-01

    Highlights: • A new stationary time series smoothing-based semiparametric model is established. • A novel semiparametric additive model based on piecewise smooth is proposed. • We model the uncertainty of data distribution for mid-term electricity forecasting. • We provide efficient long horizon simulation and extraction for external variables. • We provide stable and accurate density predictions for mid-term electricity demand. - Abstract: Accurate mid-term electricity demand forecasting is critical for efficient electric planning, budgeting and operating decisions. Mid-term electricity demand forecasting is notoriously complicated, since the demand is subject to a range of external drivers, such as climate change, economic development, which will exhibit monthly, seasonal, and annual complex variations. Conventional models are based on the assumption that original data is stable and normally distributed, which is generally insignificant in explaining actual demand pattern. This paper proposes a new semiparametric additive model that, in addition to considering the uncertainty of the data distribution, includes practical discussions covering the applications of the external variables. To effectively detach the multi-dimensional volatility of mid-term demand, a novel piecewise smooth method which allows reduction of the data dimensionality is developed. Besides, a semi-parametric procedure that makes use of bootstrap algorithm for density forecast and model estimation is presented. Two typical cases in China are presented to verify the effectiveness of the proposed methodology. The results suggest that both meteorological and economic variables play a critical role in mid-term electricity consumption prediction in China, while the extracted economic factor is adequate to reveal the potentially complex relationship between electricity consumption and economic fluctuation. Overall, the proposed model can be easily applied to mid-term demand forecasting, and

  18. Online Semiparametric Identification of Lithium-Ion Batteries Using the Wavelet-Based Partially Linear Battery Model

    Directory of Open Access Journals (Sweden)

    Caiping Zhang

    2013-05-01

    Full Text Available Battery model identification is very important for reliable battery management as well as for battery system design process. The common problem in identifying battery models is how to determine the most appropriate mathematical model structure and parameterized coefficients based on the measured terminal voltage and current. This paper proposes a novel semiparametric approach using the wavelet-based partially linear battery model (PLBM and a recursive penalized wavelet estimator for online battery model identification. Three main contributions are presented. First, the semiparametric PLBM is proposed to simulate the battery dynamics. Compared with conventional electrical models of a battery, the proposed PLBM is equipped with a semiparametric partially linear structure, which includes a parametric part (involving the linear equivalent circuit parameters and a nonparametric part [involving the open-circuit voltage (OCV]. Thus, even with little prior knowledge about the OCV, the PLBM can be identified using a semiparametric identification framework. Second, we model the nonparametric part of the PLBM using the truncated wavelet multiresolution analysis (MRA expansion, which leads to a parsimonious model structure that is highly desirable for model identification; using this model, the PLBM could be represented in a linear-in-parameter manner. Finally, to exploit the sparsity of the wavelet MRA representation and allow for online implementation, a penalized wavelet estimator that uses a modified online cyclic coordinate descent algorithm is proposed to identify the PLBM in a recursive fashion. The simulation and experimental results demonstrate that the proposed PLBM with the corresponding identification algorithm can accurately simulate the dynamic behavior of a lithium-ion battery in the Federal Urban Driving Schedule tests.

  19. Relationship Between Physical Frailty and Low-Grade Inflammation in Late-Life Depression

    NARCIS (Netherlands)

    Arts, M.H.; Collard, R.M.; Comijs, H.C.; Naude, P.J.; Risselada, R.; Naarding, P.; Oude Voshaar, R.C.

    2015-01-01

    OBJECTIVES: To determine whether physical frailty is associated with low-grade inflammation in older adults with depression, because late-life depression is associated with physical frailty and low-grade inflammation. DESIGN: Baseline data of a cohort study. SETTING: Primary care and specialized

  20. Relationship Between Physical Frailty and Low-Grade Inflammation in Late-Life Depression

    NARCIS (Netherlands)

    Arts, Matheus H. L.; Collard, Rose M.; Comijs, Hannie C.; Naude, Petrus J. W.; Risselada, Roelof; Naarding, Paul; Oude Voshaar, Richard

    ObjectivesTo determine whether physical frailty is associated with low-grade inflammation in older adults with depression, because late-life depression is associated with physical frailty and low-grade inflammation. DesignBaseline data of a cohort study. SettingPrimary care and specialized mental

  1. Relationship between physical frailty and low-grade inflammation in late-life depression

    NARCIS (Netherlands)

    Arts, M.H.; Collard, R.M.; Comijs, H.C.; Naude, P.J.; Risselada, R.; Naarding, P.; Oude Voshaar, R.C.

    2015-01-01

    Objectives To determine whether physical frailty is associated with low-grade inflammation in older adults with depression, because late-life depression is associated with physical frailty and low-grade inflammation. Design Baseline data of a cohort study. Setting Primary care and specialized mental

  2. Physical Frailty, Cognitive Impairment, and the Risk of Neurocognitive Disorder in the Singapore Longitudinal Ageing Studies.

    Science.gov (United States)

    Feng, Liang; Nyunt, Ma Shwe Zin; Gao, Qi; Feng, Lei; Lee, Tih Shih; Tsoi, Tung; Chong, Mei Sian; Lim, Wee Shiong; Collinson, Simon; Yap, Philip; Yap, Keng Bee; Ng, Tze Pin

    2017-03-01

    The independent and combined effects of physical and cognitive domains of frailty in predicting the development of mild cognitive impairment (MCI) or dementia are not firmly established. This study included cross-sectional and longitudinal analyses of physical frailty (Cardiovascular Health Study criteria), cognitive impairment (Mini-Mental State Examination [MMSE]), and neurocognitive disorder (DSM-5 criteria) among 1,575 community-living Chinese older adults from the Singapore Longitudinal Ageing Studies. At baseline, 2% were frail, 32% were prefrail, and 9% had cognitive impairment (MMSE score impairment. Physical frailty categories were not significantly associated with incident NCD, but continuous physical frailty score and MMSE score showed significant individual and joint associations with incident mild NCD and dementia. Compared with those who were robust and cognitively normal, prefrail or frail old adults without cognitive impairment had no increased risk of incident NCD, but elevated odds of association with incident NCD were observed for robust with cognitive impairment (odds ratio [OR] = 4.04, p impairment (OR = 2.22, p = .044), and especially for frail with cognitive impairment (OR = 6.37, p = .005). The prevalence of co-existing frailty and cognitive impairment (cognitive frailty) was 1% (95% confidence interval [CI]: 0.5-1.4), but was higher among participants aged 75 and older at 5.0% (95% CI: 1.8-8.1). Physical frailty is associated with increased prevalence and incidence of cognitive impairment, and co-existing physical frailty and cognitive impairment confers additionally greater risk of incident NCD.

  3. [Validity of the "Kaigo-Yobo Check-List" as a frailty index].

    Science.gov (United States)

    Shinkai, Shoji; Watanabe, Naoki; Yoshida, Hiroto; Fujiwara, Yoshinori; Nishi, Mariko; Fukaya, Taro; Lee, Sangyoon; Kim, Mi-Ji; Ogawa, Kishiko; Murayama, Hiroshi; Taniguchi, Yu; Shimizu, Yumiko

    2013-05-01

    A frailty index for Japanese older people is not yet available. This study examined the validity of "Kaigo-Yobo Check-List" (CL) as a frailty index. The study site was Kusatsu town, Gunma prefecture. Out of 612 older persons aged 65 years and over who undertook a comprehensive geriatric assessment in 2007, results from 526 who had no missing data were used to examine the cross-sectional relationship between frailty as defined by Fried's criteria (= external criteria) and CL scores in order to evaluate concurrent and construct validity. Further, 916 older individuals aged 70 years and over who responded to the baseline survey in 2001 were followed for the subsequent 4 years and 4 months regarding the onset of ADL disability, service use under the Long Term Care Insurance program, and mortality. We examined the predictive validity of the CL for such adverse outcomes after adjustment for gender, age, and comorbidity. The CL (cut-off point = 3/4) discriminated frailty from non-frailty at the sensitivity of 70.0% and specificity of 89.3%. The higher the CL score, the higher the prevalence of frailty; the trend was highly significant (P Check-List" showed good concurrent and predictive validity as a frailty index. Since it comprises 15 easy-to-answer questions, it could be widely used for research on frailty and its preventive intervention.

  4. Oral health care behavior and frailty-related factors in a care-dependent older population.

    NARCIS (Netherlands)

    Niesten, D.J.M.; Witter, D.J.; Bronkhorst, E.M.; Creugers, N.H.J.

    2017-01-01

    OBJECTIVES: To assess, in older people with different levels of care-dependency 1) which frailty- and non-frailty related predisposing, enabling and need factors are associated with a) dental service use (DSU) frequency, b) changed DSU after the onset of care-dependency, c) brushing frequency, and

  5. The association between nutritional status and frailty characteristics among geriatric outpatients.

    Science.gov (United States)

    Kurkcu, M; Meijer, R I; Lonterman, S; Muller, M; de van der Schueren, M A E

    2018-02-01

    Frailty is a common clinical syndrome in older adults and is associated with an increased risk of poor health outcomes, e.g. falls, disability, hospitalization, and mortality. Nutritional status might be an important factor contributing to frailty. This study aims to describe the association between nutritional status and characteristics of frailty in patients attending a geriatric outpatient clinic. Clinical data was collected of 475 patients who visited the geriatric outpatient department of a Dutch hospital between 2005 and 2010. Frailty was determined by: incontinence, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Geriatric Depression Scale (GDS) and Mini Mental State Exam (MMSE). Nutritional status was represented by the Mini Nutritional Assessment (MNA) and plasma concentrations of several micronutrients, whereby MNAnutritional status could prove usefulness in early clinical detection and prevention of frailty. Copyright © 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  6. Relationship between Sensory Perception and Frailty in a Community-Dwelling Elderly Population.

    Science.gov (United States)

    Somekawa, S; Mine, T; Ono, K; Hayashi, N; Obuchi, S; Yoshida, H; Kawai, H; Fujiwara, Y; Hirano, H; Kojima, M; Ihara, K; Kim, H

    2017-01-01

    Aging anorexia, defined as loss of appetite and/or reduced food intake, has been postulated as a risk factor for frailty. Impairments of taste and smell perception in elderly people can lead to reduced enjoyment of food and contribute to the anorexia of aging. To evaluate the relationship between frailty and taste and smell perception in elderly people living in urban areas. Data from the baseline evaluation of 768 residents aged ≥ 65 years who enrolled in a comprehensive geriatric health examination survey was analyzed. Fourteen out of 29-items of Appetite, Hunger, Sensory Perception questionnaire (AHSP), frailty, age, sex, BMI, chronic conditions and IADL were evaluated. AHSP was analyzed as the total score of 8 taste items (T) and 6 smell items (S). Frailty was diagnosed using a modified Fried's frailty criteria. The area under the receiver operator curves for detection of frailty demonstrated that T (0.715) had moderate accuracy, but S (0.657) had low accuracy. The cutoffs, sensitivity, specificity and Youden Index (YI) values for each perception were T: Cutoff 26.5 (YI: 0.350, sensitivity: 0.639, specificity: 0.711) and S: Cutoff 18.5 (YI: 0.246, sensitivity: 0.690, specificity: 0.556). Results from multiple logistic regression models, after adjusting for age, sex, IADL and chronic conditions showed that participants under the T cutoff were associated with exhaustion and those below the S cutoff were associated with slow walking speed. The adjusted logistic models for age, sex, IADL and chronic conditions showed significant association between T and frailty (OR 2.81, 95% CI 1.29-6.12), but not between S and frailty (OR 1.73, 95% CI 0.83-3.63). Taste and smell perception, particularly taste perception, were associated with a greater risk of frailty in community-dwelling elderly people. These results suggest that lower taste and smell perception may be an indicator of frailty in old age.

  7. Association between employee benefits and frailty in community-dwelling older adults.

    Science.gov (United States)

    Avila-Funes, José Alberto; Paniagua-Santos, Diana Leticia; Escobar-Rivera, Vicente; Navarrete-Reyes, Ana Patricia; Aguilar-Navarro, Sara; Amieva, Hélène

    2016-05-01

    The phenotype of frailty has been associated with an increased vulnerability for the development of adverse health-related outcomes. The origin of frailty is multifactorial and financial issues could be implicated, as they have been associated with health status, well-being and mortality. However, the association between economic benefits and frailty has been poorly explored. Therefore, the objective was to determine the association between employee benefits and frailty. A cross-sectional study of 927 community-dwelling older adults aged 70 years and older participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty was carried out. Employee benefits were established according to eight characteristics: bonus, profit sharing, pension, health insurance, food stamps, housing credit, life insurance, and Christmas bonus. Frailty was defined according to a slightly modified version of the phenotype proposed by Fried et al. Multinomial logistic regression models were run to determine the association between employee benefits and frailty adjusting by sociodemographic and health covariates. The prevalence of frailty was 14.1%, and 4.4% of participants rated their health status as "poor." Multinomial logistic regression analyses showed that employee benefits were statistically and independently associated with the frail subgroup (OR 0.85; 95% CI 0.74-0.98; P = 0.027) even after adjusting for potential confounders. Fewer employee benefits are associated with frailty. Supporting spreading employee benefits for older people could have a positive impact on the development of frailty and its consequences. Geriatr Gerontol Int 2016; 16: 606-611. © 2015 Japan Geriatrics Society.

  8. Stakeholders' views and experiences of care and interventions for addressing frailty and pre-frailty: A meta-synthesis of qualitative evidence.

    Directory of Open Access Journals (Sweden)

    Barbara D'Avanzo

    Full Text Available Frailty is a common condition in older age and is a public health concern which requires integrated care and involves different stakeholders. This meta-synthesis focuses on experiences, understanding, and attitudes towards screening, care, intervention and prevention for frailty across frail and healthy older persons, caregivers, health and social care practitioners. Studies published since 2001 were identified through search of electronic databases; 81 eligible papers were identified and read in full, and 45 papers were finally included and synthesized. The synthesis was conducted with a meta-ethnographic approach. We identified four key themes: Uncertainty about malleability of frailty; Strategies to prevent or to respond to frailty; Capacity to care and person and family-centred service provision; Power and choice. A bottom-up approach which emphasises and works in synchrony with frail older people's and their families' values, goals, resources and optimisation strategies is necessary. A greater employment of psychological skills, enhancing communication abilities and tools to overcome disempowering attitudes should inform care organisation, resulting in more efficient and satisfactory use of services. Public health communication about prevention and management of frailty should be founded on a paradigm of resilience, balanced acceptance, and coping. Addressing stakeholders' views about the preventability of frailty was seen as a salient need.

  9. Stakeholders’ views and experiences of care and interventions for addressing frailty and pre-frailty: A meta-synthesis of qualitative evidence

    Science.gov (United States)

    Shaw, Rachel; Riva, Silvia; Apostolo, Joao; Bobrowicz-Campos, Elzbieta; Kurpas, Donata; Bujnowska, Maria; Holland, Carol

    2017-01-01

    Frailty is a common condition in older age and is a public health concern which requires integrated care and involves different stakeholders. This meta-synthesis focuses on experiences, understanding, and attitudes towards screening, care, intervention and prevention for frailty across frail and healthy older persons, caregivers, health and social care practitioners. Studies published since 2001 were identified through search of electronic databases; 81 eligible papers were identified and read in full, and 45 papers were finally included and synthesized. The synthesis was conducted with a meta-ethnographic approach. We identified four key themes: Uncertainty about malleability of frailty; Strategies to prevent or to respond to frailty; Capacity to care and person and family-centred service provision; Power and choice. A bottom-up approach which emphasises and works in synchrony with frail older people's and their families' values, goals, resources and optimisation strategies is necessary. A greater employment of psychological skills, enhancing communication abilities and tools to overcome disempowering attitudes should inform care organisation, resulting in more efficient and satisfactory use of services. Public health communication about prevention and management of frailty should be founded on a paradigm of resilience, balanced acceptance, and coping. Addressing stakeholders’ views about the preventability of frailty was seen as a salient need. PMID:28723916

  10. Schizophrenia susceptibility and age of diagnosis--a frailty approach.

    Science.gov (United States)

    Svensson, Elisabeth; Rogvin, Maria; Hultman, Christina M; Reichborn-Kjennerud, Ted; Sandin, Sven; Moger, Tron A

    2013-06-01

    Using a frailty model approach, we aim to evaluate the effect of early-life risk factors on susceptibility and age at diagnosis of schizophrenia. We assume paternal age and familial schizophrenia influence the susceptibility, while these and several early risk factors influence the age of diagnosis. Schizophrenia incidence data were derived from the population-based Swedish Patient Registry; including individuals aged 18 to 45 years, diagnosed between 1974 and 2008. Data were analyzed by a frailty model, a random effects model in survival analysis, using a compound Poisson model. 15,340 incident schizophrenia cases were included. For individuals without familial schizophrenia, a protective effect was seen across most ages of diagnosis for females, low paternal age, born in rural areas, and being born in later cohorts. For individuals with familial schizophrenia, a protective effect is found for females diagnosed between ages 18 and 30 years, corresponding values were 18-25 years for low paternal age. Being born in rural areas and in the last birth cohort was protective for all. The estimated proportion of susceptible was 5% for those without familial schizophrenia and 18% for individuals with familial schizophrenia. There was no statistically significant effect of paternal age on the proportion of susceptible. To our knowledge, this is the first regression modeling of time to schizophrenia diagnosis allowing for a non-susceptible fraction of the population, including age dependent modeling of covariate effects and an interaction. Applying frailty model to schizophrenia provide etiological clues, elucidating patterns of susceptibility and age-at-diagnosis for which early-life factors are of importance. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. Frailty in the elderly: prevalence and associated factors.

    Science.gov (United States)

    Carneiro, Jair Almeida; Cardoso, Rafael Rodrigues; Durães, Meiriellen Silva; Guedes, Maria Clara Araújo; Santos, Frederico Leão; Costa, Fernanda Marques da; Caldeira, Antônio Prates

    2017-01-01

    to know the prevalence and factors associated with frailty in elderly assisted by the Centro Mais Vida de Referência em Assistência à Saúde do Idoso (Mais Vida Health Reference Center for the Elderly) in the North of Minas Gerais, Brazil. cross-sectional study, with sampling by convenience. Data collection occurred in 2015. Demographic and socioeconomic variables, morbidities, use of health services and the score of the Edmonton Frail Scale were analyzed. The adjusted prevalence ratios were obtained by multiple analysis of Poisson regression with robust variance. 360 elderly aged 65 or older were evaluated. Frailty prevalence was 47.2%. The variables associated with frailty were the following: advanced age elderly, who live without a partner, have a caregiver, present depressive symptoms, osteoarticular disease, as well as history of hospitalization and falls in the last twelve months. knowledge of factors associated with frailty allows development of health actions aimed at the elderly. conhecer a prevalência e fatores associados à fragilidade em idosos assistidos pelo Centro Mais Vida de Referência em Assistência à Saúde do Idoso ao norte de Minas Gerais, Brasil. estudo transversal, com amostragem por conveniência. A coleta de dados ocorreu em 2015. Analisaram-se variáveis demográficas e socioeconômicas, morbidades, utilização de serviços de saúde e o escore da Escala de Fragilidade de Edmonton. As razões de prevalências ajustadas foram obtidas por análise múltipla de regressão de Poisson com variância robusta. foram avaliados 360 idosos com idade igual ou superior a 65 anos. A prevalência de fragilidade foi 47,2%. As variáveis associadas à fragilidade foram: idosos longevos, que vivem sem companheiro(a), possuem cuidador, apresentam sintomas depressivos, doença osteoarticular, bem como história de internação e de quedas nos últimos 12 meses. o conhecimento dos fatores associados à fragilidade permite que ações de sa

  12. Relation between temperature and suicide mortality in Japan in the presence of other confounding factors using time-series analysis with a semiparametric approach.

    Science.gov (United States)

    Likhvar, Victoria; Honda, Yasushi; Ono, Masaji

    2011-01-01

    The objective of this study was to assess the relation between temperature and suicide mortality in Japan using time series analysis with a semiparametric approach. We analyzed the relation between daily fluctuations in suicide mortality and maximum temperatures for all regions in Japan over the period of time from 1972 to 1995 using a generalized additive model. The model controls for the time trend, season, selected meteorological parameters, day of the week, and holiday. Adjustment was based using penalized splines and the decision on the amount of smoothness was based on minimizing the unbiased risk estimation criterion. The results show that suicide mortality in Japan has a seasonal character and it varies from year to year, with the highest occurrence in April, as well as in the first part of the week, especially on Mondays and Tuesdays. As for the day of the week, there were only few suicide cases on Saturdays and holidays. We found that for all regions in Japan when temperature increased the suicide mortality increased on the same day (lag = 0). Analysis by method of suicide showed that when temperature increased mortality significantly increased only for suicide by a violent method. The pattern of the relation for other methods remained unclear. This study suggests that an increase in temperature has a short-term effect on suicide mortality in Japan.

  13. Prevalence of frailty and its associated factors in older hospitalised patients in Vietnam.

    Science.gov (United States)

    Vu, Huyen Thi Thanh; Nguyen, Thanh Xuan; Nguyen, Tu N; Nguyen, Anh Trung; Cumming, Robert; Hilmer, Sarah; Pham, Thang

    2017-09-15

    Frailty is an emerging issue in geriatrics and gerontology. The prevalence of frailty is increasing as the population ages. Like many developing countries, Vietnam has a rapidly ageing population. However, there have been no studies about frailty in older people in Vietnam. This study aims to investigate the prevalence of frailty and its associated factors in older hospitalised patients at the National Geriatric Hospital in Hanoi, Vietnam. Prospective observational study in inpatients aged ≥60 years at the National Geriatric Hospital in Hanoi, Vietnam from 4/2015 to 10/2015. Frailty was assessed using the Reported Edmonton Frail Scale (REFS) and Fried frailty phenotype. A total of 461 patients were recruited (56.8% female, mean age 76.2 ± 8.9 years). The prevalence of frailty was 31.9% according to the REFS. Using the Fried frailty criteria, the percentages of non-frail, pre-frail and frail participants were 24.5, 40.1 and 35.4%, respectively. Factors associated with frailty defined by REFS were age (OR 1.05 per year, 95% CI 1.03-1.08), poor reported nutritional status (OR 4.51, 95% CI 2.15-9.44), and not finishing high school (OR 2.18, 95% CI 1.37-3.46). Factors associated with frailty defined by the Fried frailty criteria included age (OR 1.07 per year, 95% CI 1.05-1.10), poor reported nutritional status (OR 2.96, 95%CI 1.43-6.11), not finishing high school (OR 1.58, 95% CI 1.01-2.46) and cardiovascular disease (OR 1.76, 95% CI 1.16-2.67). While further studies are needed to examine the impact of frailty on outcomes in Vietnam, the observed high prevalence of frailty in older inpatients is likely to have implications for health policy and planning for the ageing population in Vietnam.

  14. Semiparametric accelerated failure time cure rate mixture models with competing risks.

    Science.gov (United States)

    Choi, Sangbum; Zhu, Liang; Huang, Xuelin

    2018-01-15

    Modern medical treatments have substantially improved survival rates for many chronic diseases and have generated considerable interest in developing cure fraction models for survival data with a non-ignorable cured proportion. Statistical analysis of such data may be further complicated by competing risks that involve multiple types of endpoints. Regression analysis of competing risks is typically undertaken via a proportional hazards model adapted on cause-specific hazard or subdistribution hazard. In this article, we propose an alternative approach that treats competing events as distinct outcomes in a mixture. We consider semiparametric accelerated failure time models for the cause-conditional survival function that are combined through a multinomial logistic model within the cure-mixture modeling framework. The cure-mixture approach to competing risks provides a means to determine the overall effect of a treatment and insights into how this treatment modifies the components of the mixture in the presence of a cure fraction. The regression and nonparametric parameters are estimated by a nonparametric kernel-based maximum likelihood estimation method. Variance estimation is achieved through resampling methods for the kernel-smoothed likelihood function. Simulation studies show that the procedures work well in practical settings. Application to a sarcoma study demonstrates the use of the proposed method for competing risk data with a cure fraction. Copyright © 2017 John Wiley & Sons, Ltd.

  15. Testing for constant nonparametric effects in general semiparametric regression models with interactions

    KAUST Repository

    Wei, Jiawei

    2011-07-01

    We consider the problem of testing for a constant nonparametric effect in a general semi-parametric regression model when there is the potential for interaction between the parametrically and nonparametrically modeled variables. The work was originally motivated by a unique testing problem in genetic epidemiology (Chatterjee, et al., 2006) that involved a typical generalized linear model but with an additional term reminiscent of the Tukey one-degree-of-freedom formulation, and their interest was in testing for main effects of the genetic variables, while gaining statistical power by allowing for a possible interaction between genes and the environment. Later work (Maity, et al., 2009) involved the possibility of modeling the environmental variable nonparametrically, but they focused on whether there was a parametric main effect for the genetic variables. In this paper, we consider the complementary problem, where the interest is in testing for the main effect of the nonparametrically modeled environmental variable. We derive a generalized likelihood ratio test for this hypothesis, show how to implement it, and provide evidence that our method can improve statistical power when compared to standard partially linear models with main effects only. We use the method for the primary purpose of analyzing data from a case-control study of colorectal adenoma.

  16. Novel Semi-Parametric Algorithm for Interference-Immune Tunable Absorption Spectroscopy Gas Sensing

    Directory of Open Access Journals (Sweden)

    Umberto Michelucci

    2017-10-01

    Full Text Available One of the most common limits to gas sensor performance is the presence of unwanted interference fringes arising, for example, from multiple reflections between surfaces in the optical path. Additionally, since the amplitude and the frequency of these interferences depend on the distance and alignment of the optical elements, they are affected by temperature changes and mechanical disturbances, giving rise to a drift of the signal. In this work, we present a novel semi-parametric algorithm that allows the extraction of a signal, like the spectroscopic absorption line of a gas molecule, from a background containing arbitrary disturbances, without having to make any assumption on the functional form of these disturbances. The algorithm is applied first to simulated data and then to oxygen absorption measurements in the presence of strong fringes.To the best of the authors’ knowledge, the algorithm enables an unprecedented accuracy particularly if the fringes have a free spectral range and amplitude comparable to those of the signal to be detected. The described method presents the advantage of being based purely on post processing, and to be of extremely straightforward implementation if the functional form of the Fourier transform of the signal is known. Therefore, it has the potential to enable interference-immune absorption spectroscopy. Finally, its relevance goes beyond absorption spectroscopy for gas sensing, since it can be applied to any kind of spectroscopic data.

  17. Novel Semi-Parametric Algorithm for Interference-Immune Tunable Absorption Spectroscopy Gas Sensing.

    Science.gov (United States)

    Michelucci, Umberto; Venturini, Francesca

    2017-10-07

    One of the most common limits to gas sensor performance is the presence of unwanted interference fringes arising, for example, from multiple reflections between surfaces in the optical path. Additionally, since the amplitude and the frequency of these interferences depend on the distance and alignment of the optical elements, they are affected by temperature changes and mechanical disturbances, giving rise to a drift of the signal. In this work, we present a novel semi-parametric algorithm that allows the extraction of a signal, like the spectroscopic absorption line of a gas molecule, from a background containing arbitrary disturbances, without having to make any assumption on the functional form of these disturbances. The algorithm is applied first to simulated data and then to oxygen absorption measurements in the presence of strong fringes.To the best of the authors' knowledge, the algorithm enables an unprecedented accuracy particularly if the fringes have a free spectral range and amplitude comparable to those of the signal to be detected. The described method presents the advantage of being based purely on post processing, and to be of extremely straightforward implementation if the functional form of the Fourier transform of the signal is known. Therefore, it has the potential to enable interference-immune absorption spectroscopy. Finally, its relevance goes beyond absorption spectroscopy for gas sensing, since it can be applied to any kind of spectroscopic data.

  18. Modelling biochemical networks with intrinsic time delays: a hybrid semi-parametric approach

    Directory of Open Access Journals (Sweden)

    Oliveira Rui

    2010-09-01

    Full Text Available Abstract Background This paper presents a method for modelling dynamical biochemical networks with intrinsic time delays. Since the fundamental mechanisms leading to such delays are many times unknown, non conventional modelling approaches become necessary. Herein, a hybrid semi-parametric identification methodology is proposed in which discrete time series are incorporated into fundamental material balance models. This integration results in hybrid delay differential equations which can be applied to identify unknown cellular dynamics. Results The proposed hybrid modelling methodology was evaluated using two case studies. The first of these deals with dynamic modelling of transcriptional factor A in mammalian cells. The protein transport from the cytosol to the nucleus introduced a delay that was accounted for by discrete time series formulation. The second case study focused on a simple network with distributed time delays that demonstrated that the discrete time delay formalism has broad applicability to both discrete and distributed delay problems. Conclusions Significantly better prediction qualities of the novel hybrid model were obtained when compared to dynamical structures without time delays, being the more distinctive the more significant the underlying system delay is. The identification of the system delays by studies of different discrete modelling delays was enabled by the proposed structure. Further, it was shown that the hybrid discrete delay methodology is not limited to discrete delay systems. The proposed method is a powerful tool to identify time delays in ill-defined biochemical networks.

  19. A Semiparametric Bayesian Approach for Analyzing Longitudinal Data from Multiple Related Groups.

    Science.gov (United States)

    Das, Kiranmoy; Afriyie, Prince; Spirko, Lauren

    2015-11-01

    Often the biological and/or clinical experiments result in longitudinal data from multiple related groups. The analysis of such data is quite challenging due to the fact that groups might have shared information on the mean and/or covariance functions. In this article, we consider a Bayesian semiparametric approach of modeling the mean trajectories for longitudinal response coming from multiple related groups. We consider matrix stick-breaking process priors on the group mean parameters which allows information sharing on the mean trajectories across the groups. Simulation studies are performed to demonstrate the effectiveness of the proposed approach compared to the more traditional approaches. We analyze data from a one-year follow-up of nutrition education for hypercholesterolemic children with three different treatments where the children are from different age-groups. Our analysis provides more clinically useful information than the previous analysis of the same dataset. The proposed approach will be a very powerful tool for analyzing data from clinical trials and other medical experiments.

  20. Integrative genomic testing of cancer survival using semiparametric linear transformation models.

    Science.gov (United States)

    Huang, Yen-Tsung; Cai, Tianxi; Kim, Eunhee

    2016-07-20

    The wide availability of multi-dimensional genomic data has spurred increasing interests in integrating multi-platform genomic data. Integrative analysis of cancer genome landscape can potentially lead to deeper understanding of the biological process of cancer. We integrate epigenetics (DNA methylation and microRNA expression) and gene expression data in tumor genome to delineate the association between different aspects of the biological processes and brain tumor survival. To model the association, we employ a flexible semiparametric linear transformation model that incorporates both the main effects of these genomic measures as well as the possible interactions among them. We develop variance component tests to examine different coordinated effects by testing various subsets of model coefficients for the genomic markers. A Monte Carlo perturbation procedure is constructed to approximate the null distribution of the proposed test statistics. We further propose omnibus testing procedures to synthesize information from fitting various parsimonious sub-models to improve power. Simulation results suggest that our proposed testing procedures maintain proper size under the null and outperform standard score tests. We further illustrate the utility of our procedure in two genomic analyses for survival of glioblastoma multiforme patients. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  1. Semiparametric bivariate zero-inflated Poisson models with application to studies of abundance for multiple species

    Science.gov (United States)

    Arab, Ali; Holan, Scott H.; Wikle, Christopher K.; Wildhaber, Mark L.

    2012-01-01

    Ecological studies involving counts of abundance, presence–absence or occupancy rates often produce data having a substantial proportion of zeros. Furthermore, these types of processes are typically multivariate and only adequately described by complex nonlinear relationships involving externally measured covariates. Ignoring these aspects of the data and implementing standard approaches can lead to models that fail to provide adequate scientific understanding of the underlying ecological processes, possibly resulting in a loss of inferential power. One method of dealing with data having excess zeros is to consider the class of univariate zero-inflated generalized linear models. However, this class of models fails to address the multivariate and nonlinear aspects associated with the data usually encountered in practice. Therefore, we propose a semiparametric bivariate zero-inflated Poisson model that takes into account both of these data attributes. The general modeling framework is hierarchical Bayes and is suitable for a broad range of applications. We demonstrate the effectiveness of our model through a motivating example on modeling catch per unit area for multiple species using data from the Missouri River Benthic Fishes Study, implemented by the United States Geological Survey.

  2. Nonlinear multiple imputation for continuous covariate within semiparametric Cox model: application to HIV data in Senegal.

    Science.gov (United States)

    Mbougua, Jules Brice Tchatchueng; Laurent, Christian; Ndoye, Ibra; Delaporte, Eric; Gwet, Henri; Molinari, Nicolas

    2013-11-20

    Multiple imputation is commonly used to impute missing covariate in Cox semiparametric regression setting. It is to fill each missing data with more plausible values, via a Gibbs sampling procedure, specifying an imputation model for each missing variable. This imputation method is implemented in several softwares that offer imputation models steered by the shape of the variable to be imputed, but all these imputation models make an assumption of linearity on covariates effect. However, this assumption is not often verified in practice as the covariates can have a nonlinear effect. Such a linear assumption can lead to a misleading conclusion because imputation model should be constructed to reflect the true distributional relationship between the missing values and the observed values. To estimate nonlinear effects of continuous time invariant covariates in imputation model, we propose a method based on B-splines function. To assess the performance of this method, we conducted a simulation study, where we compared the multiple imputation method using Bayesian splines imputation model with multiple imputation using Bayesian linear imputation model in survival analysis setting. We evaluated the proposed method on the motivated data set collected in HIV-infected patients enrolled in an observational cohort study in Senegal, which contains several incomplete variables. We found that our method performs well to estimate hazard ratio compared with the linear imputation methods, when data are missing completely at random, or missing at random. Copyright © 2013 John Wiley & Sons, Ltd.

  3. Kerfdr: a semi-parametric kernel-based approach to local false discovery rate estimation

    Directory of Open Access Journals (Sweden)

    Robin Stephane

    2009-03-01

    Full Text Available Abstract Background The use of current high-throughput genetic, genomic and post-genomic data leads to the simultaneous evaluation of a large number of statistical hypothesis and, at the same time, to the multiple-testing problem. As an alternative to the too conservative Family-Wise Error-Rate (FWER, the False Discovery Rate (FDR has appeared for the last ten years as more appropriate to handle this problem. However one drawback of FDR is related to a given rejection region for the considered statistics, attributing the same value to those that are close to the boundary and those that are not. As a result, the local FDR has been recently proposed to quantify the specific probability for a given null hypothesis to be true. Results In this context we present a semi-parametric approach based on kernel estimators which is applied to different high-throughput biological data such as patterns in DNA sequences, genes expression and genome-wide association studies. Conclusion The proposed method has the practical advantages, over existing approaches, to consider complex heterogeneities in the alternative hypothesis, to take into account prior information (from an expert judgment or previous studies by allowing a semi-supervised mode, and to deal with truncated distributions such as those obtained in Monte-Carlo simulations. This method has been implemented and is available through the R package kerfdr via the CRAN or at http://stat.genopole.cnrs.fr/software/kerfdr.

  4. Housing price prediction: parametric versus semi-parametric spatial hedonic models

    Science.gov (United States)

    Montero, José-María; Mínguez, Román; Fernández-Avilés, Gema

    2018-01-01

    House price prediction is a hot topic in the economic literature. House price prediction has traditionally been approached using a-spatial linear (or intrinsically linear) hedonic models. It has been shown, however, that spatial effects are inherent in house pricing. This article considers parametric and semi-parametric spatial hedonic model variants that account for spatial autocorrelation, spatial heterogeneity and (smooth and nonparametrically specified) nonlinearities using penalized splines methodology. The models are represented as a mixed model that allow for the estimation of the smoothing parameters along with the other parameters of the model. To assess the out-of-sample performance of the models, the paper uses a database containing the price and characteristics of 10,512 homes in Madrid, Spain (Q1 2010). The results obtained suggest that the nonlinear models accounting for spatial heterogeneity and flexible nonlinear relationships between some of the individual or areal characteristics of the houses and their prices are the best strategies for house price prediction.

  5. Gene Copy Number Analysis for Family Data Using Semiparametric Copula Model

    Directory of Open Access Journals (Sweden)

    Ao Yuan

    2008-01-01

    Full Text Available Gene copy number changes are common characteristics of many genetic disorders. A new technology, array comparative genomic hybridization (a-CGH, is widely used today to screen for gains and losses in cancers and other genetic diseases with high resolution at the genome level or for specific chromosomal region. Statistical methods for analyzing such a-CGH data have been developed. However, most of the existing methods are for unrelated individual data and the results from them provide explanation for horizontal variations in copy number changes. It is potentially meaningful to develop a statistical method that will allow for the analysis of family data to investigate the vertical kinship effects as well. Here we consider a semiparametric model based on clustering method in which the marginal distributions are estimated nonparametrically, and the familial dependence structure is modeled by copula. The model is illustrated and evaluated using simulated data. Our results show that the proposed method is more robust than the commonly used multivariate normal model. Finally, we demonstrated the utility of our method using a real dataset.

  6. Bayesian Semiparametric Density Deconvolution in the Presence of Conditionally Heteroscedastic Measurement Errors

    KAUST Repository

    Sarkar, Abhra

    2014-10-02

    We consider the problem of estimating the density of a random variable when precise measurements on the variable are not available, but replicated proxies contaminated with measurement error are available for sufficiently many subjects. Under the assumption of additive measurement errors this reduces to a problem of deconvolution of densities. Deconvolution methods often make restrictive and unrealistic assumptions about the density of interest and the distribution of measurement errors, e.g., normality and homoscedasticity and thus independence from the variable of interest. This article relaxes these assumptions and introduces novel Bayesian semiparametric methodology based on Dirichlet process mixture models for robust deconvolution of densities in the presence of conditionally heteroscedastic measurement errors. In particular, the models can adapt to asymmetry, heavy tails and multimodality. In simulation experiments, we show that our methods vastly outperform a recent Bayesian approach based on estimating the densities via mixtures of splines. We apply our methods to data from nutritional epidemiology. Even in the special case when the measurement errors are homoscedastic, our methodology is novel and dominates other methods that have been proposed previously. Additional simulation results, instructions on getting access to the data set and R programs implementing our methods are included as part of online supplemental materials.

  7. LOCAL INDEPENDENCE FEATURE SCREENING FOR NONPARAMETRIC AND SEMIPARAMETRIC MODELS BY MARGINAL EMPIRICAL LIKELIHOOD

    Science.gov (United States)

    Chang, Jinyuan; Tang, Cheng Yong; Wu, Yichao

    2015-01-01

    We consider an independence feature screening technique for identifying explanatory variables that locally contribute to the response variable in high-dimensional regression analysis. Without requiring a specific parametric form of the underlying data model, our approach accommodates a wide spectrum of nonparametric and semiparametric model families. To detect the local contributions of explanatory variables, our approach constructs empirical likelihood locally in conjunction with marginal nonparametric regressions. Since our approach actually requires no estimation, it is advantageous in scenarios such as the single-index models where even specification and identification of a marginal model is an issue. By automatically incorporating the level of variation of the nonparametric regression and directly assessing the strength of data evidence supporting local contribution from each explanatory variable, our approach provides a unique perspective for solving feature screening problems. Theoretical analysis shows that our approach can handle data dimensionality growing exponentially with the sample size. With extensive theoretical illustrations and numerical examples, we show that the local independence screening approach performs promisingly. PMID:27242388

  8. Bayesian semiparametric regression in the presence of conditionally heteroscedastic measurement and regression errors.

    Science.gov (United States)

    Sarkar, Abhra; Mallick, Bani K; Carroll, Raymond J

    2014-12-01

    We consider the problem of robust estimation of the regression relationship between a response and a covariate based on sample in which precise measurements on the covariate are not available but error-prone surrogates for the unobserved covariate are available for each sampled unit. Existing methods often make restrictive and unrealistic assumptions about the density of the covariate and the densities of the regression and the measurement errors, for example, normality and, for the latter two, also homoscedasticity and thus independence from the covariate. In this article we describe Bayesian semiparametric methodology based on mixtures of B-splines and mixtures induced by Dirichlet processes that relaxes these restrictive assumptions. In particular, our models for the aforementioned densities adapt to asymmetry, heavy tails and multimodality. The models for the densities of regression and measurement errors also accommodate conditional heteroscedasticity. In simulation experiments, our method vastly outperforms existing methods. We apply our method to data from nutritional epidemiology. © 2014, The International Biometric Society.

  9. Bayesian Semiparametric Density Deconvolution in the Presence of Conditionally Heteroscedastic Measurement Errors.

    Science.gov (United States)

    Sarkar, Abhra; Mallick, Bani K; Staudenmayer, John; Pati, Debdeep; Carroll, Raymond J

    2014-10-01

    We consider the problem of estimating the density of a random variable when precise measurements on the variable are not available, but replicated proxies contaminated with measurement error are available for sufficiently many subjects. Under the assumption of additive measurement errors this reduces to a problem of deconvolution of densities. Deconvolution methods often make restrictive and unrealistic assumptions about the density of interest and the distribution of measurement errors, e.g., normality and homoscedasticity and thus independence from the variable of interest. This article relaxes these assumptions and introduces novel Bayesian semiparametric methodology based on Dirichlet process mixture models for robust deconvolution of densities in the presence of conditionally heteroscedastic measurement errors. In particular, the models can adapt to asymmetry, heavy tails and multimodality. In simulation experiments, we show that our methods vastly outperform a recent Bayesian approach based on estimating the densities via mixtures of splines. We apply our methods to data from nutritional epidemiology. Even in the special case when the measurement errors are homoscedastic, our methodology is novel and dominates other methods that have been proposed previously. Additional simulation results, instructions on getting access to the data set and R programs implementing our methods are included as part of online supplemental materials.

  10. Semiparametric approach for non-monotone missing covariates in a parametric regression model

    KAUST Repository

    Sinha, Samiran

    2014-02-26

    Missing covariate data often arise in biomedical studies, and analysis of such data that ignores subjects with incomplete information may lead to inefficient and possibly biased estimates. A great deal of attention has been paid to handling a single missing covariate or a monotone pattern of missing data when the missingness mechanism is missing at random. In this article, we propose a semiparametric method for handling non-monotone patterns of missing data. The proposed method relies on the assumption that the missingness mechanism of a variable does not depend on the missing variable itself but may depend on the other missing variables. This mechanism is somewhat less general than the completely non-ignorable mechanism but is sometimes more flexible than the missing at random mechanism where the missingness mechansim is allowed to depend only on the completely observed variables. The proposed approach is robust to misspecification of the distribution of the missing covariates, and the proposed mechanism helps to nullify (or reduce) the problems due to non-identifiability that result from the non-ignorable missingness mechanism. The asymptotic properties of the proposed estimator are derived. Finite sample performance is assessed through simulation studies. Finally, for the purpose of illustration we analyze an endometrial cancer dataset and a hip fracture dataset.

  11. A semi-parametric approach to the frequency of occurrence under a simple crossover trial.

    Science.gov (United States)

    Lui, Kung-Jong; Chang, Kuang-Chao

    2016-02-01

    To analyze the frequency of occurrence for an event of interest in a crossover design, we propose a semi-parametric approach. We develop two point estimators and four interval estimators in closed forms for the treatment effect under a random effects multiplicative risk model. Using Monte Carlo simulations, we evaluate these estimators and compare the four interval estimators with the classical interval estimator suggested elsewhere in a variety of situations. We note that the point estimator using the ratio of two arithmetic averages of mean frequencies under a multiplicative risk model can be comparable to the point estimator using the ratio of two geometric averages of mean frequencies. We note that as long as the number of patients per group is large, all the four interval estimators developed here can perform well. We also note that the classical interval estimator derived under the commonly assumed Poisson distribution for the frequency data can be conservative and lose precision if the Poisson distribution assumption is violated. We use a double-blind randomized crossover trial comparing salmeterol with a placebo in exacerbations of asthma to illustrate the practical use of these estimators. © The Author(s) 2012.

