scholarly journals Validation of a Claims-Based Frailty Index Against Physical Performance and Adverse Health Outcomes in the Health and Retirement Study

2018 ◽  
Vol 74 (8) ◽  
pp. 1271-1276 ◽  
Author(s):  
Dae Hyun Kim ◽  
Robert J Glynn ◽  
Jerry Avorn ◽  
Lewis A Lipsitz ◽  
Kenneth Rockwood ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Grip Strength ◽  
Physical Performance ◽  
Gait Speed ◽  
Daily Living ◽  
Frailty Index ◽  
Activity Of Daily Living ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Retirement Study

Abstract Background A claims-based frailty index (CFI) was developed based on a deficit-accumulation approach using self-reported health information. This study aimed to independently validate the CFI against physical performance and adverse health outcomes. Methods This retrospective cohort study included 3,642 community-dwelling older adults who had at least 1 health care encounter in the year prior to assessments of physical performance in the 2008 Health and Retirement Study wave. A CFI was estimated from Medicare claims data in the past year. Gait speed, grip strength, and the 2-year risk of death, institutionalization, disability, hospitalization, and prolonged (>30 days) skilled nursing facility (SNF) stay were evaluated for CFI categories (robust: <0.15, prefrail: 0.15–0.24, mildly frail: 0.25–0.34, moderate-to-severely frail: ≥0.35). Results The prevalence of robust, prefrail, mildly frail, and moderate-to-severely frail state was 52.7%, 38.0%, 7.1%, and 2.2%, respectively. Individuals with higher CFI had lower mean gait speed (moderate-to-severely frail vs robust: 0.39 vs 0.78 m/s) and weaker grip strength (19.8 vs 28.5 kg). Higher CFI was associated with death (moderate-to-severely frail vs robust: 46% vs 7%), institutionalization (21% vs 5%), activity of daily living disability (33% vs 9%), instrumental activity of daily living disability (100% vs 22%), hospitalization (79% vs 23%), and prolonged SNF stay (17% vs 2%). The odds ratios per 1-SD (=0.07) difference in CFI were 1.46–2.06 for these outcomes, which remained statistically significant after adjustment for age, sex, and a comorbidity index. Conclusion The CFI is useful to identify individuals with poor physical function and at greater risks of adverse health outcomes in Medicare data.

scholarly journals Brain Magnetic Susceptibility is Associated With Slower Gait in Community-Dwelling Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 878-878
Author(s):  
Victoria Poole ◽  
Robert Dawe ◽  
Sue Luergans ◽  
David Bennett ◽  
Aron Buchman ◽  
...  
Keyword(s):  
Older Adults ◽  
Magnetic Susceptibility ◽  
Health Outcomes ◽  
Gait Speed ◽  
Right Hemisphere ◽  
Community Dwelling ◽  
Gaussian Kernel ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Community Dwelling Older Adults

Abstract Age-related slowing of gait is exceedingly common and a robust predictor of various adverse health outcomes in older age. Prior neuroimaging studies have documented diverse non-specific structural brain abnormalities which are related to slow gait; however, the extent to which quantitative susceptibility mapping (QSM), which measures regional magnetic susceptibility in the brain, associates with gait speed remains unexplored. In the current study, 415 non-demented community-dwelling older adults (91 males; 81+/- 7 years) underwent an MRI (Siemens 3T TIM Trio) and in-home motor assessment. Gait speed was measured and averaged across 2 timed 8-ft walks. MR-acquired QSM data were pre-processed, registered to ICBM template, and spatially smoothed with a 5mm FWHM Gaussian kernel. When these maps entered group-level GLMs, voxel-wise associations with gait speed were of interest, after adjusting for demographics. We observed very strong negative associations between gait speed and magnetic susceptibility, such that those with slower gait had higher susceptibility in bilateral inferior frontal, superior temporal, and angular gyri (corrected p&lt;.0005). Robust associations were also observed in the middle frontal, precentral, and postcentral gyri of the right hemisphere. These novel findings suggest that reduced myelination or increased iron accumulation in these brain regions may contribute to impaired gait. Future work will need to determine to what extent these cross-sectional QSM metrics are independent predictors of incident adverse health outcomes when controlling for other common brain imaging abnormalities observed in older adults.

scholarly journals Physical Performance Characteristics of Assisted Living Residents and Risk for Adverse Health Outcomes

