14 A Systematic Review of the Prevalence and Implications of Frailty in Diabetes Mellitus

Abstract Background Frailty, an age-related state of vulnerability to adverse health outcomes, is an important factor in the management of diabetes. This systematic review aims to summarise the observational data on prevalence of frailty in diabetes and the association between frailty and generic (e.g. mortality) and diabetes specific (e.g. hypoglycaemia) outcomes. Methods We searched three electronic databases for observational studies assessing frailty in adults (≥18 years) with diabetes (type 1, type 2, or unspecified). Eligible studies quantified the prevalence or incidence of frailty or the association between frailty and clinical outcomes in the context of diabetes. Results 118 studies included, using 18 different frailty measures. Frailty phenotype was the most used (n = 69) followed by frailty index (n = 16) and the FRAIL scale (n = 10). Studies were highly heterogenous in terms of setting (88 community, 18 outpatient, 10 inpatient, 2 residential care), population demographics, and inclusion criteria. The median frailty prevalence in community-based studies using the frailty phenotype was 13% (interquartile range 7-18%). Frailty was identified in “middle-aged” (<65 years) as well as older people with diabetes. Diabetes was consistently associated with incident frailty. Frailty was associated with higher mortality, hospital admission, incident disability. Frailty was associated with hypoglycemic events in 1/1 study. Frailty was also associated cross-sectionally with micro- and macro-vascular complications, lower quality of life, and cognitive impairment. Frailty was not associated with difference in mean HbA1c, however people with frailty were more likely to have high (>9%) or low (<6.5%) HbA1c. Conclusions Frailty in diabetes is common but inconsistently measured. Frailty is associated with a range of adverse outcomes. Research gaps include the relationship between frailty and glycaemia (particularly hypoglycaemia and the relationship between HbA1c and outcomes in the context of frailty), and the impact of frailty in specific groups such as middle-aged people and in low and low-middle income countries.

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Frailty in people with rheumatoid arthritis: a systematic review of observational studies

Wellcome Open Research ◽

10.12688/wellcomeopenres.17208.1 ◽

2021 ◽

Vol 6 ◽

pp. 244

Author(s):

Peter Hanlon ◽

Holly Morrison ◽

Fraser Morton ◽

Bhautesh D Jani ◽

Stefan Siebert ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systematic Review ◽

Clinical Outcomes ◽

Observational Studies ◽

Osteoporotic Fractures ◽

Frailty Phenotype ◽

Cross Sectional ◽

Age Related ◽

The Impact ◽

The Relationship

Background: Frailty, an age-related decline in physiological reserve, is an increasingly important concept in the management of chronic diseases. The implications of frailty in people with rheumatoid arthritis are not well understood. We undertook a systematic review to assess the prevalence of frailty in people with rheumatoid arthritis, and the relationship between frailty and clinical outcomes. Methods: We searched three electronic databases (January 2001 to April 2021) for observational studies assessing the prevalence of frailty in adults (≥18 years) with rheumatoid arthritis, or analysing the relationship between frailty and clinical outcomes in the context of rheumatoid arthritis. Titles, abstracts and full texts were assessed independently by two reviewers. Study quality was assessed using an adapted Newcastle-Ottawa Scale. Results: We identified 17 analyses, from 14 different sample populations. 15/17 were cross-sectional. These studies used 11 different measures of frailty. Frailty prevalence ranged from 10% (frailty phenotype) to 36% (comprehensive rheumatologic assessment of frailty) in general adult populations with rheumatoid arthritis. In younger populations (<60 or <65 years) prevalence ranged from 2.4% (frailty phenotype) to 19.9% (Kihon checklist) while in older populations (>60 or >65) prevalence ranged from 31.2% (Kihon checklist) to 55% (Geriatric 8 tool). Frailty was associated with higher disease activity (10/10 studies), lower physical function (7/7 studies), longer disease duration (2/5 studies), hospitalization (1/1 study) and osteoporotic fractures (1/1 study). Conclusion: Our review found that frailty is common in adults with rheumatoid arthritis, including those aged <65 years, and is associated with a range of adverse features. However, these is substantial heterogeneity in how frailty is measured in rheumatoid arthritis. We found a lack of longitudinal studies making the impact of frailty on clinical outcomes over time and the extent to which frailty is caused by rheumatoid arthritis unclear.