  12. Semiparametric model and inference for spontaneous abortion data with a cured proportion and biased sampling.

    Science.gov (United States)

    Piao, Jin; Ning, Jing; Chambers, Christina D; Xu, Ronghui

    2018-01-01

    Evaluating and understanding the risk and safety of using medications for autoimmune disease in a woman during her pregnancy will help both clinicians and pregnant women to make better treatment decisions. However, utilizing spontaneous abortion (SAB) data collected in observational studies of pregnancy to derive valid inference poses two major challenges. First, the data from the observational cohort are not random samples of the target population due to the sampling mechanism. Pregnant women with early SAB are more likely to be excluded from the cohort, and there may be substantial differences between the observed SAB time and those in the target population. Second, the observed data are heterogeneous and contain a "cured" proportion. In this article, we consider semiparametric models to simultaneously estimate the probability of being cured and the distribution of time to SAB for the uncured subgroup. To derive the maximum likelihood estimators, we appropriately adjust the sampling bias in the likelihood function and develop an expectation-maximization algorithm to overcome the computational challenge. We apply the empirical process theory to prove the consistency and asymptotic normality of the estimators. We examine the finite sample performance of the proposed estimators in simulation studies and illustrate the proposed method through an application to SAB data from pregnant women. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Geriatric assessment is superior to oncologists’ clinical judgement in identifying frailty

    Science.gov (United States)

    Kirkhus, Lene; Šaltytė Benth, Jūratė; Rostoft, Siri; Grønberg, Bjørn Henning; Hjermstad, Marianne J; Selbæk, Geir; Wyller, Torgeir B; Harneshaug, Magnus; Jordhøy, Marit S

    2017-01-01

    Background: Frailty is a syndrome associated with increased vulnerability and an important predictor of outcomes in older cancer patients. Systematic assessments to identify frailty are seldom applied, and oncologists’ ability to identify frailty is scarcely investigated. Methods: We compared oncologists’ classification of frailty (onc-frail) based on clinical judgement with a modified geriatric assessment (mGA), and investigated associations between frailty and overall survival. Patients ⩾70 years referred for medical cancer treatment were eligible. mGA-frailty was defined as impairment in at least one of the following: daily activities, comorbidity, polypharmacy, physical function or at least one geriatric syndrome (cognitive impairment, depression, malnutrition, falls). Results: Three hundred and seven patients were enroled, 288 (94%) completed the mGA, 286 (93%) were rated by oncologists. Median age was 77 years, 56% had metastases, 85% performance status (PS) 0–1. Overall, 104/286 (36%) were onc-frail and 140/288 (49%) mGA-frail, the agreement was fair (kappa value 0.30 (95% CI 0.19; 0.41)), and 67 mGA-frail patients who frequently had localised disease, good PS and received curative treatment, were missed by the oncologists. Only mGA-frailty was independently prognostic for survival (HR 1.61, 95% CI 1.14; 2.27; P=0.007). Conclusions: Systematic assessment of geriatric domains is needed to aid oncologists in identifying frail patients with poor survival. PMID:28664916

  14. Frailty is associated with socioeconomic and lifestyle factors in community-dwelling older subjects.

    Science.gov (United States)

    Poli, Stefano; Cella, Alberto; Puntoni, Matteo; Musacchio, Clarissa; Pomata, Monica; Torriglia, Domenico; Vello, Natalia; Molinari, Beba; Pandolfini, Valeria; Torrigiani, Claudio; Pilotto, Alberto

    2017-08-01

    This study assessed the association between frailty and sociodemographic, socioeconomic and lifestyle factors in community-dwelling older people. This was a cross-sectional survey in a population-based sample of 542 community-dwelling subjects aged 65 years and older living in a metropolitan area in Italy. Frailty was evaluated by means of the FRAIL scale proposed by the International Association of Nutrition and Aging. Basal and instrumental activities of daily living (ADL, IADL), physical activity, sociodemographic (age, gender, marital status and cohabitation), socioeconomic (education, economic conditions and occupational status) and lifestyle domains (cultural and technological fruition and social activation) were assessed through specific validated tools. Statistical analysis was performed through multinomial logistic regression. Impairments in ADL and IADL were significantly associated with frailty, while moderate and high physical activity were inversely associated with frailty. Moreover, regarding both socioeconomic variables and lifestyle factors, more disadvantaged socioeconomic conditions and low levels of cultural fruition were significantly associated with frailty. Socioeconomic and lifestyle factors, particularly cultural fruition, are associated with frailty independently from functional impairment and low physical activity. Cultural habits may therefore represent a new target of multimodal interventions against geriatric frailty.

  15. Frailty and cognitive impairment: Unique challenges in the older emergency surgical patient.

    Science.gov (United States)

    Moug, S J; Stechman, M; McCarthy, K; Pearce, L; Myint, P K; Hewitt, J

    2016-03-01

    Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes. This paper reviews the evidence for frailty and cognitive impairment in the acute surgical setting by defining frailty and cognitive impairment, introducing methods of diagnosis, discussing the influence on prognosis and proposing strategies to improve older patient outcomes. Frailty is present in 25% of the older surgical population. Using frailty-scoring tools, frailty was associated with a significantly longer hospital stay and higher mortality at 30 and 90 days after admission to an acute surgical unit. Cognitive impairment is present in a high number of older acute surgical patients (approximately 70%), whilst acute onset cognitive impairment, termed delirium, is documented in 18%. However, patients with delirium had significantly longer hospital stays and higher in-hospital mortality than those with cognitive impairment. Improved knowledge of frailty and delirium by the emergency surgeon allows the specialised needs of older surgical patients to be taken into account. Early recognition, and consideration of minimally invasive surgery or radiological intervention alongside potentially transferable successful elective interventions such as comprehensive geriatric assessment, may help to improve short- and long-term patient outcomes in this vulnerable population.

  16. High burden and frailty: association with poor cognitive performance in older caregivers living in rural areas

    Directory of Open Access Journals (Sweden)

    Allan Gustavo Brigola

    2017-12-01

    Full Text Available Abstract Introduction: Older caregivers living in rural areas may be exposed to three vulnerable conditions, i.e., those related to care, their own aging, and their residence context. Objective: To analyze the association of burden and frailty with cognition performance in older caregivers in rural communities. Method: In this cross-sectional survey, 85 older caregivers who cared for dependent elders were included in this study. Global cognition (Addenbrooke's Cognitive Examination – Revised; Mini Mental State Examination, burden (Zarit Burden Interview and frailty (Fried's frailty phenotype were assessed. All ethical principles were observed. Results: Older caregivers were mostly women (76.7%; mean age was 69 years. Cognitive impairment was present in 15.3%, severe burden in 8.2%, frailty in 9.4%, and pre-frailty in 52.9% of the older caregivers. More severely burdened or frail caregivers had worse cognitive performance than those who were not, respectively (ANOVA test. Caregivers presenting a high burden level and some frailty degree (pre-frail or frail simultaneously were more likely to have a reduced global cognition performance. Conclusion: A significant number of older caregivers had low cognitive performance. Actions and resources to decrease burden and physical frailty may provide better cognition and well-being, leading to an improved quality of life and quality of the care provided by the caregivers.

  17. Are frailty markers associated with serious thoracic and spinal injuries among motor vehicle crash occupants?

    Science.gov (United States)

    Oskutis, Morgan Q; Lauerman, Margaret H; Kufera, Joseph A; Shanmuganathan, Kathirkamanathan; Burch, Cynthia; Kerns, Timothy; Ho, Shiu; Scalea, Thomas M; Stein, Deborah M

    2016-07-01

    While age is a known risk factor in trauma, markers of frailty are growing in their use in the critically ill. Frailty markers may reflect underlying strength and function more than chronologic age, as many modern elderly patients are quite active. However, the optimal markers of frailty are unknown. A retrospective review of The Crash Injury Research and Engineering Network (CIREN) database was performed over an 11-year period. Computed tomographic images were analyzed for multiple frailty markers, including sarcopenia determined by psoas muscle area, osteopenia determined by Hounsfield units (HU) of lumbar vertebrae, and vascular disease determined by aortic calcification. Overall, 202 patients were included in the review, with a mean age of 58.5 years. Median Injury Severity Score was 17. Sarcopenia was associated with severe thoracic injury (62.9% vs. 42.5%; p = 0.03). In multivariable analysis controlling for crash severity, sarcopenia remained associated with severe thoracic injury (p = 0.007) and osteopenia was associated with severe spine injury (p = 0.05). While age was not significant in either multivariable analysis, the association of sarcopenia and osteopenia with development of serious injury was more common with older age. Multiple markers of frailty were associated with severe injury. Frailty may more reflect underlying physiology and injury severity than age, although age is associated with frailty. Prognostic and epidemiologic study, level IV.

  18. Predictive Value of Frailty Indices for Adverse Outcomes in Older Adults.

    Science.gov (United States)

    Pérez-Zepeda, Mario Ulises; Cesari, Matteo; García-Peña, Carmen

    2016-01-01

    There are two widely used tools to classify frailty in older adults: the frailty phenotype and the frailty index. Both have been validated for prediction of adverse outcomes. To assess the ability of different frailty indices to predict a number of adverse outcomes (falls, disability, and mortality) by adding deficits in a fixed sequence (with the first five deficits as in the frailty phenotype: weakness, weight loss, slowness, exhaustion and low physical activity) or randomly. This is an analysis of the Costa-Rican Longevity and Healthy Aging Study in which ≥ 60-year-old adults were included and followed up for four years. Frailty indices were constructed, including the frailty phenotype components in the first five indices followed by the random addition of other deficits and estimating for each one the odds ratios for falls and disability and hazard ratios for mortality, adjusted for age and sex. We included 2,708 adults; mean age was 76.31 years, 54.28% were women. Indices with the highest number of deficits had the highest estimates for each adverse outcome, independent of the deficit. The higher the number of deficits in an index, the higher the estimates for adverse outcomes, independent of the type of deficit added.

  19. Is Delirium the Cognitive Harbinger of Frailty in Older Adults? A Review about the Existing Evidence

    Directory of Open Access Journals (Sweden)

    Giuseppe Bellelli

    2017-11-01

    Full Text Available Frailty is a clinical syndrome defined by the age-related depletion of the individual’s homeostatic reserves, determining an increased susceptibility to stressors and disproportionate exposure to negative health changes. The physiological systems that are involved in the determination of frailty are mutually interrelated, so that when decline starts in a given system, implications may also regard the other systems. Indeed, it has been shown that the number of abnormal systems is more predictive of frailty than those of the abnormalities in any particular system. Delirium is a transient neurocognitive disorder, characterized by an acute onset and fluctuating course, inattention, cognitive dysfunction, and behavioral abnormalities, that complicates one out of five hospital admissions. Delirium is independently associated with the same negative outcomes of frailty and, like frailty, its pathogenesis is usually multifactorial, depending on complex inter-relationships between predisposing and precipitating factors. By definition, a somatic cause should be identified, or at least suspected, to diagnose delirium. Delirium and frailty potentially share multiple pathophysiologic mechanisms and pathways, meaning that they could be thought of as the two sides to the same coin. This review aims at summarizing the existing evidence, referring both to human and animal models, to postulate that delirium may represent the cognitive harbinger of a state of frailty in older persons experiencing an acute clinical event.

  20. Anorexia of aging and its role for frailty.

    Science.gov (United States)

    Sanford, Angela M

    2017-01-01

    The purpose of this review is to examine the concept of anorexia of aging, including its complex pathophysiology and the multifaceted interventions required to prevent adverse health consequences from this geriatric syndrome. Anorexia of aging is extremely common, occurring in up to 30% of elderly individuals; however, this diagnosis is frequently missed or erroneously attributed to a normal part of the aging process. With aging, impairments in smell and taste can limit the desire to eat. Alterations in stress hormones and inflammatory mediators can lead to excess catabolism, cachexia, and reduced appetite. In addition, mood disorders, such as anxiety and depression, are powerful inhibitors of appetite. Anorexia of aging, with its negative consequences on weight and muscle mass, is a risk factor for the development of frailty and is important to screen for, as early intervention is key to reversing this debilitating condition. Anorexia of aging is a complex geriatric syndrome and a direct risk factor for frailty and thus should not be accepted as normal consequence of aging. Early diagnosis and formulating a plan for targeted interventions is critical to prevent disability and preserve function in elderly patients.

  1. Anorexia of aging: a modifiable risk factor for frailty.

    Science.gov (United States)

    Martone, Anna Maria; Onder, Graziano; Vetrano, Davide Liborio; Ortolani, Elena; Tosato, Matteo; Marzetti, Emanuele; Landi, Francesco

    2013-10-14

    Anorexia of aging, defined as a loss of appetite and/or reduced food intake, affects a significant number of elderly people and is far more prevalent among frail individuals. Anorexia recognizes a multifactorial origin characterized by various combinations of medical, environmental and social factors. Given the interconnection between weight loss, sarcopenia and frailty, anorexia is a powerful, independent predictor of poor quality of life, morbidity and mortality in older persons. One of the most important goals in the management of older, frail people is to optimize their nutritional status. To achieve this objective it is important to identify subjects at risk of anorexia and to provide multi-stimulus interventions that ensure an adequate amount of food to limit and/or reverse weight loss and functional decline. Here, we provide a brief overview on the relevance of anorexia in the context of sarcopenia and frailty. Major pathways supposedly involved in the pathogenesis of anorexia are also illustrated. Finally, the importance of treating anorexia to achieve health benefits in frail elders is highlighted.

  2. Cellular Senescence and the Biology of Aging, Disease, and Frailty.

    Science.gov (United States)

    LeBrasseur, Nathan K; Tchkonia, Tamara; Kirkland, James L

    2015-01-01

    Population aging simultaneously highlights the remarkable advances in science, medicine, and public policy, and the formidable challenges facing society. Indeed, aging is the primary risk factor for many of the most common chronic diseases and frailty, which result in profound social and economic costs. Population aging also reveals an opportunity, i.e. interventions to disrupt the fundamental biology of aging could significantly delay the onset of age-related conditions as a group, and, as a result, extend the healthy life span, or health span. There is now considerable evidence that cellular senescence is an underlying mechanism of aging and age-related conditions. Cellular senescence is a process in which cells lose the ability to divide and damage neighboring cells by the factors they secrete, collectively referred to as the senescence-associated secretory phenotype (SASP). Herein, we discuss the concept of cellular senescence, review the evidence that implicates cellular senescence and SASP in age-related deterioration, hyperproliferation, and inflammation, and propose that this underlying mechanism of aging may play a fundamental role in the biology of frailty. © 2015 Nestec Ltd., Vevey/S. Karger AG, Basel.

  3. Chronic kidney disease-related physical frailty and cognitive impairment: a systemic review.

    Science.gov (United States)

    Shen, Zhiyuan; Ruan, Qingwei; Yu, Zhuowei; Sun, Zhongquan

    2017-04-01

    The objective of this review was to assess chronic kidney disease-related frailty and cognitive impairment, as well as their probable causes, mechanisms and the interventions. Studies from 1990 to 2015 were reviewed to evaluate the relationship between chronic kidney disease and physical frailty and cognitive impairment. Of the 1694 studies from the initial search, longitudinal studies (n = 22) with the keywords "Cognitive and CKD" and longitudinal or cross-sectional studies (n = 5) with the keywords "Frailty and CKD" were included in final analysis. By pooling current research, we show clear evidence for a relationship between chronic kidney disease and frailty and cognitive impairment in major studies. Vascular disease is likely an important mediator, particularly for cognitive impairment. However, non-vascular factors also play an important role. Many of the other mechanisms that contribute to impaired cognitive function and increased frailty in CKD remain to be elucidated. In limited studies, medication therapy did not obtain the ideal effect. There are limited data on treatment strategies, but addressing the vascular disease risk factors earlier in life might decrease the subsequent burden of frailty and cognitive impairment in this population. Multidimensional interventions, which address both microvascular health and other factors, may have substantial benefits for both the cognitive impairments and physical frailty in this vulnerable population. Chronic kidney disease is a potential cause of frailty and cognitive impairment. Vascular and non-vascular factors are the possible causes. The mechanism of chronic kidney disease-induced physical frailty and cognitive impairment suggests that multidimensional interventions may be effective therapeutic strategies in the early stage of chronic kidney disease. Geriatr Gerontol Int 2017; 17: 529-544. © 2016 Japan Geriatrics Society.

  4. Validation of an integral conceptual model of frailty in older residents of assisted living facilities.

    Science.gov (United States)

    Gobbens, Robbert J J; Krans, Anita; van Assen, Marcel A L M

    2015-01-01

    The aim of this cross-sectional study was to examine the validity of an integral model of the associations between life-course determinants, disease(s), frailty, and adverse outcomes in older persons who are resident in assisted living facilities. Between June 2013 and May 2014 seven assisted living facilities were contacted. A total of 221 persons completed the questionnaire on life-course determinants, frailty (using the Tilburg Frailty Indicator), self-reported chronic diseases, and adverse outcomes disability, quality of life, health care utilization, and falls. Adverse outcomes were analyzed with sequential (logistic) regression analyses. The integral model is partially validated. Life-course determinants and disease(s) affected only physical frailty. All three frailty domains (physical, psychological, social) together affected disability, quality of life, visits to a general practitioner, and falls. Contrary to the model, disease(s) had no effect on adverse outcomes after controlling for frailty. Life-course determinants affected adverse outcomes, with unhealthy lifestyle having consistent negative effects, and women had more disability, scored lower on physical health, and received more personal and informal care after controlling for all other predictors. The integral model of frailty is less useful for predicting adverse outcomes of residents of assisted living facilities than for community-dwelling older persons, because these residents are much frailer and already have access to healthcare facilities. The present study showed that a multidimensional assessment of frailty, distinguishing three domains of frailty (physical, psychological, social), is beneficial with respect to predicting adverse outcomes in residents of assisted living facilities. Copyright © 2015. Published by Elsevier Ireland Ltd.

  5. Associations between multidimensional frailty and quality of life among Dutch older people.

    Science.gov (United States)

    Gobbens, Robbert J J; van Assen, Marcel A L M

    2017-11-01

    To examine the associations between components of physical, psychological and social frailty with quality of life among older people. This cross-sectional study was carried out in a sample of Dutch citizens. A total of 671 people aged 70 years or older completed a web-based questionnaire ('the Senioren Barometer'). This questionnaire contained the Tilburg Frailty Indicator (TFI) for measuring physical, psychological and social frailty, and the WHOQOL-OLD for measuring six quality of life facets (sensory abilities, autonomy, past, present and future activities, social participation, death and dying, intimacy) and quality of life total. Nine of fifteen individual frailty components had an effect on at least one facet of quality of life and quality of life total, after controlling for socio-demographic factors, multimorbidity and the other frailty components. Of these nine components five, two and two refer to physical, psychological and social frailty, respectively. Feeling down was the only frailty component associated with all quality of life facets and quality of life total. Both physical inactivity and lack of social relations were associated with four quality of life facets and quality of life total. This study showed that quality of life in older people is associated with physical, psychological and social frailty components, emphasizing the importance of a multidimensional assessment of frailty. Health care and welfare professionals should in particular pay attention to feeling down, physical inactivity and lack of social relations among older people, because their relation with quality of life seems to be the strongest. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Oral Disease and 3-Year Incidence of Frailty in Mexican Older Adults.

    Science.gov (United States)

    Castrejón-Pérez, Roberto Carlos; Jiménez-Corona, Aida; Bernabé, Eduardo; Villa-Romero, Antonio R; Arrivé, Elise; Dartigues, Jean-François; Gutiérrez-Robledo, Luis Miguel; Borges-Yáñez, S Aída

    2017-07-01

    Poor oral health has been associated with some components of frailty. The objective of this study was to identify the association between clinical measures of oral health and the incidence of frailty among community-dwelling older adults aged 70 or older in Mexico City. A 3-year cohort study with a probabilistic representative sample of home-dwelling elders of one district of Mexico City was performed. Baseline and follow-up interview and oral clinical evaluations were carried out by standardized examiners in participants' homes. Dependent variable was incident frailty defined according to the frailty phenotype. Independent variables were the utilization of dental services, the presence of xerostomia, the number of natural teeth, use of removable dental prostheses, presence of severe periodontitis, and presence of root remnants. Sociodemographic, behavioral, and health measures were included as confounders. The association between oral health conditions and incident frailty was modeled using Poisson regression models with robust variance estimators. The models were adjusted for confounders and interactions. We identified a 14.8% cumulative incidence of frailty. Each additional tooth was associated with a lower probability of developing frailty by 5.0% (risk ratio = 0.90; 95% CI 1.02-1.10). The 3-year risk ratio of developing frailty was 2.13 times higher (95% CI 1.01-4.50) among participants having severe periodontitis. The number of teeth and the presence of severe periodontitis are associated with the development of frailty after controlling for confounders. Further studies are needed on this topic. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

    Science.gov (United States)

    Diamond, Joshua M.; Gries, Cynthia J.; McDonnough, Jamiela; Blanc, Paul D.; Shah, Rupal; Dean, Monica Y.; Hersh, Beverly; Wolters, Paul J.; Tokman, Sofya; Arcasoy, Selim M.; Ramphal, Kristy; Greenland, John R.; Smith, Nancy; Heffernan, Pricilla; Shah, Lori; Shrestha, Pavan; Golden, Jeffrey A.; Blumenthal, Nancy P.; Huang, Debbie; Sonett, Joshua; Hays, Steven; Oyster, Michelle; Katz, Patricia P.; Robbins, Hilary; Brown, Melanie; Leard, Lorriana E.; Kukreja, Jasleen; Bacchetta, Matthew; Bush, Errol; D’Ovidio, Frank; Rushefski, Melanie; Raza, Kashif; Christie, Jason D.; Lederer, David J.

    2015-01-01

    Rationale: Frailty is associated with morbidity and mortality in abdominal organ transplantation but has not been examined in lung transplantation. Objectives: To examine the construct and predictive validity of frailty phenotypes in lung transplant candidates. Methods: In a multicenter prospective cohort, we measured frailty with the Fried Frailty Phenotype (FFP) and Short Physical Performance Battery (SPPB). We evaluated construct validity through comparisons with conceptually related factors. In a nested case–control study of frail and nonfrail subjects, we measured serum IL-6, tumor necrosis factor receptor 1, insulin-like growth factor I, and leptin. We estimated the association between frailty and disability using the Lung Transplant Valued Life Activities disability scale. We estimated the association between frailty and risk of delisting or death before transplant using multivariate logistic and Cox models, respectively. Measurements and Main Results: Of 395 subjects, 354 completed FFP assessments and 262 completed SPPB assessments; 28% were frail by FFP (95% confidence interval [CI], 24–33%) and 10% based on the SPPB (95% CI, 7–14%). By either measure, frailty correlated more strongly with exercise capacity and grip strength than with lung function. Frail subjects tended to have higher plasma IL-6 and tumor necrosis factor receptor 1 and lower insulin-like growth factor I and leptin. Frailty by either measure was associated with greater disability. After adjusting for age, sex, diagnosis, and transplant center, both FFP and SPPB were associated with increased risk of delisting or death before lung transplant. For every 1-point worsening in score, hazard ratios were 1.30 (95% CI, 1.01–1.67) for FFP and 1.53 (95% CI, 1.19–1.59) for SPPB. Conclusions: Frailty is prevalent among lung transplant candidates and is independently associated with greater disability and an increased risk of delisting or death. PMID:26258797

  8. Educational strategies to train health care professionals across the education continuum on the process of frailty prevention and frailty management: a systematic review.

    Science.gov (United States)

    Windhaber, Thomas; Koula, Maria Lamprini; Ntzani, Evangelia; Velivasi, Alexandra; Rizos, Evangelos; Doumas, Michail Theofilos; Pappas, Evangelos Elias; Onder, Graziano; Vetrano, Davide Liborio; Roudriguez Laso, Angel; Roudriguez Manjas, Leocadio; Illario, Maddalena; Roller-Wirnsberger, Regina Elisabeth

    2018-02-23

    In addition to the normal process of ageing, frailty, defined as a geriatric syndrome, is becoming more prevalent. Around 10% of people over 65 years and 25-50% of those aged over 85 years are frail. Frail elderly are more vulnerable to external stressors and have an increased risk of adverse health outcomes. To tackle these challenges, European Union (EU) member states need to develop a health work force capable of the right skills mix. A goal-centred education and training of professionals is crucial for effective and efficient health care delivery for Europe's greying population. The aim of this study was to systematically collect, review and critically appraise studies carried out to investigate the efficacy and effectiveness of comprehensive educational programmes for health professionals related to frailty prevention and/or frailty management. A systematic review was carried out searching the databases PubMed, CINAHL, Cochrane CENTRAL, Medline, Up to date and Embase. Additionally, a manual search of the reference lists and searches via Google Scholar and greylit.org was done. No relevant publications addressing the evidence and sustainability of educational/training programmes for frailty prevention and/or frailty management were identified. The result of an empty review is surprising because several educational programmes in different countries are currently run. A significant knowledge gap exists in the scientific literature regarding education and training of health care workers regarding prevention and management of frailty. Further research is needed to identify effective educational strategies for health professionals to prevent and manage frailty.

  9. A reliable measure of frailty for a community dwelling older population

    Directory of Open Access Journals (Sweden)

    Fletcher Astrid

    2010-10-01

    Full Text Available Abstract Background Frailty remains an elusive concept despite many efforts to define and measure it. The difficulty in translating the clinical profile of frail elderly people into a quantifiable assessment tool is due to the complex and heterogeneous nature of their health problems. Viewing frailty as a 'latent vulnerability' in older people this study aims to derive a model based measurement of frailty and examines its internal reliability in community dwelling elderly. Method The British Women's Heart and Health Study (BWHHS cohort of 4286 women aged 60-79 years from 23 towns in Britain provided 35 frailty indicators expressed as binary categorical variables. These indicators were corrected for measurement error and assigned relative weights in its association with frailty. Exploratory factor analysis (EFA reduced the data to a smaller number of factors and was subjected to confirmatory factor analysis (CFAwhich restricted the model by fitting the EFA-driven structure to observed data. Cox regression analysis compared the hazard ratios for adverse outcomes of the newly developed British frailty index (FI with a widely known FI. This process was replicated in the MRC Assessment study of older people, a larger cohort drawn from 106 general practices in Britain. Results Seven factors explained the association between frailty indicators: physical ability, cardiac symptoms/disease, respiratory symptoms/disease, physiological measures, psychological problems, co-morbidities and visual impairment. Based on existing concepts and statistical indices of fit, frailty was best described using a General Specific Model. The British FI would serve as a better population metric than the FI as it enables people with varying degrees of frailty to be better distinguished over a wider range of scores. The British FI was a better independent predictor of all-cause mortality, hospitalization and institutionalization than the FI in both cohorts. Conclusions

  10. Frailty phenotype and the role of levodopa challenge test in geriatric inpatients with mild parkinsonian signs.

    Science.gov (United States)

    Seiffert, Piotr; Derejczyk, Jarosław; Kawa, Jacek; Marcisz, Czesław; Czernek, Małgorzata; Szymszal, Jan; Kapko, Wojciech; Bugdol, Monika; Torbus, Anna; Stępień-Wyrobiec, Olga

    2017-08-01

    Deficiency in dopaminergic system function may be one of the hypothetical reasons of the frailty syndrome but its role still remains unclear. The aim of our study was to assess the frailty phenotype prevalence in geriatric inpatients with mild parkinsonian signs (MPS) and to investigate levodopa test in the frail patients with MPS. We examined 118 participants: 90 with MPS and 28 in control group (without MPS). The frailty syndrome presence was evaluated by the Fried criteria. Deficiency in dopaminergic system function was assessed by one of the modifications of an acute levodopa challenge test (LCT): in MPS group every patient was examined by performing Up and Go Test and also Step Test before and 3 h after taking 125 mg of Madopar (levodopa + benserazide). Sixty-nine study subjects (58%) met criteria for frailty. Fifty-five participants in MPS group (61.1% of MPS group) and fourteen (50%) in control group. All of the patients that scored positive in walk speed criterion of frailty were frail. When all MPS patients were considered, the number of components scored positive for frailty was directly related to the walk speed (r = -0.70, p < 0.0001). In MPS group LCT scores were significantly higher for frailty patients compared to non-frailty (p = 0.0027). When all MPS patients were considered, the number of components scored positive for frailty was directly related LCT score (r = 0.37, p = 0.0004). There was a relationship between LCT and walk speed (r = -0.31, p = 0.0032). Our observations provide new information about the relationship between frailty and MPS, suggest the need for increased awareness of frailty in MPS patients and conversely. Our study provides data for a discussion on pathophysiological background of the frailty syndrome (FS), emphasizing the theories of the important impact of dopaminergic system deficit and encourages further research on the role of LCT in measuring it.

  11. Emotion experience and frailty in a sample of Italian community-dwelling older adults

    Directory of Open Access Journals (Sweden)

    Mulasso A

    2017-11-01

    Full Text Available Anna Mulasso,1,2 Laura Argiolu,1 Mattia Roppolo,1 Danny Azucar,1 Emanuela Rabaglietti1 1Department of Psychology, University of Turin, Turin, Italy; 2NeuroMuscular Function Research Group, School of Exercise and Sport Sciences, Department of Medical Sciences, University of Turin, Turin, Italy Abstract: Frailty increases individual vulnerability to external stressors and involves high risk for adverse geriatric outcomes. To date, few studies have addressed the role of emotion perception and its association with frailty in aged populations. This cross-sectional study aimed to explore whether a significant association between frailty and emotional experience exists in a sample of Italian community-dwelling older adults. Our sample consisted of 104 older adults (age 76±8 years; 59.6% women living in Piedmont, Italy. Frailty was measured using the Italian version of the Tilburg Frailty Indicator (TFI, and emotion perception was measured with the Positive and Negative Affect Schedule (PANAS. The Mini–Mental State Examination was used as a screening tool for cognitive functions (people with a score ≤20 points were excluded. One-way analysis of covariance (ANCOVA, adjusted for interesting variables, and post hoc tests were performed where appropriate. According to the TFI, 57.7% of participants resulted as frail. Analysis showed a significant greater severity of frailty in the low positive affect (PA group compared to the high PA group. Similarly, those with high negative affect (NA showed significantly higher levels of frailty than the low NA group. As expected, significant differences for frailty were also found among the groups composed of 1 people with high PA and low NA, 2 people with low PA or high NA, and 3 people with low PA and high NA. Post hoc tests showed a greater severity of frailty in the second and in the third groups compared to the first one. Lastly, robust participants aged >75 years showed higher levels of PA than the group

  12. Socioeconomic status, frailty, and subjective well-being: A moderated mediation analysis in elderly Chinese.

    Science.gov (United States)

    Yang, Fang; Pang, Joyce S

    2016-11-01

    The study examined the mechanisms underlying the link between socioeconomic status and subjective well-being and explored the role of social activities using a representative sample of older adults ( N = 2773) in Shanghai, China. Results show that frailty mediated the relationship between socioeconomic status and subjective well-being, and social activities moderated the model, such that the mediation effect of frailty was significant only when social activities were lower. Moreover, the moderated mediation model was significant only for women, not for men. Findings highlight the importance of addressing frailty of older adults and promoting social activities (especially for elderly women) in future interventions.

  13. [Methodology and social, demographic, cognitive, and frailty profiles of community-dwelling elderly from seven Brazilian cities: the FIBRA Study].

    Science.gov (United States)

    Neri, Anita Liberalesso; Yassuda, Mônica Sanches; Araújo, Ludgleydson Fernandes de; Eulálio, Maria do Carmo; Cabral, Benedita Edina; Siqueira, Maria Eliane Catunda de; Santos, Geraldine Alves dos; Moura, José Guilherme de Arruda

    2013-04-01

    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.

  14. Successful Aging and Frailty: Opposite Sides of the Same Coin?

    Science.gov (United States)

    Woo, Jean; Leung, Jason; Zhang, Tiemei

    2016-09-01

    Operational definitions of successful aging place a strong emphasis on functional capacity, and strategies for successful aging include many factors common to frailty research. We explore the hypothesis that frailty and successful aging are two sides of the same coin and that walking speed may be an objective indicator of successful aging. Observational study of two Chinese cohorts using one to define "fast walkers" and applying this criteria to another cohort to examine associated factors. Community survey in cities in China. A total of 1929 men and women aged 25 to 89 years of age in four cities in China and 4000 men and women 65 years old in Hong Kong SAR China. The top 25th percentile of walking speed for the whole cohort of 1929 men was determined, and the cutoff value was used to define "fast walkers." This value was applied to the Hong Kong Chinese population to examine factors associated with fast walking speed. These factors include age, gender, socioeconomic and lifestyle factors, medical history, quality of life, cognitive function, depressive symptoms, body mass index, body composition, and telomere length. Fast walkers had better self-rated health, lower prevalence of stroke, hypertension, cataracts, osteoporosis, and impaired cognitive function. They were more likely to be current alcohol users, more physically active, consumed more vegetables, had better physical component of health-related quality of life, and received more education. They also had lower body mass index, percentage whole body fat as well as appendicular fat, and higher appendicular muscle mass index. In multivariate analysis, the significant contributing variables were age, gender, current alcohol use, physical activity level, vegetable intake, quality of life, and appendicular fat. The area under the curve value on receiver-operating characteristic analysis was 0.77 for these seven variables. Frailty and successful aging may be considered two sides of the same entity, and fast

  15. tgp: An R Package for Bayesian Nonstationary, Semiparametric Nonlinear Regression and Design by Treed Gaussian Process Models

    Directory of Open Access Journals (Sweden)

    Robert B. Gramacy

    2007-06-01

    Full Text Available The tgp package for R is a tool for fully Bayesian nonstationary, semiparametric nonlinear regression and design by treed Gaussian processes with jumps to the limiting linear model. Special cases also implemented include Bayesian linear models, linear CART, stationary separable and isotropic Gaussian processes. In addition to inference and posterior prediction, the package supports the (sequential design of experiments under these models paired with several objective criteria. 1-d and 2-d plotting, with higher dimension projection and slice capabilities, and tree drawing functions (requiring maptree and combinat packages, are also provided for visualization of tgp objects.

  16. A Semi-parametric Multivariate Gap-filling Model for Eddy Covariance Latent Heat Flux

    Science.gov (United States)

    Li, M.; Chen, Y.

    2010-12-01

    Quantitative descriptions of latent heat fluxes are important to study the water and energy exchanges between terrestrial ecosystems and the atmosphere. The eddy covariance approaches have been recognized as the most reliable technique for measuring surface fluxes over time scales ranging from hours to years. However, unfavorable micrometeorological conditions, instrument failures, and applicable measurement limitations may cause inevitable flux gaps in time series data. Development and application of suitable gap-filling techniques are crucial to estimate long term fluxes. In this study, a semi-parametric multivariate gap-filling model was developed to fill latent heat flux gaps for eddy covariance measurements. Our approach combines the advantages of a multivariate statistical analysis (principal component analysis, PCA) and a nonlinear interpolation technique (K-nearest-neighbors, KNN). The PCA method was first used to resolve the multicollinearity relationships among various hydrometeorological factors, such as radiation, soil moisture deficit, LAI, and wind speed. The KNN method was then applied as a nonlinear interpolation tool to estimate the flux gaps as the weighted sum latent heat fluxes with the K-nearest distances in the PCs’ domain. Two years, 2008 and 2009, of eddy covariance and hydrometeorological data from a subtropical mixed evergreen forest (the Lien-Hua-Chih Site) were collected to calibrate and validate the proposed approach with artificial gaps after standard QC/QA procedures. The optimal K values and weighting factors were determined by the maximum likelihood test. The results of gap-filled latent heat fluxes conclude that developed model successful preserving energy balances of daily, monthly, and yearly time scales. Annual amounts of evapotranspiration from this study forest were 747 mm and 708 mm for 2008 and 2009, respectively. Nocturnal evapotranspiration was estimated with filled gaps and results are comparable with other studies

  17. Invasive strategy and frailty in very elderly patients with acute coronary syndromes.

    Science.gov (United States)

    Llaó, Isaac; Ariza-Solé, Albert; Sanchis, Juan; Alegre, Oriol; López-Palop, Ramon; Formiga, Francesc; Marín, Francisco; Vidán, María T; Martínez-Sellés, Manuel; Sionis, Alessandro; Vives-Borrás, Miguel; Gómez-Hospital, Joan Antoni; Gómez-Lara, Josep; Roura, Gerard; Díez-Villanueva, Pablo; Núñez-Gil, Iván; Maristany, Jaume; Asmarats, Lluis; Bueno, Héctor; Abu-Assi, Emad; Cequier, Àngel

    2018-04-03

    Current guidelines recommend an early invasive strategy in patients with non-ST segment elevation acute coronary syndromes (NSTEACS). The role of an invasive strategy in frail elderly patients remains controversial. The LONGEVO-SCA registry included unselected NSTEACS patients aged ≥80 years. A geriatric assessment was performed during hospitalization, including frailty. We evaluated the impact of an invasive strategy during the admission on the incidence of cardiac death, reinfarction or new revascularisation at 6-months. From 531 patients included, 145 (27.3%) were frail. Mean age was 84.3 years. Most patients underwent an invasive strategy (407/531, 76.6%). Patients undergoing an invasive strategy were younger and had lower proportion of frailty (23.3% vs 40.3%, pstrategy-frailty was significant (p=0.032) Conclusions: An invasive strategy was independently associated with better outcomes in very elderly patients with NSTEACS. This association was different according to frailty status.

  18. Relationship between frailty and respiratory function in the community-dwelling elderly.

    Science.gov (United States)

    Pegorari, Maycon S; Ruas, Gualberto; Patrizzi, Lislei J

    2013-01-01

    To evaluate the impact of frailty on respiratory function in a community- dwelling elderly. 51 community-dwelling elderly were evaluated (mean age of 73±6 years), being 29 men (56.7%) and 22 women (43.3%). We collect the following variables: sociodemographic characteristics, frailty phenotype, pulmonary function test and assessment of the respiratory muscles using an analog manometer. The statistical analysis was performed using the Kolmogorov and Smirnov tests, one-way ANOVA, Paired Student's t-test and Pearson correlation coefficient (prespiratory pressures may decrease according to the frailty condition among the non-frail, pre-frail and frail elderly. Furthermore, it also indicated a positive correlation between inspiratory muscle strength, expiratory muscle strength and hand grip strength in pre-frail elderly. Further investigation with regards to prevention or intervention programs that incorporate actions to minimize the loss of respiratory function are necessary in order to reverse or prevent the progression of the frailty condition.

  19. Statistical Evidence for the Preference of Frailty Distributions with Regularly-Varying-at-Zero Densities

    DEFF Research Database (Denmark)

    Missov, Trifon I.; Schöley, Jonas

    Missov and Finkelstein (2011) prove an Abelian and its corresponding Tauberian theorem regarding distributions for modeling unobserved heterogeneity in fixed-frailty mixture models. The main property of such distributions is the regular variation at zero of their densities. According...... to this criterion admissible distributions are, for example, the gamma, the beta, the truncated normal, the log-logistic and the Weibull, while distributions like the log-normal and the inverse Gaussian do not satisfy this condition. In this article we show that models with admissible frailty distributions...... and a Gompertz baseline provide a better fit to adult human mortality data than the corresponding models with non-admissible frailty distributions. We implement estimation procedures for mixture models with a Gompertz baseline and frailty that follows a gamma, truncated normal, log-normal, or inverse Gaussian...

  20. Dietary Pattern Associated with Frailty: Results from Nutrition and Health Survey in Taiwan.

    Science.gov (United States)

    Lo, Yen-Li; Hsieh, Yao-Te; Hsu, Li-Lin; Chuang, Shao-Yuan; Chang, Hsing-Yi; Hsu, Chih-Cheng; Chen, Ching-Yu; Pan, Wen-Harn

    2017-09-01

    To investigate whether dietary patterns are associated with frailty phenotypes in an elderly Taiwanese population. Cross-sectional. Nutrition and Health Survey in Taiwan (NAHSIT), 2014-2016. Noninstitutionalized Taiwanese nationals aged 65 years and older enrolled in the NAHSIT (N = 923). Dietary intake was assessed using a 79-item food-frequency questionnaire (FFQ). Presence of 5 frailty phenotypes was determined using modified Fried criteria and are summed into a frailty score. Using data from the NAHSIT (2014-15), reduced rank regression was used to find a dietary pattern that explained maximal degree of variation of the frailty scores. Logistic regression models were used to estimate the association between frailty and dietary pattern. The findings were validated with data from 2016. The derived dietary pattern was characterized with a high consumption of fruit, nuts and seeds, tea, vegetables, whole grains, shellfish, milk, and fish. The prevalence of frailty was 7.8% and of prefrailty was 50.8%, defined using the modified Fried criteria. Using data from the NAHSIT (2014-15), the dietary pattern score showed an inverse dose-response relationship with prevalence of frailty and pre-frailty. Individuals in the second dietary pattern tertile were one-third as likely to be frail as those in the first tertile (adjusted odds ratio (aOR) = 0.32, 95% confidence interval (CI) = 0.12-0.85), and those in the third tertile were 4% as likely to be frail as those in the first tertile (aOR = 0.04, 95% CI = 0.01-0.18). The dietary pattern score estimated using FFQ data from the NAHSIT 2016 was also significantly and inversely associated with frailty. Individuals with a dietary pattern with more phytonutrient-rich plant foods, tea, omega-3-rich deep-sea fish, and other protein-rich foods such as shellfish and milk had a reduced prevalence of frailty. Further research is necessary to confirm these findings and investigate whether related dietary interventions can reduce frailty

  1. Association of lead and cadmium exposure with frailty in US older adults

    International Nuclear Information System (INIS)

    García-Esquinas, Esther; Navas-Acien, Ana; Pérez-Gómez, Beatriz; Artalejo, Fernando Rodríguez

    2015-01-01

    Background: Environmental lead and cadmium exposure is associated with higher risk of several age-related chronic diseases, including cardiovascular disease, chronic kidney disease and osteoporosis. These diseases may lead to frailty, a geriatric syndrome characterized by diminished physiologic reserve in multiple systems with decreased ability to cope with acute stressors. However, no previous study has evaluated the association between lead or cadmium exposure and frailty. Methods: Cross-sectional study among individuals aged ≥60 years who participated in the third U.S. National Health and Nutrition Examination Survey and had either blood lead (N=5272) or urine cadmium (N=4887) determinations. Frailty was ascertained with a slight modification of the Fried criteria, so that individuals meeting ≥3 of 5 pre-defined criteria (exhaustion, low body weight, low physical activity, weakness and slow walking speed), were considered as frail. The association between lead and cadmium with frailty was evaluated using logistic regression with adjustment for relevant confounders. Results: Median (intertertile range) concentrations of blood lead and urine cadmium were 3.9 µg/dl (2.9–4.9) and 0.62 µg/l (0.41–0.91), respectively. The prevalence of frailty was 7.1%. The adjusted odds ratios (95% confidence interval) of frailty comparing the second and third to the lowest tertile of blood lead were, respectively, 1.40 (0.96–2.04) and 1.75 (1.33–2.31). Lead concentrations were also associated with the frequency of exhaustion, weakness and slowness. The corresponding odds ratios (95% confidence interval) for cadmium were, respectively, 0.97 (0.68–1.39) and 1.55 (1.03–2.32), but this association did not hold after excluding participants with reduced glomerular filtration rate: 0.70 (0.43–1.14) and 1.09 (0.56–2.11), respectively. Conclusions: In the US older adult population, blood lead but not urine cadmium concentrations showed a direct dose

  2. Association of lead and cadmium exposure with frailty in US older adults

    Energy Technology Data Exchange (ETDEWEB)

    García-Esquinas, Esther, E-mail: esthergge@gmail.com [Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPAZ, Madrid (Spain); CIBER of Epidemiology and Public Health (CIBERESP), Madrid (Spain); Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (United States); Navas-Acien, Ana [Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (United States); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (United States); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (United States); Pérez-Gómez, Beatriz [CIBER of Epidemiology and Public Health (CIBERESP), Madrid (Spain); Environmental Epidemiology and Cancer Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid (Spain); Artalejo, Fernando Rodríguez [Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPAZ, Madrid (Spain); CIBER of Epidemiology and Public Health (CIBERESP), Madrid (Spain)

    2015-02-15

    Background: Environmental lead and cadmium exposure is associated with higher risk of several age-related chronic diseases, including cardiovascular disease, chronic kidney disease and osteoporosis. These diseases may lead to frailty, a geriatric syndrome characterized by diminished physiologic reserve in multiple systems with decreased ability to cope with acute stressors. However, no previous study has evaluated the association between lead or cadmium exposure and frailty. Methods: Cross-sectional study among individuals aged ≥60 years who participated in the third U.S. National Health and Nutrition Examination Survey and had either blood lead (N=5272) or urine cadmium (N=4887) determinations. Frailty was ascertained with a slight modification of the Fried criteria, so that individuals meeting ≥3 of 5 pre-defined criteria (exhaustion, low body weight, low physical activity, weakness and slow walking speed), were considered as frail. The association between lead and cadmium with frailty was evaluated using logistic regression with adjustment for relevant confounders. Results: Median (intertertile range) concentrations of blood lead and urine cadmium were 3.9 µg/dl (2.9–4.9) and 0.62 µg/l (0.41–0.91), respectively. The prevalence of frailty was 7.1%. The adjusted odds ratios (95% confidence interval) of frailty comparing the second and third to the lowest tertile of blood lead were, respectively, 1.40 (0.96–2.04) and 1.75 (1.33–2.31). Lead concentrations were also associated with the frequency of exhaustion, weakness and slowness. The corresponding odds ratios (95% confidence interval) for cadmium were, respectively, 0.97 (0.68–1.39) and 1.55 (1.03–2.32), but this association did not hold after excluding participants with reduced glomerular filtration rate: 0.70 (0.43–1.14) and 1.09 (0.56–2.11), respectively. Conclusions: In the US older adult population, blood lead but not urine cadmium concentrations showed a direct dose

  3. Are frailty scales better than anesthesia or surgical scales to determine risk in cardiac surgery?

    OpenAIRE

    Kovacs, Judit; Moraru, Liviu; Antal, Krisztina; Cioc, Adrian; Voidazan, Septimiu; Szabo, Attila

    2016-01-01

    Background In the last year there has been an increasing interest for using frailty scales for risk stratification of elderly patients undergoing major surgery. We planned to compare two frailty scales with risk scales already used in cardiac surgery, to study which of these scores have better prognostic value predicting postoperative outcome in open heart surgery. Methods We conducted a prospective clinical trial, including 57 patients over 65 years. We calculated Cardiac Anesthesia Risk Eva...