2008 ◽  
Vol 48 (2) ◽  
pp. 203-212 ◽  
Author(s):  
C. A. Giuliani ◽  
A. L. Gruber-Baldini ◽  
N. S. Park ◽  
L. A. Schrodt ◽  
F. Rokoske ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Physical Performance ◽  
Assisted Living ◽  
Performance Characteristics ◽  
Adverse Health ◽  
Adverse Health Outcomes

scholarly journals Productivity Improvements in Hip and Knee Surgery

Arthritis ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-8
Author(s):  
Frank A. Sloan ◽  
Linda K. George ◽  
Linyan Hu
Keyword(s):  
Propensity Score ◽  
Health Outcomes ◽  
Physical Functioning ◽  
Daily Living ◽  
Secular Trends ◽  
Activity Of Daily Living ◽  
Control Groups ◽  
Hip And Knee Surgery ◽  
Retirement Study ◽  
Over Time

Productivity improvements that occur as technologies become widely used are not well documented. This study measured secular trends over 1998–2010 in productivity of hip and knee procedures gauged in terms of changes in physical function and pain after versus before surgery. We used data from the Health and Retirement Study. Health outcomes from surgery were measured by 6 physical functioning scales and 2 pain indicators. We used propensity score matching to obtain nonsurgery control groups. Not only were there substantial improvements in physical functioning and pain reduction after receipt of these procedures in all years, but also we documented improvements in health outcomes over time. Largest improvements were for reductions in numbers of Activity and Instrumental Activity of Daily Living limitations for knee procedures.

scholarly journals Different Combinations of Mobility Metrics Derived From a Wearable Sensor Are Associated With Distinct Health Outcomes in Older Adults

2019 ◽  
Vol 75 (6) ◽  
pp. 1176-1183 ◽  
Author(s):  
Aron S Buchman ◽  
Robert J Dawe ◽  
Sue E Leurgans ◽  
Thomas A Curran ◽  
Timothy Truty ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Gait Speed ◽  
Daily Living ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Adverse Health Outcomes ◽  
Backward Elimination ◽  
Cox Proportional Hazards Models

Abstract Background Gait speed is a robust nonspecific predictor of health outcomes. We examined if combinations of gait speed and other mobility metrics are associated with specific health outcomes. Methods A sensor (triaxial accelerometer and gyroscope) placed on the lower back, measured mobility in the homes of 1,249 older adults (77% female; 80.0, SD = 7.72 years). Twelve gait scores were extracted from five performances, including (a) walking, (b) transition from sit to stand, (c) transition from stand to sit, (d) turning, and (e) standing posture. Using separate Cox proportional hazards models, we examined which metrics were associated with time to mortality, incident activities of daily living disability, mobility disability, mild cognitive impairment, and Alzheimer’s disease dementia. We used a single integrated analytic framework to determine which gait scores survived to predict each outcome. Results During 3.6 years of follow-up, 10 of the 12 gait scores predicted one or more of the five health outcomes. In further analyses, different combinations of 2–3 gait scores survived backward elimination and were associated with the five outcomes. Sway was one of the three scores that predicted activities of daily living disability but was not included in the final models for other outcomes. Gait speed was included along with other metrics in the final models predicting mortality and activities of daily living disability but not for other outcomes. Conclusions When analyzing multiple mobility metrics together, different combinations of mobility metrics are related to specific adverse health outcomes. Digital technology enhances our understanding of impaired mobility and may provide mobility biomarkers that predict distinct health outcomes.

scholarly journals Functional ageing in fibrotic interstitial lung disease: the impact of frailty on adverse health outcomes

2019 ◽  
Vol 55 (1) ◽  
pp. 1900647 ◽  
Author(s):  
Sabina A. Guler ◽  
Joanne M. Kwan ◽  
Janice M. Leung ◽  
Nasreen Khalil ◽  
Pearce G. Wilcox ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Interstitial Lung Disease ◽  
Health Outcomes ◽  
Lung Disease ◽  
Clinical Decision Making ◽  
Frailty Index ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
The Impact