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Diagnostic and predictive accuracy of the Clinical Frailty Scale among hospitalised older medical patients: a systematic review and meta-analysis protocol

BMJ Open ◽

10.1136/bmjopen-2020-040765 ◽

2021 ◽

Vol 11 (1) ◽

pp. e040765

Author(s):

Aoife Leahy ◽

Margaret O’Connor ◽

Jennifer Condon ◽

Sarah Heywood ◽

Elaine Shanahan ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Diagnostic Accuracy ◽

Meta Analysis ◽

Frailty Index ◽

Adverse Outcomes ◽

Nursing Home Admission ◽

Reference Standard ◽

Clinical Frailty Scale ◽

Frailty Phenotype

IntroductionFrailty is a common condition affecting older adults and is associated with increased mortality and adverse outcomes. Identification of older adults at risk of adverse outcomes is central to subsequent resource planning and targeted interventions. This systematic review and meta-analysis will examine the: (1) diagnostic accuracy of the Clinical Frailty Scale (CFS) in identifying hospitalised adults ≥65 years with frailty and a medical diagnosis compared with the reference standard Frailty Index or Frailty Phenotype and (2) predictive value of the CFS in determining those at increased risk of subsequent adverse outcomes.Methods and analysisWe will include cross-sectional, retrospective and prospective cohort studies, and randomised controlled trials that assess either the diagnostic accuracy of the CFS when compared with the reference standard Frailty Index/Frailty Phenotype or the predictive validity of the CFS to predict subsequent adverse outcomes in hospitalised adults over 65 years with medical complaints. Adverse outcomes include falls, functional decline, unplanned Emergency Department attendance, emergency rehospitalisation, nursing home admission or death. A systematic search will be conducted in Embase, AMED, MEDLINE (Ebsco, Ovid, Pubmed), CINAHL, PsycINFO, Cochrane Library. Studies will be limited to those published from 2005 to 30 October 2019. Two independent reviewers will screen all titles and abstracts to identify relevant studies. The methodological quality of studies will be independently assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. A CFS score of >4 will be used to identify frailty. We will construct 2×2 tables and determine true positives, true negatives, false positives and false negatives for each study when compared with the reference standard and for each adverse outcome. A bivariate random effects model will be applied to generate pooled summary estimates of sensitivity and specificity.Ethics and disseminationEthical approval is not required for this systematic review. We will disseminate our findings through a peer-reviewed journal.

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The relationship between micronutrient status and sleep patterns: a systematic review

Public Health Nutrition ◽

10.1017/s1368980016002603 ◽

2016 ◽

Vol 20 (4) ◽

pp. 687-701 ◽

Cited By ~ 13

Author(s):

Xiaopeng Ji ◽

Michael A Grandner ◽

Jianghong Liu

Keyword(s):

Systematic Review ◽

Older Adults ◽

Sleep Duration ◽

Future Research ◽

Sleep Stages ◽

Sleep Patterns ◽

Age Related ◽

Micronutrient Status ◽

The Impact ◽

The Relationship

AbstractObjectiveTo review articles on the relationship of dietary and circulating micronutrients with sleep patterns, and to identify issues surrounding implications for future research and public health practice.DesignA systematic review was conducted. PubMed, Embase and Scopus were searched through January 2016.SettingBoth experimental and observational studies were included. However, studies that focused on secondary sleep impairment due to comorbidities were excluded.SubjectsIndividuals in different age groups, from infants to older adults.ResultsA total of twenty-six articles were selected. In the articles reviewed, researchers generally supported a potential role of micronutrients, particularly Fe and Mg, in the development of sleep stages among infants and in reversing age-related alterations in sleep architecture in older adults. Micronutrient status has also been linked to sleep duration, with sleep duration positively associated with Fe, Zn and Mg levels, and negatively associated with Cu, K and vitamin B12 levels. The mechanisms underlying these relationships include the impact of micronutrients on excitatory/inhibitory neurotransmitters and the expression of circadian genes.ConclusionsAlthough the number of studies on the relationship between micronutrient status and sleep remains low, evidence has emerged that suggests a link between dietary/circulating micronutrients and sleep. Future research is needed to investigate the dose-dependent as well as the longitudinal relationships between micronutrient levels and human sleep across populations, test the interactions among micronutrients on sleep outcomes, and ultimately examine the clinical relevance of micronutrients on sleep health.