  4. Frailty measurement and outcomes in interventional studies: protocol for a systematic review of randomised control trials.

    Science.gov (United States)

    Shears, Melissa; McGolrick, Danielle; Waters, Braden; Jakab, Marnie; Boyd, J Gordon; Muscedere, John

    2017-12-26

    Frailty is associated with reduced functional capacity, decreased resistance to stressors and is predictive of a range of adverse health outcomes, including dependency, hospitalisation and mortality. Early identification of frailty may prevent, reduce and postpone adverse health outcomes. However, there is a need for additional evidence to guide decision-making for the care of frail patients since frail persons are frequently excluded from studies, the differential impact of frailty is often not examined in clinical trials and few large-scale clinical trials examining frail cohorts have been conducted. Randomised control trials (RCTs) published to date have used a diverse range of definitions of frailty, as well as a variety of outcome measures. The objective of this systematic review is to comprehensively characterise the frail populations enrolled and the end points reported in frailty RCTs. We will identify all RCTs reporting on the outcome of interventions in adult (age ≥18 years) frail populations as defined by authors, in all settings of care. Databases will include MEDLINE, CINAHL, EMBASE, PsycInfo, Global Health, the Joanna Briggs database and Cochrane Library. Two reviewers will independently determine trial eligibility. For each included trial, we will conduct duplicate independent data extraction, inter-rater reliability, risk of bias assessment and evaluation of the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach. This systematic review will comprehensively identify RCTs including frail patients to identify how frailty is measured and which outcomes are reported. The results of this systematic review may inform clinicians caring for persons with frailty, facilitate conduct of future RCTs and inform future efforts to develop common data elements and core outcomes for frailty studies. Our findings will be disseminated through conference presentation and publication in peer-reviewed journals

  5. Linear and nonlinear analysis of postural control in frailty syndrome.

    Science.gov (United States)

    Vassimon-Barroso, Verena de; Catai, Aparecida Maria; Buto, Marcele Stephanie De Souza; Porta, Alberto; Takahashi, Anielle Cristhine De Medeiros

    Adaptive postural control can be impaired in the presence of frailty syndrome, given that this condition causes homeostatic dysregulation in physiological systems. To compare the center of pressure (CoP) displacements of non-frail, pre-frail, and frail elderly subjects in the standing position before and after postural transition of sitting and rising from a chair, using linear and nonlinear methods. Forty-two elderly subjects were divided into 3 groups: non-frail (n=15), pre-frail (n=15), and frail (n=12). The CoP displacements in the anteroposterior (AP) and mediolateral (ML) direction in the orthostatic position, 30s before and after sitting down and rising from a chair, were evaluated by means of linear measurements (root mean square (RMS), amplitude, and total average speed) and nonlinear measurements (corrected approximate entropy - CApEn), sample entropy (SampEn), and complexity index (CI) and its normalized versions. After sitting and rising, there was an increase in RMS in the ML direction in all groups and in the AP direction in the non-frail and frail groups. The frail group showed no reduction in entropy values in either direction, and the pre-frail group showed no reduction in the ML direction. The results of this study indicate that, in the presence of frailty syndrome, the organization of CoP displacements does not show less regularity after sitting and rising from a chair, reflecting a possible impairment of the integration of the systems involved in postural control. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  6. Aging, disability, and frailty: implications for universal design.

    Science.gov (United States)

    Crews, Douglas E; Zavotka, Susan

    2006-01-01

    Throughout the world all populations are seeing burgeoning numbers of "elders", defined as persons aged 65 year and older. In many countries, including Japan, the United States, Norway, Sweden and the United Kingdom, those aged over 65 are at or approaching 15% of the population. As their numbers have increased, so have their health care expenses, leading to extensive research on the health, well being, and life expectancy of these increasingly older elders. Today this group is further sub-divided: the young-old ages 65-74, the old-old ages 75-84, and the oldest-old ages 85+, for both health care and research purposes. However broad variation still characterizes even these groupings. Rates of frailty and disability increase with increasing age among these elders. For example, inabilities to complete at least one activity of daily living increased from about 5-7% at ages 65-69 years to about 28-36% at ages 85+ in 1987. Death rates continue to decline at all ages past 50 years and rates of disability seem to be doing the same. For the foreseeable future, we may expect increasing numbers of older, frail elders than in previous decades. Thus, people are not only living longer, they generally are healthier at advanced ages than were previous cohorts, thus "old age" disabilities of the 20th century will be put off to even older ages during the 21st century. As yet there is no clear way to assess senescent changes in humans, although activities of daily living, allostatic load, and frailty indices have all been suggested. One future need is greater development and use of universal and accessible design in all aspects of the built environment.

  7. COMPLEX MANAGEMENT OF FRAILTY FRACTURES--CASE REPORT.

    Science.gov (United States)

    Costescu, Elena Puin; Dronic, Aliona; Alexa, Loana Dana; Alexa, O

    2016-01-01

    Frailty fractures encompass pelvic ring fractures in the elderly--a condition more frequently encountered in women, usually with pre-existing osteoporosis. The incidence of these fractures is increasing, following the increase in average life expectancy. Most of the times, they are the result of a minor injury, of which the patient has little or no recollection; the clinical signs and symptoms, radiological changes and the degree of fracture stability vary greatly. As such, there is a wide range of therapeutic options and one of the most important decisions for the physician is choosing between surgery and conservative treatment. We present the case of an elderly female patient with multiple pelvic ring fractures, and a medical history of cardiovascular disease and osteoporosis; the orthopedic examination recommended conservative treatment which was carried out in the Geriatric Clinic of the "Dr. C.I. Parhon" Hospital. Following the complete physical examination and through geriatric evaluation, a complex therapeutic plan was devised, which included: recovery through physiotherapy, adequate nutrition, psychological support, treatment of the cardiovascular comorbidities and prevention of the consequences of extended bed rest. The treatment lasted for 60 days and the outcome was favorable: decreased bone frailty, mainly through preserving muscle tone and osteoarticular function, correction of malnutrition, improvement of depression and partial recovery of patient's mobility; the results of our therapy made it possible for the patient to return home, where she leaves alone. She will need help with daily household chores, but she intends to continue the recovery therapy as means of increasing her quality of life and independence.

  8. Impact of frailty in older patients with diabetes mellitus: An overview.

    Science.gov (United States)

    Cobo, Amelia; Vázquez, Luis A; Reviriego, Jesús; Rodríguez-Mañas, Leocadio

    2016-01-01

    Diabetes and frailty are two conditions that frequently occur concurrently and are increasingly prevalent in the older patient. We review the concept, epidemiology and consequences of frailty, and the implications of the presence of frailty in the management of diabetes. Frailty is associated with decreased quality of life, a risk of falls, new or increased disability, hospitalization, and increased mortality. All of these factors affect the management of diabetes in older patients. It is important to rule out frailty in all diabetic patients aged >70 years; if frailty is suspected, a comprehensive and multidisciplinary medical and functional assessment of the patient should be conducted to develop an individualized treatment plan. This plan should include nutritional measures, physical activity, and education on self-care and diabetes; drugs should not be used without a clear indication. Antihyperglycemic drugs that may cause excessive weight loss and/or are associated with a high risk of hypoglycemia should be avoided. Copyright © 2016 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  9. Active steps for diabetes: a community-campus partnership addressing frailty and diabetes.

    Science.gov (United States)

    Pariser, Gina; Hager, Kathy; Gillette, Patricia; Golemboski, Karen; Jackson, Kimberly

    2014-01-01

    The purpose of this study was to examine the effects of Active Steps for Diabetes (ASD), a self-management education (DSME) program for aging adults with diabetes and frailty, on blood glucose control (A1C) and level of frailty of participants. Fifty females (62.2 ± 10.1 years old) with type 2 diabetes and frailty completed the program; 16 used a walking aid. Outcome measures included A1C and the modified Physical Performance Test (mPPT). Repeated measures analysis of variance was used to compare outcomes before and after the program and between participants who did and did not use a walking aid. ASD was effective in reducing A1C and frailty in participants who did and did not use a walking aid. The reduction in A1C was similar for the 2 groups. The reduction in frailty was greater for the group that used a walking aid. Physical activity, a keystone for blood glucose control, is difficult for older adults who are frail. ASD provides a model for DSME that may reduce frailty of participants and increase their capacity for physical activity.

  10. The association between living alone and frailty in a rural Japanese population: the Nagasaki Islands study.

    Science.gov (United States)

    Yamanashi, Hirotomo; Shimizu, Yuji; Nelson, Mark; Koyamatsu, Jun; Nagayoshi, Mako; Kadota, Koichiro; Tamai, Mami; Ariyoshi, Koya; Maeda, Takahiro

    2015-12-01

    Demographic changes in Japan have resulted in an increased number of elderly living alone. The aim of this study was to identify if there is an association between frailty and living alone. We conducted a cross-sectional study of 1602 Japanese men and women living in isolated islands. Information obtained included height, body weight, handgrip strength, and family structure; antihypertensive, hypoglycaemic, and lipid-lowering medication use; history of stroke or ischaemic heart disease, smoking history, alcohol intake, joint pain or swelling. Relevant laboratory test results were obtained from recent health check-ups. The Frailty Index for Japanese elderly, a 15-item self-report questionnaire was completed by participants and the Kessler Psychological Distress Scale (K6) was administered. After individuals aged below 60 years old or those with missing data were excluded, data from 1224 participants were analysed. Living alone (single household family structure) was significantly associated with frailty in men (odds ratio [OR] 3.85; 95% confidence interval [CI] 1.94-7.65), but not in women (OR 1.08; 95% CI 0.72-1.63). This association in men remained statistically significant after adjustment for known risk factors for frailty. In the elderly population in rural Nagasaki, men living alone have a high risk of frailty. Screening and intervention to prevent frailty in this population is urgently needed.

  11. Long-term Associations Between Physical Frailty and Performance in Specific Cognitive Domains.

    Science.gov (United States)

    Bunce, David; Batterham, Philip J; Mackinnon, Andrew J

    2018-02-01

    No longitudinal epidemiological research has reported associations between physical frailty and performance in specific cognitive domains. Our aim was to investigate whether such associations existed in the absence of accompanying neurodegenerative disorders such as mild cognitive impairment (MCI) and dementia. We addressed this issue in a population-based sample of 896 adults aged 70 years and older over 4 waves of data covering a 12-year period. Physical frailty was assessed and a cognitive battery included measures of processing speed, verbal fluency, face and word recognition, episodic memory and simple and choice reaction time (RT). Latent growth models showed frailty was associated with poorer baseline performance in processing speed, verbal fluency, simple and choice RT, and choice intraindividual RT variability. However, no significant effects of frailty on slopes of cognition were observed, suggesting that frailty was not associated with cognitive decline. Importantly, when the models took possible dementia into account, significant effects were retained suggesting that differences were not associated with dementia-related neurodegenerative disorders. The findings suggest that frailty-related cognitive deficits may exist independently of mechanisms underpinning neurodegenerative disorders such as MCI and dementia. If confirmed, this finding suggests a new avenue for preventative and therapeutic interventions in clinical and public health contexts for older adults. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Assessment of frailty in elderly pre-dialysis population using simple tools

    Directory of Open Access Journals (Sweden)

    Hatem Ali

    2017-01-01

    Full Text Available Prevalence of chronic kidney disease (CKD is increasing worldwide principally among the elderly population many of whom will eventually need renal replacement therapy. The relationship between frailty and CKD in the elderly population has been recognized. However, studies concentrating on frailty in pre-dialysis patients are limited. CKD predisposes to frailty through many potential mechanisms; anemia, bone mineral disease, oxidative stress, and malnutrition which in turn lead to progression of CKD culminating in a vicious cycle. Identifying potential causes of frailty in elderly pre-dialysis patients and recognizing individuals at risk should be an area of focus to nephrologists and researchers. Modalities that may improve frailty in elderly pre-dialysis patients such as treatment of anemia and bone mineral disease may improve outcome. However, this has not been established and further research is needed. The aim of this review is to address the importance of recognizing frailty in elderly pre-dialysis patients using simple tools and describing its implications on clinical outcome.

  13. High Intensity Interval Training (HIIT) improves physical performance and frailty in aged mice.

    Science.gov (United States)

    Seldeen, Kenneth Ladd; Lasky, Ginger; Leiker, Merced Maria; Pang, Manhui; Personius, Kirkwood Ely; Troen, Bruce Robert

    2017-06-17

    Sarcopenia and frailty are highly prevalent in older individuals, increasing the risk of disability and loss of independence. High intensity interval training (HIIT) may provide a robust intervention for both sarcopenia and frailty by achieving both strength and endurance benefits with lower time commitments than other exercise regimens. To better understand the impacts of HIIT during aging, we compared 24-month-old C57BL/6J sedentary mice with those that were administered 10-minute uphill treadmill HIIT sessions three times per week over 16 weeks. Baseline and endpoint assessments included body composition, physical performance, and frailty based upon criteria from the Fried physical frailty scale. HIIT trained mice demonstrated dramatic improvement in grip strength (HIIT 10.9% versus -3.9% in sedentary mice), treadmill endurance (32.6% versus -2.0%), and gait speed (107.0% versus 39.0%). Muscles from HIIT mice also exhibited greater mass, larger fiber size, and an increase in mitochondrial biomass. Furthermore, HIIT exercise showed dramatic reduction in frailty scores in 5 of 6 mice that were frail or pre-frail at baseline, with 4 ultimately becoming non-frail. The uphill treadmill HIIT exercise sessions were well tolerated by aged mice and led to dramatic performance gains, improvement in underlying muscle physiology, and reduction in frailty. Published by Oxford University Press on behalf of The Gerontological Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  14. Frailty and sarcopenia: The potential role of an aged immune system.

    Science.gov (United States)

    Wilson, Daisy; Jackson, Thomas; Sapey, Elizabeth; Lord, Janet M

    2017-07-01

    Frailty is a common negative consequence of ageing. Sarcopenia, the syndrome of loss of muscle mass, quality and strength, is more common in older adults and has been considered a precursor syndrome or the physical manifestation of frailty. The pathophysiology of both syndromes is incompletely described with multiple causes, inter-relationships and complex pathways proposed. Age-associated changes to the immune system (both immunesenescence, the decline in immune function with ageing, and inflammageing, a state of chronic inflammation) have been suggested as contributors to sarcopenia and frailty but a direct causative role remains to be established. Frailty, sarcopenia and immunesenescence are commonly described in older adults but are not ubiquitous to ageing. There is evidence that all three conditions are reversible and all three appear to share common inflammatory drivers. It is unclear whether frailty, sarcopenia and immunesenescence are separate entities that co-occur due to coincidental or potentially confounding factors, or whether they are more intimately linked by the same underlying cellular mechanisms. This review explores these possibilities focusing on innate immunity, and in particular associations with neutrophil dysfunction, inflammation and known mechanisms described to date. Furthermore, we consider whether the age-related decline in immune cell function (such as neutrophil migration), increased inflammation and the dysregulation of the phosphoinositide 3-kinase (PI3K)-Akt pathway in neutrophils could contribute pathogenically to sarcopenia and frailty. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  15. Effect of a Prebiotic Formulation on Frailty Syndrome: A Randomized, Double-Blind Clinical Trial.

    Science.gov (United States)

    Buigues, Cristina; Fernández-Garrido, Julio; Pruimboom, Leo; Hoogland, Aldert J; Navarro-Martínez, Rut; Martínez-Martínez, Mary; Verdejo, Yolanda; Mascarós, Mari Carmen; Peris, Carlos; Cauli, Omar

    2016-06-14

    Aging can result in major changes in the composition and metabolic activities of bacterial populations in the gastrointestinal system and result in impaired function of the immune system. We assessed the efficacy of prebiotic Darmocare Pre(®) (Bonusan Besloten Vennootschap (BV), Numansdorp, The Netherlands) to evaluate whether the regular intake of this product can improve frailty criteria, functional status and response of the immune system in elderly people affected by the frailty syndrome. The study was a placebo-controlled, randomized, double blind design in sixty older participants aged 65 and over. The prebiotic product was composed of a mixture of inulin plus fructooligosaccharides and was compared with placebo (maltodextrin). Participants were randomized to a parallel group intervention of 13 weeks' duration with a daily intake of Darmocare Pre(®) or placebo. Either prebiotic or placebo were administered after breakfast (between 9-10 a.m.) dissolved in a glass of water carefully stirred just before drinking. The primary outcome was to study the effect on frailty syndrome. The secondary outcomes were effect on functional and cognitive behavior and sleep quality. Moreover, we evaluated whether prebiotic administration alters blood parameters (haemogram and biochemical analysis). The overall rate of frailty was not significantly modified by Darmocare Pre(®) administration. Nevertheless, prebiotic administration compared with placebo significantly improved two frailty criteria, e.g., exhaustion and handgrip strength (p sleep quality. The use of novel therapeutic approaches influencing the gut microbiota-muscle-brain axis could be considered for treatment of the frailty syndrome.

  16. Frail Elders in an Urban District Setting in Malaysia: Multidimensional Frailty and Its Correlates.

    Science.gov (United States)

    Sathasivam, Jeyanthini; Kamaruzzaman, Shahrul Bahyah; Hairi, Farizah; Ng, Chiu Wan; Chinna, Karuthan

    2015-11-01

    In the past decade, the population in Malaysia has been rapidly ageing. This poses new challenges and issues that threaten the ability of the elderly to independently age in place. A multistage cross-sectional study on 789 community-dwelling elderly individuals aged 60 years and above was conducted in an urban district in Malaysia to assess the geriatric syndrome of frailty. Using a multidimensional frailty index, we detected 67.7% prefrail and 5.7% frail elders. Cognitive status was a significant correlate for frailty status among the respondents as well as those who perceived their health status as very poor or quite poor; but self-rated health was no longer significant when controlled for sociodemographic variables. Lower-body weakness and history of falls were associated with increasing frailty levels, and this association persisted in the multivariate model. This study offers support that physical disability, falls, and cognition are important determinants for frailty. This initial work on frailty among urban elders in Malaysia provides important correlations and identifies potential risk factors that can form the basis of information for targeted preventive measures for this vulnerable group in their prefrail state. © 2015 APJPH.

  17. The impact of frailty on depressive disorder in later life: Findings from the Netherlands Study of depression in older persons.

    Science.gov (United States)

    Collard, R M; Arts, M H L; Schene, A H; Naarding, P; Oude Voshaar, R C; Comijs, H C

    2017-06-01

    Physical frailty and depressive symptoms are reciprocally related in community-based studies, but its prognostic impact on depressive disorder remains unknown. A cohort of 378 older persons (≥60 years) suffering from a depressive disorder (DSM-IV criteria) was reassessed at two-year follow-up. Depressive symptom severity was assessed every six months with the Inventory of Depressive Symptomatology, including a mood, motivational, and somatic subscale. Frailty was assessed according to the physical frailty phenotype at the baseline examination. For each additional frailty component, the odds of non-remission was 1.24 [95% CI=1.01-1.52] (P=040). Linear mixed models showed that only improvement of the motivational (Pdepression. Since only improvement of mood symptoms was independent of frailty severity, one may hypothesize that frailty and residual depression are easily mixed-up in psychiatric treatment. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  18. A semi-parametric within-subject mixture approach to the analyses of responses and response times.

    Science.gov (United States)

    Molenaar, Dylan; Bolsinova, Maria; Vermunt, Jeroen K

    2017-10-17

    In item response theory, modelling the item response times in addition to the item responses may improve the detection of possible between- and within-subject differences in the process that resulted in the responses. For instance, if respondents rely on rapid guessing on some items but not on all, the joint distribution of the responses and response times will be a multivariate within-subject mixture distribution. Suitable parametric methods to detect these within-subject differences have been proposed. In these approaches, a distribution needs to be assumed for the within-class response times. In this paper, it is demonstrated that these parametric within-subject approaches may produce false positives and biased parameter estimates if the assumption concerning the response time distribution is violated. A semi-parametric approach is proposed which resorts to categorized response times. This approach is shown to hardly produce false positives and parameter bias. In addition, the semi-parametric approach results in approximately the same power as the parametric approach. © 2017 The British Psychological Society.

  19. Semi-Parametric Maximum Likelihood Method for Interaction in Case-Mother Control-Mother Designs: Package SPmlficmcm

    Directory of Open Access Journals (Sweden)

    Moliere Nguile-Makao

    2015-12-01

    Full Text Available The analysis of interaction effects involving genetic variants and environmental exposures on the risk of adverse obstetric and early-life outcomes is generally performed using standard logistic regression in the case-mother and control-mother design. However such an analysis is inefficient because it does not take into account the natural family-based constraints present in the parent-child relationship. Recently, a new approach based on semi-parametric maximum likelihood estimation was proposed. The advantage of this approach is that it takes into account the parental relationship between the mother and her child in estimation. But a package implementing this method has not been widely available. In this paper, we present SPmlficmcm, an R package implementing this new method and we propose an extension of the method to handle missing offspring genotype data by maximum likelihood estimation. Our choice to treat missing data of the offspring genotype was motivated by the fact that in genetic association studies where the genetic data of mother and child are available, there are usually more missing data on the genotype of the offspring than that of the mother. The package builds a non-linear system from the data and solves and computes the estimates from the gradient and the Hessian matrix of the log profile semi-parametric likelihood function. Finally, we analyze a simulated dataset to show the usefulness of the package.

  20. Multiresponse semiparametric regression for modelling the effect of regional socio-economic variables on the use of information technology

    Science.gov (United States)

    Wibowo, Wahyu; Wene, Chatrien; Budiantara, I. Nyoman; Permatasari, Erma Oktania

    2017-03-01

    Multiresponse semiparametric regression is simultaneous equation regression model and fusion of parametric and nonparametric model. The regression model comprise several models and each model has two components, parametric and nonparametric. The used model has linear function as parametric and polynomial truncated spline as nonparametric component. The model can handle both linearity and nonlinearity relationship between response and the sets of predictor variables. The aim of this paper is to demonstrate the application of the regression model for modeling of effect of regional socio-economic on use of information technology. More specific, the response variables are percentage of households has access to internet and percentage of households has personal computer. Then, predictor variables are percentage of literacy people, percentage of electrification and percentage of economic growth. Based on identification of the relationship between response and predictor variable, economic growth is treated as nonparametric predictor and the others are parametric predictors. The result shows that the multiresponse semiparametric regression can be applied well as indicate by the high coefficient determination, 90 percent.

  1. Prevalence of Frailty in Patients with Osteoporotic Vertebral Compression Fracture and Its Association with Numbers of Fractures.

    Science.gov (United States)

    Kim, Ho Joong; Park, Saejong; Park, Soo Hyun; Park, Jiwon; Chang, Bong Soon; Lee, Choon Ki; Yeom, Jin S

    2018-03-01

    To assess the association between frailty and osteoporotic vertebral compression fracture (OVCF) and to evaluate the relationship between numbers of OVCFs and frailty. We enrolled 760 subjects, including 59 patients (with OVCF) and 701 controls (without OVCF). Successful matching provided 56 patient-control pairs. We analyzed principal clinical and demographic information, which included sex, age, height, weight, body mass index (BMI), variable frailty phenotypes, and Oswestry Disability Index (ODI) and EuroQol 5-dimension questionnaire (EQ-5D) scores. The association between frailty and OVCF was ascertained. In addition, the degrees of disability and quality of life attributable to frailty were determined. The prevalence of frailty was significantly higher in the OVCF group than in the control group (pratio (OR)=0.704; 95% confidence interval (CI), 0.543-0.913] and ≥3 fractures (OR=9.213; 95% CI, 1.529-55.501) within the OVCF group were associated with higher odds of frailty. The present study showed significant relationships between frailty and OVCF, severity of symptoms, and disability induced by OVCF. Furthermore, frailty could be a causal and/or resulting factor of OVCFs. © Copyright: Yonsei University College of Medicine 2018

  2. Frailty and sarcopenia in Bogotá: results from the SABE Bogotá Study.

    Science.gov (United States)

    Samper-Ternent, Rafael; Reyes-Ortiz, Carlos; Ottenbacher, Kenneth J; Cano, Carlos A

    2017-04-01

    Latin American countries like Colombia are experiencing a unique aging process due to a mixed epidemiological regime of communicable and non-communicable diseases. To estimate the prevalence of frailty and sarcopenia among older adults in Colombia and identify variables associated with these conditions. Data come from the "Salud Bienestar y Envejecimiento" (SABE) Bogotá Study, a cross-sectional study conducted in 2012 in Bogotá, Colombia. Sociodemographic, health, cognitive and anthropometric measures were collected from 2000 community-dwelling adults aged 60 years and older. Frailty variable was created using the Fried phenotype and sarcopenia following the European Working Group on Sarcopenia in Older People algorithm. Logistic regression analyses were used to identify factors associated with frailty and sarcopenia. A total of 135 older adults are frail (9.4 %), while 166 have sarcopenia (11.5 %). Older age and female gender have a significant association with both conditions (Frailty: Age OR 1.05, 95 % CI 1.03-1.06, Gender OR 1.44, 95 % CI 1.12-1.84; Sarcopenia: Age 1.04, 95 % CI 1.02-1.07, Gender OR 1.51, 95 % CI 1.05-2.17). Depression was also significantly associated with frailty (OR 1.17, 95 % CI 1.12-1.22), while smoking was significantly associated with sarcopenia (OR 2.38, 95 % CI 1.29-4.37). Finally, higher function, measured by independence in IADL (Instrumental Activities of Daily Living) was significantly associated with less frailty (OR 0.74, 95 % CI 0.64-0.86). Education, higher number of comorbidities, better MMSE score, activities of daily living disability and alcohol consumption were not significantly associated with frailty or sarcopenia. Frailty, sarcopenia and multimorbidity are overlapping, yet distinct conditions in this sample. There are potentially reversible factors that are associated with frailty and sarcopenia in this sample. Future studies need to analyze the best way to prevent these conditions, and examine individuals

  3. Varying Coefficient Panel Data Model in the Presence of Endogenous Selectivity and Fixed Effects

    OpenAIRE

    Malikov, Emir; Kumbhakar, Subal C.; Sun, Yiguo

    2013-01-01

    This paper considers a flexible panel data sample selection model in which (i) the outcome equation is permitted to take a semiparametric, varying coefficient form to capture potential parameter heterogeneity in the relationship of interest, (ii) both the outcome and (parametric) selection equations contain unobserved fixed effects and (iii) selection is generalized to a polychotomous case. We propose a two-stage estimator. Given consistent parameter estimates from the selection equation obta...

  4. Application of semi-parametric single-index two-part regression and parametric two-part regression in estimation of the cost of functional gastrointestinal disorders.

    Science.gov (United States)

    Shojai, Mohadese; Kazemnejad, Anoshirvan; Zayeri, Farid; Vahedi, Mohsen

    2013-01-01

    For the purpose of cost modeling, the semi-parametric single-index two-part model was utilized in the paper. Furthermore, as functional gastrointestinal diseases which are well-known as common causes of illness among the society people in terms of both the number of patients and prevalence in a specific time interval, this research estimated the average cost of functional gastrointestinal diseases. Health care policy-makers seek for real and accurate estimations of society's future medical costs. However, data dealt with in hygienic studies have characteristics which make their analysis complicated; distribution of cost data is highly skewed since many patients pay great costs. In addition, medical costs of many persons are zero in a specific time interval. Indeed, medical costs data are often right skewed, including remarkable number of zeros, and may be distributed non-homogeneously. In modeling these costs by the semi-parametric single-index two-part model, parameters were determined by method of least squares; a result of this method was compared with the results yielded from two-part parametric model. Average costs of functional gastrointestinal diseases and their standard deviation in semi-parametric and parametric methods were yielded as $72.69±108.96 (R(2)=0.38) and $75.93±122.29 (R(2)=0.33) respectively. Based on R(2) index, the semi-parametric model is recognized as the best model. Totally, the two-part parametric regression model is a simple and available model which can be easily interpreted; on the other hand, though the single-index two-part semi-parametric model cannot be easily interpreted, it has considerable flexibility. The study goals can be indeed used as the main factor for choosing one of these two models.

  5. Preoperative Frailty Score for 30-Day Morbidity and Mortality After Cranial Neurosurgery.

    Science.gov (United States)

    Tomlinson, Samuel B; Piper, Keaton; Kimmell, Kristopher T; Vates, G Edward

    2017-11-01

    Evaluating preoperative frailty is critical for guiding shared surgical decision-making. The purpose of this study was to develop a novel preoperative frailty index for classification of adverse outcomes following cranial neurosurgery procedures. The American College of Surgeons National Surgical Quality Improvement Program database was queried for all cranial neurosurgery cases from 2006 to 2014. Sequential univariate and multivariate testing was used to identify significant independent predictors of 30-day mortality. Frailty scores were computed by summating across weighted predictors. Receiver operating characteristic curve analysis quantified the discriminative capacity of the frailty score for classifying mortality and other major adverse outcomes. List-wise exclusion of patients with incomplete datasets yielded a final sample of 27,098 patients (mortality rate = 3.9%). Multivariate regression testing identified 19 independent predictors of 30-day mortality. Receiver operating characteristic curve analysis revealed impressive outcome discrimination (area under the curve = 0.87, P mortality (15.4%) and major adverse outcomes (32.0%) compared with patients in the "low-risk" group (n = 21,943, mortality = 1.2%, major adverse outcomes = 4.0%). The frailty score remained highly discriminative across all age groups examined. Neurosurgical patients undergo extensive preoperative evaluation, but the field currently lacks a robust bedside scoring system for quantifying patient frailty. In this study, we introduced a novel preoperative frailty index capable of classifying 30-day morbidity and mortality outcomes following cranial neurosurgeries. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Adherence to a Mediterranean diet is associated with lower incidence of frailty: A longitudinal cohort study.

    Science.gov (United States)

    Veronese, Nicola; Stubbs, Brendon; Noale, Marianna; Solmi, Marco; Rizzoli, Renè; Vaona, Alberto; Demurtas, Jacopo; Crepaldi, Gaetano; Maggi, Stefania

    2017-09-04

    There is a paucity of data investigating the relationship between the Mediterranean diet and frailty, with no data among North American people. We aimed to investigate if adherence to a Mediterranean diet is associated with a lower incidence of frailty in a large cohort of North American people. This study included subjects at higher risk or having knee osteoarthritis. Adherence to the Mediterranean diet was evaluated using a validated Mediterranean diet score (aMED) as proposed by Panagiotakos and classified into five categories. Frailty was defined using the Study of Osteoporotic Fracture (SOF) index as the presence of ≥2 out of: (i) weight loss ≥5% between baseline and the subsequent follow-up visit; (ii) inability to do five chair stands; (iii) low energy level. During the 8 years follow-up, of the 4421 participants initially included (mean age: 61.2 years, % of females = 58.0), the incidence of frailty was approximately half in those with a higher adherence to the Mediterranean diet (8 for 1000 person years) vs. those with a lower adherence (15 for 1000 persons-years). After adjusting for 10 potential confounders (age, sex, race, body mass index, education, smoking habits, yearly income, physical activity level, Charlson co-morbidity index and daily energy intake), participants with the highest aMED scores were found to have a significant reduction in incident frailty (hazard ratio = 0.71; 95% CIs: 0.50-0.99, p = 0.047) with respect to those in a lower category. Regarding individual components of the Mediterranean diet, low consumption of poultry was found to be associated with higher risk of frailty. A higher adherence to a Mediterranean diet was associated with a lower incidence of frailty over an 8-year follow-up period, even after adjusting for potential confounders. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  7. Oxidative stress is related to frailty, not to age or sex, in a geriatric population: lipid and protein oxidation as biomarkers of frailty.

    Science.gov (United States)

    Inglés, Marta; Gambini, Juan; Carnicero, Jose A; García-García, Francisco J; Rodríguez-Mañas, Leocadio; Olaso-González, Gloria; Dromant, Mar; Borrás, Consuelo; Viña, Jose

    2014-07-01

    To ascertain whether indicators of oxidative damage to lipids (malondialdehyde (MDA)) and proteins (protein carbonylation) are biomarkers of frailty, after adjusting for age, sex, and other possible confounders. Cross-sectional cohort study. Community. Toledo Study for Healthy Aging participants (N = 742, aged 65-95), classified as frail (n = 54), prefrail (n = 278) and nonfrail (n = 410) according to the Fried criteria. Blood plasma was obtained using centrifugation (1,500 G, 15 minutes) and immediately frozen at -80°C. Plasma lipid peroxidation was determined by measuring the MDA formed from lipoperoxides using high-performance liquid chromatography and protein carbonylation was measured using Western blot. Age- and sex-adjusted levels of lipoperoxides (measured as MDA) and protein carbonylation in plasma proved to be related to frailty, even after including possible independent confounders. Circulating oxidative damage biomarkers, such as MDA and protein carbonylation, are related to frailty and not to age or sex. These parameters may be considered as potential biomarkers of frailty in the context of a multidisciplinary health-promoting approach for older adults. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  8. Frail or hale: Skeletal frailty indices in Medieval London skeletons.

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    Marklein, Kathryn E; Crews, Douglas E

    2017-01-01

    To broaden bioarchaeological applicability of skeletal frailty indices (SFIs) and increase sample size, we propose indices with fewer biomarkers (2-11 non-metric biomarkers) and compare these reduced biomarker SFIs to the original metric/non-metric 13-biomarker SFI. From the 2-11-biomarker SFIs, we choose the index with the fewest biomarkers (6-biomarker SFI), which still maintains the statistical robusticity of a 13-biomarker SFI, and apply this index to the same Medieval monastic and nonmonastic populations, albeit with an increased sample size. For this increased monastic and nonmonastic sample, we also propose and implement a 4-biomarker SFI, comprised of biomarkers from each of four stressor categories, and compare these SFI distributions with those of the non-metric biomarker SFIs. From the Museum of London WORD database, we tabulate multiple SFIs (2- to 13-biomarkers) for Medieval monastic and nonmonastic samples (N = 134). We evaluate associations between these ten non-metric SFIs and the 13-biomarker SFI using Spearman's correlation coefficients. Subsequently, we test non-metric 6-biomarker and 4-biomarker SFI distributions for associations with cemetery, age, and sex using Analysis of Variance/Covariance (ANOVA/ANCOVA) on larger samples from the monastic and nonmonastic cemeteries (N = 517). For Medieval samples, Spearman's correlation coefficients show a significant association between the 13-biomarker SFI and all non-metric SFIs. Utilizing a 6-biomarker and parsimonious 4-biomarker SFI, we increase the nonmonastic and monastic samples and demonstrate significant lifestyle and sex differences in frailty that were not observed in the original, smaller sample. Results from the 6-biomarker and parsimonious 4-biomarker SFIs generally indicate similarities in means, explained variation (R2), and associated P-values (ANOVA/ANCOVA) within and between nonmonastic and monastic samples. We show that non-metric reduced biomarker SFIs provide alternative indices for

  9. Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients.

    Science.gov (United States)

    Joosten, Etienne; Demuynck, Mathias; Detroyer, Elke; Milisen, Koen

    2014-01-06

    The prevalence and significance of frailty are seldom studied in hospitalized patients. Aim of this study is to evaluate the prevalence of frailty and to determine the extent that frailty predicts delirium, falls and mortality in hospitalized older patients. In a prospective study of 220 older patients, frailty was determined using the Cardiovascular Health Study (CHS) and the Study of Osteoporotic Fracture (SOF) frailty index. Patients were classified as nonfrail, prefrail, and frail, according to the specific criteria. Covariates included clinical and laboratory parameters. Outcome variables included in hospital delirium and falls, and 6-month mortality. The CHS frailty index was available in all 220 patients, of which 1.5% were classified as being nonfrail, 58.5% as prefrail, and 40% as frail. The SOF frailty index was available in 204 patients, of which 16% were classified as being nonfrail, 51.5% as prefrail, and 32.5% as frail. Frailty, as identified by the CHS and SOF indexes, was a significant risk factor for 6-month mortality. However, after adjustment for multiple risk factors, frailty remained a strong independent risk factor only for the model with the CHS index (OR 4.7, 95% CI 1.7-12.8). Frailty (identified by CHS and SOF indexes) was not found to be a risk factor for delirium or falls. Frailty, as measured by the CHS index, is an independent risk factor for 6-month mortality. The CHS and the SOF indexes have limited value as risk assessment tools for specific geriatric syndromes (e.g., falls and delirium) in hospitalized older patients.

  10. Assessment of Commonly Used Frailty Markers for High- and Extreme-Risk Patients Undergoing Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Forcillo, Jessica; Condado, Jose F; Ko, Yi-An; Yuan, Michael; Binongo, Jose N; Ndubisi, Nnaemeka M; Kelly, John J; Babaliaros, Vasilis; Guyton, Robert A; Devireddy, Chandan; Leshnower, Bradley G; Stewart, James P; Perrault, Louis P; Khairy, Paul; Thourani, Vinod H

    2017-12-01

    The effect of frailty on outcomes after transcatheter aortic valve replacement (TAVR) remains incompletely understood. The objective of this study was to evaluate the performance of four commonly used frailty markers as predictors of early and late outcomes among patients undergoing TAVR. A review was performed of 361 high- and extreme-risk patients undergoing TAVR from 2011 to 2015. Four frailty variables were assessed: serum albumin (g/dL), 5-m walk (seconds), grip strength (kg), and Katz index of independence in activities of daily living. Logistic regression was used to examine the association between the frailty indicators and 30-day composite of mortality, stroke, new heart block requiring permanent pacemaker, major or life-threatening bleeding, acute renal failure, major vascular complication, and 30-day readmission rate. Minimum distance to the perfect point (0, 1) was performed to delineate a cutoff point for each frailty indicator, and risk models were compared using receiver-operating characteristics curves. The composite of outcomes occurred in 28% of patients. Serum albumin, activities of daily living, and 5-m walk were independent predictors for 30-day composite outcomes, but only albumin was predictive of 30-day mortality. A new frailty model (four frailty indicators, age, and sex) to predict 30-day mortality was created and compared with The Society of Thoracic Surgeons predicted risk of mortality. Better discrimination was found with the new frailty model (area under the curve 0.74 versus 0.58). New individual frailty variable cutoff values were found to predict our composite of events. Among high- and extreme-risk patients undergoing TAVR, our new frailty model was more discriminative of 30-day mortality than The Society of Thoracic Surgeons predicted risk of mortality. New cutoff values for frailty indicators were identified and will require further validation. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All

  11. An evaluation of frailty factors among elderly and their mutual links in elderly women in the Olomouc region

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    Tereza Kaplanová

    2017-03-01

    Full Text Available Background: Ageing has a significant impact on the functional status and capacity in physical, cognitive, sensory and nutritional areas. The age-related changes include changes in body composition as well as changes in the musculoskeletal system including a significant loss of muscle mass and demineralization of bone. Objective: The aim of this study was to evaluate the relationship between selected parameters of frailty factors in older women from the Olomouc region. Methods: The research group consisted of 225 women (aged 60-81 years attending University of the Third Age at the Faculty of Physical Culture, Palacký University Olomouc and women from senior clubs in Olomouc. Body composition was assessed by multifrequency bioelectrical impedance. Muscle strength in the hand flexors was evaluated using a digital pinch grip. Information on bone density was obtained through local densitometer. To verify the strength of relation between variables Pearson correlation coefficients were calculated. Results: Relationship between body composition, muscle strength and bone density proved to be statistically significant. Moderate positive correlation was found between the grip strengths of both hands, bone density of both calcaneus and the amount of fat-free mass, muscle mass, cell mass and the size of the basal metabolic rate in range from .41 to .49. The relationship between muscle strength and bone density was weak (r < .30 but statistically significant. Conclusions: These results confirm the relationship between aspects of the frailty of elderly women, especially the relationship between muscle strength, bone density and selected parameters of body composition.

  12. Characterisation of Physical Frailty and Associated Physical and Functional Impairments in Mild Cognitive Impairment

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    Ma Shwe Zin Nyunt

    2017-12-01

    Full Text Available ObjectiveTo characterize the physical frailty phenotype and its associated physical and functional impairments in mild cognitive impairment (MCI.MethodParticipants with MCI (N = 119, normal low cognition (NLC, N = 138, and normal high cognition (NHC, N = 1,681 in the Singapore Longitudinal Ageing Studies (SLAS-2 were compared on the prevalence of physical frailty, low lean body mass, weakness, slow gait, exhaustion and low physical activity, and POMA balance and gait impairment and fall risk.ResultsThere were significantly higher prevalence of frailty in MCI (18.5%, than in NLC (8.0% and NHC (3.9%, and pre-frailty in MCI (54.6%, NLC (52.9% than in NHC (48.0%. Age, sex, and ethnicity-adjusted OR (95% CI of association with MCI (versus NHC for frailty were 4.65 (2.40–9.04 and for pre-frailty, 1.67 (1.07–2.61. Similar significantly elevated prevalence and adjusted ORs of association with MCI were observed for frailty-associated physical and functional impairments. Further adjustment for education, marital status, living status, comorbidities, and GDS significantly reduced the OR estimates. However, the OR estimates remained elevated for frailty: 3.86 (1.83–8.17, low body mass: 1.70 (1.08–2.67, slow gait: 1.84 (1.17–2.89, impaired gait: 4.17 (1.98–8.81, and elevated fall risk 3.42 (1.22–9.53.ConclusionTwo-thirds of MCI were physically frail or pre-frail, most uniquely due to low lean muscle mass, slow gait speed, or balance and gait impairment. The close associations of frailty and physical and functional impairment with MCI have important implications for improving diagnostic acuity of MCI and targetting interventions among cognitively frail individuals to prevent dementia and disability.