BackgroundAccelerated biological and functional ageing is common in fibrotic interstitial lung disease (ILD); however, their impact on adverse health outcomes has not been evaluated in this population.MethodsPatients were prospectively recruited from a specialised ILD clinic. Functional ageing was determined by frailty index and biological age by measurement of absolute telomere length (aTL) from patients' peripheral blood leukocytes. Adverse health outcomes included health-related quality of life (St George's Respiratory Questionnaire), number and length of respiratory and non-respiratory hospitalisations, medication tolerability and time to death or lung transplantation. Multivariable models were used to determine the risks and rates of adverse health outcomes associated with the frailty index and aTL.Results540 patients with fibrotic ILD, including 100 with idiopathic pulmonary fibrosis (IPF), provided 749 frailty index assessments, with 189 patients providing blood samples. The frailty index was strongly associated with quality of life, rate of hospitalisation, time to hospital discharge and mortality, including adjustment for age, sex, disease severity and IPF diagnosis. Mortality prognostication was improved by the addition of the frailty index to commonly used clinical parameters and previously validated composite indices. Conversely, aTL was not associated with most adverse health outcomes. The effect of chronological age on outcomes was mediated primarily by the frailty index, and to a lesser extent by aTL.ConclusionsFunctional ageing is associated with adverse health outcomes in patients with fibrotic ILD, indicating the need for consideration of the individual functional age into clinical decision-making.

scholarly journals Associations between a laboratory frailty index and adverse health outcomes across age and sex

2019 ◽  
Vol 2 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Joanna M. Blodgett ◽  
Olga Theou ◽  
Arnold Mitnitski ◽  
Susan E. Howlett ◽  
Kenneth Rockwood
Keyword(s):  
Health Outcomes ◽  
Frailty Index ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Age And Sex

scholarly journals A frailty index based on laboratory deficits in community-dwelling men predicted their risk of adverse health outcomes

2016 ◽  
Vol 45 (4) ◽  
pp. 463-468 ◽  
Author(s):  
Joanna M. Blodgett ◽  
Olga Theou ◽  
Susan E. Howlett ◽  
Frederick C. W. Wu ◽  
Kenneth Rockwood
Keyword(s):  
Health Outcomes ◽  
Frailty Index ◽  
Community Dwelling ◽  
Adverse Health ◽  
Adverse Health Outcomes

scholarly journals Prediction of Adverse Health Outcomes in Older People Using a Frailty Index Based on Routine Primary Care Data

2012 ◽  
Vol 68 (3) ◽  
pp. 301-308 ◽  
Author(s):  
I. Drubbel ◽  
N. J. de Wit ◽  
N. Bleijenberg ◽  
R. J. C. Eijkemans ◽  
M. J. Schuurmans ◽  
...  
Keyword(s):  
Primary Care ◽  
Older People ◽  
Health Outcomes ◽  
Frailty Index ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Primary Care Data

scholarly journals Frailty Prevalence in the COMPASS-ND Study of Neurodegenerative Disorders

2019 ◽  
Vol 22 (4) ◽  
pp. 205-212 ◽  
Author(s):  
Jacqueline R. Burt ◽  
Judith Godin ◽  
Josée Filion ◽  
Manuel Montero-Odasso ◽  
Kenneth Rockwood ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Status ◽  
Health Outcomes ◽  
Neurodegenerative Disorders ◽  
Frailty Index ◽  
Frailty Phenotype ◽  
Frailty Status ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
The Difference

BackgroundFrailty is characterized by increased vulnerability to adverse health outcomes. The prevalence of frailty across neurodegenerative disorders (NDD) is largely unknown. Symptoms of frailty and NDD overlap, calling into question a tautology in some frailty instruments. Our objectives were 1) to construct a Frailty Index (FI) independent of NDD symptoms, and 2) to estimate frailty prevalence in a broad NDD cohort using both the Frailty Phenotype (FP) and the constructed FI as measures.MethodsData from the Canadian COMPASS-ND cohort study were assessed for applicability to FI construction. Frailty status accord-ing to FI and FP criteria were ascertained for each participant. Results81 items were selected for the FI. In the cohort (150 participants; 46% women; mean age 73.6±7.0; 10 NDD subgroups), frailty was identified in 11% and 14% of participants according to the FI and FP, respectively. The difference between estimates was not significant. The FP classified most participants (84%) as pre-frail. ConclusionThe presence of frailty elements, regardless of whether they are part of NDD, is likely to influence health status. Given the FP identified a large proportion of the cohort as pre-frail or frail, it is likely worthwhile to identify frailty in the context of NDD.

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