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Preclinical models of frailty: Focus on interventions and their translational impact: A review

Nutrition and Healthy Aging ◽

10.3233/nha-200103 ◽

2020 ◽

pp. 1-17

Author(s):

Manish Mishra ◽

Susan E. Howlett

Keyword(s):

Frailty Index ◽

Experimental Studies ◽

Adverse Outcomes ◽

The Body ◽

Assessment Tools ◽

Preclinical Models ◽

Frailty Phenotype ◽

The Past ◽

Pharmaceutical Agents ◽

The Impact

The concept of frailty refers to heterogeneity in the risk of adverse outcomes for people of the same age. It is traditionally thought of as the inability of the body to maintain homeostasis. It can help explain differences between chronological and biological age and can quantify healthspan in experimental studies. Although clinical studies have developed tools to quantify frailty over the past two decades, preclinical models of frailty have only recently been introduced. This review describes the notion of frailty and outlines two commonly used clinical approaches to quantify frailty: the frailty phenotype and the frailty index. Translation of these methodologies for use in animals is introduced and studies that use these models to evaluate interventions designed to attenuate or exacerbate frailty are discussed. These include studies involving manipulation of diet, implementation of exercise regimens and tests of pharmaceutical agents to exacerbate or attenuate frailty. Together, this body of work suggests that preclinical frailty assessment tools are a valuable new resource to quantify the impact of interventions on overall health. Future studies could deploy these models to evaluate new frailty therapies, test combinations of interventions and assess interventions to enhance the ability to resist stressors in the setting of ageing.

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Examining Organizational, Cultural, and Individual-Level Factors Related to Workplace Safety and Health Awareness and Risks: A Systematic Review and Metric Analysis (Preprint)

10.2196/preprints.12356 ◽

2018 ◽

Author(s):

Edmund W. J. Lee ◽

Han Zheng ◽

Htet Htet Aung ◽

Megha Rani Aroor ◽

Chen Li ◽

...

Keyword(s):

Systematic Review ◽

Citation Count ◽

Workplace Safety ◽

Key Factors ◽

Health Awareness ◽

Individual Level ◽

Metric Analysis ◽

Safety And Health ◽

The Impact ◽

The Relationship

BACKGROUND Promoting safety and health awareness and mitigating risks are of paramount importance to companies in high-risk industries. Yet, there are very few studies that have synthesized findings from existing online workplace safety and health literature to identify what are the key factors that are related to (a) safety awareness, (b) safety risks, (c) health awareness, and (d) health risks. OBJECTIVE As one of the first systematic reviews in the area of workplace health and safety, this study aims to identify the factors related to safety and health awareness as well as risks, and systematically map these factors within three levels: organizational, cultural, and individual level. Also, this review aims to assess the impact of these workplace safety and health publications in both academic (e.g., academic databases, Mendeley, and PlumX) and non-academic settings (e.g., social media platform). METHODS The systematic review was conducted in line with procedures recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). First, Proquest, ScienceDirect and Scopus were identified as suitable databases for the systematic review. Second, after inputting search queries related to safety and health awareness and risks, the articles were evaluated based on a set of inclusion and exclusion criteria. Third, the factors identified in the included articles were coded systematically. Fourth, the research team assessed the impact of the articles through a combination of traditional and new metric analysis methods: citation count, Altmetric Attention Score, Mendeley readers count, usage count, and capture count. RESULTS Out of a total of 4,831 articles retrieved from the three databases, 51 articles were included in the final sample and were systematically coded. The results revealed six categories of organizational (management commitment, management support, organizational safety communication, safety management systems, physical work environment, and organizational environment), two cultural (interpersonal support and organizational culture), and four individual (perception, motivation, attitude and behavior) level factors that relate to safety and health awareness and risk. In terms of impact, the relationship between citation count and the various metrics measuring academic activity (e.g., Mendeley readers, usage count, and capture count) were mostly significant while the relationship between citation count and Altmetric Attention Score was non-significant. CONCLUSIONS This study provides a macro view of the current state of workplace safety and health research and gives scholars an indication on some of the key factors of safety and health awareness and risks. Researchers should also be cognizant that while their work may receive attention from the scholarly community, it is important to tailor their communication messages for the respective industries they are studying to maximize the receptivity and impact of their findings. CLINICALTRIAL N.A.

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The health and relationship dynamics of late-life couples: a systematic review of the literature

Ageing and Society ◽

10.1017/s0144686x08007903 ◽

2009 ◽

Vol 29 (3) ◽

pp. 455-480 ◽

Cited By ~ 62

Author(s):

RUTH B. WALKER ◽

MARY A. LUSZCZ

Keyword(s):

Systematic Review ◽

Marital Quality ◽

Late Life ◽

The United States ◽

Health It ◽

Social Emotional ◽

Marital Relations ◽

The Impact ◽

The Relationship ◽

Adequate Communication

ABSTRACTLate-life husband and wife relationships are increasingly recognised as an important factor in promoting wellbeing, particularly in terms of the health, social, emotional, financial and practical needs of older people. Knowledge of marital dynamics and how they affect both members of a couple remains scarce. This systematic review aimed to identify and appraise research that has focused explicitly on the dynamics of the relationship, as evinced by data frombothspouses. Implementing rigorous identification strategies, 45 articles were identified and reviewed. These studies were grouped into three broad thematic areas: marital relations and satisfaction; concordance in emotional state or physical health; and the interplay between marital quality and wellbeing. The issues found to affect marital relations and satisfaction in late life included equality of roles, having adequate communication, and transitions to living apart. There is strong evidence for couple concordance in depression, that marital relationships affect ill-health, longevity and recovery from illness, and reciprocally that ill-health impacts on the marriage itself. The research also suggests important gender differences in the impact of marital dynamics on health. It has led to the conclusion that there is a need for more diverse studies of late-life marriages, particularly ones that examine the dynamics of non-traditional elderly couples and that extend beyond a predominant focus on the Caucasian population of the United States.