  13. Acute Kidney Injury and Subsequent Frailty Status in Survivors of Critical Illness: A Secondary Analysis.

    Science.gov (United States)

    Abdel-Kader, Khaled; Girard, Timothy D; Brummel, Nathan E; Saunders, Christina T; Blume, Jeffrey D; Clark, Amanda J; Vincz, Andrew J; Ely, E Wesley; Jackson, James C; Bell, Susan P; Archer, Kristin R; Ikizler, T Alp; Pandharipande, Pratik P; Siew, Edward D

    2018-01-25

    Acute kidney injury frequently complicates critical illness and is associated with high morbidity and mortality. Frailty is common in critical illness survivors, but little is known about the impact of acute kidney injury. We examined the association of acute kidney injury and frailty within a year of hospital discharge in survivors of critical illness. Secondary analysis of a prospective cohort study. Medical/surgical ICU of a U.S. tertiary care medical center. Three hundred seventeen participants with respiratory failure and/or shock. None. Acute kidney injury was determined using Kidney Disease Improving Global Outcomes stages. Clinical frailty status was determined using the Clinical Frailty Scale at 3 and 12 months following discharge. Covariates included mean ICU Sequential Organ Failure Assessment score and Acute Physiology and Chronic Health Evaluation II score as well as baseline comorbidity (i.e., Charlson Comorbidity Index), kidney function, and Clinical Frailty Scale score. Of 317 patients, 243 (77%) had acute kidney injury and one in four patients with acute kidney injury was frail at baseline. In adjusted models, acute kidney injury stages 1, 2, and 3 were associated with higher frailty scores at 3 months (odds ratio, 1.92; 95% CI, 1.14-3.24; odds ratio, 2.40; 95% CI, 1.31-4.42; and odds ratio, 4.41; 95% CI, 2.20-8.82, respectively). At 12 months, a similar association of acute kidney injury stages 1, 2, and 3 and higher Clinical Frailty Scale score was noted (odds ratio, 1.87; 95% CI, 1.11-3.14; odds ratio, 1.81; 95% CI, 0.94-3.48; and odds ratio, 2.76; 95% CI, 1.34-5.66, respectively). In supplemental and sensitivity analyses, analogous patterns of association were observed. Acute kidney injury in survivors of critical illness predicted worse frailty status 3 and 12 months postdischarge. These findings have important implications on clinical decision making among acute kidney injury survivors and underscore the need to understand the drivers of

  14. Feasibility and reliability of frailty assessment in the critically ill: a systematic review.

    Science.gov (United States)

    Pugh, Richard J; Ellison, Amy; Pye, Kate; Subbe, Christian P; Thorpe, Chris M; Lone, Nazir I; Clegg, Andrew

    2018-02-26

    For healthcare systems, an ageing population poses challenges in the delivery of equitable and effective care. Frailty assessment has the potential to improve care in the intensive care setting, but applying assessment tools in critical illness may be problematic. The aim of this systematic review was to evaluate evidence for the feasibility and reliability of frailty assessment in critical care. Our primary search was conducted in Medline, Medline In-process, EMBASE, CINAHL, PsycINFO, AMED, Cochrane Database of Systematic Reviews, and Web of Science (January 2001 to October 2017). We included observational studies reporting data on feasibility and reliability of frailty assessment in the critical care setting in patients 16 years and older. Feasibility was assessed in terms of timing of evaluation, the background, training and expertise required for assessors, and reliance upon proxy input. Reliability was assessed in terms of inter-rater reliability. Data from 11 study publications are included, representing 8 study cohorts and 7761 patients. Proxy involvement in frailty assessment ranged from 58 to 100%. Feasibility data were not well-reported overall, but the exclusion rate due to lack of proxy availability ranged from 0 to 45%, the highest rate observed where family involvement was mandatory and the assessment tool relatively complex (frailty index, FI). Conventional elements of frailty phenotype (FP) assessment required modification prior to use in two studies. Clinical staff tended to use a simple judgement-based tool, the clinical frailty scale (CFS). Inter-rater reliability was reported in one study using the CFS and although a good level of agreement was observed between clinician assessments, this was a small and single-centre study. Though of unproven reliability in the critically ill, CFS was the tool used most widely by critical care clinical staff. Conventional FP assessment required modification for general application in critical care, and an FI

  15. Dairy Consumption and Risk of Frailty in Older Adults: A Prospective Cohort Study.

    Science.gov (United States)

    Lana, Alberto; Rodriguez-Artalejo, Fernando; Lopez-Garcia, Esther

    2015-09-01

    To examine the association between consumption of dairy products and risk of frailty in community-dwelling older adults. Prospective cohort study. General population from the older cohort of the Study on Nutrition and Cardiovascular Risk in Spain. Community-dwelling adults aged 60 and older free of frailty at baseline (N = 1,871). From 2008 to 2010, food consumption was assessed using a validated diet history. Participants were examined again in 2012 to assess incident frailty, defined as at least three of the five Fried criteria (exhaustion, weakness, low physical activity, slow walking speed, unintentional weight loss). Adjusted odds ratios (OR) for the main confounders were obtained using logistic regression. During follow-up, 134 new cases of frailty were identified. Participants consuming seven or more servings per week of low-fat milk and yogurt had lower incidence of frailty (OR = 0.52; 95% confidence interval (CI) = 0.29-0.90; P for trend = .03) than those consuming less than one serving per week. Specifically, consumers of seven or more servings per week of low-fat milk and yogurt had less risk of slow walking speed (OR = 0.64, 95% CI = 0.44-0.92, P trend = .01) and of weight loss (OR = 0.54, 95% CI = 0.33-0.87, P trend = .02). Consuming seven or more servings per week of whole milk or yogurt (OR = 1.53, 95% CI = 0.90-2.60, P trend = .10) or of cheese (OR = 0.91, 95% CI = 0.52-1.61; P trend = .61) was not associated with incident frailty. Higher consumption of low-fat milk and yogurt was associated with lower risk of frailty and, specifically, of slow walking speed and weight loss. Current recommendations to prevent frailty include protein supplementation; thus, although experimental research is needed, increasing the consumption of low-fat yogurt and milk might prevent frailty in older adults. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  16. The association between frailty, the metabolic syndrome, and mortality over the lifespan.

    Science.gov (United States)

    Kane, Alice E; Gregson, Edward; Theou, Olga; Rockwood, Kenneth; Howlett, Susan E

    2017-04-01

    Frailty and the metabolic syndrome are each associated with poor outcomes, but in very old people (90+ years) only frailty was associated with an increased mortality risk. We investigated the relationship between frailty, metabolic syndrome, and mortality risk, in younger (20-65 years) and older (65+ years) people. This is a secondary analysis of the US National Health and Nutrition Examination Survey (NHANES) datasets for 2003-2004 and 2005-2006, linked with mortality data up to 2011. The metabolic syndrome was defined using the International Diabetes Federation criteria. Frailty was operationalized using a 41-item frailty index (FI). Compared to the younger group (n = 6403), older adults (n = 2152) had both a higher FI (0.10 ± 0.00 vs. 0.22 ± 0.00, p metabolic syndrome (24.1 vs. 45.5%, p metabolic syndrome and FI were correlated in younger people (r = 0.25, p metabolic syndrome did so only in the younger group. In Cox models, adjusted for age, sex, race, education, and each other, the FI was associated with increased mortality risk at both ages (younger HR 1.05 (1.04-1.06); older HR 1.04 (1.03-1.04) whereas the metabolic syndrome did not contribute to mortality risk. The FI better predicted mortality than did the metabolic syndrome, regardless of age.

  17. The protective effect of neighborhood composition on increasing frailty among older Mexican Americans: a barrio advantage?

    Science.gov (United States)

    Aranda, María P; Ray, Laura A; Snih, Soham Al; Ottenbacher, Kenneth J; Markides, Kyriakos S

    2011-10-01

    Little is known about the nature of the frailty syndrome in older Hispanics who are projected to be the largest minority older population by 2050. The authors examine prospectively the relationship between medical, psychosocial, and neighborhood factors and increasing frailty in a community-dwelling sample of Mexican Americans older than 75 years. Based on a modified version of the Cardiovascular Health Study Frailty Index, the authors examine 2-year follow-up data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) to ascertain the rates and determinants of increasing frailty among 2,069 Mexican American adults 75+ years of age at baseline. Respondents at risk of increasing frailty live in a less ethnically dense Mexican-American neighborhood, are older, do not have private insurance or Medicare, have higher levels of medical conditions, have lower levels of cognitive functioning, and report less positive affect. Personal as well as neighborhood characteristics confer protective effects on individual health in this representative, well-characterized sample of older Mexican Americans. Potential mechanisms that may be implicated in the protective effect of ethnically homogenous communities are discussed.

  18. Frailty and quality of life in elderly patients with acute coronary syndrome.

    Science.gov (United States)

    Lisiak, Magdalena; Uchmanowicz, Izabella; Wontor, Radosław

    2016-01-01

    Frail elderly people are at risk of developing adverse health outcomes such as disability, hospitalization, and mortality. In recent years, the literature has drawn attention to the role of frailty syndrome (FS) in acute coronary syndrome (ACS). There are few studies regarding the relationship between two multidimensional variables such as FS and quality of life (QoL). The aim of the study was to investigate the relationship between FS and early QoL of elderly patients with ACS (≥65 years old). The study was conducted among 91 patients aged 65 years and over with ACS. The MacNew questionnaire was used to evaluate QoL and the Tilburg frailty indicator to evaluate frailty. FS was present in 82.4% of patients. The average Tilburg frailty indicator score was 7.43±2.57. A negative correlation between the global values of FS and QoL was shown (r=-0.549, Pelderly patients with ACS, there is a need to identify frailty in order to implement additional therapeutic and nursing strategies in ACS.

  19. Dysphonia in nursing home and assisted living residents: prevalence and association with frailty.

    Science.gov (United States)

    G Nichols, Brent; Varadarajan, Varun; Bock, Jonathan M; Blumin, Joel H

    2015-01-01

    Previous studies of geriatric dysphonia prevalence have been limited to ambulatory outpatient and senior communities. Our goal was to identify prevalence of dysphonia in nursing home residents and assisted living residents and search for correlations between indices of dysphonia and indices of frailty. Prospective epidemiological survey. Residents of a vertically integrated senior care organization who were 65 or older and able to understand and complete the questionnaire were recruited to complete the voice handicap index 10 (VHI-10) to assess for dysphonia (VHI-10 > 10 = dysphonia) and Vulnerable Elders Survey 13 (VES-13), a validated instrument to assess for frailty (VES > 3 = frailty). A total of 119 residents were surveyed. Thirty-three percent of nursing home residents, and 25% of assisted living residents reported dysphonia with 29% of all respondents reporting dysphonia. The mean VHI-10 was 7.4, the median was 5, and the interquartile range was 2-12.5. There was a significant relationship between VHI-10 and VES-13 score (P = 0.029). There were no statistically significant relationships between frailty, age, or type of living and dysphonia or VHI-10. There is a high prevalence of voice dysfunction in assisted living and nursing home residents. The correlation between VHI-10 and VES-13 suggests that voice declines as frailty increases. Copyright © 2015 The Voice Foundation. All rights reserved.

  20. Development of a Physiological Frailty Index for the World Trade Center General Responder Cohort

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    Ghalib A. Bello

    2018-01-01

    Full Text Available Responders to the 9/11/2001 WTC attacks were exposed to multiple toxic pollutants. Since 2002, the health of the responder cohort has been continuously tracked by the WTC Health Monitoring Program. However, no assessments have been made of frailty, an important health metric given the current average age of the WTC responder cohort (55 years. In this study, we use laboratory test results and other physiological parameters to construct a physiological frailty index (FI-Lab for this cohort. The study sample comprised responders aged 40 years or older who completed a health monitoring visit at Mount Sinai Center within the past 5 years. For each subject, FI-Lab was computed as the proportion of 20 physiological parameters (lab tests, pulmonary function, and blood pressure on which the subject had abnormal values. Using negative binomial regression models, we tested FI-Lab’s association with the SF-12 wellbeing score and various demographic characteristics. FI-Lab showed strong associations with the physical and mental components of the SF-12 as well as age, race, and smoking status. Using a cutoff of 0.25 to define presence of physiological/preclinical frailty, we found frailty prevalence in the study sample to be approximately 12%. This study demonstrates the feasibility of assessing preclinical frailty in the WTC responder cohort.

  1. [Living and dying with frailty : Qualitative interviews with elderly people in the domestic environment].

    Science.gov (United States)

    Klindtworth, Katharina; Geiger, Karin; Pleschberger, Sabine; Bleidorn, Jutta; Schneider, Nils; Müller-Mundt, Gabriele

    2017-02-01

    Frail older people are becoming an increasingly more important target group in healthcare provision. Little is known about patients' views on frailty and its various impacts, especially towards the end of life. This study was carried out to analyze the needs of frail elderly people at the end of life. A qualitative, longitudinal case study design was applied and included 31 frail older patients (≥ 70 year) with a Canadian study of health and aging (CSHA) clinical frailty scale (CFS) grade 6/7 from urban and rural areas within the region of Lower Saxony. The analysis was based on guided interviews and followed the principles of grounded theory. From the patients' perspective frailty is perceived as a process of increasing complexity of health problems, increased vulnerability and reduced ability to perform tasks. Frailty is experienced as various deficits including the physical, psychological, social and existential dimensions. Living and dying in a familiar environment and maintaining autonomy was identified as a core category. Key determinants were access to and quality of healthcare services as well as various individual and social resources. A palliative biopsychosocial care approach should be established early in the process of frailty, including advance care planning in order to meet the patients' needs of staying in a familiar environment. General practitioners as well as home care nursing personnel have to collaborate in order to balance issues of autonomy with increased care needs and the support of informal carers as key partners towards the end of life.

  2. Frailty and geriatric syndromes in elderly assisted in primary health care

    Directory of Open Access Journals (Sweden)

    Vera Elizabeth Closs

    2016-06-01

    Full Text Available The aim of this study was to describe the association between frailty and geriatric syndromes (GS [cognitive impairment (CI; postural instability (PI; urinary/fecal incontinence (UFI; polypharmacy (PP; and immobility (IM] and the frequency of these conditions in elderly people assisted in primary health care. Five hundred twenty-one elderly participants of The Multidimensional Study of the Elderly in the Family Health Strategy (EMI-SUS were evaluated. Sociodemographic data, identification of frailty (Fried phenotype and GS were collected. Multinomial logistic regression analysis was performed. The frequency of frailty was 21.5%, prefrailty 51.1% and robustness 27.4%. The frequency of CI was 54.7%, PP 41.2%, PI 36.5%, UFI 14% and IM 5.8%. The odds of frailty when compared to robustness and adjusted for gender, age, depression, self-perception of health, nutritional status, falls, vision and hearing, was significantly higher in elderly with CI, PI and PP. The adjusted odds of prefrail when compared to robustness was significantly higher only in elderly with CI. The most frequently presented number of GS (0-5 was two geriatric syndromes (26.87%. The frequency of frailty was high among elderly in primary health care and was associated with three of five GS (CI - PI - PP.

  3. Predicting clustered dental implant survival using frailty methods.

    Science.gov (United States)

    Chuang, S-K; Cai, T

    2006-12-01

    The purpose of this study was to predict future implant survival using information on risk factors and on the survival status of an individual's existing implant(s). We considered a retrospective cohort study with 677 individuals having 2349 implants placed. We proposed to predict the survival probabilities using the Cox proportional hazards frailty model, with three important risk factors: smoking status, timing of placement, and implant staging. For a non-smoking individual with 2 implants placed, an immediate implant and in one stage, the marginal probability that 1 implant would survive 12 months was 85.8% (95%CI: 77%, 91.7%), and the predicted joint probability of surviving for 12 months was 75.1% (95%CI: 62.1%, 84.7%). If 1 implant was placed earlier and had survived for 12 months, then the second implant had an 87.5% (95%CI: 80.3%, 92.4%) chance of surviving 12 months. Such conditional and joint predictions can assist in clinical decision-making for individuals.

  4. Gait Speed Measurement for Elderly Patients with Risk of Frailty

    Directory of Open Access Journals (Sweden)

    Xavier Ferre

    2017-01-01

    Full Text Available The ageing of the population poses a threat to both public and private health and social systems. In the last 50 years, life expectancy has increased by an average of 20 years, and by the year 2050, life expectancy will exceed 90 years of age. However, quality of life in the last years of life is not guaranteed due to conditions such as functional decline and frailty, ultimately progressing to disability. Thus, the detection of such a condition in time is of utmost importance. This paper presents an ultrasonic sensor-based gait speed measurement device controlled via a mobile interface, which permits patients to self-assess physical performance. The system was developed and validated in an iterative process involving a total of 28 subjects (21 in the first round and 7 in the second one. After first evaluation at Hospital Universitario de Getafe, some technical problems arose whereas usability testing was well evaluated. The second version addressing the identified issues was technically validated at university premises with good and promising results. Future work envisages deployment of the system developed at subjects’ homes to be remotely and unobtrusively monitored.

  5. Danish version of the Tilburg Frailty Indicator – Translation, cross-cultural adaption and validity pretest by cognitive interviewing

    DEFF Research Database (Denmark)

    Andreasen, Jane; Sørensen, Erik E; Gobbens, Robbert J J

    2014-01-01

    The Tilburg Frailty Indicator (TFI) is a self-administered questionnaire with a bio-psycho-social integrated approach that measures the degree of frailty in elderly persons. The TFI was developed in the Netherlands and tested in a population of elderly Dutch men and women. The aim of this study w...

  6. Assessing Upper-Extremity Motion: An Innovative, Objective Method to Identify Frailty in Older Bed-Bound Trauma Patients.

    Science.gov (United States)

    Toosizadeh, Nima; Joseph, Bellal; Heusser, Michelle R; Orouji Jokar, Tahereh; Mohler, Jane; Phelan, Herb A; Najafi, Bijan

    2016-08-01

    Despite increasing evidence that assessing frailty facilitates medical decision-making, a quick and clinically simple frailty assessment tool is not available for trauma settings. This study examined accuracy and acceptability of a novel wearable technology (upper-extremity frailty [UEF]) to objectively assess frailty status in older adults (65 years or older) admitted to the hospital due to traumatic ground-level falls. Frailty was measured using a validated modified Rockwood questionnaire, the Trauma-Specific Frailty Index (TSFI), as the gold standard. Participants performed a 20-second trial of rapid elbow flexion with the dominant elbow in a supine posture while wearing the UEF system. We recruited 101 eligible older adults (age 79 ± 9 years). Parameters of the UEF indicative of slowness, weakness, and exhaustion during elbow flexion were independent predictors of the TSFI score, while adjusted for age, sex, and body mass index. A high agreement (r = 0.72, p falls within a previous year, with highest correlation observed for elbow flexion slowness (r = -0.41). The results suggest that a simple test of 20-second elbow flexion may be practical and sensitive to identify frailty among hospitalized older adults. The UEF test is independent of walking assessments, reflects several frailty markers, and it is practical for bed-bound patients. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  7. A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study

    Science.gov (United States)

    BACKGROUND: The frailty syndrome is as a well-established condition of risk for disability. Aim of the study is to explore whether a physical activity (PA) intervention can reduce prevalence and severity of frailty in a community-dwelling elders at risk of disability. METHODS: Exploratory analyses ...

  8. The impact of frailty on healthcare utilisation in Ireland: evidence from the Irish longitudinal study on ageing.

    Science.gov (United States)

    Roe, Lorna; Normand, Charles; Wren, Maev-Ann; Browne, John; O'Halloran, Aisling M

    2017-09-05

    To examine the impact of frailty on medical and social care utilisation among the Irish community-dwelling older population to inform strategies of integrated care for older people with complex needs. Participants aged ≥65 years from the Irish Longitudinal Study on Ageing (TILDA) representative of the Irish community-dwelling older population were analysed (n = 3507). The frailty index was used to examine patterns of utilisation across medical and social care services. Multivariate logistic and negative binomial regression models were employed to examine the impact of frailty on service utilisation outcomes after controlling for other factors. The prevalence of frailty and pre-frailty was 24% (95% CI: 23, 26%) and 45% (95% CI: 43, 47%) respectively. Frailty was a significant predictor of utilisation of most social care and medical care services after controlling for the main correlates of frailty and observed individual effects. Frailty predicts utilisation of many different types of healthcare services rendering it a useful risk stratification tool for targeting strategies of integrated care. The pattern of care is predominantly medical as few of the frail older population use social care prompting questions about sub-groups of the frail older population with unmet care needs.

  9. Changes in Frailty Predict Changes in Cognition in Older Men: The Honolulu-Asia Aging Study.

    Science.gov (United States)

    Armstrong, Joshua J; Godin, Judith; Launer, Lenore J; White, Lon R; Mitnitski, Arnold; Rockwood, Kenneth; Andrew, Melissa K

    2016-06-15

    As cognitive decline mostly occurs in late life, where typically it co-exists with many other ailments, it is important to consider frailty in understanding cognitive change. Here, we examined the association of change in frailty status with cognitive trajectories in a well-studied cohort of older Japanese-American men. Using the prospective Honolulu-Asia Aging Study (HAAS), 2,817 men of Japanese descent were followed (aged 71-93 at baseline). Starting in 1991 with follow-up health assessments every two to three years, cognition was measured using the Cognitive Abilities Screening Instrument (CASI). For this study, health data was used to construct an accumulation of deficits frailty index (FI). Using six waves of data, multilevel growth curve analyses were constructed to examine simultaneous changes in cognition in relation to changes in FI, controlling for baseline frailty, age, education, and APOE-ɛ4 status. On average, CASI scores declined by 2.0 points per year (95% confidence interval 1.9-2.1). Across six waves, each 10% within-person increase in frailty from baseline was associated with a 5.0 point reduction in CASI scores (95% confidence interval 4.7-5.2). Baseline frailty and age were associated both with lower initial CASI scores and with greater decline across the five follow-up assessments (p age. Using a multidimensional measure of frailty, both baseline status and within-person changes in frailty were predictive of cognitive trajectories.

  10. Semiparametric profile likelihood estimation for continuous outcomes with excess zeros in a random-threshold damage-resistance model.

    Science.gov (United States)

    Rice, John D; Tsodikov, Alex

    2017-05-30

    Continuous outcome data with a proportion of observations equal to zero (often referred to as semicontinuous data) arise frequently in biomedical studies. Typical approaches involve two-part models, with one part a logistic model for the probability of observing a zero and some parametric continuous distribution for modeling the positive part of the data. We propose a semiparametric model based on a biological system with competing damage manifestation and resistance processes. This allows us to derive a closed-form profile likelihood based on the retro-hazard function, leading to a flexible procedure for modeling continuous data with a point mass at zero. A simulation study is presented to examine the properties of the method in finite samples. We apply the method to a data set consisting of pulmonary capillary hemorrhage area in lab rats subjected to diagnostic ultrasound. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  11. Evaluating Left-Censored Data Through Substitution, Parametric, Semi-parametric, and Nonparametric Methods: A Simulation Study.

    Science.gov (United States)

    Tekindal, Mustafa Agah; Erdoğan, Beyza Doğanay; Yavuz, Yasemin

    2017-06-01

    In this study, an attempt was made to determine the degrees of bias in particular sampling sizes and methods. The aim of the study was to determine deviations from the median, the mean, and the standard deviation (SD) in different sample sizes and at different censoring rates for log-normal, exponential, and Weibull distributions in the case of full and censored data sampling. Thus, the concept of "censoring" and censoring types was handled in the first place. Then substitution, parametric (MLE), nonparametric (KM), and semi-parametric (ROS) methods were introduced for the evaluation of left-censored observations. Within the scope of the present study, the data were produced uncensored based on the different parameters of each distribution. Then the datasets were left-censored at the ratios of 5, 25, 45, and 65 %. The censored data were estimated through substitution (LOD and LOD/[Formula: see text]), parametric (MLE), semi-parametric (ROS), and nonparametric (KM) methods. In addition, evaluation was made by increasing the sample size from 20 to 300 by tens. Performance comparison was made between the uncensored dataset and the censored dataset on the basis of deviations from the median, the mean, and the SD. The results of simulation studies show that LOD/[Formula: see text] and ROS methods give better results than other methods in deviation from the mean in different sample sizes and at different censoring rates, while ROS gives better results than other methods in deviation from the median in almost all sample sizes and at almost all censoring rates.

  12. Frailty and quality of life in elderly primary health care users.

    Science.gov (United States)

    Lenardt, Maria Helena; Carneiro, Nathalia Hammerschmidt Kolb; Binotto, Maria Angélica; Willig, Mariluci Hautsch; Lourenço, Tânia Maria; Albino, Jéssica

    2016-06-01

    to investigate the association between physical frailty and quality of life in elderly users of primary health care in the capital of the state of Paraná. a cross-sectional, quantitative study with 203 elders. Data collected included: physical activity questionnaires, weight loss, fatigue/exhaustion, quality of life, performance of gait speed tests, and handgrip strength. of the 203 older adults, 115 were pre-frail, 49 were non-frail, and 39 were frail, with a significant association with functional capacity and quality of life in all groups. The dimensions resulting from physical aspects, pain, and vitality were associated with those that were non-frail. in this study, frailty syndrome was inversely proportional to the quality of life, and significantly associated with functional capacity of older adults. Physical frailty is a manageable condition which can be targeted through geriatric nursing interventions.

  13. [The challenge of clinical complexity in the 21st century: Could frailty indexes be the answer?

    Science.gov (United States)

    Amblàs-Novellas, Jordi; Espaulella-Panicot, Joan; Inzitari, Marco; Rexach, Lourdes; Fontecha, Benito; Romero-Ortuno, Roman

    The number of older people with complex clinical conditions and complex care needs continues to increase in the population. This is presenting many challenges to healthcare professionals and healthcare systems. In the face of these challenges, approaches are required that are practical and feasible. The frailty paradigm may be an excellent opportunity to review and establish some of the principles of comprehensive Geriatric Assessment in specialties outside Geriatric Medicine. The assessment of frailty using Frailty Indexes provides an aid to the 'situational diagnosis' of complex clinical situations, and may help in tackling uncertainty in a person-centred approach. Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Comparison of frailty among Japanese, Brazilian Japanese descendants and Brazilian community-dwelling older women.

    Science.gov (United States)

    Sampaio, Priscila Yukari Sewo; Sampaio, Ricardo Aurélio Carvalho; Yamada, Minoru; Ogita, Mihoko; Arai, Hidenori

    2015-06-01

    To investigate frailty in Japanese, Brazilian Japanese descendants and Brazilian older women. The collected data included sociodemographic and health-related characteristics, and the frailty index Kihon Checklist. We analyzed the differences between the mean scores of Kihon Checklist domains (using ancova) and the percentage of frail women (using χ(2)-test). We carried out a binary logistic regression with Kihon Checklist domains. A total of 211 participants (Japanese n = 84, Brazilian Japanese descendants n = 55, Brazilian n = 72) participated in this research. The Brazilian participants had the highest total Kihon Checklist scores (more frail), whereas the Brazilian Japanese descendants had the lowest scores (P Brazilian group had more participants with oral dysfunction (P Brazilian women were likely to be more frail than the participants in other groups. More than the environment itself, the lifestyle and sociodemographic conditions could affect the frailty of older Brazilian women. © 2014 Japan Geriatrics Society.

  15. Adherence to Mediterranean Diet Reduces Incident Frailty Risk: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Kojima, Gotaro; Avgerinou, Christina; Iliffe, Steve; Walters, Kate

    2018-01-11

    To conduct a systematic review of the literature on prospective cohort studies examining associations between adherence to a Mediterranean diet and incident frailty and to perform a meta-analysis to synthesize the pooled risk estimates. Systematic review and meta-analysis. Embase, MEDLINE, CINAHL, PsycINFO, and Cochrane Library were systematically searched on September 14, 2017. We reviewed references of included studies and relevant review papers and performed forward citation tracking for additional studies. Corresponding authors were contacted for additional data necessary for a meta-analysis. Community-dwelling older adults (mean age ≥60). Incident frailty risk according to adherence to a Mediterranean diet. Two reviewers independently screened the title, abstract, and full text to ascertain the eligibility of 125 studies that the systematic search of the literature identified, and four studies were included (5,789 older people with mean follow-up of 3.9 years). Two reviewers extracted data from the studies independently. All four studies provided adjusted odds ratios (ORs) of incident frailty risk according to three Mediterranean diet score (MDS) groups (0-3, 4-5, and 6-9). Greater adherence to a Mediterranean diet was associated with significantly lower incident frailty risk (pooled OR = 0.62, 95% CI = 0.47-0.82, P = .001 for MDS 4-5; pooled OR = 0.44, 95% CI = 0.31-0.64, P Mediterranean diet is associated with significantly lower risk of incident frailty in community-dwelling older people. Future studies should confirm these findings and evaluate whether adherence to a Mediterranean diet can reduce the risk of frailty, including in non-Mediterranean populations. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

  16. Effect of a Prebiotic Formulation on Frailty Syndrome: A Randomized, Double-Blind Clinical Trial

    Directory of Open Access Journals (Sweden)

    Cristina Buigues

    2016-06-01

    Full Text Available Aging can result in major changes in the composition and metabolic activities of bacterial populations in the gastrointestinal system and result in impaired function of the immune system. We assessed the efficacy of prebiotic Darmocare Pre® (Bonusan Besloten Vennootschap (BV, Numansdorp, The Netherlands to evaluate whether the regular intake of this product can improve frailty criteria, functional status and response of the immune system in elderly people affected by the frailty syndrome. The study was a placebo-controlled, randomized, double blind design in sixty older participants aged 65 and over. The prebiotic product was composed of a mixture of inulin plus fructooligosaccharides and was compared with placebo (maltodextrin. Participants were randomized to a parallel group intervention of 13 weeks’ duration with a daily intake of Darmocare Pre® or placebo. Either prebiotic or placebo were administered after breakfast (between 9–10 a.m. dissolved in a glass of water carefully stirred just before drinking. The primary outcome was to study the effect on frailty syndrome. The secondary outcomes were effect on functional and cognitive behavior and sleep quality. Moreover, we evaluated whether prebiotic administration alters blood parameters (haemogram and biochemical analysis. The overall rate of frailty was not significantly modified by Darmocare Pre® administration. Nevertheless, prebiotic administration compared with placebo significantly improved two frailty criteria, e.g., exhaustion and handgrip strength (p < 0.01 and p < 0.05, respectively. No significant effects were observed in functional and cognitive behavior or sleep quality. The use of novel therapeutic approaches influencing the gut microbiota–muscle–brain axis could be considered for treatment of the frailty syndrome.

  17. Log-normal frailty models fitted as Poisson generalized linear mixed models.

    Science.gov (United States)

    Hirsch, Katharina; Wienke, Andreas; Kuss, Oliver

    2016-12-01

    The equivalence of a survival model with a piecewise constant baseline hazard function and a Poisson regression model has been known since decades. As shown in recent studies, this equivalence carries over to clustered survival data: A frailty model with a log-normal frailty term can be interpreted and estimated as a generalized linear mixed model with a binary response, a Poisson likelihood, and a specific offset. Proceeding this way, statistical theory and software for generalized linear mixed models are readily available for fitting frailty models. This gain in flexibility comes at the small price of (1) having to fix the number of pieces for the baseline hazard in advance and (2) having to "explode" the data set by the number of pieces. In this paper we extend the simulations of former studies by using a more realistic baseline hazard (Gompertz) and by comparing the model under consideration with competing models. Furthermore, the SAS macro %PCFrailty is introduced to apply the Poisson generalized linear mixed approach to frailty models. The simulations show good results for the shared frailty model. Our new %PCFrailty macro provides proper estimates, especially in case of 4 events per piece. The suggested Poisson generalized linear mixed approach for log-normal frailty models based on the %PCFrailty macro provides several advantages in the analysis of clustered survival data with respect to more flexible modelling of fixed and random effects, exact (in the sense of non-approximate) maximum likelihood estimation, and standard errors and different types of confidence intervals for all variance parameters. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Visual Impairment Screening at the Geriatric Frailty Clinic for Assessment of Frailty and Prevention of Disability at the Gérontopôle.

    Science.gov (United States)

    Soler, V; Sourdet, S; Balardy, L; Abellan van Kan, G; Brechemier, D; Rougé-Bugat, M E; Tavassoli, N; Cassagne, M; Malecaze, F; Nourhashémi, F; Vellas, B

    2016-01-01

    To evaluate visual performance and factors associated with abnormal vision in patients screened for frailty at the Geriatric Frailty Clinic (GFC) for Assessment of Frailty and Prevention of Disability at Toulouse University Hospital. Retrospective, observational cross-sectional, single-centre study. Institutional practice. Patients were screened for frailty during a single-day hospital stay between October 2011 and October 2014 (n = 1648). Collected medical records included sociodemographic data (including living environment and educational level), anthropometric data, and clinical data. The general evaluation included the patient's functional status using the Activities of Daily Living (ADL) scale and the Instrumental Activity of Daily Living (IADL) scale, the Mini-Mental State Examination (MMSE) for cognition testing, and the Short Physical Performance Battery (SPPB) for physical performance. We also examined Body Mass Index (BMI), the Mini-Nutritional Assessment (MNA), and the Hearing Handicap Inventory for the Elderly Screening (HHIE-S) tool. The ophthalmologic evaluation included assessing visual acuity using the Snellen decimal chart for distant vision, and the Parinaud chart for near vision. Patients were divided into groups based on normal distant/near vision (NDV and NNV groups) and abnormal distant/near vision (ADV and ANV groups). Abnormal distant or near vision was defined as visual acuity inferior to 20/40 or superior to a Parinaud score of 2, in at least one eye. Associations with frailty-associated factors were evaluated in both groups. The mean age of the population was 82.6 ± 6.2 years. The gender distribution was 1,061 females (64.4%) and 587 males (35.6%). According to the Fried criteria, 619 patients (41.1%) were pre-frail and 771 (51.1%) were frail. Distant and near vision data were available for 1425 and 1426 patients, respectively. Distant vision was abnormal for 437 patients (30.7%). Near vision was abnormal for 199 patients (14%). Multiple

  19. The Case for Stage-Specific Frailty Interventions Spanning Community Aging to Cognitive Impairment.

    Science.gov (United States)

    Chong, Mei Sian; Tay, Laura; Ismail, Noor Hafizah; Tan, Chay Hoon; Yew, Suzanne; Yeo, Audrey; Ye, Ruijing; Leung, Bernard; Ding, Yew Yoong

    2015-11-01

    To explore factors associated with frailty across the continuum of healthy aging to cognitive impairment (mild cognitive impairment [MCI], mild and moderate Alzheimer disease [AD]). Cross-sectional study. Senior activity centers and the outpatient memory clinic of a tertiary hospital. Community-dwelling and functionally independent adults aged 50 years and older and older adults attending the memory clinic with MCI, and mild and moderate AD diagnoses. We recruited 299 participants comprising 200 cognitively healthy individuals, 16 with MCI, 68 with mild AD, and 15 with moderate AD. We collected measures of comorbidities, cognitive and functional performance, physical activity level, and anthropometric and nutritional status. Frailty was defined using Buchmann criteria, and sarcopenic obesity (SO) was defined using the Asian Working Group for Sarcopenia criteria and the revised National Cholesterol and Education Panel-obesity definition of waist circumference. Multiple logistic regression was performed to identify factors associated with frailty as a whole group and separately based on cognitive subgroups. There were 16.7% of patients who met frailty criteria. Frailty prevalence was lowest in the well elderly (3.5%) and subsequently followed a U-shaped prevalence from MCI to mild and moderate AD, respectively. Specific univariate differences were noted in age, hypertension, ischemic heart disease, depressive symptoms, social differences, and functional scores. Multivariable logistic regression showed age, cognitive status, and SO to be significantly associated with frailty status. Subgroup analysis showed only SO to be significant (odds ratio [OR] 15.55, 95% confidence interval [CI] 1.63-148.42) in well elderly and only cognition to be associated with frailty (OR 0.89, 95% CI 0.80-0.99) among the cognitively impaired. Our findings lend initial support to the case for stage-specific interventions for physical frailty with the focus on SO in healthy community

  20. The impact of older person's frailty on the care-related quality of life of their informal caregiver over time: results from the TOPICS-MDS project.

    Science.gov (United States)

    Oldenkamp, Marloes; Hagedoorn, Mariët; Wittek, Rafael; Stolk, Ronald; Smidt, Nynke

    2017-10-01

    To examine the impact of changes in an older person's frailty on the care-related quality of life of their informal caregiver. Five research projects in the TOPICS-MDS database with data of both older person and informal caregiver at baseline and after 12 months follow-up were selected. Frailty was measured in five health domains (functional limitations, psychological well-being, social functioning, health-related quality of life, self-rated health). Care-related quality of life was measured with the Care-Related Quality of Life instrument (CarerQoL-7D), containing two positive (fulfilment, perceived support) and five negative dimensions (relational problems, mental health problems, physical health problems, financial problems, problems combining informal care with daily activities). 660 older person/caregiver couples were included. Older persons were on average 79 (SD 6.9) years of age, and 61% was female. Caregivers were on average 65 (SD 12.6) years of age, and 68% was female. Results of the multivariable linear and logistic regression analyses showed that an increase in older person's frailty over time was related to a lower total care-related quality of life of the caregiver, and to more mental and physical health problems, and problems with combining informal care with daily activities at follow-up. A change in the older person's psychological well-being was most important for the caregiver's care-related quality of life, compared to the other health domains. Health professionals observing decreasing psychological well-being of an older person and increasing hours of informal care provision should be aware of the considerable problems this may bring to their informal caregiver, and should tailor interventions to support informal caregivers according to their specific needs and problems.

  1. Frequency of frailty and its association with cognitive status and survival in older Chileans

    Directory of Open Access Journals (Sweden)

    Albala C

    2017-06-01

    Full Text Available Cecilia Albala,1 Lydia Lera,1 Hugo Sanchez,1 Barbara Angel,1 Carlos Márquez,1 Patricia Arroyo,2 Patricio Fuentes2 1Public Health Nutrition Unit, Institute of Nutrition and Food Technology (INTA, University of Chile, 2Faculty of Medicine, Clinical Hospital, University of Chile, Santiago, Chile Background: Age-associated brain physiologic decline and reduced mobility are key elements of increased age-associated vulnerability.Objective: To study the frequency of frailty phenotype and its association with mental health and survival in older Chileans.Methods: Follow-up of ALEXANDROS cohorts designed to study disability associated with obesity in community-dwelling people 60 years and older living in Santiago, Chile. At baseline, 2,098 (67% women of 2,372 participants were identified as having the frailty phenotype: weak handgrip dynamometry, unintentional weight loss, fatigue/exhaustion, five chair-stands/slow walking speed and difficulty walking (low physical activity. After 10–15 years, 1,298 people were evaluated and 373 had died. Information regarding deaths was available for the whole sample.Results: The prevalence of frailty at baseline (≥3 criteria in the whole sample was 13.9% (women 16.4%; men 8.7% and the pre-frailty prevalence (1–2 criteria was 63.8% (65.0% vs 61.4%, respectively. Frailty was associated with cognitive impairment (frail 48.1%; pre-frail 21.7%; nonfrail 20.5%, P<0.001 and depression (frail 55.1%; pre-frail 27.3%; nonfrail 18.8%, P<0.001. Logistic regression models for frailty adjusted for sex and age showed a strong association between frailty and mild cognitive impairment (MCI (odds ratio [OR] =3.93; 95% CI: 1.41–10.92. Furthermore, an important association was found for depression and frailty (OR =2.36; 95% CI 1.82–3.06. Age- and sex-adjusted hazard ratios (HRs for death showed an increased risk with increasing frailty: pre-frail HR =1.56 (95% CI: 1.07–2.29, frail HR =1.91 (95% CI: 1.15–3.19; after

  2. Identifying Some Risk Factors for the Time to Death of the Elderly Using the Semi-Parametric Blended Model of Survival Analysis With Competing Risks

    Directory of Open Access Journals (Sweden)

    Samane Hajiabbasi

    2018-01-01

    Conclusion In single-variable fitting, age, history of myocardial infarction, history of stroke, and kidney problems were identified to have significant effects on the time to death of the elderly. Based on one-variable semi-parametric competing risk mixture fitted models, more significant risk factors for the time to death of elderly was identified when compared with a fitted multivariate mode to the data. This implies that the role of some independent variables can be explained by other independent variables.

  3. Is Technology Present in Frailty? Technology a Back-up Tool for Dealing with Frailty in the Elderly: A Systematic Review.

    Science.gov (United States)

    Mugueta-Aguinaga, Iranzu; Garcia-Zapirain, Begonya

    2017-04-01

    This study analyzes the technologies used in dealing with frailty within the following areas: prevention, care, diagnosis and treatment. The aim of this paper is, on the one hand, to analyze the extent to which technology is present in terms of its relationship with frailty and what technological resources are used to treat it. Its other purpose is to define new challenges and contributions made by physiotherapy using technology. Eighty documents related to research, validation and/or the ascertaining of different types of hardware, software or both were reviewed in prominent areas. The authors used the following scales: in the area of diagnosis, Fried's phenotype model of frailty and a model based on trials for the design of devices. The technologies developed that are based on these models accounted for 55% and 45% of cases respectively. In the area of prevention, the results proved similar regarding the use of wireless sensors with cameras (35.71%), and Kinect™ sensors (28.57%) to analyze movements and postures that indicate a risk of falling. In the area of care, results were found referring to the use of different motion, physiological and environmental wireless sensors (46,15%), i.e. so-called smart homes. In the area of treatment, the results show with a percentage of 37.5% that the Nintendo ® Wii™ console is the most used tool for treating frailty in elderly persons. Further work needs to be carried out to reduce the gap existing between technology, frail elderly persons, healthcare professionals and carers to bring together the different views about technology. This need raises the challenge of developing and implementing technology in physiotherapy via serious games that may via play and connectivity help to improve the functional capacity, general health and quality of life of frail individuals.

  4. On selection of optimal stochastic model for accelerated life testing

    International Nuclear Information System (INIS)

    Volf, P.; Timková, J.

    2014-01-01

    This paper deals with the problem of proper lifetime model selection in the context of statistical reliability analysis. Namely, we consider regression models describing the dependence of failure intensities on a covariate, for instance, a stressor. Testing the model fit is standardly based on the so-called martingale residuals. Their analysis has already been studied by many authors. Nevertheless, the Bayes approach to the problem, in spite of its advantages, is just developing. We shall present the Bayes procedure of estimation in several semi-parametric regression models of failure intensity. Then, our main concern is the Bayes construction of residual processes and goodness-of-fit tests based on them. The method is illustrated with both artificial and real-data examples. - Highlights: • Statistical survival and reliability analysis and Bayes approach. • Bayes semi-parametric regression modeling in Cox's and AFT models. • Bayes version of martingale residuals and goodness-of-fit test

  5. Frailty and Constellations of Factors in Aging HIV-infected and Uninfected Women--The Women's Interagency HIV Study.

    Science.gov (United States)

    Gustafson, D R; Shi, Q; Thurn, M; Holman, S; Minkoff, H; Cohen, M; Plankey, M W; Havlik, R; Sharma, A; Gange, S; Gandhi, M; Milam, J; Hoover, D

    2016-01-01

    Biological similarities are noted between aging and HIV infection. Middle-aged adults with HIV infection may present as elderly due to accelerated aging or having more severe aging phenotypes occurring at younger ages. We explored age-adjusted prevalence of frailty, a geriatric condition, among HIV+ and at risk HIV- women. Cross-sectional. The Women's Interagency HIV Study (WIHS). 2028 middle-aged (average age 39 years) female participants (1449 HIV+; 579 HIV-). The Fried Frailty Index (FFI), HIV status variables, and constellations of variables representing Demographic/health behaviors and Aging-related chronic diseases. Associations between the FFI and other variables were estimated, followed by stepwise regression models. Overall frailty prevalence was 15.2% (HIV+, 17%; HIV-, 10%). A multivariable model suggested that HIV infection with CD4 count40 years; current or former smoking; income ≤$12,000; moderate vs low fibrinogen-4 (FIB-4) levels; and moderate vs high estimated glomerular filtration rate (eGFR) were positively associated with frailty. Low or moderate drinking was protective. Frailty is a multidimensional aging phenotype observed in mid-life among women with HIV infection. Prevalence of frailty in this sample of HIV-infected women exceeds that for usual elderly populations. This highlights the need for geriatricians and gerontologists to interact with younger 'at risk' populations, and assists in the formulation of best recommendations for frailty interventions to prevent early aging, excess morbidities and early death.

