ORAL FRAILTY IS ASSOCIATED WITH MULTIFACETED FRAILTY IN ELDERLY OUTPATIENTS AT COMMUNITY DENTAL CLINICS

Abstract Aim For achieving healthy aging, frailty prevention is essential. Because it is reported that accumulated declines in multiple oral functions (i.e. oral frailty) could lead to frailty progression, detailed countermeasures for oral frailty are currently required. However, dentists of community dental clinics don’t even know a prevalence of oral frailty among outpatients. Thus, we aimed to identify the prevalence of oral frailty and to examine the association with frailty in outpatients at community dental clinics. Methods The subjects were elderly outpatients at dental clinics in Kanagawa, Japan. Frailty was assessed using the Kihon checklists (KCL); those with ≥8 KCL score were classified as frailty. Furthermore, multiple functions (physical, nutrition, and oral) were assessed using subscale of the KCL. Oral frailty was defined as ≥3 deteriorations out of 5 oral status (remaining teeth, chewing ability, articulatory oral motor skill, subjective difficulties in eating and swallowing). Results Of 1,699 outpatients (mean age, 75 ± 6.3 years old; 40% men), 12% were frailty and 21% were oral frailty. When adjusted by confounding factors such as age and sex, those with oral frailty were associated with higher prevalence of frailty (OR, 3.25; 95%CI, 2.34-4.53), decreased physical and oral functions (OR, 1.53; 95%CI, 1.07-2.16: OR, 8.14; 95%CI, 6.05-10.95, respectively). Conclusions Oral frailty was associated with multi-faceted frailty in outpatients at community dental clinics. In addition to the importance of maintenance of whole oral functions including treating teeth, our findings suggest that it is also indispensable to consider the multi-faceted frailty for elderly patients.

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Effect of an Oral Frailty Measures Program on Community-Dwelling Elderly People: A Cluster-Randomized Controlled Trial

Gerontology ◽

10.1159/000516968 ◽

2021 ◽

pp. 1-10

Author(s):

Maki Shirobe ◽

Yutaka Watanabe ◽

Tomoki Tanaka ◽

Hirohiko Hirano ◽

Takeshi Kikutani ◽

...

Keyword(s):

Controlled Trial ◽

Intervention Group ◽

Tongue Pressure ◽

Control Group ◽

Oral Motor ◽

Randomized Controlled ◽

Chewing Ability ◽

Baseline Characteristics ◽

Cluster Randomized ◽

Oral Frailty

Introduction: Oral frailty describes a trivial decline in the oral function and is considered to be related to frailty. Thus, effective management of oral frailty could prevent or ameliorate physical frailty and the need for care. However, there is a lack of consensus regarding specific interventions for oral frailty. In this cluster-randomized controlled trial, we investigated the effects of a newly developed oral frailty measures program mentored by dentists and dental hygienists for elderly people in a clinical setting. Methods: Of 3,296 participants included in a field survey, 219 who regularly visited dental clinics and met at least 3 of the following 6 criteria for oral frailty were considered eligible: <20 natural teeth, decreased chewing ability, decreased articulatory oral-motor skills, decreased tongue pressure, and substantial subjective difficulties in eating and swallowing. After applying the inclusion and exclusion criteria, we studied 51 patients in the intervention group (14 men and 37 women; mean age, 78.6 years) and 32 patients in the control group (7 men and 25 women; mean age, 78.0 years). We implemented a 12-week oral frailty measures program only for the intervention group. The program included preparatory oral exercises, mouth-opening training, tongue pressure training, prosodic training, and masticatory training. Primary outcome measures were the chewing ability score, articulatory oral motor skill for /ta/, tongue pressure, subjective difficulty in eating tough foods, and subjective difficulty in swallowing. We compared baseline characteristics using the Mann-Whitney U and χ2 tests for continuous and categorical variables, respectively. A repeated-measures two-way ANOVA was used to determine the efficacy of independent intervention variables, following the Wilcoxon signed-rank test. The groups (intervention/control) and time (baseline/week 12) were the independent variables. Oral frailty measures were the dependent variables. Results: Baseline characteristics and assessment results were similar between groups. We observed significant improvements in the intervention group in terms of articulatory oral motor skill for /ta/ and tongue pressure (p < 0.001). No improvements were observed in the control group. Discussion/Conclusion: Our results suggest that our oral frailty measures program effectively alleviates oral frailty. Future studies are needed to clarify the impact on preventing physical frailty and improving the nutritional status.