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Exploring Early Detection of Frailty Syndrome in Older Adults: Evaluation of Oxi-Immune Markers, Clinical Parameters and Modifiable Risk Factors

Antioxidants ◽

10.3390/antiox10121975 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1975

Author(s):

Armanda Teixeira-Gomes ◽

Blanca Laffon ◽

Vanessa Valdiglesias ◽

Johanna M. Gostner ◽

Thomas Felder ◽

...

Keyword(s):

Older Adults ◽

Immune Activation ◽

Future Research ◽

Clinical Parameters ◽

Frailty Syndrome ◽

Immune Markers ◽

Frailty Phenotype ◽

Age Related ◽

Inflammatory Molecules ◽

The Relationship

Ageing is accompanied with a decline in several physiological systems. Frailty is an age-related syndrome correlated to the loss of homeostasis and increased vulnerability to stressors, which is associated with increase in the risk of disability, comorbidity, hospitalisation, and death in older adults. The aim of this study was to understand the relationship between frailty syndrome, immune activation, and oxidative stress. Serum concentrations of vitamins A and E were also evaluated, as well as inflammatory biomarkers (CRP and IL-6) and oxidative DNA levels. A group of Portuguese older adults (≥65 years old) was engaged in this study and classified according to Fried’s frailty phenotype. Significant increases in the inflammatory mediators (CRP and IL-6), neopterin levels, kynurenine to tryptophan ratio (Kyn/Trp), and phenylalanine to tyrosine ratio (Phe/Tyr), and significant decreases in Trp and Tyr concentrations were observed in the presence of frailty. IL-6, neopterin, and Kyn/Trp showed potential as predictable biomarkers of frailty syndrome. Several clinical parameters such as nutrition, dependency scales, and polypharmacy were related to frailty and, consequently, may influence the associations observed. Results obtained show a progressive immune activation and production of pro-inflammatory molecules in the presence of frailty, agreeing with the inflammageing model. Future research should include different dimensions of frailty, including psychological, social, biological, and environmental factors.

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Abstract P274: Relationship Between Stroke Quality Metrics and Patient Outcomes: A Systematic Review

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap274 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Carol J Parker ◽

Mathew J Reeves

Keyword(s):

Systematic Review ◽

Acute Care ◽

Patient Outcomes ◽

Stroke Care ◽

Evidence Base ◽

Quality Metrics ◽

Care Quality ◽

Stroke Recurrence ◽

The Impact ◽

The Relationship

Background: Stroke quality metrics play an increasingly important role in quality improvement efforts and policies, but the relationship between quality metrics and patient-orientated outcomes are not well described. We conducted a systematic review of observational hospital-based studies examining this relationship. Methods: We searched MEDLINE and EMBASE for studies published before December 31, 2010 that examined the relationship between 2 or more stroke quality metrics and patient-oriented outcomes in acute stroke admissions. Outcomes included mortality, length of stay, discharge to home, functional status, and stroke recurrence. Results: A total of 470 hits were identified. After screening the titles and abstracts, 27 studies underwent full review, and 14 were deemed eligible. Given the variation in study characteristics, quality metrics, and outcomes utilized, it was not possible to generate summary estimates describing the relationship between quality metric compliance and patient-oriented outcomes. Evidence of a positive relationship between quality metrics and improved patient outcomes was limited by the lack of high quality studies. Four of the 14 studies found a statistically significant relationship between increased compliance with acute care quality metrics and improved patient-oriented outcomes. Two studies failed to find an association between acute care measures and improved outcomes, but did find statistically significant positive relationships between compliance with post-acute rehabilitation measures and improved patient outcomes. Five other studies reported mixed findings, while the remaining three found no relationships. Conclusions: We found a limited evidence-base addressing the impact of compliance on stroke quality metrics and patient-oriented outcomes. Generation of data clarifying the relationship between compliance with stroke quality metrics and stroke-related outcomes should be prioritized so that the current investments undertaken to improve stroke care can be sustained.

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