  6. FRAILTY AND CONSTELLATIONS OF FACTORS IN AGING HIV-INFECTED AND UNINFECTED WOMEN - THE WOMEN'S INTERAGENCY HIV STUDY

    Science.gov (United States)

    GUSTAFSON, D.R.; SHI, Q.; THURN, M.; HOLMAN, S.A.; MINKOFF, H.; COHEN, M.; PLANKEY, M.W.; HAVLIK, R.; SHARMA, A.; GANGE, S.; GANDHI, M.; MILAM, J.; HOOVER, D.

    2016-01-01

    Background Biological similarities are noted between aging and HIV infection. Middle-aged adults with HIV infection may present as elderly due to accelerated aging or having more severe aging phenotypes occurring at younger ages. Objectives We explored age-adjusted prevalence of frailty, a geriatric condition, among HIV+ and at risk HIV− women. Design Cross-sectional. Setting The Women's Interagency HIV Study (WIHS). Participants 2028 middle-aged (average age 39 years) female participants (1449 HIV+; 579 HIV−). Measurements The Fried Frailty Index (FFI), HIV status variables, and constellations of variables representing Demographic/health behaviors and Aging-related chronic diseases. Associations between the FFI and other variables were estimated, followed by stepwise regression models. Results Overall frailty prevalence was 15.2% (HIV+, 17%; HIV−, 10%). A multivariable model suggested that HIV infection with CD4 count40 years; current or former smoking; income ≤$12,000; moderate vs low fibrinogen-4 (FIB-4) levels; and moderate vs high estimated glomerular filtration rate (eGFR) were positively associated with frailty. Low or moderate drinking was protective. Conclusions Frailty is a multidimensional aging phenotype observed in mid-life among women with HIV infection. Prevalence of frailty in this sample of HIV-infected women exceeds that for usual elderly populations. This highlights the need for geriatricians and gerontologists to interact with younger `at risk' populations, and assists in the formulation of best recommendations for frailty interventions to prevent early aging, excess morbidities and early death. PMID:26980368

  7. The Prediction of ADL and IADL Disability Using Six Physical Indicators of Frailty: A Longitudinal Study in the Netherlands

    Science.gov (United States)

    Gobbens, Robbert J. J.; van Assen, Marcel A. L. M.

    2014-01-01

    Frailty is a predictor of disability. A proper understanding of the contribution of individual indicators of frailty in the prediction of disability is a requisite for preventive interventions. The aim of this study was to determine the predictive power of the individual physical frailty indicators: gait speed, physical activity, hand grip strength, Body Mass Index (BMI), fatigue, and balance, for ADL and IADL disability. The sample consisted of 505 community-dwelling persons (≥75 years, response rate 35.1%). Respondents first participated between November 2007 and June 2008, and a subset of all respondents participated again one year later (N = 264, 52.3% response rate). ADL and IADL disability were assessed by the Groningen Activity Restriction Scale. BMI was assessed by self-report, and the other physical frailty indicators were assessed with the TUG test (gait speed), the LAPAQ (physical activity), a hand grip strength test, the SFQ (fatigue), and the Four-test balance scale. All six physical frailty indicators were associated with ADL and IADL disability. After controlling for previous disability, sociodemographic characteristics, self-perceived lifestyle, and chronic diseases, only gait speed was predictive of both ADL and IADL disability, whereas there was a small effect of fatigue on IADL disability. Hence, these physical frailty indicators should be included in frailty assessment when predicting future disability. PMID:24782894

  8. The Association of Frailty With Outcomes and Resource Use After Emergency General Surgery: A Population-Based Cohort Study.

    Science.gov (United States)

    McIsaac, Daniel I; Moloo, Husein; Bryson, Gregory L; van Walraven, Carl

    2017-05-01

    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. We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS. Our main exposure was preoperative frailty, as defined by the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. The Adjusted Clinical Groups frailty-defining diagnoses indicator is a binary variable that uses 12 clusters of frailty-defining diagnoses. Our main outcome measures were 1-year all-cause mortality (primary), intensive care unit admission, length of stay, institutional discharge, and costs of care (secondary). Of 77,184 patients, 19,779 (25.6%) were frail. Death within 1 year occurred in 6626 (33.5%) frail patients compared with 11,366 (19.8%) nonfrail patients. After adjustment for sociodemographic and surgical confounders, this resulted in a hazard ratio of 1.29 (95% confidence interval [CI] 1.25-1.33). The risk of death for frail patients varied significantly across the postoperative period and was particularly high immediately after surgery (hazard ratio on postoperative day 1 = 23.1, 95% CI 22.3-24.1). Frailty was adversely associated with all secondary outcomes, including a 5.82-fold increase in the adjusted odds of institutional discharge (95% CI 5.53-6.12). After EGS, frailty is associated with increased rates of mortality, institutional discharge, and resource use. Strategies that might improve perioperative outcomes in frail EGS patients need to be developed and tested.

  9. The relationship between frailty, anxiety and depression, and health-related quality of life in elderly patients with heart failure.

    Science.gov (United States)

    Uchmanowicz, Izabella; Gobbens, Robbert J J

    2015-01-01

    Elderly people constitute over 80% of the population of patients with heart failure (HF). Frailty is a distinct biological syndrome that reflects decreased physiologic reserve and resistance to stressors. Moreover, frailty can serve as an independent predictor of visits to the emergency department, hospitalizations, and mortality. The purpose of this paper was to assess the relationship between frailty, anxiety and depression, and the health-related quality of life (HRQoL) of elderly patients with HF. The study included 100 patients (53 men and 47 women) with a diagnosis of HF. Frailty was measured using the Tilburg Frailty Indicator (TFI) scale. HRQoL was measured using the 36-Item Short Form Medical Outcomes Study Survey. To determine the prevalence of anxiety and depression, the Hospital Anxiety and Depression Scale was used. Frailty was found in 89% of the studied population. The study showed significant inverse correlations between the values of the physical component scale (PCS) domain results and TFI score, and a significant inverse correlation between the values of the mental component scale (MCS) domain and TFI score. When participants showed increased levels of frailty as measured by the TFI scale, there was also an increase in the levels of anxiety and depression. With increased anxiety and depression, there was deterioration in the quality of life of patients with HF. Frailty has a negative impact on the HRQoL results of elderly patients with HF. The assessment of frailty syndrome, and anxiety and depression should be taken into account when estimating risk and making therapeutic decisions for cardiovascular disease treatment and care.

  10. The role of sports clubs in helping older people to stay active and prevent frailty: a longitudinal mediation analysis.

    Science.gov (United States)

    Watts, Paul; Webb, Elizabeth; Netuveli, Gopalakrishnan

    2017-07-14

    Frailty is a common syndrome in older adults characterised by increased vulnerability to adverse health outcomes as a result of decline in functional and physiological measures. Frailty predicts a range of poor health and social outcomes and is associated with increased risk of hospital admission. The health benefits of sport and physical activity and the health risks of inactivity are well known. However, less is known about the role of sports clubs and physical activity in preventing and managing frailty in older adults. The objective of this study is to examine the role of membership of sports clubs in promoting physical activity and reducing levels of frailty in older adults. We used data from waves 1 to 7 of the English Longitudinal Study of Ageing (ELSA). Survey items on physical activity were combined to produce a measure of moderate or vigorous physical activity for each wave. Frailty was measured using an index of accumulated deficits. A total of sixty deficits, including symptoms, disabilities and diseases were recorded through self-report and tests. Direct and indirect relationships between sports club membership, levels of physical activity and frailty were examined using a cross-lagged panel model. We found evidence for an indirect relationship between sports club membership and frailty, mediated by physical activity. This finding was observed when examining time-specific indirect pathways and the total of all indirect pathways across seven waves of survey data (Est = -0.097 [95% CI = -0.124,-0.070], p = sports clubs may be useful in preventing and managing frailty in older adults, both directly and indirectly through increased physical activity levels. Sports clubs accessible to older people may improve health in this demographic by increasing activity levels and reducing frailty and associated comorbidities. There is a need for investment in these organisations to provide opportunities for older people to achieve the levels of physical activity

  11. Estimation in the positive stable shared frailty Cox proportional hazards model

    DEFF Research Database (Denmark)

    Martinussen, Torben; Pipper, Christian Bressen

    2005-01-01

    model in situations where the correlated survival data show a decreasing association with time. In this paper, we devise a likelihood based estimation procedure for the positive stable shared frailty Cox model, which is expected to obtain high efficiency. The proposed estimator is provided with large...

  12. Validation of an integral conceptual model of frailty in older residents of assisted living facilities

    NARCIS (Netherlands)

    Gobbens, R.J.J.; Krans, A.; van Assen, M.A.L.M.

    2015-01-01

    Objective The aim of this cross-sectional study was to examine the validity of an integral model of the associations between life-course determinants, disease(s), frailty, and adverse outcomes in older persons who are resident in assisted living facilities. Methods Between June 2013 and May 2014

  13. Validation of an integral conceptual model of frailty in older residents of assisted living facilities

    NARCIS (Netherlands)

    Gobbens, Robbert J J; Krans, Anita; van Assen, Marcel A L M

    2015-01-01

    Objective: The aim of this cross-sectional study was to examine the validity of an integral model of the associations between life-course determinants, disease(s), frailty, and adverse outcomes in older persons who are resident in assisted living facilities. Methods: Between June 2013 and May 2014

  14. Additive gamma frailty models with applications to competing risks in related individuals

    DEFF Research Database (Denmark)

    Eriksson, Frank; Scheike, Thomas

    2015-01-01

    Epidemiological studies of related individuals are often complicated by the fact that follow-up on the event type of interest is incomplete due to the occurrence of other events. We suggest a class of frailty models with cause-specific hazards for correlated competing events in related individual...

  15. Frailty profile for geriatric patients in outpatient clinic of RSUP H. Adam Malik Medan

    Science.gov (United States)

    Permatasari, T. D.; Sihombing, B.; Arianto, P.

    2018-03-01

    Frailty is a circumstance of increased vulnerability to bad resolution of homeostasis after a stressor occasion, which increases the risk of adverse outcomes. Early detection of frailty in elderly patients is a must but is rarely in the Geriatric Outpatient settings. We conducted a study to see the frailty profile for geriatric patients in the outpatient clinic of RSUP H. Adam Malik Medan. A cross-sectional research with a descriptive method was in the Geriatric Outpatient Clinic of Adam Malik Hospital from July-September 2016. The population of this study was patients from the Geriatric Outpatient Clinic, and sampling was by using consecutive methods. Samples were by questionnaires assessing (FRAIL Scale).This study was140 patients. Based on age, the age group of 81-90 years was dominantly frail (53.8%). Most of the subjects worked as government employees (109 subjects), and most of them were robust (42.2%). Based on income, both groups were dominated by robust (38.3% and 41.3%, respectively). Based on BMI, most were robust with underweight 33.5%, normoweight 37.8%, and obese 44.7%. Among the 140 patients, frailty was in the 27.1% of the subjects and the contributing factors were Age, Gender, and Obesity.

  16. Association of frailty in hospitalized and institutionalized elderly in the community-dwelling

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    Suzele Cristina Coelho Fabrício-Wehbe

    2016-08-01

    Full Text Available ABSTRACT Objective: to investigate the association between frailty with hospitalization and institutionalization in a follow-up study of elderly residents. Method: the follow-up study was performed in 2008 and 2013 with elderly of both genders, aged 65 years and older who were living in the community-dwelling. The sampling procedure performed was probabilistic, with dual-stage clustering. In 2008, 515 elderly people were interviewed and, in 2013, 262. We used the socioeconomic and demographic data, self-reported morbidity, specific data of hospitalization and institutionalization. Frailty was measured by the Edmonton Frail Scale (EFS, and functional capacity through the Functional Independence Measure. Results: we found the mean gross EFS score was higher among resident elderly who were hospitalized and institutionalized and was statistically significant in both investigated years. Conclusion: the confirmation of association between frailty and hospitalization and institutionalization reinforces the importance of the subject, and highlights frailty as an important tool for risk estimates for these adverse events.

  17. Frailty, prefrailty and employment outcomes in Health and Employment After Fifty (HEAF) Study

    NARCIS (Netherlands)

    Palmer, Keith T; D'Angelo, Stefania; Harris, E Clare; Linaker, Cathy; Gale, Catharine R; Evandrou, Maria; Syddall, Holly; Staa, Tjeerd P van; Cooper, Cyrus; Aihie Sayer, Avan; Coggon, David; Walker-Bone, Karen

    OBJECTIVES: Demographic changes are requiring people to work longer. No previous studies, however, have focused on whether the 'frailty' phenotype (which predicts adverse events in the elderly) is associated with employment difficulties. To provide information, we assessed associations in the Health

  18. Anthropometric Measures and Frailty Prediction in the Elderly: An Easy-to-Use Tool

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    Vera Elizabeth Closs

    2017-01-01

    Full Text Available Purpose. Anthropometry is a useful tool for assessing some risk factors for frailty. Thus, the aim of this study was to verify the discriminatory performance of anthropometric measures in identifying frailty in the elderly and to create an easy-to-use tool. Methods. Cross-sectional study: a subset from the Multidimensional Study of the Elderly in the Family Health Strategy (EMI-SUS evaluating 538 older adults. Individuals were classified using the Fried Phenotype criteria, and 26 anthropometric measures were obtained. The predictive ability of anthropometric measures in identifying frailty was identified through logistic regression and an artificial neural network. The accuracy of the final models was assessed with an ROC curve. Results. The final model comprised the following predictors: weight, waist circumference, bicipital skinfold, sagittal abdominal diameter, and age. The final neural network models presented a higher ROC curve of 0.78 (CI 95% 0.74–0.82 (P<0.001 than the logistic regression model, with an ROC curve of 0.71 (CI 95% 0.66–0.77 (P<0.001. Conclusion. The neural network model provides a reliable tool for identifying prefrailty/frailty in the elderly, with the advantage of being easy to apply in the primary health care. It may help to provide timely interventions to ameliorate the risk of adverse events.

  19. Tracing Pedagogic Frailty in Arts and Humanities Education: An Autoethnographic Perspective

    Science.gov (United States)

    Kinchin, Ian M.; Wiley, Christopher

    2018-01-01

    This paper offers an approach to support the development of reflective teaching practice among university academics that can be used to promote dialogue about quality enhancement and the student experience. Pedagogic frailty has been proposed as a unifying concept that may help to integrate institutional efforts to enhance teaching within…

  20. The influence of frailty syndrome on medication adherence among elderly patients with hypertension

    Directory of Open Access Journals (Sweden)

    Jankowska-Polańska B

    2016-12-01

    Full Text Available Beata Jankowska-Polańska,1 Krzysztof Dudek,2 Anna Szymanska-Chabowska,3 Izabella Uchmanowicz1 1Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 2Department of Logistic and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, 3Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland Background: Hypertension affects about 80% of people older than 80 years; however, diagnosis and treatment are difficult because about 55% of them do not adhere to treatment recommendations due to low socioeconomic status, comorbidities, age, physical limitations, and frailty syndrome.Aims: The purposes of this study were to evaluate the influence of frailty on medication adherence among elderly hypertensive patients and to assess whether other factors influence adherence in this group of patients.Methods and results: The study included 296 patients (mean age 68.8±8.0 divided into frail (n=198 and non-frail (n=98 groups. The Polish versions of the Tilburg Frailty Indicator (TFI for frailty assessment and 8-item Morisky Medication Adherence Scale for adherence assessment were used. The frail patients had lower medication adherence in comparison to the non-frail subjects (6.60±1.89 vs 7.11±1.42; P=0.028. Spearman’s rank correlation coefficients showed that significant determinants with negative influence on the level of adherence were physical (rho =-0.117, psychological (rho =-0.183, and social domain (rho =-0.163 of TFI as well as the total score of the questionnaire (rho =-0.183. However, multiple regression analysis revealed that only knowledge about complications of untreated hypertension (β=0.395 and satisfaction with the home environment (β=0.897 were found to be independent stimulants of adherence level.Conclusion: Frailty is highly prevalent among elderly hypertensive patients. Higher level of frailty

  1. Osteosarcopenic Obesity: Prevalence and Relation With Frailty and Physical Performance in Middle-Aged and Older Women.

    Science.gov (United States)

    Szlejf, Claudia; Parra-Rodríguez, Lorena; Rosas-Carrasco, Oscar

    2017-08-01

    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. Cross-sectional analysis of a prospective cohort. The FraDySMex study, a 2-round evaluation of community-dwelling adults from 2 municipalities in Mexico City. Participants were 434 women aged 50 years or older, living in the designated area in Mexico City. Body composition was measured with dual-energy X-ray absorptiometry and OSO was defined by the coexistence of sarcopenia, osteopenia, or osteoporosis and obesity. Information regarding demographic characteristics; comorbidities; mental status; nutritional status; and history of falls, fractures, and hospitalization was obtained from questionnaires. Objective measurements of muscle strength and function were grip strength using a hand dynamometer, 6-meter gait speed using a GAIT Rite instrumented walkway, and lower extremity functioning measured by the Short Physical Performance Battery (SPPB). Frailty was assessed using the Frailty Phenotype (Fried criteria), the Gerontopole Frailty Screening Tool (GFST), and the FRAIL scale, to build 3 logistic regression models. The prevalence of OSO was 19% (n = 81). Frailty (according to the Frailty Phenotype and the GFST) and poor physical performance measured by the SPPB were independently associated with OSO, controlled by age. In the logistic regression model assessing frailty with the Frailty Phenotype, the odds ratio (95% confidence interval) for frailty was 4.86 (2.47-9.55), and for poor physical performance it was 2.11 (1.15-3.89). In the model assessing frailty with the GFST, it was 2.12 (1.10-4.11), and for poor physical performance it was 2.15 (1.18-3.92). Finally, in the model with the FRAIL scale, it was 1.69 (0.85-3.36) for frailty and 2.29 (1.27-4.15) for poor physical performance. OSO is a frequent condition in middle-aged and older women

  2. Is Neighborhood Green Space Associated With Less Frailty? Evidence From the Mr. and Ms. Os (Hong Kong) Study.

    Science.gov (United States)

    Yu, Ruby; Wang, Dan; Leung, Jason; Lau, Kevin; Kwok, Timothy; Woo, Jean

    2018-02-02

    To examine whether neighborhood green space was related to frailty risk longitudinally and to examine the relative contributions of green space, physical activity, and individual health conditions to the frailty transitions. Four thousand community-dwelling Chinese adults aged ≥65 years participating in the Mr. and Ms. Os (Hong Kong) study in 2001-2003 were followed up for 2 years. The percentage of green space within a 300-meter radial buffer around the participants' place of residence was derived for each participant at baseline based on the normalized difference vegetation index. Frailty status was classified according to the Fried criteria at baseline and after 2 years. Ordinal logistic regression and path analysis were used to examine associations between green space and the frailty transitions, adjusting for demographics, socioeconomic status, lifestyle factors, health conditions, and baseline frailty status. At baseline, 53.5% of the participants met the criterion for robust, 41.5% were classified as prefrailty, and 5.0% were frail. After 2 years, 3240 participants completed all the measurements. Among these, 18.6% of prefrail or frail participants improved, 66% remained in their frailty state, and 26.8% of robust or prefrail participants progressed in frailty status. In multivariable models, the frailty status of participants living in neighborhoods with more than 34.1% green space (the highest quartile) at baseline was more likely to improve at the 2-year follow-up than it was for those living in neighborhoods with 0 to 4.5% (the lowest quartile) [odds ratio (OR): 1.29, 95% confidence interval (CI): 1.04-1.60; P for trend: 0.022]. When men and women were analyzed separately, the association between green space and frailty remained significant in men (OR: 1.40, 95% CI: 1.03-1.90) but not in women. Path analysis showed that green space directly affects frailty transitions (β = 0.041, P space on the 2-year frailty transitions is comparable to those

  3. Frailty as a Risk Factor for Falls Among Community Dwelling People: Evidence From a Meta-Analysis.

    Science.gov (United States)

    Cheng, Mei-Hsun; Chang, Shu-Fang

    2017-09-01

    This study was conducted to investigate the relationships between different frailty stages and the fall incidence rates of community-dwelling older adults. The differences between various frailty indicators regarding assessment accuracy of the fall incidence rates of community-dwelling elders were also analyzed. Finally, the relationship between frailty and recurrent falls was explored. This study comprised a systematic literature review and meta-analysis. Two researchers independently examined and extracted the related literature. The key search terms included frailty, frail, fall, older people, older, geriatric, and senior. The literature sampling period was from January 2001 to December 2016. The quality of each paper was assessed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases of the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and MEDLINE were used to conduct a systematic literature search by using the random effect mode to analyze the compiled papers. A total of 102,130 community-dwelling older adults ≥65 years of age and 33,503 older adults who had experienced a fall were compiled to investigate the relationship between frailty and falls. The meta-analysis results revealed that compared with robust older adults, frail older adults demonstrated the greatest risk for falls, followed by prefrail older adults. Furthermore, the use of different frailty indicators to predict the fall incidence rates of older adults yielded nonsignificantly different outcomes. In short, studies of either cardiovascular health or osteoporotic fracture indicators are effective for predicting the risk for falls in older people. Finally, this study confirmed that compared with robust older adults, frail older adults were more likely to experience recurrent falls. Frailty is a crucial healthcare topic of people with geriatric syndromes. Frail older adults are

  4. [Frailty and long term mortality, disability and hospitalisation in Spanish older adults. The FRADEA Study].

    Science.gov (United States)

    Martínez-Reig, Marta; Flores Ruano, Teresa; Fernández Sánchez, Miguel; Noguerón García, Alicia; Romero Rizos, Luis; Abizanda Soler, Pedro

    2016-01-01

    The objective of this study was to analyse whether frailty is related to long-term mortality, incident disability in basic activities of daily living (BADL), and hospitalisation. A concurrent cohort study conducted on 993 participants over age 70 from the FRADEA Study. Frailty was determined with Fried frailty phenotype. Data was collected on mortality, hospitalisation and incident disability in BADL (bathing, grooming, dressing, toileting, eating or transferring) during the follow-up period. The risk of adverse events was determined by logistic regression, Kaplan-Meier analysis, and Cox proportional hazard analysis adjusted for age, sex, Barthel index, comorbidity and institutionalization. Mean follow-up was 952 days (SD 408), during which 182 participants (18.4%) died. Frail participants had an increased adjusted risk of death (HR 4.5, 95%CI: 1.8-11.1), incident disability in BADL (OR 2.7, 95%CI: 1.3-5.9) and the combined event mortality or incident disability (OR 3.0, 95%CI: 1.5-6.1). Pre-frail subjects had an increased adjusted risk of death (HR 2.9, 95%CI: 1.2-6.5), incident disability in BADL (OR 2.1, 95%CI: 1.2-3.6), and the combined event mortality or incident disability (OR 2.2, 95%CI: 1.3-3.6). There was a positive association between frailty and hospitalisation, which almost reached statistical significance (OR 1.7, 95%CI: 1.0-3.0). Frailty is long-term associated with mortality and incident disability in BADL in a Spanish cohort of older adults. Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Factors associated with frailty in primary care: a prospective cohort study.

    Science.gov (United States)

    Diez-Ruiz, Ana; Bueno-Errandonea, Antonio; Nuñez-Barrio, Jazmina; Sanchez-Martín, Inmaculada; Vrotsou, Kalliopi; Vergara, Itziar

    2016-04-28

    Frailty can be defined as a progressive loss of reserve and adaptive capacity associated with an overall deterioration in health that can result in disability, loss of independence, hospitalisation, extensive use of healthcare resources, admission to long-term care and death. Nevertheless, despite widespread use of the term, there is no agreement on the definition of frailty or an instrument to identify it in a straightforward way. The purpose of the current study was to explore which factors are associated with frailty-related adverse outcomes in elderly individuals and to propose a suitable tool for identifying such individuals, particularly in primary care settings. A prospective open cohort study of community dwelling, independent individuals aged 75 or over, followed up for 2 years. The study was entirely conducted in a primary care setting. Study variables included independence status measured by Barthel's Index and the Lawton Instrumental Activities of Daily Living Scale, functional performance, assessed by Timed Up and Go (TUG) and Gait Speed (GS) tests and levels of polipharmacy, comorbidity and social support. Outcome variables were specific frailty-related adverse events, namely, loss of independence and death. Overall, 215 community-dwelling independent individuals initiated the study. Of these, 46 were lost to follow-up and 50 had frailty-related adverse events during the follow-up period. Individuals with adverse events during the study had poorer functional status at baseline. The multivariate model that best explained the occurrence of these events included the variables of age, presence of polipharmacy and the TUG time. The AUC (Area under the curve) of this model was 0.822. Given the simplicity of assessing the three derived factors and their combined discriminant power, the proposed model may be considered a suitable tool for identifying frail patients, i.e., people more likely to lose their independence or die within a relatively short time

  6. Prevalence and determinants of frailty and associated comorbidities among older Gurkha welfare pensioners in Nepal.

    Science.gov (United States)

    Devkota, Sirjana; Anderson, Bruce; Soiza, Roy L; Myint, Phyo K

    2017-12-01

    Population aging is increasing in low-income countries. Despite this, there is distinct lack of knowledge about the prevalence of comorbidities and determinants of frailty among older people in these countries. We examined data from "Health and Social Care Needs Assessment Survey of the Gurkha Welfare Pensioners" carried out in 2014. Participants were aged ≥60 years from the Gorakha, Lamjung and Tanahu districts of Nepal. Face-to-face interviews were carried out using validated questionnaires. Demographic data, socioeconomic status, and self-reported symptoms and illnesses were collected. Frailty was assessed using the Canadian Study of Health and Aging scale. Univariable and multivariable regression models were constructed to identify the determinants of frailty defined as Canadian Study of Health and Aging scale ≥4. A total of 253 participants (32.0% men) were included in the present study. Most (82.2%) participants were from the Janajati ethnic background. Men who were ex-servicemen had higher educational attainment than women, most of whom (95.3%) were widows of ex-servicemen (P health issues, such as anxiety and insomnia, compared with men. The prevalence of frailty was 46.2% (46.3% in men and 46.1% in women). In this population, frailty was significantly associated with older age, smoking, living with son, breathing problems, unspecified pain and fatigue, poor dental health, and history of falls and fracture (P low-income setting. Concerted efforts should be made with regard to how best to tackle this globally. Geriatr Gerontol Int 2017; 17: 2493-2499. © 2017 Japan Geriatrics Society.

  7. Multi-parametric MR imaging of quadriceps musculature in the setting of clinical frailty syndrome

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    Melville, David M.; Sharma, Puneet; Taljanovic, Mihra S. [University of Arizona College of Medicine, Department of Medical Imaging, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ (United States); Mohler, Jane; Fain, Mindy; Muchna, Amy E. [University of Arizona College of Medicine, Arizona Center on Aging, Tucson, AZ (United States); Krupinski, Elizabeth [University of Arizona College of Medicine, Department of Medical Imaging, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ (United States); Emory University, Department of Radiology and Imaging Services, Atlanta, GA (United States)

    2016-05-15

    Frailty is a common geriatric syndrome associated with loss of skeletal muscle mass (sarcopenia) conferring an increased risk of rapid decline in health and function with increased vulnerability to adverse outcomes. The purpose of this study was to investigate the correlation between diffusion tensor, T2 and intramuscular fat content values of the quadriceps muscle group and clinical frailty status using diffusion tensor MR imaging. Subjects were recruited from the Arizona Frailty cohort composed of all females with frailty status based on the Fried criteria, including 6 non-frail and 10 pre-frail/frail adults, as well as a community sample of 11 young, healthy controls. Axial images of both thighs were obtained on a 3-T magnet with T1, T2 and diffusion tensor imaging as well as intramuscular fat analysis. Diffusion tensor and T2 values were determined by region-of-interest measurements at the proximal, mid and distal thirds of both thighs. Data were evaluated to determine differences between measured values and frailty status. The mean fractional anisotropy (FA) values in the bilateral quadriceps muscles demonstrated significant differences (F = 7.558, p = 0.0030) between the control and pre-frail/frail and non-frail and pre-frail/frail groups. There was a significant difference in mean T2 (F = 21.675, p < 0.0001) and lipid content (F = 19.266, p < 0.0001) among all three groups in the total quadriceps muscle group. The quadriceps musculature of pre-frail/frail adults demonstrated increased FA compared to young controls and non-frail adults with increasing T2 and intramuscular fat among the control, non-frail and pre-frail/frail categories. (orig.)

  8. Vitamin D Binding Protein Affects the Correlation of 25(OHD and Frailty in the Older Men

    Directory of Open Access Journals (Sweden)

    Yi Wang

    2014-01-01

    Full Text Available Vitamin D binding protein (DBP may alter the biologic activity of 25-hydroxyvitamin D [25(OHD]. The objective of our present study was to determine the joint effect of serum 25(OHD and DBP on the risk of frailty. Five hundred sixteen male participants aged 70 years or older were recruited in Changsha city and its surrounding area in Hunan province of China. Frailty was defined as the presence of at least three of the five following criteria: weakness, low physical activity, slow walking speed, exhaustion, and weight loss. Multivariate linear regression analysis was performed to assess the relationship between 25(OHD and DBP levels. Odds ratios (ORs for frailty were evaluated across quartiles of 25(OHD and DBP levels, adjusted age, education, and body mass index. The results showed that participants in the lowest quartile of 25(OHD and the highest quartile of DBP levels, the lowest quartile of 25(OHD and the lowest quartile of DBP levels, and those in the the lower quartile of 25(OHD and lowest quartile of DBP levels had significantly higher OR of being frail compared with those in the highest quartile of 25(OHD and lowest quartile of DBP, with OR of 3.18 (95% CI: 1.46–4.56, P<0.05, 2.63 (95% CI: 1.31–3.68, P<0.01, and 2.52 (95% CI: 1.22–3.52, P<0.05, respectively. The results indicate that the joint effect of serum 25(OHD and DBP levels is associated with the risk of frailty, and serum DBP levels affects 25(OHD-frailty relationship in the older men.

  9. Frailty and cardiovascular risk in community-dwelling elderly: a population-based study.

    Science.gov (United States)

    Ricci, Natalia Aquaroni; Pessoa, Germane Silva; Ferriolli, Eduardo; Dias, Rosangela Correa; Perracini, Monica Rodrigues

    2014-01-01

    Evidence suggests a possible bidirectional connection between cardiovascular disease (CVD) and the frailty syndrome in older people. To verify the relationship between CVD risk factors and the frailty syndrome in community-dwelling elderly. This population-based study used data from the Fragilidade em Idosos Brasileiros (FIBRA) Network Study, a cross-sectional study designed to investigate frailty profiles among Brazilian older adults. Frailty status was defined as the presence of three or more out of five of the following criteria: unintentional weight loss, weakness, self-reported fatigue, slow walking speed, and low physical activity level. The ascertained CVD risk factors were self-reported and/or directly measured hypertension, diabetes mellitus, obesity, waist circumference measurement, and smoking. Of the 761 participants, 9.7% were characterized as frail, 48.0% as pre-frail, and 42.3% as non-frail. The most prevalent CVD risk factor was hypertension (84.4%) and the lowest one was smoking (10.4%). It was observed that among those participants with four or five risk factors there was a higher proportion of frail and pre-frail compared with non-frail (Fisher's exact test: P=0.005; P=0.021). Self-reported diabetes mellitus was more prevalent among frail and pre-frail participants when compared with non-frail participants (Fisher's exact test: P≤0.001; P≤0.001). There was little agreement between self-reported hypertension and hypertension identified by blood pressure measurement. Hypertension was highly prevalent among the total sample. In addition, frail and pre-frail older people corresponded to a substantial proportion of those with more CVD risk factors, especially diabetes mellitus, highlighting the need for preventive strategies in order to avoid the co-occurrence of CVD and frailty.

  10. The Timed Up and Go Test as a Measure of Frailty in Urologic Practice.

    Science.gov (United States)

    Pangilinan, Jayce; Quanstrom, Kathryn; Bridge, Mark; Walter, Louise C; Finlayson, Emily; Suskind, Anne M

    2017-08-01

    To evaluate the prevalence of frailty, a known predictor of poor outcomes, among patients presenting to an academic nononcologic urology practice and to examine whether frailty differs among patients who did and did not undergo urologic surgery. The Timed Up and Go Test (TUGT), a parsimonious measure of frailty, was administered to patients ages ≥65. The TUGT, demographic data, urologic diagnoses, and procedural history were abstracted from the medical record into a prospective database. TUGT times were categorized as nonfrail (≤10 seconds), prefrail (11-14 seconds), and frail (≥15 seconds). These times were evaluated across age and urologic diagnoses and compared between patients who did and did not undergo urologic surgery using chi-square and t tests. The TUGT was recorded for 78.9% of patient visits from December 2015 to May 2016. For 1089 patients, average age was 73.3 ± 6.3 years; average TUGT time was 11.6 ± 6.0 seconds; 30.0% were categorized as prefrail and 15.2% as frail. TUGT times increased with age, with 56.9% of patients age 86 and over categorized as frail. Times varied across diagnoses (highest average TUGT was 14.3 ± 11.9 seconds for patients with urinary tract infections); however, no difference existed between patients who did and did not undergo surgery (P = .94). Among our population, prefrailty and frailty were common, TUGT times increased with age and varied by urologic diagnosis, but did not differ between patients who did and did not undergo urologic surgery, presenting an opportunity to consider frailty in preoperative surgical decision making. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Gender-associated factors for frailty and their impact on hospitalization and mortality among community-dwelling older adults: a cross-sectional population-based study

    Directory of Open Access Journals (Sweden)

    Qin Zhang

    2018-02-01

    Full Text Available Background Frailty associated with aging increases the risk of falls, disability, and death. We investigated gender-associated factors for frailty. Methods Data of 3,079 geriatric subjects were retrieved from the National Health and Nutrition Examination Survey (NHANES 2007–2010 database. After excluding 1,126 subjects with missing data on frailty, medical history and survival, data of 1,953 patients were analyzed. Main endpoints were frailty prevalence, mortality rates and causes of death. Results Frailty prevalence was 5.4% in males, 8.8% in females. Significant risk factors for geriatric frailty in males were being widowed/divorced/separated, low daily total calorie intake, physical inactivity, sleeping >9 h, smoking and hospitalization history; and in females were obesity, physical inactivity, sleeping <6 h, family history of diabetes and heart attack, and hospitalization history. Frail subjects had higher mortality rates (22.5% male; 8.5% female than pre-frail (8.7% male; 6.4% female and non-frail (5.4% male; 2.5% female. Main causes of death were heart diseases (41% and chronic lower respiratory diseases (23.0% in males and nephritis/nephrosis (32.3% and chronic lower respiratory diseases (17.6% in females. Discussion Factors associated with frailty differ by gender, with higher frailty prevalence in females and higher mortality in males. Gender-associated factors for frailty identified in this study may be useful in evaluating frailty and guiding development of public health measures for prevention. Key Message Common predictive factors for frailty among older adults of both genders, including more frequent previous hospitalizations, physical inactivity, and certain gender-associated factors for frailty, are consistent with results of other NHANES studies in which self-reported higher levels of illness and sedentary behavior were directly associated with frailty.

  12. Discrimination ability of comorbidity, frailty, and subjective health to predict mortality in community-dwelling older people

    DEFF Research Database (Denmark)

    Kusumastuti, Sasmita; Gerds, Thomas Alexander; Lund, Rikke

    2017-01-01

    OBJECTIVE: To investigate the added value of comorbidity, frailty, and subjective health to mortality predictions in community-dwelling older people and whether it changes with increasing age. PARTICIPANTS: 36,751 community-dwelling subjects aged 50-100 from the longitudinal Survey of Health......, Ageing, and Retirement in Europe. METHODS: Mortality risk associated with Comorbidity Index, Frailty Index, Frailty Phenotype, and subjective health was analysed using Cox regression. The extent to which health indicators modified individual mortality risk predictions was examined and the added ability......, and household income. CONCLUSION: Calendar age encompasses most of the discrimination ability to predict mortality. The added value of comorbidity, frailty, and subjective health to mortality predictions decreases with increasing age....

  13. Efficient Semiparametric Marginal Estimation for the Partially Linear Additive Model for Longitudinal/Clustered Data

    KAUST Repository

    Carroll, Raymond

    2009-04-23

    We consider the efficient estimation of a regression parameter in a partially linear additive nonparametric regression model from repeated measures data when the covariates are multivariate. To date, while there is some literature in the scalar covariate case, the problem has not been addressed in the multivariate additive model case. Ours represents a first contribution in this direction. As part of this work, we first describe the behavior of nonparametric estimators for additive models with repeated measures when the underlying model is not additive. These results are critical when one considers variants of the basic additive model. We apply them to the partially linear additive repeated-measures model, deriving an explicit consistent estimator of the parametric component; if the errors are in addition Gaussian, the estimator is semiparametric efficient. We also apply our basic methods to a unique testing problem that arises in genetic epidemiology; in combination with a projection argument we develop an efficient and easily computed testing scheme. Simulations and an empirical example from nutritional epidemiology illustrate our methods.

  14. Simultaneous Bayesian inference for skew-normal semiparametric nonlinear mixed-effects models with covariate measurement errors.

    Science.gov (United States)

    Huang, Yangxin; Dagne, Getachew A

    2012-01-01

    Longitudinal data arise frequently in medical studies and it is a common practice to analyze such complex data with nonlinear mixed-effects (NLME) models which enable us to account for between-subject and within-subject variations. To partially explain the variations, covariates are usually introduced to these models. Some covariates, however, may be often measured with substantial errors. It is often the case that model random error is assumed to be distributed normally, but the normality assumption may not always give robust and reliable results, particularly if the data exhibit skewness. Although there has been considerable interest in accommodating either skewness or covariate measurement error in the literature, there is relatively little work that considers both features simultaneously. In this article, our objectives are to address simultaneous impact of skewness and covariate measurement error by jointly modeling the response and covariate processes under a general framework of Bayesian semiparametric nonlinear mixed-effects models. The method is illustrated in an AIDS data example to compare potential models which have different distributional specifications. The findings from this study suggest that the models with a skew-normal distribution may provide more reasonable results if the data exhibit skewness and/or have measurement errors in covariates.

  15. Bayesian semiparametric nonlinear mixed-effects joint models for data with skewness, missing responses, and measurement errors in covariates.

    Science.gov (United States)

    Huang, Yangxin; Dagne, Getachew

    2012-09-01

    It is a common practice to analyze complex longitudinal data using semiparametric nonlinear mixed-effects (SNLME) models with a normal distribution. Normality assumption of model errors may unrealistically obscure important features of subject variations. To partially explain between- and within-subject variations, covariates are usually introduced in such models, but some covariates may often be measured with substantial errors. Moreover, the responses may be missing and the missingness may be nonignorable. Inferential procedures can be complicated dramatically when data with skewness, missing values, and measurement error are observed. In the literature, there has been considerable interest in accommodating either skewness, incompleteness or covariate measurement error in such models, but there has been relatively little study concerning all three features simultaneously. In this article, our objective is to address the simultaneous impact of skewness, missingness, and covariate measurement error by jointly modeling the response and covariate processes based on a flexible Bayesian SNLME model. The method is illustrated using a real AIDS data set to compare potential models with various scenarios and different distribution specifications. © 2011, The International Biometric Society.

  16. Glycemic Excursions in Type 1 Diabetes in Pregnancy: A Semiparametric Statistical Approach to Identify Sensitive Time Points during Gestation

    Directory of Open Access Journals (Sweden)

    Resmi Gupta

    2017-01-01

    Full Text Available Aim. To examine the gestational glycemic profile and identify specific times during pregnancy that variability in glucose levels, measured by change in velocity and acceleration/deceleration of blood glucose fluctuations, is associated with delivery of a large-for-gestational-age (LGA baby, in women with type 1 diabetes. Methods. Retrospective analysis of capillary blood glucose levels measured multiple times daily throughout gestation in women with type 1 diabetes was performed using semiparametric mixed models. Results. Velocity and acceleration/deceleration in glucose levels varied across gestation regardless of delivery outcome. Compared to women delivering LGA babies, those delivering babies appropriate for gestational age exhibited significantly smaller rates of change and less variation in glucose levels between 180 days of gestation and birth. Conclusions. Use of innovative statistical methods enabled detection of gestational intervals in which blood glucose fluctuation parameters might influence the likelihood of delivering LGA baby in mothers with type 1 diabetes. Understanding dynamics and being able to visualize gestational changes in blood glucose are a potentially useful tool to assist care providers in determining the optimal timing to initiate continuous glucose monitoring.

  17. Glycemic Excursions in Type 1 Diabetes in Pregnancy: A Semiparametric Statistical Approach to Identify Sensitive Time Points during Gestation

    Science.gov (United States)

    Gupta, Resmi; Khoury, Jane; Altaye, Mekibib; Dolan, Lawrence

    2017-01-01

    Aim. To examine the gestational glycemic profile and identify specific times during pregnancy that variability in glucose levels, measured by change in velocity and acceleration/deceleration of blood glucose fluctuations, is associated with delivery of a large-for-gestational-age (LGA) baby, in women with type 1 diabetes. Methods. Retrospective analysis of capillary blood glucose levels measured multiple times daily throughout gestation in women with type 1 diabetes was performed using semiparametric mixed models. Results. Velocity and acceleration/deceleration in glucose levels varied across gestation regardless of delivery outcome. Compared to women delivering LGA babies, those delivering babies appropriate for gestational age exhibited significantly smaller rates of change and less variation in glucose levels between 180 days of gestation and birth. Conclusions. Use of innovative statistical methods enabled detection of gestational intervals in which blood glucose fluctuation parameters might influence the likelihood of delivering LGA baby in mothers with type 1 diabetes. Understanding dynamics and being able to visualize gestational changes in blood glucose are a potentially useful tool to assist care providers in determining the optimal timing to initiate continuous glucose monitoring. PMID:28280744

  18. Cancer and frailty in older adults: a nested case-control study of the Mexican Health and Aging Study

    Science.gov (United States)

    Pérez-Zepeda, Mario Ulises; Cárdenas-Cárdenas, Eduardo; Cesari, Matteo; Navarrete-Reyes, Ana Patricia; Gutiérrez-Robledo, Luis Miguel

    2016-01-01

    Purpose Understanding how the convergence between chronic and complex diseases—such as cancer—and emerging conditions of older adults—such as frailty—takes place would help in halting the path that leads to disability in this age group. The objective of this manuscript is to describe the association between a past medical history of cancer and frailty in Mexican older adults. Methods This is a nested in cohort case-control study of the Mexican Health and Aging Study. Frailty was categorized by developing a 55-item frailty index that was also used to define cases in two ways: incident frailty (incident >0.25 frailty index score) and worsening frailty (negative residuals from a regression between 2001 and 2012 frailty index scores). Exposition was defined as self-report of cancer between 2001 and 2012. Older adults with a cancer history were further divided into recently diagnosed (10 years from the initial diagnosis). Odds ratios were estimated by fitting a logistic regression adjusted for confounding variables. Results Out of a total of 8022 older adults with a mean age of 70.6 years, the prevalence of a past medical history of cancer was 3.6 % (n = 288). Among these participants, 45.1 % had been diagnosed with cancer more than 10 years previously. A higher risk of incident frailty compared to controls [odds ratio (OR) 1.53 (95 % confidence interval (CI) 1.04–2.26, p = 0.03); adjusted model OR 1.74 (95 % CI 1.15–2.61, p = 0.008)] was found in the group with a recent cancer diagnosis. Also, an inverse association between a remote cancer diagnosis and worsening frailty was found [OR = 0.56 (95 % CI 0.39–0.8), p = 0.002; adjusted model OR 0.61 (95 % CI 0.38–0.99, p = 0.046)]. Conclusions Cancer is associated with a higher frailty index, with a potential relevant role of the time that has elapsed since the cancer diagnosis. Implications for cancer survivors Cancer survivors may be more likely to develop frailty or worsening of the health status at an

  19. Effects of non-sporting and sporting qigong on frailty and quality of life among breast cancer patients receiving chemotherapy.

    Science.gov (United States)

    Huang, Sheng-Miauh; Tseng, Ling-Ming; Chien, Li-Yin; Tai, Chen-Jei; Chen, Ping-Ho; Hung, Chia Tai; Hsiung, Yvonne

    2016-04-01

    To explore the effects of non-sporting qigong (NSQG) and sporting qigong (SQG) on frailty and quality of life (QOL) of breast cancer patients during chemotherapy. A time series (three-group, pre-test-post-test) quasi-experimental design was applied in the study. Ninety-five participants were assigned to three groups: controls (n = 31), NSQG (n = 33), or SQG (n = 31). All patients performed the qigong interventions three times per week for at least 30 min per session. Data were collected in face-to-face interviews before chemotherapy and at 1 and 3 months after chemotherapy. Frailty was assessed using the Edmonton Frail Scale. The Medical Outcomes Survey Short-Form 36-Taiwanese version was used to evaluate the physical and mental component scores of QOL. In the 1st and 3rd months after practicing qigong, patients in the SQG group had lower frailty scores than those in the control group. In the 3rd month after the intervention, patients in the NSQG group also had lower frailty scores and higher mental component scores for QOL than those in the control group. Patients with higher frailty scores had worse physical and mental component scores for QOL than those with lower frailty scores. The Sobel test showed that the frailty score mediated SQG and physical component scores for QOL. SQG and NSQG appeared to be beneficial for improving frailty and QOL among the breast cancer patients receiving chemotherapy in the study. The results are preliminary and larger, well-constructed clinical studies are needed to verify the findings. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Exploring the relationship between national economic indicators and relative fitness and frailty in middle-aged and older Europeans

    Science.gov (United States)

    Theou, Olga; Brothers, Thomas D.; Rockwood, Michael R.; Haardt, David; Mitnitski, Arnold; Rockwood, Kenneth

    2013-01-01

    Background: on an individual level, lower-income has been associated with disability, morbidity and death. On a population level, the relationship of economic indicators with health is unclear. Objective: the purpose of this study was to evaluate relative fitness and frailty in relation to national income and healthcare spending, and their relationship with mortality. Design and setting: secondary analysis of data from the Survey of Health, Ageing and Retirement in Europe (SHARE); a longitudinal population-based survey which began in 2004. Subjects: a total of 36,306 community-dwelling people aged 50 and older (16,467 men; 19,839 women) from the 15 countries which participated in the SHARE comprised the study sample. A frailty index was constructed as the proportion of deficits present in relation to the 70 deficits available in SHARE. The characteristics of the frailty index examined were mean, prevalence of frailty and proportion of the fittest group. Results: the mean value of the frailty index was lower in higher-income countries (0.16 ± 0.12) than in lower-income countries (0.20 ± 0.14); the overall mean frailty index was negatively correlated with both gross domestic product (r = −0.79; P < 0.01) and health expenditure (r = −0.63; P < 0.05). Survival in non-frail participants at 24 months was not associated with national income (P = 0.19), whereas survival in frail people was greater in higher-income countries (P < 0.05). Conclusions: a country's level of frailty and fitness in adults aged 50+ years is strongly correlated with national economic indicators. In higher-income countries, not only is the prevalence of frailty lower, but frail people also live longer. PMID:23443511

  1. Frailty index and its associations with self-neglect, social support and sociodemographic characteristics among older adults in rural China.

    Science.gov (United States)

    Li, Jie; Zhao, Dongdong; Dong, Bao; Yu, Dandan; Ren, Qiongqiong; Chen, Jian; Qin, Qirong; Bi, Peng; Sun, Yehuan

    2018-03-01

    The frailty index is used to measure the health status of older individuals. However, its association with self-neglect, social support and sociodemographic characteristics of older adults is underexplored. The purpose of the present study was to explore such associations among the rural older adults in Anhui Province of China, and to provide scientific evidence for policy-makers to improve the health and well-being of older adults in rural China. A cross-sectional survey was undertaken among 3048 older adults in rural China. The frailty index was measured by an accumulation of deficits of 40 items. Ordinal logistic regression models were carried out to explore the associations of self-neglect, social support and sociodemographic characteristics with the frailty index. The frailty rate was 15.8% among the participants. Older adults who showed self-neglect, were female, had a lower education level, had a lower monthly income and did not drink alcohol were more prone to having frailty in the 60-76 years age group, whereas older adults who showed self-neglect, had poor social support, were female, were not smokers and did not drink alcohol were more likely to have frailty in the ≥77 years age group (P neglect and social support was found in the 60-76 years age group. Age differences were shown in the associations between self-neglect, social support, sociodemographic characteristics and frailty index, which suggests different measures should be used accordingly for frailty prevention and management. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 Japan Geriatrics Society.

  2. A study of clinical assessment of frailty in patients on maintenance hemodialysis supported by cashless government scheme

    Directory of Open Access Journals (Sweden)

    Manjusha Yadla

    2017-01-01

    Full Text Available This is a prospective cohort study to assess the prevalence of frailty in patients undergoing maintenance hemodialysis (HD under the government-funded scheme at our center and to assess the relationship between frailty and falls, hospitalizations, and mortality. This was done at our center which is completely supported by the government, which provides HD to all the patients under poverty line. Epidemiological data, anthropometric measurements, comorbidities assessment, frailty assessment using Fried criteria, subsequent hospitalizations, falls, and mortality were recorded in our prevalent dialysis population at our center between October 2014 and October 2015. Two hundred and twenty-six patients were enrolled during this period. Twenty-one patients were excluded as they did not satisfy the inclusion criteria. Two hundred and five prospective patients were studied for the predictors of frailty. Frailty was present in 82% of the study population. Mean age of our study population was 44.95 ± 13.27 years. On univariate analysis, diabetes mellitus, hypertension (HTN, cerebrovascular accident (CVA, left ventricular dysfunction (LVD, peripheral vascular disease (PVD, smoking, hepatitis C, inadequate dialysis, intradialytic hypotension (IDH, interdialytic weight gain, low serum creatinine <4 mg/dL, and anemia (Hb <10 g/dL were found to be statistically significantly different between frail and nonfrail groups On multivariate regression analysis, only HTN, PVD, CVA, anemia, smoking, and IDH were found to be significant. Frailty is highly prevalent among dialysis population. Factors predicting frailty include HTN, smoking, LVD, PVD, CVA, smoking, anemia, and IDH. Frailty is a significant risk factor for falls and hospitalizations.

  3. A frailty instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE).

    LENUS (Irish Health Repository)

    Romero-Ortuno, Roman

    2010-01-01

    A frailty paradigm would be useful in primary care to identify older people at risk, but appropriate metrics at that level are lacking. We created and validated a simple instrument for frailty screening in Europeans aged ≥50. Our study is based on the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE, http:\\/\\/www.share-project.org), a large population-based survey conducted in 2004-2005 in twelve European countries.

  4. Determinants of musculoskeletal frailty and the risk of falls in old age.

    Science.gov (United States)

    Runge, M; Hunter, G

    2006-01-01

    Neuromuscular parameters that describe locomotion are indispensable variables for the diagnosis and treatment of frailty, fall risk and osteoporosis. A scientifically-based standardized locomotor assessment should be an essential part of medical examinations in research and clinical practice. There has been no previous consensus regarding which test procedures should be included in a locomotor assessment. The goal of this article is to provide a rationale for the selection of appropriate locomotor tests in a comprehensive locomotor assessment for elderly patients. We propose that a locomotor assessment should comprise the parameters that have been proven predictive for both falls and impending disability. The parameters should be measured in the standard units of physics. Therefore, we propose the following tests for a standardized locomotor assessment: (1) Self-selected gait velocity as the single best measure of general locomotor status and a good predictor of age-related adverse events; (2) Chair rise test (timed 5 chair rises) which measures power on vertical movement and the hip surrounding muscles as the most important neuromuscular risk factor for falls and fall-related fractures; (3) Tandem standing and tandem walking to measure postural capacity (balance) to the side; (4) Timed up and go test as a global screening procedure; (5) Clinical gait analysis with special focus on regularity; and (6) At least on a research level, movement must be measured referring to the terms of physics by mechanography. Mechanography (Leonardo force plate system, Novotec Pforzheim, Germany) records the time course of ground reaction forces, velocity of the vertical movements of the center of mass and power during unrestricted physiological movements. In the mechanogram the eccentric and concentric phases of movements can be differentiated and the storage of energy in the elastic elements of the body can be examined. The kinetics of human movement is explained by mechanograms of

  5. Model selection criterion in survival analysis

    Science.gov (United States)

    Karabey, Uǧur; Tutkun, Nihal Ata

    2017-07-01

    Survival analysis deals with time until occurrence of an event of interest such as death, recurrence of an illness, the failure of an equipment or divorce. There are various survival models with semi-parametric or parametric approaches used in medical, natural or social sciences. The decision on the most appropriate model for the data is an important point of the analysis. In literature Akaike information criteria or Bayesian information criteria are used to select among nested models. In this study,the behavior of these information criterion is discussed for a real data set.

  6. Frailty and cardiovascular risk in community-dwelling elderly: a population-based study

    Directory of Open Access Journals (Sweden)

    Ricci NA

    2014-10-01

    Full Text Available Natalia Aquaroni Ricci,1 Germane Silva Pessoa,1 Eduardo Ferriolli,2 Rosangela Correa Dias,3 Monica Rodrigues Perracini1 1Master’s and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID, São Paulo, 2Faculty of Medicine, Universidade de São Paulo (USP, Ribeirão Preto, 3Department of Physiotherapy, Universidade Federal de Minas Gerais (UFMG, Belo Horizonte, Brazil Background: Evidence suggests a possible bidirectional connection between cardiovascular disease (CVD and the frailty syndrome in older people.Purpose: To verify the relationship between CVD risk factors and the frailty syndrome in community-dwelling elderly.Methods: This population-based study used data from the Fragilidade em Idosos Brasileiros (FIBRA Network Study, a cross-sectional study designed to investigate frailty profiles among Brazilian older adults. Frailty status was defined as the presence of three or more out of five of the following criteria: unintentional weight loss, weakness, self-reported fatigue, slow walking speed, and low physical activity level. The ascertained CVD risk factors were self-reported and/or directly measured hypertension, diabetes mellitus, obesity, waist circumference ­measurement, and smoking.Results: Of the 761 participants, 9.7% were characterized as frail, 48.0% as pre-frail, and 42.3% as non-frail. The most prevalent CVD risk factor was hypertension (84.4% and the lowest one was smoking (10.4%. It was observed that among those participants with four or five risk factors there was a higher proportion of frail and pre-frail compared with non-frail (Fisher’s exact test: P=0.005; P=0.021. Self-reported diabetes mellitus was more prevalent among frail and pre-frail participants when compared with non-frail participants (Fisher’s exact test: P≤0.001; P≤0.001. There was little agreement between self-reported hypertension and hypertension identified by blood pressure measurement.Conclusion: Hypertension was

  7. Frailty syndrome and all-cause mortality in demented patients: the Italian Longitudinal Study on Aging.

    Science.gov (United States)

    Solfrizzi, Vincenzo; Scafato, Emanuele; Frisardi, Vincenza; Sancarlo, Daniele; Seripa, Davide; Logroscino, Giancarlo; Baldereschi, Marzia; Crepaldi, Gaetano; Di Carlo, Antonio; Galluzzo, Lucia; Gandin, Claudia; Inzitari, Domenico; Maggi, Stefania; Pilotto, Alberto; Panza, Francesco

    2012-04-01

    Cognition has already been considered as a component of frailty, and it has been demonstrated that it is associated with adverse health outcomes. We estimated the prevalence of frailty syndrome in an Italian older population and its predictive role on all-cause mortality and disability in nondemented subjects and in demented patients. We evaluated 2,581 individuals recruited from the Italian Longitudinal Study on Aging, a population-based sample of 5,632 subjects, aged 65-84 years old. Participants received identical baseline evaluation at the 1st survey (1992-1993) and were followed at 2nd (1995-1996) and 3rd survey (2000-2001). A phenotype of frailty according to partially modified measurement of Cardiovascular Health Study criteria was operationalized. The overall prevalence of frailty syndrome in this population-based study was 7.6% (95% confidence interval (CI) 6.55-8.57). Frail individuals noncomorbid or nondisable were 9.1% and 39.3%, respectively, confirming an overlap but not concordance in the co-occurrence among these conditions. Frailty was associated with a significantly increased risk of all-cause mortality over a 3-year follow-up (hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.52-2.60) and over a 7-year follow-up (HR 1.74, 95% CI 1.44-2.16), but with significant increased risk of disability only over a 3-year follow-up (HR 1.32, 95% CI 1.06-1.86 over a 3-year follow-up and HR 1.16, 95% CI 0.88-1.56 over a 7-year follow-up). Frail demented patients were at higher risk of all-cause mortality over 3- (HR 3.33, 95% CI 1.28-8.29) and 7-year follow-up periods (HR 1.89, 95% CI 1.10-3.44), but not of disability. Frailty syndrome was a short-term predictor of disability in nondemented older subjects and short- and long-term predictor of all-cause mortality in nondemented and demented patients.

  8. Frailty and Its Contributory Factors in Older Adults: A Comparison of Two Asian Regions (Hong Kong and Taiwan).

    Science.gov (United States)

    Yu, Ruby; Wu, Wan-Chi; Leung, Jason; Hu, Susan C; Woo, Jean

    2017-09-21

    This study aimed to compare the prevalence of frailty across three Chinese populations: Hong Kong, Taiwan-urban and Taiwan-rural. Contributing factors to disparities in frailty were also examined. Data were derived from the Osteoporotic Fractures in Men (MrOs) and Women (MsOs) (Hong Kong) Study ( n = 4000) and the Taiwan Longitudinal Study on Aging ( n = 2392). Frailty was defined as an index calculated from 30 multiple deficits. The ratio of the frailty index to life expectancy at birth (FI/LE) was used as an indicator of compression of morbidity. Frailty was more prevalent in Taiwan-urban (33.1%) and Taiwan-rural (38.1%) compared to Hong Kong (16.6%, p Hong Kong (0.20, p Hong Kong and Taiwan-urban populations, but not in Taiwan-rural. Living alone was associated with frailty in Hong Kong men, but not in Hong Kong women or Taiwanese people. For all study populations, older age and being a woman constituted the highest attributable factor. This comparison provides useful data to inform government policies.

  9. Relationship between chronic kidney disease with diabetes or hypertension and frailty in community-dwelling Japanese older adults.

    Science.gov (United States)

    Lee, Sungchul; Lee, Sangyoon; Harada, Kazuhiro; Bae, Seongryu; Makizako, Hyuma; Doi, Takehiko; Tsutsumimoto, Kota; Hotta, Ryo; Nakakubo, Sho; Park, Hyuntae; Suzuki, Takao; Shimada, Hiroyuki

    2017-10-01

    The aim of the present study was to evaluate the relationship between kidney function with concomitant diabetes or hypertension and frailty in community-dwelling Japanese older adults. The participants were 9606 residents (community-dwelling Japanese older adults) who completed baseline assessments. The estimated glomerular filtration rate (mL/min/1.73 m 2 ) was determined according to the serum creatinine level, and participants were classified into four mutually exclusive categories: ≥60.0 (normal range), 45.0-59.9, 30.0-44.9 and who met three, four or five criteria satisfied the definition of having frailty. Multivariate logistic regression was used to examine the relationships between estimated glomerular filtration rate and frailty. After multivariate adjustment, participants with lower kidney function (estimated glomerular filtration rate hypertension (OR 2.53, 95% CI 1.45-5.12) showed a significantly increased risk of frailty in the lower kidney function group, regardless of multivariate controls. Furthermore, the analyses showed an even greater increase in the risk of frailty in patients with a history of both diabetes and hypertension (OR 3.67, 95% CI 1.13-14.1) CONCLUSIONS: A lower level of kidney function was associated with a higher risk of frailty in community-dwelling Japanese older adults. Geriatr Gerontol Int 2017; 17: 1527-1533. © 2016 Japan Geriatrics Society.

  10. Frailty as a Predictor of Future Falls Among Community-Dwelling Older People: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Kojima, Gotaro

    2015-12-01

    Although multiple longitudinal studies have investigated frailty as a predictor of future falls, the results were mixed. Thus far, no systematic review or meta-analysis on this topic has been conducted. To review the evidence of frailty as a predictor of future falls among community-dwelling older people. Systematic review of literature and meta-analysis were performed using 6 electronic databases (Embase, Scopus, MEDLINE, CINAHL Plus, PsycINFO, and the Cochrane Library) searching for studies that prospectively examined risk of future fall risk according to frailty among community-dwelling older people published from 2010 to April 2015 with no language restrictions. Of 2245 studies identified through the systematic review, 11 studies incorporating 68,723 individuals were included in the meta-analysis. Among 7 studies reporting odds ratios (ORs), frailty and prefrailty were significantly associated with higher risk of future falls (pooled OR = 1.84, 95% confidence interval [95% CI] = 1.43-2.38, P dwelling older people despite various criteria used to define frailty. The future fall risk according to frailty seemed to be higher in men than in women. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  11. Inflammaging and Frailty Status Do Not Result in an Increased Extracellular Vesicle Concentration in Circulation

    Directory of Open Access Journals (Sweden)

    Ainhoa Alberro

    2016-07-01

    Full Text Available In the last decades extracellular vesicles (EVs have emerged as key players for intercellular communication. In the case of inflammation, several studies have reported that EV levels are increased in circulation during inflammatory episodes. Based on this, we investigated whether aging results in elevated EV number, as a basal proinflammatory status termed “inflammaging” has been described in aged individuals. Moreover, we also hypothesized that frailty and dependence conditions of the elderly could affect EV concentration in plasma. Results showed that inflammaging, frailty or dependence status do not result in EV increase, at least in the total number of EVs in circulation. These results open a new perspective for investigating the role of EVs in human aging and in the inflammaging process.

  12. Frailty is associated with a history with more falls in elderly hospitalised patients

    DEFF Research Database (Denmark)

    Schultz, Martin; Rosted, Elizabeth; Sanders, Suzanne

    2015-01-01

    INTRODUCTION: When elderly people are admitted to hospital, their risk of falling may often not be recognised. The risk of falling in the elderly is linked to frailty. In a Danish study, it was found that the "Identification of Seniors at Risk" screen (ISAR) predicted the patients' amount of health...... problems, days in hospital and readmission. It may therefore also be a predictor of frailty. This study aimed to evaluate how many elderly patients were admitted to an emergency department (ED) because of a fall and to examine if there was a correlation between these patients and their ISAR score. METHODS...... experienced a fall. Of those, 67% were not referred for further fall assessment. Patients who had experienced falls had more health problems than patients without falls (mean 5.7 versus mean 4.4 (p = 0.00)) and more had cognitive impairment (31% versus 14% (p = 0.00)). A positive correlation was found between...

  13. IGF-1, the Cross Road of the Nutritional, Inflammatory and Hormonal Pathways to Frailty

    Science.gov (United States)

    Maggio, Marcello; De Vita, Francesca; Lauretani, Fulvio; Buttò, Valeria; Bondi, Giuliana; Cattabiani, Chiara; Nouvenne, Antonio; Meschi, Tiziana; Dall’Aglio, Elisabetta; Ceda, Gian Paolo

    2013-01-01

    The decline in functional capacity is a heterogeneous phenomenon in the elderly. An accelerated ageing determines a frail status. It results in an increased vulnerability to stressors for decreased physiological reserves. The early identification of a frail status is essential for preventing loss of functional capacity, and its clinical consequences. Frailty and mobility limitation result from an interplay of different pathways including multiple anabolic deficiency, inflammation, oxidative stress, and a poor nutritional status. However, the age-related decline in insulin-like growth factor 1 (IGF-1) bioactivity deserves special attention as it could represent the ideal crossroad of endocrine, inflammatory, and nutritional pathways to frailty. Several minerals, namely magnesium, selenium, and zinc, appear to be important determinants of IGF-1 bioactivity. This review aims to provide an overview of the potential usefulness of nutrients modulating IGF-1 as potential therapeutic targets in the prevention of mobility limitation occurring in frail older subjects. PMID:24152751

  14. Predicting mortality and incident immobility in older Belgian men by characteristics related to sarcopenia and frailty

    DEFF Research Database (Denmark)

    Kruse, C; Goemaere, S; De Buyser, S

    2018-01-01

    and bone mineral density scores were the most important predictors. INTRODUCTION: Machine learning principles were used to predict 5-year mortality and 3-year incident severe immobility in a population of older men by frailty and sarcopenia characteristics. METHODS: Using prospective data from 1997 on 264......There is an increasing awareness of sarcopenia in older people. We applied machine learning principles to predict mortality and incident immobility in older Belgian men through sarcopenia and frailty characteristics. Mortality could be predicted with good accuracy. Serum 25-hydroxyvitamin D...... the most important predictors of immobility. Sarcopenia assessed by lean mass estimates was relevant to mortality prediction but not immobility prediction. CONCLUSIONS: Using advanced statistical models and a machine learning approach 5-year mortality can be predicted with good accuracy using a Bayesian...

  15. An exploration into pedagogic frailty: Transitioning from face-to-face to online

    Directory of Open Access Journals (Sweden)

    Irina Niculescu

    2017-09-01

    Full Text Available Pedagogic frailty and concept mapping can simultaneously encourage personal and organisational change by supporting critical reflection and resilience. These ideas are nascent within higher education institutions and currently, at the University of Surrey, are only developed through face-to-face sessions. This revealed the need for a scalable intervention which engages academics with the discourse on introspective and professional development practices. In response, we have created the design for a blended programme of online foundation for concept mapping leading to face-to-face workshops to explore the pedagogic frailty model. This paper will discuss some significant challenges arising from transitioning self-reflective practices from face-to-face to online spaces. In the process, we will consider ways in which learning design can take the learner context into account.

  16. Issues of Selection in Human Survivorship

    DEFF Research Database (Denmark)

    Hansen, Hans Oluf

    , and Iceland during the past 250 years and in Japan any ten years between 1950 and 1990 is approached appropriately by the model. Reduced natural selection may account for a substantial part of the empirical mortality change in the course of the demographic transition. Survivorship in the late nineteenth......Is variation in empirical mortality across populations consistent with a hypothesis of selec-tion? To examine this proposition an extended frailty mortality model is put forward; incor-porating biological frailty; a common non-parametric hazard, joint for men and women, rep-resenting endogenous...... and the twentieth century ties selection to major medical advances and rapid recent mortality decline, probably with consequences for future health and survivorship....

  17. Waist circumference is a better predictor of risk for frailty than BMI in the community-dwelling elderly in Beijing.

    Science.gov (United States)

    Liao, Qiuju; Zheng, Zheng; Xiu, Shuangling; Chan, Piu

    2018-03-27

    Obesity is found to be associated with frailty. Body mass index (BMI) and waist circumference (WC) are the commonly used measures for obesity, the former is more closely related to general obesity and body weight; the latter can more accurately reflect abdominal obesity and is more closely associated with metabolic disorders. In this study, we intend to study the relationship between frailty, BMI and WC among older people. Data were derived from the Beijing Longitudinal Study on Aging II Cohort, which included 6320 people 65 years or older from three urban districts in Beijing. A Frailty Index derived from 33 items was developed according to Rockwood's cumulative deficits method. A Frailty Index ≥ 0.25 was used as the cut-off criteria. BMI was classified as underweight, normal, overweight, or obese (BMI (≥ 28.0 kg/m 2 , 22.6%) or a larger WC (18.5%) were more likely to be frail. People with normal BMI and overweight people do not suffer from higher prevalence for frailty. In comparison with individuals with normal BMI (18.5-BMI and large WC (odds ratio 1.68; 95% CI 1.33-2.12), have overweight and large WC (odds ratio 1.58; 95% CI 1.23-1.96), or have obesity and large WC (odds ratio 2.28; 95% CI 1.79-2.89). In people with normal WC, only those who are underweight have a higher risk for frailty (odds ratio 1.65, 95% CI 1.08-2.52). In comparison with BMI, the relation of WC with the risk for frailty was much closer. Abdominal obesity is more closely associated with incidence of frailty than general obesity in the elderly. Older adults with large waist circumference are more likely to be frail. Frailty in the elderly might be more closely related to metabolic disorders. WC might be a better measurement to detect frailty than BMI, given its relationship with metabolic disorders.

  18. Aged-associated cytomegalovirus and Epstein-Barr virus reactivation and cytomegalovirus relationship with the frailty syndrome in older women.

    Directory of Open Access Journals (Sweden)

    Ronaldo Luis Thomasini

    Full Text Available Immunosenescence is an age-related reduction of immune system activity that can be associated with frailty. This study aimed to compare cytomegalovirus (CMV and Epstein-Barr virus (EBV reactivations (based on viremias between young and elderly women who had a chronic CMV and/or EBV infection (i.e., an IgG+ serostatus without an acute infection (i.e., an IgM- serostatus, and among the elderly group categorized according to frailty status. DNA was extracted from plasma using standard protocols and serostatus was determined by enzyme-linked immunosorbent assay. Quantitative real-time polymerase chain reaction analyses for CMV and EBV were carried out and viral loads were determined. Among elderly women (n = 71, 59% were positive for CMV, in contrast to only 8% of young women (n = 73. Elderly women classified as frail, pre-frail, and non-frail presented 82%, 56%, and 48% positivity for CMV, respectively. Frequency and viral load were significantly higher in the elderly group vs. the young group (p < 0.0001 and p = 0.01, respectively and in elderly with frailty vs. those without frailty (p = 0.007 and p = 0.03, respectively. The frequency of CMV reactivation presented odds ratios of 11.77 for aging and 6.13 for frailty, and relative risks of 5.39 for aging and 1.93 for frailty. EBV was detected in 30% of the elderly women and 15% of the young women (p = 0.04; however, the viral load did not significantly differ between the two age groups. The frequency of EBV reactivation presented odds ratios of 2.36 for aging and 2.90 for frailty, and relative risks of 1.96 for aging and 2.12 for frailty. However, no difference in EBV viral load among the frailty status subgroups was found. In conclusion, the frequency of CMV reactivation was associated with aging and ongoing frailty, whereas the frequency of EBV reactivation was associated only with aging.

  19. A Frailty Instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE

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    Romero-Ortuno Roman

    2010-08-01

    Full Text Available Abstract Background A frailty paradigm would be useful in primary care to identify older people at risk, but appropriate metrics at that level are lacking. We created and validated a simple instrument for frailty screening in Europeans aged ≥50. Our study is based on the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE, http://www.share-project.org, a large population-based survey conducted in 2004-2005 in twelve European countries. Methods Subjects: SHARE Wave 1 respondents (17,304 females and 13,811 males. Measures: five SHARE variables approximating Fried's frailty definition. Analyses (for each gender: 1 estimation of a discreet factor (DFactor model based on the frailty variables using LatentGOLD®. A single DFactor with three ordered levels or latent classes (i.e. non-frail, pre-frail and frail was modelled; 2 the latent classes were characterised against a biopsychosocial range of Wave 1 variables; 3 the prospective mortality risk (unadjusted and age-adjusted for each frailty class was established on those subjects with known mortality status at Wave 2 (2007-2008 (11,384 females and 9,163 males; 4 two web-based calculators were created for easy retrieval of a subject's frailty class given any five measurements. Results Females: the DFactor model included 15,578 cases (standard R2 = 0.61. All five frailty indicators discriminated well (p N = 10,420; 66.9%, pre-frail (N = 4,025; 25.8%, and frail (N = 1,133; 7.3%. Relative to the non-frail class, the age-adjusted Odds Ratio (with 95% Confidence Interval for mortality at Wave 2 was 2.1 (1.4 - 3.0 in the pre-frail and 4.8 (3.1 - 7.4 in the frail. Males: 12,783 cases (standard R2 = 0.61, all frailty indicators had p N = 10,517; 82.3%, pre-frail (N = 1,871; 14.6%, and frail (N = 395; 3.1%; age-adjusted OR (95% CI for mortality: 3.0 (2.3 - 4.0 in the pre-frail, 6.9 (4.7 - 10.2 in the frail. Conclusions The SHARE Frailty Instrument has sufficient construct and

  20. The influence of frailty syndrome on acceptance of illness in elderly patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Uchmanowicz I

    2016-09-01

    Full Text Available Izabella Uchmanowicz,1 Beata Jankowska-Polanska,1 Mariusz Chabowski,2 Bartosz Uchmanowicz,1 Andrzej M Fal3 1Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 2Division of Nursing in Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 3Department of Healthcare Organisation and Economics, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland Abstract: COPD is one of the most debilitating diseases. Frailty syndrome and advanced age may decrease the acceptance of illness, quality of life, and worsen health conditions in these patients, as well as lead to an increase in health care expenses. The aim of the study was to assess how the level of frailty affects the acceptance of illness in elderly patients with COPD. We also aimed to evaluate the associations between sociodemographic and clinical factors and the level of acceptance of illness, anxiety, and frailty in this group of patients. The study included 102 COPD patients with a mean age of 63.2 (standard deviation =6.5 years and grades I (3%, II (37%, III (52%, and IV (8% by Global Initiative for Chronic Obstructive Lung Disease. The Polish versions of the Acceptance of Illness Scale and Tilburg frailty indicator were used. Frailty syndrome was found in 77 (75.5% patients, with an average score of 7.42 (standard deviation =2.24. Coexisting diseases such as hypertension (46.07%, coronary artery disease (32.35%, heart failure (28.43%, diabetes (18.63%, and heart arrhythmia (9.8% were found among the subjects. The overall level of acceptance of illness was 20.6 (standard deviation =7.62. A lower level of acceptance of illness was associated with a higher level of frailty, especially in the physical and social domain. Elderly patients with severe COPD are more prone to frailty and decreased acceptance of their disease in comparison to patients with other chronic diseases

  1. [Successful aging and indicators of frailty in the elderly. Octabaix Study].

    Science.gov (United States)

    Ferrer, Assumpta; Formiga, Francesc; Sanz, Héctor; Monserrate, Elena; Verges, Dolors

    2014-11-01

    Successful aging as a process of adaptation to the optimal state is little known in older people. To describe successful aging and to analyze the factors associated with frailty in people aged 86 years. A cross-sectional study of a clinical trial at the second year of follow-up (Octabaix Study). Seven Primary Care Centers. Non-institutionalized subjects born in 1924. Data on sociodemographic, comorbidity and geriatric assessment scales were collected. Frailty was defined by the presence of 3 or more of the following criteria: muscle weakness, slow walking, weight loss, exhaustion, low physical activity. Successful aging was defined as: Barthel index >90/100 and Lobo test ≥ 24/35. Multiple regression analysis was performed. A total of 273 patients were evaluated, 39.2% men. The prevalence of successful aging was 47.2% (129). In the unsuccessful aging, the frailty prevalence was 34.7% (50). The frailty factors associated with unsuccessful aging were low activity (OR: 7.56; 95%CI: 3.8 -14.9), weakness (OR: 6.08; 95%CI: 2.5-14.7), slowness (OR: 5.1; 95%CI: 2.8-9.5), and exhaustion (OR: 3.6; 95%CI: 1.6-8.3). The prevalence of successful aging is high in 86-year-old community-dwelling subjects. The low physical activity multiplied by seven, and muscle weakness by 6, were the factors most associated with unsuccessful aging. Therefore, incorporating screening designed to detect these two factors could improve future interventions towards more optimal aging in the community, if these results are confirmed in future studies. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  2. Prevalence of frailty-related risk factors in older adults seen by community nurses.

    Science.gov (United States)

    Ballard, Julianne; Mooney, Mary; Dempsey, Orla

    2013-03-01

    To describe the frequency of four frailty-related risk factors in a cohort of older adults visited by community nurses in Dublin, Ireland. The Irish public health nursing service allows for both professional and self referral. Risk factors examined were suspected cognitive impairment, nutritional and fall risk, and activities of daily living dependence. Retrospective cross-sectional clinical audit. The study incorporated a retrospective clinical audit of files (N = 120) obtained from community nursing visits over 9 months in 2009-2010. A chi-square analysis tested for association between each risk factor and oldest age, living alone, professional referral to the nursing service, and presence of formal home support. Findings revealed a cohort prevalence of suspected cognitive impairment at 16·4%. Risk of malnutrition and risk of a fall were 20·2% and 30·8%, respectively. The cohort was dependent in activities of daily living at a rate of 23·5%. Participants dependent in activities of daily living were less likely to live alone and were more likely to have referred themselves to community nursing. Associations between the four frailty-related risk factors and receiving formal home support were not significant. This study results suggest that dependency in activities of daily living (an outcome of frailty) is strongly associated with a decreased likelihood of living alone and increased likelihood of referring oneself to community nursing services. Further research is necessary to examine how frailty screening in the referral process may enhance identification of older adults' community nursing needs in Dublin, Ireland. © 2012 Blackwell Publishing Ltd.

  3. Symptoms of Apathy Independently Predict Incident Frailty and Disability in Community-Dwelling Older Adults.

    Science.gov (United States)

    Ayers, Emmeline; Shapiro, Miriam; Holtzer, Roee; Barzilai, Nir; Milman, Sofiya; Verghese, Joe

    2017-05-01

    Although depressive symptoms are widely recognized as a predictor of functional decline among older adults, little is known about the predictive utility of apathy in this population. We prospectively examined apathy symptoms as predictors of incident slow gait, frailty, and disability among non-demented, community-dwelling older adults. We examined 2 independent prospective cohort studies-the LonGenity study (N = 625, 53% women, mean age = 75.2 years) and the Central Control of Mobility in Aging (CCMA) study (N = 312, 57% women, mean age = 76.4 years). Individuals were recruited from 2008 to 2014. Apathy was assessed using 3 items from the Geriatric Depression Scale. Slow gait was defined as 1 standard deviation or more below age- and sex-adjusted mean values, frailty was defined using the Cardiovascular Health Study criteria, and disability was assessed with a well-validated disability scale. The prevalence of apathy was 20% in the LonGenity cohort and 26% in the CCMA cohort. The presence of apathy at baseline, independent of depressive symptoms (besides apathy), increased the risk of developing incident slow gait (hazard ratio [HR] = 2.10; 95% CI, 1.36-3.24; P = .001), frailty (HR = 2.86; 95% CI, 1.96-4.16; P Apathy is associated with increased risk of developing slow gait, frailty, and disability, independent of other established risk factors, in non-demented older adults. Apathy should be screened for as a potentially preventable cause of functional decline in clinical psychiatric settings. © Copyright 2017 Physicians Postgraduate Press, Inc.

  4. Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study

    OpenAIRE

    McAdams-DeMarco, Mara A; Suresh, Sunitha; Law, Andrew; Salter, Megan L; Gimenez, Luis F; Jaar, Bernard G; Walston, Jeremy D; Segev, Dorry L

    2013-01-01

    Background Patients undergoing hemodialysis are at high risk of falls, with subsequent complications including fractures, loss of independence, hospitalization, and institutionalization. Factors associated with falls are poorly understood in this population. We hypothesized that insights derived from studies of the elderly might apply to adults of all ages undergoing hemodialysis; we focused on frailty, a phenotype of physiological decline strongly associated with falls in the elderly. Method...

  5. Reliability and validity of the Tilburg Frailty Indicator (TFI) among Chinese community-dwelling older people.

    Science.gov (United States)

    Dong, Lijuan; Liu, Na; Tian, Xiaoyu; Qiao, Xiaoxia; Gobbens, Robbert J J; Kane, Robert L; Wang, Cuili

    2017-11-01

    To translate the Tilburg Frailty Indicator (TFI) into Chinese and assess its reliability and validity. A sample of 917 community-dwelling older people, aged ≥60 years, in a Chinese city was included between August 2015 and March 2016. Construct validity was assessed using alternative measures corresponding to the TFI items, including self-rated health status (SRH), unintentional weight loss, walking speed, timed-up-and-go tests (TUGT), making telephone calls, grip strength, exhaustion, Short Portable Mental Status Questionnaire (SPMSQ), Geriatric Depression scale (GDS-15), emotional role, Adaptability Partnership Growth Affection and Resolve scale (APGAR) and Social Support Rating Scale (SSRS). Fried's phenotype and frailty index were measured to evaluate criterion validity. Adverse health outcomes (ADL and IADL disability, healthcare utilization, GDS-15, SSRS) were used to assess predictive (concurrent) validity. The internal consistency reliability was good (Cronbach's α=0.71). The test-retest reliability was strong (r=0.88). Kappa coefficients showed agreements between the TFI items and corresponding alternative measures. Alternative measures correlated as expected with the three domains of TFI, with an exclusion that alternative psychological measures had similar correlations with psychological and physical domains of the TFI. The Chinese TFI had excellent criterion validity with the AUCs regarding physical phenotype and frailty index of 0.87 and 0.86, respectively. The predictive (concurrent) validities of the adverse health outcomes and healthcare utilization were acceptable (AUCs: 0.65-0.83). The Chinese TFI has good validity and reliability as an integral instrument to measure frailty of older people living in the community in China. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Do no harm: Risk aversion versus risk management in the context of pedagogic frailty

    Directory of Open Access Journals (Sweden)

    Julie A. Hulme

    2017-09-01

    Full Text Available Innovation in teaching ensures that education remains fit for purpose in a changing world. The model of pedagogic frailty proposes that educators may perceive innovation as risky, which may inhibit innovation, and thus reduce opportunities to update learning experiences. Within psychology, psychological literacy (the skills, knowledge and attributes acquired as outcomes of studying psychology is becoming increasingly central to the curriculum. Educators are teaching more applied psychology, which requires new pedagogic approaches and are adopting and modelling core professional values espoused as components of psychological literacy, including evidence-based practice, ethics, and professional competence. We argue that psychology educators (and those from other disciplines may assess the risk of innovation through the lenses of these professional values. The decision to maintain ‘safe’ practices may reflect a risk management approach, rather than frailty. We propose a model whereby frailty may depend on social context and risk in different educational circumstances. The professional values associated with psychological literacy and similar integrative disciplinary constructs, which at first seem to hinder innovation, may promote innovation which is creative and safe, and will facilitate the development of a rigorous evidence base to inform future practice.

  7. Association of the modified frailty index with adverse outcomes after penile prosthesis implantation.

    Science.gov (United States)

    Madbouly, Khaled; AlHajeri, Dulaim; Habous, Mohamad; Binsaleh, Saleh

    2017-06-01

    To investigate frailty as a predictor of surgical outcome in elderly patients undergoing penile prosthesis implantation. A total of 54 elderly patients, above 60 years of age, underwent penile prosthesis implantation between 2012 and 2014. Their data were collected and retrospectively analyzed. A modified frailty index (mFI) was calculated for each patient based on 11 risk factors from the Canadian Study of Health and Aging Frailty Index. The 1-year adverse outcomes were correlated with mFI, patients' and procedure's risk factors. Mean age was 64.9 ± 5.2 years. No mortality was reported in our patients, however, one-year adverse outcomes were encountered in 43 (79.6%) patients. Among all studied variables, the 1-year adverse outcomes was not significantly association with mFI, but with preoperative glycosylated hemoglobin A1c (HbA1c) (p = 0.031) and associated Peyronie's disease (PD) (p = 0.000). HbA1c, dyslipidemia, hypertension, PD and duration of the procedure were predictive of infection complications (p prosthesis implantation adverse outcomes in elderly patients with impotence. Degree of diabetic control and association with PD was associated with the 1-year adverse outcomes and infection complications.

  8. Frailty, disability and physical exercise in the aging process and in chronic kidney disease.

    Science.gov (United States)

    Greco, Antonio; Paroni, Giulia; Seripa, Davide; Addante, Filomena; Dagostino, Mariangela P; Aucella, Filippo

    2014-01-01

    Frailty in the elderly is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. It is usually associated to adverse health outcomes and to one-year mortality risk. Physical exercise has found to be effective in preventing frailty and disability in this population. Chronic kidney disease (CKD) is also a clinical condition where protein energy-wasting, sarcopenia and dynapenia ,very common symptoms in the frail elderly, may occur. Moreover elderly and CKD patients are both affected by an impaired physical performance that may be reversed by physical exercise with an improvement of the survival rate. These similarities suggest that frailty may be a common pathway of aging and CKD that may induce disability and that can be prevented by a multidimensional approach in which physical exercise plays an important role. © 2014 S. Karger AG, Basel.

  9. Using concept mapping for faculty development in the context of pedagogic frailty

    Directory of Open Access Journals (Sweden)

    Bárbara de Benito

    2017-09-01

    Full Text Available The quality of teaching does not depend exclusively on the knowledge and experience of teachers, but also on the contextual variables that go along with the teaching (attitude, objectives, students, resources, etc. or dimensions of pedagogic frailty (regulative and instructional discourse, pedagogy and discipline, research teaching nexus and locus of control. Identifying these variables may help to enhance teaching. A procedure for the capture, representation and transfer of knowledge between peers regarding active didactic methodologies supported by Information and Communication Technologies (ICT was applied in a case study research. The data were represented by concept maps. The aim was to identify variables that affect Technological Pedagogical Content Knowledge (TPACK, the use of technology in teaching and pedagogic frailty, through the analysis of the interrelations among the concept maps.The analysis of the maps shows the implementation of many innovations with ICT (project-based learning, service-learning, collaborative learning, their positive aspects and the difficulties in carrying them out. The teachers involved pointed out some factors that contribute to the development of pedagogic frailty, including the number of students in each class, the organization of teaching, the motivation, among others, and as conditions for a greater progress in innovative educational experiments using ICT.

  10. Frailty, Disability and Physical Exercise in the Aging Process and in Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Antonio Greco

    2014-07-01

    Full Text Available Frailty in the elderly is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. It is usually associated to adverse health outcomes and to one-year mortality risk. Physical exercise has found to be effective in preventing frailty and disability in this population. Chronic kidney disease (CKD is also a clinical condition where protein energy-wasting, sarcopenia and dynapenia ,very common symptoms in the frail elderly, may occur. Moreover elderly and CKD patients are both affected by an impaired physical performance that may be reversed by physical exercise with an improvement of the survival rate. These similarities suggest that frailty may be a common pathway of aging and CKD that may induce disability and that can be prevented by a multidimensional approach in which physical exercise plays an important role.

  11. Identification of serum sirtuins as novel noninvasive protein markers for frailty.

    Science.gov (United States)

    Kumar, Rahul; Mohan, Navinath; Upadhyay, Ashish Datt; Singh, Amrendra Pratap; Sahu, Vishal; Dwivedi, Sadanand; Dey, Aparajit B; Dey, Sharmistha

    2014-12-01

    Frailty has emerged as a major health issue among older patients. A consensus on definition and diagnosis is yet to be achieved. Various biochemical abnormalities have been reported in frailty. Activation of sirtuins, a conserved family of NAD-dependent proteins, is one of the many mimics of calorie restriction which improves lifespan and health in experimental animals. In this cross-sectional study, we assessed the circulating sirtuin levels in 119 (59.5%) nonfrail and 81 (40.5%) frail individuals, diagnosed by Fried's criteria. Serum SIRT1, SIRT2, and SIRT3 were estimated by surface plasmon resonance (SPR) and Western blot. Serum sirtuins level in mean+SD; SIRT1 (nonfrail -4.67 ± 0.48 ng/μL; frail - 3.72 ± 0.48 ng/μL; P diabetes mellitus, hypertension, cognitive status (Mini Mental State Examination scores) and number of comorbidities. For detecting the optimum diagnostic cutoff value a ROC analysis was carried out. The area under curve for SIRT1 was 0.9037 (cutoff - 4.29 ng/μL; sensitivity - 81.48%; specificity - 79.83%) and SIRT3 was 0.7988 (cutoff - 6.61 ng/μL; sensitivity - 70.37%; specificity - 70.59%). This study shows that lower circulating SIRT1 and SIRT3 levels can be distinctive marker of frailty. © 2014 The Authors. Aging Cell published by the Anatomical Society and John Wiley & Sons Ltd.

  12. The additive nonparametric and semiparametric Aalen model as the rate function for a counting process

    DEFF Research Database (Denmark)

    Scheike, Thomas Harder

    2002-01-01

    for the rate function, i.e., the instantaneous probability of an event conditional on only a selected set of covariates. When the rate function for the counting process is of Aalen form we show that the usual Aalen estimator can be used and gives almost unbiased estimates. The usual martingale based variance...

  13. Screening for Frailty in Hospitalized Older Adults: Reliability and Feasibility of the Maastricht Frailty Screening Tool for Hospitalized Patients (MFST-HP).

    Science.gov (United States)

    Warnier, Ron M J; van Rossum, Erik; van Leendert, Jannic A A; Pijls, Noor A T; Mulder, Wubbo J; Schols, Jos M G A; Kempen, Gertrudis I J M

    2016-09-01

    As nurses in hospitals are confronted with increasing numbers of older patients, their geriatric nursing skills and knowledge must be integrated into daily clinical practice. Early risk identification via screening tools may help improve geriatric care. To reduce the assessment burden of nurses, the Maastricht Frailty Screening Tool for Hospitalized Patients (MFST-HP) was developed. The aim of the current study was to explore aspects of reliability, validity, and feasibility of the MFST-HP. Intrarater reliability was assessed by measuring patients two times within 24 hours. Interrater reliability was assessed by having patients screened by two different nurses. Construct validity was studied by the associations between the MFST-HP scores and age and comorbidities. Intraclass correlation coefficients for both intra- and interrater reliability were good (>0.93). Older patients and those with more comorbidity showed higher scores on the MFST-HP compared to younger patients and those with less comorbidity. The MFST-HP shows promise as a reliable, valid, and feasible screening tool for frailty among hospitalized older adults. [Res Gerontol Nurs. 2016; 9(5):243-251.]. Copyright 2016, SLACK Incorporated.

  14. The 6-minute walk is associated with frailty and predicts mortality in older adults with heart failure

    Science.gov (United States)

    Boxer, RS; Kleppinger, A; Ahmad, A; Annis, K; Hager, WD; Kenny, AM

    2011-01-01

    Introduction HF may contribute to the development of functional decline and frailty in older adults. Methods Sixty HF patients with EF ≤ 40% evaluated in 2004–5 were reevaluated in 2008. Six-minute walk distance (6MW), frailty score, and biomarkers (25-hydroxyvitamin D, C-reactive protein and interleukin-6[IL6]) were measured. Participants were categorized at baseline and follow-up into 3 groups: non-frail/normal endurance (NF/NE), non-frail/low endurance (NF/LE) and frail/low endurance (F/LE). Survival time was assessed according to frailty/endurance status and associated predictors of mortality. Results Forty-three men, 17 women (mean age 78±12) were contacted. At follow up 20 died, 20 participated and 20 did not participate. There were no changes in frailty/endurance status over time (McNemar; p=0.19). Deaths occurred in 18% of NF/NE, 45% of NF/LE and 60% of F/LE. NF/NE had greater survival rates than NF/LE (p=.032) and F/LE (p=.014). The 6MW and frailty score were independently predictive of mortality with hazard ratio.82(.72–.94) and 1.64(1.19–2.26) respectively, as was NYHA and IL6. Backward stepwise Cox- regression revealed that 6MW and frailty each were associated with mortality (p=0.005) and highly correlated. Conclusions Physical function is an important predictor of mortality in older adults with HF. The 6MW may be useful as a measure of frailty. PMID:20887617

  15. Obesity and physical frailty in older adults: a scoping review of lifestyle intervention trials.

    Science.gov (United States)

    Porter Starr, Kathryn N; McDonald, Shelley R; Bales, Connie W

    2014-04-01

    Many frail older adults are thin, weak, and undernourished; this component of frailty remains a critical concern in the geriatric field. However, there is also strong evidence that excessive adiposity contributes to frailty by reducing the ability of older adults to perform physical activities and increasing metabolic instability. Our scoping review explores the impact of being obese on physical frailty in older adults by summarizing the state of the science for both clinical markers of physical function and biomarkers for potential underlying causes of obesity-related decline. We used the 5-stage methodological framework of Arksey and O'Malley to conduct a scoping review of randomized trials of weight loss and/or exercise interventions for obesity (body mass index ≥ 30 kg/m(2)) in older adults (aged >60 years), examining the outcomes of inflammation, oxidative stress, and lipid accumulation in muscle, as well as direct measures of physical function. Our initial search yielded 212 articles; exclusion of cross-sectional and observational studies, cell culture and animal studies, disease-specific interventions, and articles published before 2001 led to a final result of 21 articles. Findings of these trials included the following major points. The literature consistently confirmed benefits of lifestyle interventions to physical function assessed at the clinical level. Generally speaking, weight loss alone produced a greater effect than exercise alone, and the best outcomes were achieved with a combination of weight loss and exercise, especially exercise programs that combined aerobic, resistance, and flexibility training. Weight loss interventions tended to reduce markers of inflammation and/or oxidative damage when more robust weight reduction was achieved and maintained over time, whereas exercise did not change markers of inflammation. However, participation in a chronic exercise program did reduce the oxidative stress induced by an acute bout of exercise

  16. Can Sarcopenia Quantified by Ultrasound of the Rectus Femoris Muscle Predict Adverse Outcome of Surgical Intensive Care Unit Patients and Frailty? A Prospective, Observational Cohort Study

    Science.gov (United States)

    Mueller, Noomi; Murthy, Sushila; Tainter, Christopher R.; Lee, Jarone; Richard, Kathleen; Fintelmann, Florian J.; Grabitz, Stephanie D.; Timm, Fanny Pauline; Levi, Benjamin; Kurth, Tobias; Eikermann, Matthias

    2016-01-01

    Objective To compare sarcopenia and frailty for outcome prediction in surgical intensive care unit (SICU) patients. Background Frailty has been associated with adverse outcomes and describes a status of muscle weakness and decreased physiological reserve leading to increased vulnerability to stressors. However, frailty assessment depends on patient cooperation. Sarcopenia can be quantified by ultrasound and the predictive value of sarcopenia at SICU admission for adverse outcome has not been defined. Methods We conducted a prospective, observational study of SICU patients. Sarcopenia was diagnosed by ultrasound measurement of rectus femoris cross-sectional area. Frailty was diagnosed by the Frailty Index Questionnaire based on 50 variables. Relationship between variables and outcomes was assessed by multivariable regression analysis NCT02270502. Results Sarcopenia and frailty were quantified in 102 patients and observed in 43.1% and 38.2%, respectively. Sarcopenia predicted adverse discharge disposition (discharge to nursing facility or in-hospital mortality, odds ratio 7.49; 95% confidence interval 1.47–38.24; P = 0.015) independent of important clinical covariates, as did frailty (odds ratio 8.01; 95% confidence interval 1.82–35.27; P = 0.006); predictive ability did not differ between sarcopenia and frailty prediction model, reflected by a likelihood ratio of χ2 = 21.74 versus 23.44, respectively, and a net reclassification improvement (NRI) of −0.02 (P = 0.87). Sarcopenia and frailty predicted hospital length of stay and the frailty model had a moderately better predictive accuracy for this outcome. Conclusions Bedside diagnosis of sarcopenia by ultrasound predicts adverse discharge disposition in SICU patients equally well as frailty. Sarcopenia assessed by ultrasound may be utilized as rapid beside modality for risk stratification of critically ill patients. PMID:26655919

  17. Physical frailty in late-life depression is associated with deficits in speed-dependent executive functions

    Science.gov (United States)

    Potter, Guy G.; McQuoid, Douglas R.; Whitson, Heather E.; Steffens, David C.

    2015-01-01

    Objective To examine the association between physical frailty and neurocognitive performance in late-life depression (LLD). Methods Cross-sectional design using baseline data from a treatment study of late-life depression. Individuals aged 60 and older diagnosed with Major Depressive Disorder at time of assessment (N = 173). All participants received clinical assessment of depression and completed neuropsychological testing during a depressive episode. Physical frailty was assessed using an adaptation of the FRAIL scale. Neuropsychological domains were derived from a factor analysis that yielded three factors: 1) Speeded Executive and Fluency, Episodic Memory, and Working Memory. Associations were examined with bivariate tests and multivariate models. Results Depressed individuals with a FRAIL score >1 had worse performance than nonfrail depressed across all three factors; however, Speeded Executive and Fluency was the only factor that remained significant after controlling for depression symptom severity and demographic characteristics. Conclusions Although physical frailty is associated with broad neurocognitive deficits in LLD, it is most robustly associated with deficits in speeded executive functions and verbal fluency. Causal inferences are limited by the cross-sectional design, and future research would benefit from a comparison group of nondepressed older adults with similar levels of frailty. Research is needed to understand the mechanisms underlying associations among depression symptoms, physical frailty, and executive dysfunction, and how they are related to the cognitive and symptomatic course of LLD. PMID:26313370

  18. Adverse effects of frailty on social functioning in older adults: Results from the Longitudinal Aging Study Amsterdam.

    Science.gov (United States)

    Hoogendijk, Emiel O; Suanet, Bianca; Dent, Elsa; Deeg, Dorly J H; Aartsen, Marja J

    2016-01-01

    The aim of this study was to examine the association between physical frailty and social functioning among older adults, cross-sectionally and prospectively over 3 years. The study sample consisted of 1115 older adults aged 65 and over from two waves of the Longitudinal Aging Study Amsterdam, a population based study. Frailty was measured at T1 (2005/2006) using the criteria of the frailty phenotype, which includes weight loss, weak grip strength, exhaustion, slow gait speed and low physical activity. Social functioning was assessed at T1 and T2 (2008/2009) and included social network size, instrumental support, emotional support, and loneliness. Cross-sectional linear regression analyses adjusted for covariates (age, sex, educational level and number of chronic diseases) showed that pre-frail and frail older adults had a smaller network size and higher levels of loneliness compared to their non-frail peers. Longitudinal linear regression analyses adjusted for covariates and baseline social functioning showed that frailty was associated with an increase in loneliness over 3 years. However, the network size and levels of social support of frail older adults did not further decline over time. Frailty is associated with poor social functioning, and with an increase in loneliness over time. The social vulnerability of physical frail older adults should be taken into account in the care provision for frail older adults. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. A SIEVE M-THEOREM FOR BUNDLED PARAMETERS IN SEMIPARAMETRIC MODELS, WITH APPLICATION TO THE EFFICIENT ESTIMATION IN A LINEAR MODEL FOR CENSORED DATA*

    Science.gov (United States)

    Ding, Ying; Nan, Bin

    2013-01-01

    In many semiparametric models that are parameterized by two types of parameters – a Euclidean parameter of interest and an infinite-dimensional nuisance parameter, the two parameters are bundled together, i.e., the nuisance parameter is an unknown function that contains the parameter of interest as part of its argument. For example, in a linear regression model for censored survival data, the unspecified error distribution function involves the regression coefficients. Motivated by developing an efficient estimating method for the regression parameters, we propose a general sieve M-theorem for bundled parameters and apply the theorem to deriving the asymptotic theory for the sieve maximum likelihood estimation in the linear regression model for censored survival data. The numerical implementation of the proposed estimating method can be achieved through the conventional gradient-based search algorithms such as the Newton-Raphson algorithm. We show that the proposed estimator is consistent and asymptotically normal and achieves the semiparametric efficiency bound. Simulation studies demonstrate that the proposed method performs well in practical settings and yields more efficient estimates than existing estimating equation based methods. Illustration with a real data example is also provided. PMID:24436500

  20. Risk factors and protective factors associated with incident or increase of frailty among community-dwelling older adults: A systematic review of longitudinal studies

    NARCIS (Netherlands)

    Feng, Z. (Zeyun); M. Lugtenberg; Franse, C. (Carmen); Fang, X. (Xinye); Hu, S. (Shanlian); Jin, C. (Chunlin); H. Raat (Hein)

    2017-01-01

    textabstractIntroduction: Frailty is one of the greatest challenges facing our aging population, as it can lead to adverse outcomes such as institutionalization, hospitalization, and mortality. However, the factors that are associated with frailty are poorly understood. We performed a systematic

  1. Screening for markers of frailty and perceived risk of adverse outcomes using the Risk Instrument for Screening in the Community (RISC).

    LENUS (Irish Health Repository)

    O Caoimh, Rónán

    2014-09-19

    Functional decline and frailty are common in community dwelling older adults, increasing the risk of adverse outcomes. Given this, we investigated the prevalence of frailty-associated risk factors and their distribution according to the severity of perceived risk in a cohort of community dwelling older adults, using the Risk Instrument for Screening in the Community (RISC).

  2. Percentile-Based ETCCDI Temperature Extremes Indices for CMIP5 Model Output: New Results through Semiparametric Quantile Regression Approach

    Science.gov (United States)

    Li, L.; Yang, C.

    2017-12-01

    Climate extremes often manifest as rare events in terms of surface air temperature and precipitation with an annual reoccurrence period. In order to represent the manifold characteristics of climate extremes for monitoring and analysis, the Expert Team on Climate Change Detection and Indices (ETCCDI) had worked out a set of 27 core indices based on daily temperature and precipitation data, describing extreme weather and climate events on an annual basis. The CLIMDEX project (http://www.climdex.org) had produced public domain datasets of such indices for data from a variety of sources, including output from global climate models (GCM) participating in the Coupled Model Intercomparison Project Phase 5 (CMIP5). Among the 27 ETCCDI indices, there are six percentile-based temperature extremes indices that may fall into two groups: exceedance rates (ER) (TN10p, TN90p, TX10p and TX90p) and durations (CSDI and WSDI). Percentiles must be estimated prior to the calculation of the indices, and could more or less be biased by the adopted algorithm. Such biases will in turn be propagated to the final results of indices. The CLIMDEX used an empirical quantile estimator combined with a bootstrap resampling procedure to reduce the inhomogeneity in the annual series of the ER indices. However, there are still some problems remained in the CLIMDEX datasets, namely the overestimated climate variability due to unaccounted autocorrelation in the daily temperature data, seasonally varying biases and inconsistency between algorithms applied to the ER indices and to the duration indices. We now present new results of the six indices through a semiparametric quantile regression approach for the CMIP5 model output. By using the base-period data as a whole and taking seasonality and autocorrelation into account, this approach successfully addressed the aforementioned issues and came out with consistent results. The new datasets cover the historical and three projected (RCP2.6, RCP4.5 and RCP

  3. The relationship between nutrition and frailty: Effects of protein intake, nutritional supplementation, vitamin D and exercise on muscle metabolism in the elderly. A systematic review.

    Science.gov (United States)

    Artaza-Artabe, Iñaki; Sáez-López, Pilar; Sánchez-Hernández, Natalia; Fernández-Gutierrez, Naiara; Malafarina, Vincenzo

    2016-11-01

    Frailty is a geriatric syndrome that predicts the onset of disability, morbidity and mortality in elderly people; it is a state of pre-disability and is reversible. The aim of this review is to assess how nutrition influences both the risk of developing frailty and its treatment. We searched two databases, PubMed and Web of Science. We included epidemiologic studies and clinical trials carried out on people aged over 65 years. We included 32 studies with a total of over 50,000 participants. The prevalence of frailty is ranges from 15% among elderly people living in the community to 54% among those hospitalized. Furthermore, the prevalence of frailty is disproportionately high among elderly people who are malnourished. Malnutrition, which is very prevalent in geriatric populations, is one of the main risk factors for the onset of frailty. A good nutritional status and, wherever necessary, supplementation with macronutrients and micronutrients reduce the risk of developing frailty. Physical exercise has been shown to improve functional status, helps to prevent frailty and is an effective treatment to reverse it. Despite the relatively large number of studies included, this review has some limitations. Firstly, variability in the design of the studies and their different aims reduce their comparability. Secondly, several of the studies did not adequately define frailty. Poor nutritional status is associated with the onset of frailty. Screening and early diagnosis of malnutrition and frailty in elderly people will help to prevent the onset of disability. Effective treatment is based on correction of the macro- and micronutrient deficit and physical exercise. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. [The validity of the "Kihon Check-list" as an index of frailty and its biomarkers and inflammatory markers in elderly people].

    Science.gov (United States)

    Ogawa, Kishiko; Fujiwara, Yoshinori; Yoshida, Hiroto; Nishi, Mariko; Fukaya, Taro; Kim, Miji; Amano, Hidenori; Lee, Sanyoon; Watanabe, Naoki; Shinkai, Shoji

    2011-01-01

    The present study was designed to assess the validity of the "Kihon ("basic") Check-list (KCL)" as a frailty index, and to investigate its biomarkers in an elderly population. We enrolled 420 elderly persons aged 65 years and over in comprehensive geriatric assessments in 2007 and 2008. We examined the temporal relationship between the Fried frailty criteria (external criteria) and KCL items 1-20 to evaluate concurrent validity. In 2008, 665 elderly people aged 65 years and over who participated in the comprehensive geriatric assessment in 2008 were assessed based on their frailty and non-frailty using the KCL. We compared biomarkers, including TNF-α, IL-6, CRP and β(2)-microglobulin (β(2)-MG) between frail and non-frail groups. The KCL items 1-20 showed good concurrent validity against the Fried criteria in terms of frailty. When using a cut-off point of 5/6, the KCL items 1-20 showed a sensitivity of 60.0% and a specificity of 86.4% for the Fried frailty criteria. Overall, 34 males (12.3%) and 74 females (19.0%) were defined as frail. Among varying biomarkers, IL-6 (odds ratio [OR] of highest tertile vs. lowest tertile, 2.05; 95% confidence interval [CI]: 1.15-3.64), grip strength (OR: 0.19; 95% CI: 0.07-0.46) and walking speed (OR: 0.23; 95% CI: 0.12-0.45) were significantly associated with risks of frailty. The highest tertile of IL-6 and β(2)-MG combined highly increased the risk of frailty (OR: 5.61; 95% CI: 2.34-13.11) compared with those in the lowest tertile of the 2 markers combined. The KCL items 1-20 can be used as a frailty index for Japanese elderly population. IL-6 and β(2)-MG are potential candidates for biomarkers of frailty.

  5. Specifying the content of home-based health behaviour change interventions for older people with frailty or at risk of frailty: an exploratory systematic review.

    Science.gov (United States)

    Gardner, Benjamin; Jovicic, Ana; Belk, Celia; Kharicha, Kalpa; Iliffe, Steve; Manthorpe, Jill; Goodman, Claire; Drennan, Vari M; Walters, Kate

    2017-02-09

    To identify trials of home-based health behaviour change interventions for frail older people, describe intervention content and explore its potential contribution to intervention effects. 15 bibliographic databases, and reference lists and citations of key papers, were searched for randomised controlled trials of home-based behavioural interventions reporting behavioural or health outcomes. Participants' homes. Community-dwelling adults aged ≥65 years with frailty or at risk of frailty. Trials were coded for effects on thematically clustered behavioural, health and well-being outcomes. Intervention content was described using 96 behaviour change techniques, and 9 functions (eg, education, environmental restructuring). 19 eligible trials reported 22 interventions. Physical functioning was most commonly assessed (19 interventions). Behavioural outcomes were assessed for only 4 interventions. Effectiveness on most outcomes was limited, with at most 50% of interventions showing potential positive effects on behaviour, and 42% on physical functioning. 3 techniques (instruction on how to perform behaviour, adding objects to environment, restructuring physical environment) and 2 functions (education and enablement) were more commonly found in interventions showing potential than those showing no potential to improve physical function. Intervention content was not linked to effectiveness on other outcomes. Interventions appeared to have greatest impact on physical function where they included behavioural instructions, environmental modification and practical social support. Yet, mechanisms of effects are unclear, because impact on behavioural outcomes has rarely been considered. Moreover, the robustness of our findings is also unclear, because interventions have been poorly reported. Greater engagement with behavioural science is needed when developing and evaluating home-based health interventions. ID=CRD42014010370. Published by the BMJ Publishing Group Limited. For

  6. [Effects of an intervention program for community-dwelling elderly to improve frailty and dietary habits].

    Science.gov (United States)

    Kawabata, Teruko; Takemi, Yukari; Murayama, Hiroshi; Nishi, Mariko; Shimizu, Yumiko; Narita, Miki; Kim, Mi-Ji; Shinkai, Shoji

    2015-01-01

    The effects of a comprehensive intervention program for community-dwelling elderly on frailty and dietary habits were examined. We conducted randomized control trials to examine the efficacy of the intervention. To examine lasting changes, we made paired comparisons between pre- and post- intervention and at a three-month follow-up. The subjects were recruited in Hatoyama town, Saitama prefecture. The program was composed of exercise, nutritional education, and social participation and was held from October to December 2011. The exercise program aimed at fall prevention and took place twice per week for 60 min. The nutritional education aimed at prevention of malnutrition, and the social participation program aimed at prevention of "homeboundness"; both were held once per week for 30 min. Questionnaires inquired about frailty and dietary variety. A blood test was conducted to ascertain nutritional state, and a brief self-administered diet history questionnaire was used to estimate food and nutrient intake. To examine the efficacy of the intervention, 22 control subjects (CR) and 21 subjects in the intervention group (IV) were analyzed with intention to treat. To examine lasting changes, 16 subjects in IV who correctly completed surveys at each of the three time points were analyzed, using repeated ANOVA and a multiple comparison procedure. 1. Men comprised 70-80% of subjects, and the average age was 75.7±5.4 and 74.7±5.4 years in IV and CR, respectively. 2. There was no significant difference in pre- and post-intervention changes between IV and CR in frailty, which was the main outcome of the study. 3. A significant difference in pre- and post-intervention values was noted in ① "homeboundness", one of the components of frailty (median [25-75%tile]): IV 0 [0-0] and CR 0 [0-1] (P=0.023); ② nutrient intake (mean±standard deviation [SD], energy ratio [%E]): protein, IV 2.3±0.7 and CR -0.3±2.0 (P=0.002); animal protein, IV 2.4±1.5 and CR -0.5±1.5 (P=0

  7. Relationship between employment histories and frailty trajectories in later life: evidence from the English Longitudinal Study of Ageing.

    Science.gov (United States)

    Lu, Wentian; Benson, Rebecca; Glaser, Karen; Platts, Loretta G; Corna, Laurie M; Worts, Diana; McDonough, Peggy; Di Gessa, Giorgio; Price, Debora; Sacker, Amanda

    2017-05-01

    Given the acceleration of population ageing and policy changes to extend working lives, evidence is needed on the ability of older adults to work for longer. To understand more about the health impacts of work, this study examined the relationship between employment histories before retirement and trajectories of frailty thereafter. The sample comprised 2765 women and 1621 men from the English Longitudinal Study of Ageing. We used gendered typologies of life-time employment and a frailty index (FI). Multilevel growth curve models were used to predict frailty trajectories by employment histories. Women who had a short break for family care, then did part-time work till 59 years had a lower FI after 60 years than those who undertook full-time work until 59 years. Women who were largely family carers or non-employed throughout adulthood, had higher levels of frailty at 60 years but experienced a slower decline with age. Men who worked full-time but early exited at either 49 or 60 years had a higher FI at 65 years than those who worked full-time up to 65 years. Interaction between employment histories and age indicated that men in full-time work who experienced an early exit at 49 tended to report slower declines. For women, experiencing distinct periods throughout the lifecourse of either work or family care may be advantageous for lessening frailty risk in later life. For men, leaving paid employment before 65 years seems to be beneficial for decelerating increases in frailty thereafter. Continuous full-time work until retirement age conferred no long-term health benefits. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Blood Pressure, Antihypertensive Polypharmacy, Frailty, and Risk for Serious Fall Injuries Among Older Treated Adults With Hypertension.

    Science.gov (United States)

    Bromfield, Samantha G; Ngameni, Cedric-Anthony; Colantonio, Lisandro D; Bowling, C Barrett; Shimbo, Daichi; Reynolds, Kristi; Safford, Monika M; Banach, Maciej; Toth, Peter P; Muntner, Paul

    2017-08-01

    Antihypertensive medication and low systolic blood pressure (BP) and diastolic BP have been associated with an increased falls risk in some studies. Many older adults have indicators of frailty, which may increase their risk for falls. We contrasted the association of systolic BP, diastolic BP, number of antihypertensive medication classes taken, and indicators of frailty with risk for serious fall injuries among 5236 REGARDS study (Reasons for Geographic and Racial Difference in Stroke) participants ≥65 years taking antihypertensive medication at baseline with Medicare fee-for-service coverage. Systolic BP and diastolic BP were measured, and antihypertensive medication classes being taken assessed through a pill bottle review during a study visit. Indicators of frailty included low body mass index, cognitive impairment, depressive symptoms, exhaustion, impaired mobility, and history of falls. Serious fall injuries were defined as fall-related fractures, brain injuries, or joint dislocations using Medicare claims through December 31, 2014. Over a median of 6.4 years, 802 (15.3%) participants had a serious fall injury. The multivariable-adjusted hazard ratio for a serious fall injury among participants with 1, 2, or ≥3 indicators of frailty versus no frailty indicators was 1.18 (95% confidence interval, 0.99-1.40), 1.49 (95% confidence interval, 1.19-1.87), and 2.04 (95% confidence interval, 1.56-2.67), respectively. Systolic BP, diastolic BP, and number of antihypertensive medication classes being taken at baseline were not associated with risk for serious fall injuries after multivariable adjustment. In conclusion, indicators of frailty, but not BP or number of antihypertensive medication classes, were associated with increased risk for serious fall injuries among older adults taking antihypertensive medication. © 2017 American Heart Association, Inc.

  9. Effects of multi-domain interventions in (pre)frail elderly on frailty, functional, and cognitive status: a systematic review.

    Science.gov (United States)

    Dedeyne, Lenore; Deschodt, Mieke; Verschueren, Sabine; Tournoy, Jos; Gielen, Evelien

    2017-01-01

    Frailty is an aging syndrome caused by exceeding a threshold of decline across multiple organ systems leading to a decreased resistance to stressors. Treatment for frailty focuses on multi-domain interventions to target multiple affected functions in order to decrease the adverse outcomes of frailty. No systematic reviews on the effectiveness of multi-domain interventions exist in a well-defined frail population. This systematic review aimed to determine the effect of multi-domain compared to mono-domain interventions on frailty status and score, cognition, muscle mass, strength and power, functional and social outcomes in (pre)frail elderly (≥65 years). It included interventions targeting two or more domains (physical exercise, nutritional, pharmacological, psychological, or social interventions) in participants defined as (pre)frail by an operationalized frailty definition. The databases PubMed, EMBASE, CINAHL, PEDro, CENTRAL, and the Cochrane Central register of Controlled Trials were searched from inception until September 14, 2016. Additional articles were searched by citation search, author search, and reference lists of relevant articles. The protocol for this review was registered on PROSPERO (CRD42016032905). Twelve studies were included, reporting a large diversity of interventions in terms of content, duration, and follow-up period. Overall, multi-domain interventions tended to be more effective than mono-domain interventions on frailty status or score, muscle mass and strength, and physical functioning. Results were inconclusive for cognitive, functional, and social outcomes. Physical exercise seems to play an essential role in the multi-domain intervention, whereby additional interventions can lead to further improvement (eg, nutritional intervention). Evidence of beneficial effects of multi-domain compared to mono-domain interventions is limited but increasing. Additional studies are needed, focusing on a well-defined frail population and with

  10. Cognitive Frailty in China: Results from China Comprehensive Geriatric Assessment Study

    Directory of Open Access Journals (Sweden)

    Lina Ma

    2017-10-01

    Full Text Available ObjectiveCognitive frailty (CF refers to the co-occurrence of physical frailty (PF and cognitive impairment in persons without dementia. We aimed to explore the prevalence and associated factors of CF in China.MethodData were obtained from the China Comprehensive Geriatric Assessment Study. A total of 5,708 community-dwelling older adults without dementia were included. CF was assessed using the Mini–Mental State Examination for the evaluation of cognitive status and the Comprehensive Geriatric Assessment-Frailty Index for the evaluation of PF. Participants with both cognitive impairment and PF were classified as having CF. Sociodemographic and clinical history was also collected. Logistic analysis was used to explore the association between the associated factors and CF.ResultsThe overall crude prevalence of CF was 3.3% [95% confidence interval (CI = 3.0–4.0], and the standard prevalence of CF was 2.7% (95% CI = 2.0–3.0. The prevalence of CF was significantly higher in women than men and higher in residents of rural areas than urban areas. Moreover, the prevalence of CF was found to increase with age. Multiple factor analysis showed that depression (OR = 2.462, 95% CI = 1.066–5.687 and hearing impairment (OR = 2.713, 95% CI = 1.114–6.608 were independent associated factors of CF in elderly individuals with PF.ConclusionOur results provide the first empirical evidence of CF in China. We have identified several associated factors with CF which should be considered while assessing older adults. More studies in Chinese population with CF are demanded to confirm with our findings.

  11. Screening for frailty in older adults using a self-reported instrument

    Directory of Open Access Journals (Sweden)

    Daniella Pires Nunes

    2015-01-01

    Full Text Available OBJECTIVE To validate a screening instrument using self-reported assessment of frailty syndrome in older adults. METHODS This cross-sectional study used data from the Saúde, Bem-estar e Envelhecimento study conducted in Sao Paulo, SP, Southeastern Brazil. The sample consisted of 433 older adult individuals (≥ 75 years assessed in 2009. The self-reported instrument can be applied to older adults or their proxy respondents and consists of dichotomous questions directly related to each component of the frailty phenotype, which is considered the gold standard model: unintentional weight loss, fatigue, low physical activity, decreased physical strength, and decreased walking speed. The same classification proposed in the phenotype was utilized: not frail (no component identified; pre-frail (presence of one or two components, and frail (presence of three or more components. Because this is a screening instrument, “process of frailty” was included as a category (pre-frail and frail. Cronbach’s α was used in psychometric analysis to evaluate the reliability and validity of the criterion, the sensitivity, the specificity, as well as positive and negative predictive values. Factor analysis was used to assess the suitability of the proposed number of components. RESULTS Decreased walking speed and decreased physical strength showed good internal consistency (α = 0.77 and 0.72, respectively; however, low physical activity was less satisfactory (α = 0.63. The sensitivity and specificity for identifying pre-frail individuals were 89.7% and 24.3%, respectively, while those for identifying frail individuals were 63.2% and 71.6%, respectively. In addition, 89.7% of the individuals from both the evaluations were identified in the “process of frailty” category. CONCLUSIONS The self-reported assessment of frailty can identify the syndrome among older adults and can be used as a screening tool. Its advantages include simplicity, rapidity, low cost

  12. An evaluation of medication appropriateness and frailty among residents of aged care homes in Malaysia

    Science.gov (United States)

    Hasan, Syed Shahzad; Kow, Chia Siang; Verma, Rohit Kumar; Ahmed, Syed Imran; Mittal, Piyush; Chong, David W.K.

    2017-01-01

    Abstract Aging is significantly associated with the development of comorbid chronic conditions. These conditions indicate the use of multiple medications, and are often warranted by clinical guidelines. The aim of the present study was to evaluate medication appropriateness and frailty among Malaysian aged care home residents with chronic disease. The participants were 202 elderly (≥65 years) individuals, a cross-sectional sample from 17 aged care homes. After ethics approval, each participant was interviewed to collect data on sociodemographics, frailty status (Groningen Frailty Indicator [GFI]), medication appropriateness (Medication Appropriateness Index (MAI), the 2015 Beers’ criteria (Potentially Inappropriate Medication [PIM]), and 2014 STOPP criteria (Potentially Inappropriate Prescribing [PIP]). The findings show that 81% (n = 164) and 42% (n = 85) were taking medications for cardiovascular and central nervous system-related conditions, respectively, and 34% were using medications for diabetes (n = 69). Each participant had a mean of 2.9 ± 1.5 chronic diseases, with an average GFI score of 6.4 ± 3.6. More than three-quarters of the participants (76%) were frail and polypharmacy was a factor in nearly half (48%); 41% and 36% were prescribed at least one PIP and PIM, respectively, whereas the average MAI score was 0.6 (range: 0–6). The number of medications used per participant correlated significantly and positively (0.21, P = .002) with GFI score. These findings reinforce the need for participants of aged care homes to receive periodic medication review aimed at minimizing morbidity associated with inappropriate pharmacotherapy. PMID:28858118

  13. Standard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis.

    LENUS (Irish Health Repository)

    Tapper, Elliot B

    2015-04-04

    The risk of morbidity and mortality for hospitalized patients with cirrhosis is high and incompletely captured by conventional indices. We sought to evaluate the predictive role of frailty in an observational cohort study of inpatients with decompensated cirrhosis between 2010 and 2013. The primary outcome was 90-day mortality. Secondary outcomes included discharge to a rehabilitation hospital, 30-day readmission, and length of stay. Frailty was assessed with three metrics: activities of daily living (ADL), the Braden Scale, and the Morse fall risk score. A predictive model was validated by randomly dividing the population into training and validation cohorts: 734 patients were admitted 1358 times in the study period. The overall 90-day mortality was 18.3%. The 30-day readmission rate was 26.6%, and the rate of discharge to a rehabilitation facility was 14.3%. Adjusting for sex, age, Model for End-Stage Liver Disease, sodium, and Charlson index, the odds ratio for the effect of an ADL score of less than 12 of 15 on mortality is 1.83 (95% confidence interval [CI] 1.05-3.20). A predictive model for 90-day mortality including ADL and Braden Scale yielded C statistics of 0.83 (95% CI 0.80-0.86) and 0.77 (95% CI 0.71-0.83) in the derivation and validation cohorts, respectively. Discharge to a rehabilitation hospital is predicted by both the ADL (<12) and Braden Scale (<16), with respective adjusted odds ratios of 3.78 (95% CI 1.97-7.29) and 6.23 (95% CI 2.53-15.4). Length of stay was associated with the Braden Scale (<16) (hazard ratio = 0.63, 95% CI 0.44-0.91). No frailty measure was associated with 30-day readmission.

  14. Exercise: the lifelong supplement for healthy ageing and slowing down the onset of frailty.

    Science.gov (United States)

    Viña, Jose; Rodriguez-Mañas, Leocadio; Salvador-Pascual, Andrea; Tarazona-Santabalbina, Francisco José; Gomez-Cabrera, Mari Carmen

    2016-04-15

    The beneficial effects of exercise have been well recognized for over half a century. Dr Jeremy Morris's pioneering studies in the fifties showed a striking difference in cardiovascular disease between the drivers and conductors on the double-decker buses in London. These studies sparked off a vast amount of research on the effects of exercise in health, and the general consensus is that exercise contributes to improved outcomes and treatment for several diseases including osteoporosis, diabetes, depression and atherosclerosis. Evidence of the beneficial effects of exercise is reviewed here. One way of highlighting the impact of exercise on disease is to consider it from the perspective of good practice. However, the intensity, duration, frequency (dosage) and counter indications of the exercise should be taken into consideration to individually tailor the exercise programme. An important case of the beneficial effect of exercise is that of ageing. Ageing is characterized by a loss of homeostatic mechanisms, on many occasions leading to the development of frailty, and hence frailty is one of the major geriatric syndromes and exercise is very useful to mitigate, or at least delay, it. Since exercise is so effective in reducing frailty, we would like to propose that exercise be considered as a supplement to other treatments. People all over the world have been taking nutritional supplements in the hopes of improving their health. We would like to think of exercise as a physiological supplement not only for treating diseases, but also for improving healthy ageing. © 2016 The Authors. The Journal of Physiology © 2016 The Physiological Society.

  15. Improvement of Risk Prediction After Transcatheter Aortic Valve Replacement by Combining Frailty With Conventional Risk Scores.

    Science.gov (United States)

    Schoenenberger, Andreas W; Moser, André; Bertschi, Dominic; Wenaweser, Peter; Windecker, Stephan; Carrel, Thierry; Stuck, Andreas E; Stortecky, Stefan

    2018-02-26

    This study sought to evaluate whether frailty improves mortality prediction in combination with the conventional scores. European System for Cardiac Operative Risk Evaluation (EuroSCORE) or Society of Thoracic Surgeons (STS) score have not been evaluated in combined models with frailty for mortality prediction after transcatheter aortic valve replacement (TAVR). This prospective cohort comprised 330 consecutive TAVR patients ≥70 years of age. Conventional scores and a frailty index (based on assessment of cognition, mobility, nutrition, and activities of daily living) were evaluated to predict 1-year all-cause mortality using Cox proportional hazards regression (providing hazard ratios [HRs] with confidence intervals [CIs]) and measures of test performance (providing likelihood ratio [LR] chi-square test statistic and C-statistic [CS]). All risk scores were predictive of the outcome (EuroSCORE, HR: 1.90 [95% CI: 1.45 to 2.48], LR chi-square test statistic 19.29, C-statistic 0.67; STS score, HR: 1.51 [95% CI: 1.21 to 1.88], LR chi-square test statistic 11.05, C-statistic 0.64; frailty index, HR: 3.29 [95% CI: 1.98 to 5.47], LR chi-square test statistic 22.28, C-statistic 0.66). A combination of the frailty index with either EuroSCORE (LR chi-square test statistic 38.27, C-statistic 0.72) or STS score (LR chi-square test statistic 28.71, C-statistic 0.68) improved mortality prediction. The frailty index accounted for 58.2% and 77.6% of the predictive information in the combined model with EuroSCORE and STS score, respectively. Net reclassification improvement and integrated discrimination improvement confirmed that the added frailty index improved risk prediction. This is the first study showing that the assessment of frailty significantly enhances prediction of 1-year mortality after TAVR in combined risk models with conventional risk scores and relevantly contributes to this improvement. Copyright © 2018 American College of Cardiology Foundation

  16. A shared frailty model for case-cohort samples: parent and offspring relations in an adoption study

    DEFF Research Database (Denmark)

    Petersen, Liselotte; Sørensen, Thorkild I A; Andersen, Per Kragh

    2010-01-01

    probability weighting to account for the sampling in a conditional, shared frailty Poisson model and to use the robust variance estimator proposed by Moger et al. (Statist. Med. 2008; 27:1062-1074).To explore the performance of the estimation procedure, a simulation study was conducted. We studied situations...... of their biological and adoptive parents were collected with the purpose of studying the association of survival between the adoptee and his/her biological or adoptive parents. Motivated by this study, we explored how to make inference in a shared frailty model for case-cohort data. Our approach was to use inverse...

  17. Incidence and mortality of fractures by frailty level over 80 years of age: cohort study using UK electronic health records.

    Science.gov (United States)

    Ravindrarajah, Rathi; Hazra, Nisha C; Charlton, Judith; Jackson, Stephen H D; Dregan, Alex; Gulliford, Martin C

    2018-01-21

    This study aimed to estimate the association of frailty with incidence and mortality of fractures at different sites in people aged over 80 years. Cohort study. UK family practices from 2001 to 2014. 265 195 registered participants aged 80 years and older. Frailty status classified into 'fit', 'mild', 'moderate' and 'severe' frailty. Fractures, classified into non-fragility and fragility, including fractures of femur, pelvis, shoulder and upper arm, and forearm/wrist. Incidence of fracture, and mortality within 90 days and 1 year, were estimated. There were 28 643 fractures including: non-fragility fractures, 9101; femur, 12 501; pelvis, 2172; shoulder and upper arm, 4965; and forearm/wrist, 6315. The incidence of each fracture type was higher in women and increased with frailty category (femur, severe frailty compared with 'fit', incidence rate ratio (IRR) 2.4, 95% CI 2.3 to 2.6). Fractures of the femur (95-99 years compared with 80-84 years, IRR 2.7, 95% CI 2.6 to 2.9) and pelvis (IRR 2.9, 95% CI 2.5 to 3.3) were strongly associated with age but non-fragility and forearm fractures were not. Mortality within 90 days was greatest for femur fracture (adjusted HR, compared with forearm fracture 4.3, 95% CI 3.7 to 5.1). Mortality was higher in men and increased with age (HR 5.3, 95% CI 4.3 to 6.5 in those over 100 years compared with 80-84 years) but was less strongly associated with frailty category. Similar associations with fractures were seen at 1-year mortality. The incidence of fractures at all sites was higher in women and strongly associated with advancing frailty status, while the risk of mortality after a fracture was greater in men and was associated with age rather than frailty category. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Inference on the Univariate Frailty Model: A Bayesian Reference Analysis Approach

    Science.gov (United States)

    Tomazella, Vera Lucia D.; Martins, Camila Bertini; Bernardo, Jose Miguel

    2008-11-01

    In this work we present an approach involving objective Bayesian reference analysis to the Frailty model with univariate survival time and sources of heterogeneity that are not captured by covariates. The derivation unconditional hazard and survival leads to the Lomax distribution, also known as the Pareto distribution of the second kind. This distribution has an important position in life testing to adjust data from business failures. Reference analysis, introduced by Bernardo (1979) produce a new solution for this problem. The results are illustrated with survival data analyzed in the literature and simulated data.

  19. The impact of frailty on oral care behavior of older people: a qualitative study

    Science.gov (United States)

    2013-01-01

    Background Frailty has been demonstrated to negatively influence dental service-use and oral self-care behavior of older people. The aim of this study was to explore how the type and level of frailty affect the dental service-use and oral self-care behavior of frail older people. Methods We conducted a qualitative study through 51 open interviews with elders of varying frailty in the East-Netherlands, and used a thematic analysis to code transcripts, discussions and reviews of the attributes and meaning of the themes to the point of consensus among the researchers. Results Three major themes and five sub-themes emerged from our analyses. The major themes indicate that frail elders: A) favor long-established oral hygiene routines to sustain a sense of self-worth; B) discontinue oral hygiene routines when burdened by severe health complaints, in particular chronic pain, low morale and low energy; and C) experience psychological and social barriers to oral health care when institutionalized. The subthemes associated with the discontinuation of oral care suggest that the elders accept more oral pain or discomfort because they: B1) lack belief in the results of dental visits and tooth cleaning; B2) trivialize oral health and oral care in the general context of their impaired health and old age; and B3) consciously use their sparse energy for priorities other than oral healthcare. Institutionalized elderly often discontinue oral care because of C1) disorientation and C2) inconveniencing social supports. Conclusion The level and type of frailty influences people’s perspectives on oral health and related behaviors. Frail elders associate oral hygiene with self-worth, but readily abandon visits to a dentist unless they feel that a dentist can relieve specific problems. When interpreted according to the Motivational Theory of Life Span Development, discontinuation of oral care by frail elderly could be viewed as a manifestation of adaptive development. Simple measures

  20. The impact of frailty on oral care behavior of older people: a qualitative study.

    Science.gov (United States)

    Niesten, Dominique; van Mourik, Krista; van der Sanden, Wil

    2013-11-01

    Frailty has been demonstrated to negatively influence dental service-use and oral self-care behavior of older people. The aim of this study was to explore how the type and level of frailty affect the dental service-use and oral self-care behavior of frail older people. We conducted a qualitative study through 51 open interviews with elders of varying frailty in the East-Netherlands, and used a thematic analysis to code transcripts, discussions and reviews of the attributes and meaning of the themes to the point of consensus among the researchers. Three major themes and five sub-themes emerged from our analyses. The major themes indicate that frail elders: A) favor long-established oral hygiene routines to sustain a sense of self-worth; B) discontinue oral hygiene routines when burdened by severe health complaints, in particular chronic pain, low morale and low energy; and C) experience psychological and social barriers to oral health care when institutionalized. The subthemes associated with the discontinuation of oral care suggest that the elders accept more oral pain or discomfort because they: B1) lack belief in the results of dental visits and tooth cleaning; B2) trivialize oral health and oral care in the general context of their impaired health and old age; and B3) consciously use their sparse energy for priorities other than oral healthcare. Institutionalized elderly often discontinue oral care because of C1) disorientation and C2) inconveniencing social supports. The level and type of frailty influences people's perspectives on oral health and related behaviors. Frail elders associate oral hygiene with self-worth, but readily abandon visits to a dentist unless they feel that a dentist can relieve specific problems. When interpreted according to the Motivational Theory of Life Span Development, discontinuation of oral care by frail elderly could be viewed as a manifestation of adaptive development. Simple measures aimed at recognizing indicators for poor

  1. Developing higher-order thinking skills with concept mapping: A case of pedagogic frailty

    Directory of Open Access Journals (Sweden)

    Alberto J. Cañas

    2017-09-01

    Full Text Available Concept maps have been proposed as a tool that can help develop and exercise higher-order thinking skills, including critical thinking, reflective thinking, synthesis, analysis, among others. In this paper, we review how the different aspects of constructing a concept map can help develop and exercise these skills, and discuss why most students never reach the level of concept mapping skills required to exercises their higher-order thinking skills, in what we propose is a case of pedagogic frailty involving the ‘Pedagogy and Discipline’ and ‘Locus of Control’ dimensions.

  2. Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women.

    Science.gov (United States)

    Ensrud, Kristine E; Ewing, Susan K; Taylor, Brent C; Fink, Howard A; Cawthon, Peggy M; Stone, Katie L; Hillier, Teresa A; Cauley, Jane A; Hochberg, Marc C; Rodondi, Nicolas; Tracy, J Kathleen; Cummings, Steven R

    2008-02-25

    Frailty, as defined by the index derived from the Cardiovascular Health Study (CHS index), predicts risk of adverse outcomes in older adults. Use of this index, however, is impractical in clinical practice. We conducted a prospective cohort study in 6701 women 69 years or older to compare the predictive validity of a simple frailty index with the components of weight loss, inability to rise from a chair 5 times without using arms, and reduced energy level (Study of Osteoporotic Fractures [SOF index]) with that of the CHS index with the components of unintentional weight loss, poor grip strength, reduced energy level, slow walking speed, and low level of physical activity. Women were classified as robust, of intermediate status, or frail using each index. Falls were reported every 4 months for 1 year. Disability (> or =1 new impairment in performing instrumental activities of daily living) was ascertained at 4(1/2) years, and fractures and deaths were ascertained during 9 years of follow-up. Area under the curve (AUC) statistics from receiver operating characteristic curve analysis and -2 log likelihood statistics were compared for models containing the CHS index vs the SOF index. Increasing evidence of frailty as defined by either the CHS index or the SOF index was similarly associated with an increased risk of adverse outcomes. Frail women had a higher age-adjusted risk of recurrent falls (odds ratio, 2.4), disability (odds ratio, 2.2-2.8), nonspine fracture (hazard ratio, 1.4-1.5), hip fracture (hazard ratio, 1.7-1.8), and death (hazard ratio, 2.4-2.7) (P falls (AUC = 0.61 for both models; P = .66), disability (AUC = 0.64; P = .23), nonspine fracture (AUC = 0.55; P = .80), hip fracture (AUC = 0.63; P = .64), or death (AUC = 0.72; P = .10). Results were similar when -2 log likelihood statistics were compared. The simple SOF index predicts risk of falls, disability, fracture, and death as well as the more complex CHS index and may provide a useful definition of

  3. Comparing clinician descriptions of frailty and geriatric syndromes using electronic health records: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Laura J. Anzaldi

    2017-10-01

    Full Text Available Abstract Background Geriatric syndromes, including frailty, are common in older adults and associated with adverse outcomes. We compared patients described in clinical notes as “frail” to other older adults with respect to geriatric syndrome burden and healthcare utilization. Methods We conducted a retrospective cohort study on 18,341 Medicare Advantage enrollees aged 65+ (members of a large nonprofit medical group in Massachusetts, analyzing up to three years of administrative claims and structured and unstructured electronic health record (EHR data. We determined the presence of ten geriatric syndromes (falls, malnutrition, dementia, severe urinary control issues, absence of fecal control, visual impairment, walking difficulty, pressure ulcers, lack of social support, and weight loss from claims and EHR data, and the presence of frailty descriptions in clinical notes with a pattern-matching natural language processing (NLP algorithm. Results Of the 18,341 patients, we found that 2202 (12% were described as “frail” in clinical notes. “Frail” patients were older (82.3 ± 6.8 vs 75.9 ± 5.9, p < .001 and had higher rates of healthcare utilization, including number of inpatient hospitalizations and emergency department visits, than the rest of the population (p < .001. “Frail” patients had on average 4.85 ± 1.72 of the ten geriatric syndromes studied, while non-frail patients had 2.35 ± 1.71 (p = .013. Falls, walking difficulty, malnutrition, weight loss, lack of social support and dementia were more highly correlated with frailty descriptions. The most common geriatric syndrome pattern among “frail” patients was a combination of walking difficulty, lack of social support, falls, and weight loss. Conclusions Patients identified as “frail” by providers in clinical notes have higher rates of healthcare utilization and more geriatric syndromes than other patients. Certain geriatric syndromes were more highly

  4. Penalized variable selection in competing risks regression.

    Science.gov (United States)

    Fu, Zhixuan; Parikh, Chirag R; Zhou, Bingqing

    2017-07-01

    Penalized variable selection methods have been extensively studied for standard time-to-event data. Such methods cannot be directly applied when subjects are at risk of multiple mutually exclusive events, known as competing risks. The proportional subdistribution hazard (PSH) model proposed by Fine and Gray (J Am Stat Assoc 94:496-509, 1999) has become a popular semi-parametric model for time-to-event data with competing risks. It allows for direct assessment of covariate effects on the cumulative incidence function. In this paper, we propose a general penalized variable selection strategy that simultaneously handles variable selection and parameter estimation in the PSH model. We rigorously establish the asymptotic properties of the proposed penalized estimators and modify the coordinate descent algorithm for implementation. Simulation studies are conducted to demonstrate the good performance of the proposed method. Data from deceased donor kidney transplants from the United Network of Organ Sharing illustrate the utility of the proposed method.

  5. Do Performance-based Health Measures Reflect Differences in Frailty Among Immigrants Age 50+ in Europe?

    Science.gov (United States)

    Brothers, Thomas D; Theou, Olga; Rockwood, Kenneth

    2014-09-01

    Life course influences, including country of residence and country of birth, are associated with frailty index scores. We investigated these associations using performance-based health measures. Among 33,745 participants age 50+ (mean age 64.8 ± 10.1; 55% women) in the Survey of Health, Ageing, and Retirement in Europe, grip strength, delayed word recall, and semantic verbal fluency were assessed. Participants were grouped by country of residence (Northern/Western Europe or Southern/Eastern Europe), and by country of birth (native-born, immigrants born in low- and middle-income countries [LMICs], or immigrants born in high-income countries [HICs]). Participants in Southern/Eastern Europe had lower mean test scores than those in Northern/Western Europe, and their scores did not differ by country of birth group. In Northern/Western Europe, compared with native-born participants, LMIC-born immigrants demonstrated lower mean grip strength (32.8 ± 7.6 kg vs. 35.7 ± 7.7 kg), delayed recall (2.9 ± 1.9 vs. 3.6 ± 1.9), and verbal fluency scores (16.0 ± 6.9 vs. 20.3 ± 7.0). HIC-born immigrants had mean scores higher than LMIC-born immigrants, but lower than native-born participants (all pnational income levels of both country of residence and country of birth. This was similar to previously observed differences in frailty index scores.

  6. Physiological frailty index (PFI): quantitative in-life estimate of individual biological age in mice.

    Science.gov (United States)

    Antoch, Marina P; Wrobel, Michelle; Kuropatwinski, Karen K; Gitlin, Ilya; Leonova, Katerina I; Toshkov, Ilia; Gleiberman, Anatoli S; Hutson, Alan D; Chernova, Olga B; Gudkov, Andrei V

    2017-03-19

    The development of healthspan-extending pharmaceuticals requires quantitative estimation of age-related progressive physiological decline. In humans, individual health status can be quantitatively assessed by means of a frailty index (FI), a parameter which reflects the scale of accumulation of age-related deficits. However, adaptation of this methodology to animal models is a challenging task since it includes multiple subjective parameters. Here we report a development of a quantitative non-invasive procedure to estimate biological age of an individual animal by creating physiological frailty index (PFI). We demonstrated the dynamics of PFI increase during chronological aging of male and female NIH Swiss mice. We also demonstrated acceleration of growth of PFI in animals placed on a high fat diet, reflecting aging acceleration by obesity and provide a tool for its quantitative assessment. Additionally, we showed that PFI could reveal anti-aging effect of mTOR inhibitor rapatar (bioavailable formulation of rapamycin) prior to registration of its effects on longevity. PFI revealed substantial sex-related differences in normal chronological aging and in the efficacy of detrimental (high fat diet) or beneficial (rapatar) aging modulatory factors. Together, these data introduce PFI as a reliable, non-invasive, quantitative tool suitable for testing potential anti-aging pharmaceuticals in pre-clinical studies.

  7. [Impact of frailty factors in elderly people older than 75 years with prosthesis of the hip].

    Science.gov (United States)

    Dallière, O; Blanchon, M A; Blanc, P; Presles, E; Gonthier, R

    2004-11-01

    Hip pathology of hip requiring a surgical assumption of responsibility (coxarthrose invalidating, hip fracture) is increasing, and after the year 2025, the number of interventions will double. In parallel, the number of elderly people (older than 75 years) with malnutrition associated with cognitive impairment and reduced autonomy is on the increase. So the concept of frail elderly identified by specific criteria allows for better defining the health needs of heterogeneous elderly people. The objective of this study was to determine the influence of frailty factors on autonomy and clinical outcome after intervention for prosthesis of the hip. This prospective work, completed over 8 months, included 55 patients with total or intermediate prostheses of hip, whatever the cause, recruited from rehabilitation wards. Results from a pre-established questionnaire defined the personal status and social framework of these patients. A medical examination evaluated cognitive function Mini Mental State (MMS), nutritional state (IMC) and the level of autonomy immediately after surgery (the first 2 weeks) by the measurement of functional independence (MIF). The second MIF was carried out by the same operator at the end of the assumption of responsibility by the institution. Three factors of frailty influenced progress at the time of reacquisition of autonomy: cognitive impairment (P load and adaptation.

  8. A procedure for creating a frailty index based on deficit accumulation in aging mice.

    Science.gov (United States)

    Parks, Randi J; Fares, Elias; Macdonald, Jennifer K; Ernst, Matthew C; Sinal, Christopher J; Rockwood, Kenneth; Howlett, Susan E

    2012-03-01

    This study developed an approach to quantify frailty with a frailty index (FI) and investigated whether age-related changes in contractions, calcium transients, and ventricular myocyte length were more prominent in mice with a high FI. The FI combined 31 variables that reflect different aspects of health in middle-aged (∼12 months) and aged (∼30 months) mice of both sexes. Aged animals had a higher FI than younger animals (FI = 0.43 ± 0.03 vs 0.08 ± 0.02, p < .001, n = 12). Myocyte hypertrophy increased by 30%-50% as the FI increased in aged animals. Peak contractions decreased more than threefold from lowest to highest FI values in aged mice (p < .037), but calcium transients were unaffected. Similar results were seen with an FI based on eight noninvasive variables identified as underlying factors. These results show that an FI can be developed for murine models and suggest that age-associated changes in myocytes are more prominent in animals with a high FI.

  9. The Prevalence and Correlates of Frailty in Urban and Rural Populations in Latin America, China, and India: A 10/66 Population-Based Survey.

    Science.gov (United States)

    Llibre Rodriguez, Juan J; Prina, A Matthew; Acosta, Daisy; Guerra, Mariella; Huang, Yueqin; Jacob, K S; Jimenez-Velasquez, Ivonne Z; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph D; Jotheeswaran, A T; Acosta, Isaac; Liu, Zhaorui; Prince, Martin J

    2018-04-01

    There have been few cross-national studies of the prevalence of the frailty phenotype conducted among low or middle income countries. We aimed to study the variation in prevalence and correlates of frailty in rural and urban sites in Latin America, India, and China. Cross-sectional population-based catchment area surveys conducted in 8 urban and 4 rural catchment areas in 8 countries; Cuba, Dominican Republic, Puerto Rico, Venezuela, Peru, Mexico, China, and India. We assessed weight loss, exhaustion, slow walking speed, and low energy consumption, but not hand grip strength. Therefore, frailty phenotype was defined on 2 or more of 4 of the usual 5 criteria. We surveyed 17,031 adults aged 65 years and over. Overall frailty prevalence was 15.2% (95% confidence inteval 14.6%-15.7%). Prevalence was low in rural (5.4%) and urban China (9.1%) and varied between 12.6% and 21.5% in other sites. A similar pattern of variation was apparent after direct standardization for age and sex. Cross-site variation in prevalence of frailty indicators varied across the 4 indicators. Controlling for age, sex, and education, frailty was positively associated with older age, female sex, lower socioeconomic status, physical impairments, stroke, depression, dementia, disability and dependence, and high healthcare costs. There was substantial variation in the prevalence of frailty and its indicators across sites in Latin America, India, and China. Culture and other contextual factors may impact significantly on the assessment of frailty using questionnaire and physical performance-based measures, and achieving cross-cultural measurement invariance remains a challenge. A consistent pattern of correlates was identified, suggesting that in all sites, the frailty screen could identify older adults with multiple physical, mental, and cognitive morbidities, disability and needs for care, compounded by socioeconomic disadvantage and catastrophic healthcare spending. Copyright © 2017. Published

  10. Frailty and its impact on health-related quality of life: a cross-sectional study on elder community-dwelling preventive health service users.

    Directory of Open Access Journals (Sweden)

    Yaw-Wen Chang

    Full Text Available BACKGROUND: The purpose of this study was to identify the incidence of frailty and to investigate the relationship between frailty status and health-related quality of life (HRQoL in the community-dwelling elderly population who utilize preventive health services. METHODS: People aged 65 years and older who visited a medical center in Taipei City from March to August in 2011 for an annual routine check-up provided by the National Health Insurance were eligible. A total of 374 eligible elderly adults without cognitive impairment had a mean age of 74.6±6.3 years. Frailty status was determined according to the Fried frailty criteria. HRQoL was measured with Short Form-36 (SF-36. Multiple regression analyses examined the relationship between frailty status and the two summary scales of SF-36. Models were adjusted for the participants' sociodemographic and health status. RESULTS: After adjusting for sociodemographic and health-related covariables, frailty was found to be more significantly associated (p<0.001 with lower scores on both physical and mental health-related quality of life summary scales compared with robustness. For the frailty phenotypes, slowness represented the major contributing factor in the physical component scale of SF-36, and exhaustion was the primary contributing factor in the mental component scale. CONCLUSION: The status of frailty is closely associated with HRQoL in elderly Taiwanese preventive health service users. The impacts of frailty phenotypes on physical and mental aspects of HRQoL differ.

  11. Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa.

    Science.gov (United States)

    Biritwum, R B; Minicuci, N; Yawson, A E; Theou, O; Mensah, G P; Naidoo, N; Wu, F; Guo, Y; Zheng, Y; Jiang, Y; Maximova, T; Kalula, S; Arokiasamy, P; Salinas-Rodríguez, A; Manrique-Espinoza, B; Snodgrass, J J; Sterner, K N; Eick, G; Liebert, M A; Schrock, J; Afshar, S; Thiele, E; Vollmer, S; Harttgen, K; Strulik, H; Byles, J E; Rockwood, K; Mitnitski, A; Chatterji, S; Kowal, P

    2016-09-01

    The severe burden imposed by frailty and disability in old age is a major challenge for healthcare systems in low- and middle-income countries alike. The current study aimed to provide estimates of the prevalence of frailty and disability in older adult populations and to examine their relationship with socioeconomic factors in six countries. Focusing on adults aged 50+ years, a frailty index was constructed as the proportion of deficits in 40 variables, and disability was assessed using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), as part of the Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, Russia and South Africa. This study included a total of 34,123 respondents. China had the lowest percentages of older adults with frailty (13.1%) and with disability (69.6%), whereas India had the highest percentages (55.5% and 93.3%, respectively). Both frailty and disability increased with age for all countries, and were more frequent in women, although the sex gap varied across countries. Lower levels of both frailty and disability were observed at higher levels of education and wealth. Both education and income were protective factors for frailty and disability in China, India and Russia, whereas only income was protective in Mexico, and only education in South Africa. Age-related frailty and disability are increasing concerns for older adult populations in low- and middle-income countries. The results indicate that lower levels of frailty and disability can be achieved for older people, and the study highlights the need for targeted preventive approaches and support programs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. The role of frailty in explaining the association between the metabolic syndrome and mortality in older adults

    NARCIS (Netherlands)

    Hoogendijk, Emiel O; Huisman, Martijn; van Ballegooijen, Adriana J

    2017-01-01

    The association between the metabolic syndrome (MetS) and adverse outcomes in older adults may be explained by other health conditions. This study examined the role of frailty in explaining the association between MetS and mortality, independent of comorbidity. Data were used from 1247 men and women

  13. Serum 25-hydroxyvitamin D, transitions between frailty states, and mortality in older adults: the Invecchiare in Chianti Study

    NARCIS (Netherlands)

    Shardell, M.; D'Adamo, C.; Alley, D.E.; Miller, R.R.; Hicks, G.E.; Milaneschi, Y.; Semba, R.D.; Cherubini, A.; Bandinelli, S.; Ferrucci, L.

    2012-01-01

    Objectives To assess whether serum 25-hydroxyvitamin D (25(OH)D) concentrations relate to transitions between the states of robustness, prefrailty, and frailty and to mortality in older adults. Design The Invecchiare in Chianti (InCHIANTI) Study, a prospective cohort study. Setting Tuscany, Italy.

  14. Dynamic Factor Models With Macro, Frailty and Industry Effects for U.S. Default Counts: The Credit Crisis of 2008

    NARCIS (Netherlands)

    Koopman, S.J.; Lucas, A.; Schwaab, B.

    2012-01-01

    We develop a high-dimensional, nonlinear, and non-Gaussian dynamic factor model for the decomposition of systematic default risk conditions into latent components for (1) macroeconomic/financial risk, (2) autonomous default dynamics (frailty), and (3) industry-specific effects. We analyze discrete

  15. Frailty and geography: should these two factors be added to the ABCDE contemporary guide to diabetes therapy?

    Science.gov (United States)

    Maddaloni, Ernesto; D'Onofrio, Luca; Pozzilli, Paolo

    2016-02-01

    On the road towards personalized treatments for type 2 diabetes, we suggest here that two parameters could be added to the ABCDE algorithm, 'F' for frailty and 'G' for geography. Indeed, the progressive ageing of population is causing a simultaneous increase of frailty worldwide. The identification of the optimal therapeutic approach is often difficult in frail subjects because of the complexity of 'frailty syndrome'. Nevertheless, given the relevance of diabetes in the development and progression of frailty, a safe and effective cure of diabetes is extremely important to guarantee a good medical outcome. There are few data about diabetes treatment in this delicate category of patients, and the choice of the appropriate therapy mostly remains a challenge. Moreover, type 2 diabetes affects more than 382 million people of different countries, races and ethnicities. To face the lack of solid evidence-based medicine for the treatment of diabetes in different ethnic groups, it is extremely important to increase knowledge about the different pathophysiology of diabetes according to ethnicity. In this way, a tailored approach to treatment of various ethnic groups living in the same or different regions can eventually be developed. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  16. An Easy Assessment of Frailty at Baseline Independently Predicts Prognosis in Very Elderly Patients With Acute Coronary Syndromes.

    Science.gov (United States)

    Alegre, Oriol; Formiga, Francesc; López-Palop, Ramón; Marín, Francisco; Vidán, María T; Martínez-Sellés, Manuel; Carol, Antoni; Sionis, Alessandro; Díez-Villanueva, Pablo; Aboal, Jaime; Palau-Vendrel, Anna; Bueno, Héctor; Rivera, Angel Perez; Sanchís, Juan; Abu-Assi, Emad; Corbí, Miguel; Castillo, Juan C; Bañeras, Jordi; González-Salvado, Violeta; Cequier, Àngel; Ariza-Solé, Albert

    2018-04-01

    Information about the impact of frailty in patients with acute coronary syndromes (ACS) is scarce. No study has assessed the prognostic impact of frailty as measured by the FRAIL scale in very elderly patients with ACS. The prospective multicenter LONGEVO-SCA registry included unselected patients with ACS aged 80 years or older. A comprehensive geriatric assessment was performed during hospitalization, including frailty assessment by the FRAIL scale. The primary endpoint was mortality at 6 months. A total of 532 patients were included. Mean age was 84.3 years, 61.7% male. Most patients had positive troponin levels (84%) and high GRACE risk score values (mean 165). A total of 205 patients were classified as prefrail (38.5%) and 145 as frail (27.3%). Frail and prefrail patients had a higher prevalence of comorbidities, lower left ventricle ejection fraction, and higher mean GRACE score value. A total of 63 patients (11.8%) were dead at 6 months. Both prefrailty and frailty were associated with higher 6-month mortality rates (P < .001). After adjusting for potential confounders, this association remained significant (hazard ratio [HR] 2.71; 95% confidence interval [CI] 1.09-6.73 for prefrailty and HR 2.99; 95% CI 1.20-7.44 for frailty, P = .024). The other independent predictors of mortality were age, Charlson Index, and GRACE risk score. The FRAIL scale is a simple tool that independently predicts mortality in unselected very elderly patients with ACS. The presence of prefrailty criteria also should be taken into account when performing risk stratification of these patients. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  17. [Frailty, disability and multi-morbidity: the relationship with quality of life and healthcare costs in elderly people].

    Science.gov (United States)

    Lutomski, Jennifer E; Baars, Maria A E; Boter, Han; Buurman, Bianca M; den Elzen, Wendy P J; Jansen, Aaltje P D; Kempen, Gertrudis I J M; Steunenberg, Bas; Steyerberg, Ewout W; Olde Rikkert, Marcel G M; Melis, René J F

    2014-01-01

    To assess the independent and combined impact of frailty, multi-morbidity, and activities of daily living (ADL) limitations on self-reported quality of life and healthcare costs in elderly people. Cross-sectional, descriptive study. Data came from The Older Persons and Informal Caregivers Minimum DataSet (TOPICS-MDS), a pooled dataset with information from 41 projects across the Netherlands from the Dutch national care for the Elderly programme. Frailty, multi-morbidity and ADL limitations, and the interactions between these domains, were used as predictors in regression analyses with quality of life and healthcare costs as outcome measures. Analyses were stratified by living situation (independent or care home). Directionality and magnitude of associations were assessed using linear mixed models. A total of 11,093 elderly people were interviewed. A substantial proportion of elderly people living independently reported frailty, multi-morbidity, and/or ADL limitations (56.4%, 88.3% and 41.4%, respectively), as did elderly people living in a care home (88.7%, 89.2% and 77,3%, respectively). One-third of elderly people living at home (31.9%) reported all three conditions compared with two-thirds of elderly people living in a care home (68.3%). In the multivariable analysis, frailty had a strong impact on outcomes independently of multi-morbidity and ADL limitations. Elderly people experiencing problems across all three domains reported the poorest quality-of-life scores and the highest healthcare costs, irrespective of their living situation. Frailty, multi-morbidity and ADL limitations are complementary measurements, which together provide a more holistic understanding of health status in elderly people. A multi-dimensional approach is important in mapping the complex relationships between these measurements on the one hand and the quality of life and healthcare costs on the other.

  18. Impact of Physical Activity on Frailty Status and How to Start a Semiological Approach to Muscular System

    Directory of Open Access Journals (Sweden)

    Maximiliano Smietniansky

    2015-12-01

    Full Text Available Introduction: The world population is aging, and this demographic fact is associated with an increased prevalence of sedentary lifestyles, sarcopenia and frailty; all of them with impact on health status. Biologic reserve determination in the elderly with comorbidity poses a challenge for medical activities. Frailty is an increasingly used concept in the geriatric medicine literature, which refers to an impairment in biologic reserve. There is a close and multidirectional relationship between physical activity, the muscular system function, and a fit status; decline in this dimensions is associated with poor outcomes. The aim of this article is to make a narrative review on the relationship between physical activity, sarcopenia and frailty syndrome. Results: The low level of physical activity, sarcopenia and frailty, are important predictors for development of disability, poor quality of life, falls, hospitalizations and all causes mortality. For clinical practice we propose a semiological approach based on measurement of muscle performance, mass and also level of physical activity, as a feasible way to determine the biologic reserve. This evidence shows us that the evaluation of muscle mass and performance, provides important prognostic information because the deterioration of these variables is associated with poor clinical outcomes in older adults followed up in multiple cohorts. Conclusions: Low activity is a mechanism and at the same time part of the frailty syndrome. The determination of biologic reserve is important because it allows the prognostic stratification of the patient and constitutes an opportunity for intervention. The clinician should be aware of the clinical tools that evaluate muscular system and level of physical activity, because they place us closer to the knowledge of health status.

  19. Frailty syndrome in an independent urban population in Brazil (FIBRA study: a cross-sectional populational study

    Directory of Open Access Journals (Sweden)

    Larissa Barradas Calado

    Full Text Available ABSTRACT: CONTEXT AND OBJECTIVE: Frailty is a multifactorial syndrome. The aim of this study was to determine the prevalence and characteristics of frailty syndrome in an elderly urban population. DESIGN AND SETTING: Cross-sectional study carried out at the homes of a randomized sample representing the independent elderly individuals of Ribeirão Preto, Brazil. METHODS: Sociodemographic characteristics, clinical data and criteria of the frailty phenotype were obtained at the subjects' homes; 385 individuals were evaluated. Frailty was defined based on detection of weight loss, exhaustion, weakness, slowness and low physical activity level. Individuals with three or more of these characteristics were classified as frail and those with one or two as pre-frail. Specific cutoff points for weakness, slowness and low physical activity level were calculated. RESULTS: The participants' mean age was 73.9 ± 6.5 years, and 64.7% were women. 12.5% had lost weight over the last year; 20.5% showed exhaustion, 17.1% slowness, 24.4% low physical activity level and 20.5% weakness. 9.1% were considered frail and 49.6% pre-frail. Frail subjects were older, attended more medical visits, had a higher chance of hospitalization within the last 12 months and had more cerebrovascular events, diabetes, neoplasms, osteoporosis and urinary and fecal incontinence. CONCLUSION: In this independent elderly population, there were numerous frail and pre-frail individuals. Frailty syndrome was associated with high morbidity. Cutoff points for weakness, slowness and low physical activity level should be adjusted for the population under study. It is essential to identify frail and pre-frail older individuals for appropriate interventions.

  20. Nutritional status according to the mini nutritional assessment (MNA®) and frailty in community dwelling older persons: a close relationship.

    Science.gov (United States)

    Bollwein, J; Volkert, D; Diekmann, R; Kaiser, M J; Uter, W; Vidal, K; Sieber, C C; Bauer, J M

    2013-04-01

    This study investigates the association between MNA results and frailty status in community-dwelling older adults. In addition the relevance of singular MNA items and subscores in this regard was tested. Cross-sectional study. Community-dwelling older adults were recruited in the region of Nürnberg, Germany. 206 volunteers aged 75 years or older without cognitive impairment (Mini Mental State Examination >24 points), 66.0% female. Frailty was defined according to Fried et al. as presence of three, pre-frailty as presence of one or two of the following criteria: weight loss, exhaustion, low physical activity, low handgrip strength and slow walking speed. Malnutrition (malnutrition (17-23.5 points) were determined by MNA®. 15.1% of the participants were at risk of malnutrition, no participant was malnourished. 15.5 % were frail, 39.8% pre-frail and 44.7% non-frail. 46.9% of the frail, 12.2% of the pre-frail and 2.2% of the non-frail participants were at risk of malnutrition (pmalnutrition were either pre-frail or frail. For the anthropometric, dietary, subjective and functional, but not for the general MNA subscore, frail participants scored significantly lower than pre-frail (p<0.01), and non-frail participants (p<0.01). Twelve of the 18 MNA items were also significantly associated with frailty (p<0.05). These results underline the close association between frailty syndrome and nutritional status in older persons. A profound understanding of the interdependency of these two geriatric concepts will represent the basis for successful treatment strategies.

  1. Differences in the effect of exercise interventions between prefrail older adults and older adults without frailty: A pilot study.

    Science.gov (United States)

    Takano, Eiko; Teranishi, Toshio; Watanabe, Toyoaki; Ohno, Kensuke; Kitaji, Shiko; Sawa, Shunji; Kanada, Yoshikiyo; Toba, Kenji; Kondo, Izumi

    2017-09-01

    We aimed to clarify whether there are differences in the effect of exercise interventions between prefrail older adults and older adults without frailty. The participants were community-dwelling older adults (mean age 75.1 ± 5.1 years). The participants were instructed to use a training method at home to prevent frailty. The effects of the intervention were evaluated at 4 months. Outcome measures were the Timed Up and Go test, grip strength, one leg balance, knee extension strength and the fall risk index. The present study used the criteria for frailty status of the National Center for Geriatrics and Gerontology in Japan. The studied sample included prefrail participants (n = 17) and robust participants (n = 24). We compared the value of outcome measures before and after the intervention in each group using two-way repeated measures analysis of variance. There were significant differences for the group effect for one leg balance (P < 0.01), and there were significant differences for the time effect for Timed Up and Go, one leg balance and knee extension strength (P < 0.01). In these outcomes, there were no significant interactions between frailty status and intervention. Four prefrail participants (mean age 78.0 ± 3.8 years) returned to the robust status after the intervention. No participants became frail. These results suggest that we can expect similar interventional effects for prefrail older adults and robust older adults. It is important that a frail status be prevented in prefrail older adults by using an exercise intervention. Further studies are required to determine the different effects of exercise intervention on prefrail status compared with frailty status in community-dwelling older adults. Geriatr Gerontol Int 2017; 17: 1265-1269. © 2016 Japan Geriatrics Society.

  2. Systolic Blood Pressure Trajectory, Frailty, and All-Cause Mortality >80 Years of Age: Cohort Study Using Electronic Health Records.

    Science.gov (United States)

    Ravindrarajah, Rathi; Hazra, Nisha C; Hamada, Shota; Charlton, Judith; Jackson, Stephen H D; Dregan, Alex; Gulliford, Martin C

    2017-06-13

    Clinical trials show benefit from lowering systolic blood pressure (SBP) in people ≥80 years of age, but nonrandomized epidemiological studies suggest lower SBP may be associated with higher mortality. This study aimed to evaluate associations of SBP with all-cause mortality by frailty category >80 years of age and to evaluate SBP trajectories before death. A population-based cohort study was conducted using electronic health records of 144 403 participants ≥80 years of age registered with family practices in the United Kingdom from 2001 to 2014. Participants were followed for ≤5 years. Clinical records of SBP were analyzed. Frailty status was classified using the e-Frailty Index into the categories of fit, mild, moderate, and severe. All-cause mortality was evaluated by frailty status and mean SBP in Cox proportional-hazards models. SBP trajectories were evaluated using person months as observations, with mean SBP and antihypertensive treatment status estimated for each person month. Fractional polynomial models were used to estimate SBP trajectories over 5 years before death. During follow-up, 51 808 deaths occurred. Mortality rates increased with frailty level and were greatest at SBP mortality was 7.7 per 100 person years at SBP 120 to 139 mm Hg, 15.2 at SBP 110 to 119 mm Hg, and 22.7 at SBP mortality may be accounted for by reverse causation if participants with lower blood pressure values are closer, on average, to the end of life. © 2017 The Authors.

  3. Frailty as a predictor of mortality in the elderly emergency general surgery patient.

    Science.gov (United States)

    Goeteyn, Jens; Evans, Louis A; De Cleyn, Siem; Fauconnier, Sigrid; Damen, Caroline; Hewitt, Jonathan; Ceelen, Wim

    2017-12-01

    The number of surgical procedures performed in elderly and frail patients has greatly increased in the last decades. However, there is little research in the elderly emergency general surgery patient. The aim of this study was to assess the prevalence of frailty in the emergency general surgery population in Belgium. Secondly, we examined the length of hospital stay, readmission rate and mortality at 30 and 90 days. We conducted a prospective observational study at Ghent University Hospital. All patients older than 65 admitted to a general surgery ward from the emergency department were eligible for inclusion. Primary endpoint was mortality at 30 days. Secondary outcomes were mortality at 90 days, readmissions and length of stay. Cross-sectional observations were performed using the Fisher exact test, Mann-Whitney U-test, or one-way ANOVA. We performed a COX multivariable analysis to identify independent variables associated with mortality at 30 and 90 days as well as the readmission risk. Data were collected from 98 patients in a four-month period. 23.5% of patients were deemed frail. 79% of all patients underwent abdominal surgery. Univariate analyses showed that polypharmacy, multimorbidity, a history of falls, hearing impairment and urinary incontinence were statistically significantly different between the non-frail and the group. Frail patients showed a higher incidence for mortality within 30 days (9% versus 1.3% (p = .053)). There were no differences between the two groups for mortality at 90 days, readmission, length of stay and operation. Frailty was a predictor for mortality at 90 days (p= .025) (hazard ratio (HR) 10.83 (95%CI 1.34-87.4)). Operation (p= .084) (HR 0.16 (95%CI 0.16-1.29)) and the presence of chronic cardiac failure (p= .049) (HR 0.38 (95%CI 0.14-0.99)) were protective for mortality at 90 days. Frailty is a significant predictor for mortality for elderly patients undergoing emergency abdominal/general surgery. Level II therapeutic

  4. Resistance Training and Co-supplementation with Creatine and Protein in Older Subjects with Frailty.

    Science.gov (United States)

    Collins, J; Longhurst, G; Roschel, H; Gualano, B

    2016-01-01

    Studies assessing the effects co-supplementation with creatine and protein, along with resistance training, in older individuals with frailty are lacking. This is an exploratory trial from the Pro-Elderly study ("Protein Intake and Resistance Training in Aging") aimed at gathering knowledge on the feasibility, safety, and efficacy of co-supplementation with creatine and protein supplementation, combined with resistance training, in older individuals with frailty. A 14-week, double-blind, randomized, parallel-group, placebo controlled exploratory trial. The subjects were randomly assigned to whey protein and creatine co-supplementation (WHEY+CR) or whey protein supplementation (WHEY) group. All subjects undertook a supervised exercise training program and were assessed at baseline and after 14 weeks. Muscle function, body composition, blood parameters, and self-reported adverse events were assessed. No interaction effects (between-group differences) were observed for any dependent variables (p > 0.05 for all). However, there were main time-effects in handgrip (WHEY+CR = 26.65 ± 31.29; WHEY = 13.84 ± 14.93 Kg; p = 0.0005), timed-up-and-go (WHEY+CR = -11.20 ± 9.37; WHEY = -17.76 ± 21.74 sec; p = 0.006), and timed-stands test (WHEY+CR = 47.50 ± 35.54; WHEY = 46.87 ± 24.23 reps; p = 0.0001), suggesting that WHEY+CR and WHEY were similarly effective in improving muscle function. All of the subjects showed improvements in at least two of the three functional tests, regardless of their treatments. Body composition and blood parameters were not changed (p > 0.05). No severe adverse effects were observed. Co-supplementation with creatine and whey protein was well-tolerable and free of adverse events in older subjects with frailty undertaking resistance training. Creatine supplementation did not augment the adaptive effects of resistance training along with whey protein on body composition or muscle function in this population. Clinicaltrials.gov: NCT01890382.

  5. Elderly who take care of elderly: a study on the Frailty Syndrome.

    Science.gov (United States)

    Santos-Orlandi, Ariene Angelini Dos; Brito, Tábatta Renata Pereira de; Ottaviani, Ana Carolina; Rossetti, Estefani Serafim; Zazzetta, Marisa Silvana; Pavarini, Sofia Cristina Iost

    2017-01-01

    Identifying prevalence of frailty in elderly caregivers inserted in a high social vulnerability context and its correlation with sociodemographic and health aspects. Descriptive, correlational and cross-sectional study. Forty elderly caregivers were evaluated with: questionnaire for caregiver characterization, Mini Mental State Examination, Katz Index, Lawton instrumental activities of daily living scale, Geriatric Depression Scale and the frailty phenotype proposed by Fried. Interviews were conducted at their residences and scheduled in advance. All ethical precautions were observed. Data were analyzed with the Stata statistical program version 11.0. 10% of elderly caregivers were frail. There was a significant correlation between frailty and sex, instrumental activities of daily living and cognition. Female caregivers, partially dependent individuals regarding instrumental activities of daily living and with worse cognitive state deserve a special attention from health services. Identificar a prevalência de fragilidade em cuidadores idosos inseridos em contexto de alta vulnerabilidade social e sua correlação com aspectos sociodemográficos e de saúde. Estudo descritivo, correlacional, transversal. Foram avaliados 40 cuidadores idosos utilizando-se: questionário para caracterização do cuidador, Mini Exame do Estado Mental, Índice de Katz, Escala de atividades instrumentais de vida diária de Lawton, Escala de Depressão Geriátrica e o fenótipo de fragilidade proposto por Fried. As entrevistas foram realizadas no domicílio, sendo previamente agendadas. Todos os cuidados éticos foram observados. Os dados foram analisados com apoio do pacote estatístico Stata versão 11.0. 10,0% dos cuidadores idosos eram frágeis. Houve correlação significativa entre fragilidade e: sexo, atividades instrumentais de vida diária e cognição. Conclusão: Cuidadoras do sexo feminino, indivíduos parcialmente dependentes em relação às atividades instrumentais de vida

  6. Effect of weight loss and exercise on frailty in obese older adults.

    Science.gov (United States)

    Villareal, Dennis T; Banks, Marian; Sinacore, David R; Siener, Catherine; Klein, Samuel

    2006-04-24

    Obesity exacerbates the age-related decline in physical function and causes frailty in older persons. However, appropriate treatment for obese older persons is unknown. We evaluated the effects of weight loss and exercise therapy on physical function and body composition in obese older persons. We screened 40 obese older volunteers and eventually randomized 27 frail obese older volunteers to treatment or control groups. Treatment consisted of 6 months of weekly behavioral therapy for weight loss in conjunction with exercise training 3 times per week. Physical function was evaluated with measurements of frailty (Physical Performance Test, peak oxygen consumption, and Functional Status Questionnaire); strength, gait, and balance tests; body composition with dual-energy x-ray absorptiometry; and quality of life using the Medical Outcomes Survey 36-Item Short-Form Health Survey. Results are reported as mean +/- SD. Two subjects in the treatment group did not comply with the intervention, and 1 subject in the control group withdrew. Analyses included all 27 subjects originally randomized to the treatment and control groups. The treatment group lost 8.4% +/- 5.6% of body weight, whereas weight did not change in the control group (+0.5% +/- 2.8%; Pvs +1.7 +/- 4.1 kg; Pvs -1.0 +/- 3.5 kg; P = .75) in the treatment group. The Physical Performance Test score (2.6 +/- 2.5 vs 0.1 +/- 1.0; P = .001), peak oxygen consumption (1.7 +/- 1.6 vs 0.3 +/- 1.1 mL/min per kilogram; P = .02), and Functional Status Questionnaire score (2.9 +/- 3.7 vs -0.2 +/- 3.9; P = .02) improved in treated subjects compared with control subjects. Treatment also improved strength, walking speed, obstacle course, 1-leg limb stance time, and health survey physical subscale scores (all P<.05). These findings suggest that weight loss and exercise can ameliorate frailty in obese older adults. Trial Registration clinicaltrials.gov Identifier: NCT00146133.

  7. The prevalence and incidence of frailty in Pre-diabetic and diabetic community-dwelling older population: results from Beijing longitudinal study of aging II (BLSA-II).

    Science.gov (United States)

    Chhetri, Jagadish Kumar; Zheng, Zheng; Xu, Xitong; Ma, Cuihong; Chan, Piu

    2017-02-08

    Various factors including cardio-metabolic disorders are found to be correlated with frailty. With the increase in age, older adults are likely to have elevated blood glucose level. In this study we intend to investigate the prevalence and incidence of frailty in the pre-diabetic and diabetic community dwelling elderly population and the associated risk factors. At baseline total of 10,039 subjects with a mean age of 70.51 (±7.82) were included. A total of 6,293 older adults were followed up at 12 months. A Frailty index (FI) with 32 items was developed using Rockwood's cumulative deficits method. Frailty index ≥0.25 was used as cut-off criteria for the diagnosis of frailty. Diagnosis of pre-diabetes and diabetes was set according to the World Health Organization (WHO) criteria for fasting plasma glucose (FPG) level. Chi-square tests were performed to compare percentages by 3 major groups (non-diabetes, pre-diabetes, diabetes), ANOVA and student's t-tests was used to compare means of group for continuous variables. Multiple logistic regression models were performed to estimate the risk factors for frailty in non-diabetic, pre-diabetic and diabetic elderly populations using baseline and longitudinal data. Diabetic population had a much higher prevalence (19.32%) and incidence (12.32%) of frailty, compared to that of non-diabetic older adults (prevalence of 11.92% and incidence of 7.04%). And pre-diabetics had somewhat similar prevalence of 11.43% and slightly higher incidence of 8.73% for frailty than non-diabetic older adults. Diabetics were at 1.36 (95% CI = 1.18,1.56) and 1.56 (95%CI = 1.32,1.85) fold increase in risk of frailty compared to non-diabetic population for prevalence and incidence, respectively. Being female, urban living, high waist circumference, less house work and need regular anti-diabetic medications were independent risk factors only in pre-diabetic and diabetic older adults. This study confirms that diabetes is an independent

  8. Estimating effectiveness in HIV prevention trials with a Bayesian hierarchical compound Poisson frailty model

    Science.gov (United States)

    Coley, Rebecca Yates; Browna, Elizabeth R.

    2016-01-01

    Inconsistent results in recent HIV prevention trials of pre-exposure prophylactic interventions may be due to heterogeneity in risk among study participants. Intervention effectiveness is most commonly estimated with the Cox model, which compares event times between populations. When heterogeneity is present, this population-level measure underestimates intervention effectiveness for individuals who are at risk. We propose a likelihood-based Bayesian hierarchical model that estimates the individual-level effectiveness of candidate interventions by accounting for heterogeneity in risk with a compound Poisson-distributed frailty term. This model reflects the mechanisms of HIV risk and allows that some participants are not exposed to HIV and, therefore, have no risk of seroconversion during the study. We assess model performance via simulation and apply the model to data from an HIV prevention trial. PMID:26869051

  9. The complexity of bipolar and borderline personality: an expression of 'emotional frailty'?

    Science.gov (United States)

    McDermid, Joanna; McDermid, Robert C

    2016-01-01

    The purpose of this article is to review recent findings regarding the comorbidity of bipolar disorder with borderline personality disorder (BPD). The conceptualization of the comorbid condition is explored in the context of complexity theory. Recent studies highlight distinguishing features between the two disorders. The course of illness of the comorbid condition is generally considered to be more debilitating than bipolar disorder alone. Some of the differentiating features of bipolar disorder and BPD are highlighted. It is also crucial to consider a co-morbid diagnosis as worse outcomes may be anticipated than for bipolar disorder alone. The concept of 'emotional frailty' is introduced and the comorbid bipolar disorder-BPD condition is considered an expression of this syndrome.

  10. Frailty as a Predictor of Institutionalization Among Adults With Intellectual and Developmental Disabilities.

    Science.gov (United States)

    McKenzie, Katherine; Ouellette-Kuntz, Hélène; Martin, Lynn

    2016-04-01

    Adults with intellectual and developmental disabilities (IDD) frequently become frail earlier than the general population, resulting in higher care needs. This population is at risk for institutionalization, or re-institutionalization, into long-term care (LTC). Using a retrospective cohort design to follow 3,034 individuals (18-99 years) living in Ontario, Canada, and assessed with the Resident Assessment Instrument-Home Care, individuals were characterized with a frailty index (FI) for persons with IDD. Survival analyses determined differences in rates of admission to LTC and survival in the community. Frail individuals had greater rates of admission than non-frail individuals, adjusted HR = 2.19, 95% CI [1.81, 2.64]. The FI predicts institutionalization.

  11. Effectiveness of a multicomponent exercise program in the attenuation of frailty in long-term nursing home residents: study protocol for a randomized clinical controlled trial

    OpenAIRE

    Rodriguez-Larrad, Ana; Arrieta, Haritz; Rezola, Chloe; Kortajarena, Maider; Yanguas, Jose Javier; Iturburu, Miren; Susana, Mar?a Gil; Irazusta, Jon

    2017-01-01

    Background There is increasing evidence suggesting that cognition and physical frailty interact within a c