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POLYPHARMACY IN ELDERLY OUT PATIENTS

Ulyanovsk Medico-biological Journal ◽

10.34014/2227-1848-2019-2-16-22 ◽

2019 ◽

pp. 16-22

Author(s):

E.A. Panova ◽

V.A. Serov ◽

A.M. Shutov ◽

N.N. Bakumtseva ◽

M.Yu. Kuzovenkova

Keyword(s):

Drug Therapy ◽

Elderly Patients ◽

Drug Prescription ◽

Daily Practice ◽

Drug Prescriptions ◽

Ulcer Disease ◽

Start Criteria ◽

Therapeutic Value ◽

Elderly Outpatients ◽

Oncological Diseases

The aim of the work is to study the daily practice of prescribing drugs at the outpatient stage of medical care and to analyze the data obtained based Beers 2012 criteria and STOPP / START version 1. Materials and Methods. The authors analyzed drug prescriptions for 150 outpatients, who were over 65 years old. Results. Cardiovascular diseases, diseases of the osteo-articular system and type 2 diabetes mellitus prevailed in the morbidity structure of patients. Oncological diseases, thyroid diseases, bronchial asthma, cataracts, pancreatitis, anemia, peptic ulcer disease were diagnosed in some patients. All drug prescriptions during the year were taken into account. Simultaneous prescription of more than 4 drugs was considered polypharmacy. All the patients were monitored for a year since drug prescriptions had been made. Death was taken as the end point. The authors considered drug therapy to be irrational according to Beers and STOPP / START criteria. The therapeutic value of drug prescription audit based on restrictive lists was evaluated. Conclusions. Polypharmacy is observed in more than half of elderly outpatients. According to Beers 2012 criteria, irrational drug therapy was detected in 20 % of elderly patients, according to STOPP and START lists – in 43.3 % and 66.6 %, respectively. The lack of drug prescriptions in accordance with START criteria is associated with increased mortality of elderly patients. Keywords: polypharmacy, pharmacotherapy, drug therapy, geriatrics, restrictive lists, Beers criteria, STOPP / START criteria. Цель работы – изучение ежедневной практики назначения лекарственных препаратов на амбулаторном этапе медицинской помощи и анализ полученных данных на основе критериев ограничительных перечней Бирса 2012 г. и STOPP/START версии 1. Материалы и методы. Проанализированы лекарственные назначения 150 пациентам старше 65 лет, находившимся на амбулаторном лечении. Результаты. В структуре заболеваемости пациентов преобладали сердечно-сосудистые заболевания, а также болезни костно-суставной системы и сахарный диабет 2-го типа. Онкологические заболевания, заболевания щитовидной железы, бронхиальная астма, катаракта, панкреатит, анемия, язвенная болезнь диагностированы у единичных больных. Учитывались все лекарственные назначения в течение года. За полипрагмазию принималось одновременное назначение более 4 препаратов. В течение последующего года отслеживалось состояние пациентов, за конечную точку принята смерть. Выявлена нерациональная лекарственная терапия на основе критериев Бирса и STOPP/START. Оценена терапевтическая значимость аудита лекарственных назначений по ограничительным перечням. Выводы. Полипрагмазия наблюдается более чем у половины амбулаторных пациентов пожилого возраста. На основе критериев ограничительных перечней Бирса 2012 г. нерациональная лекарственная терапия выявлена у 20 % пациентов пожилого возраста, на основе критериев STOPP и START – у 43,3 и 66,6 % соответственно. Отсутствие назначений лекарств в соответствии с критериями START ассоциировано с увеличением смертности пациентов пожилого возраста. Ключевые слова: полипрагмазия, фармакотерапия, лекарственная терапия, гериатрия, ограничительные перечни, критерии Бирса, критерии STOPP/START.

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Surgery for meningioma in the elderly and long-term survival: comparison with an age- and sex-matched general population and with younger patients

Journal of Neurosurgery ◽

10.3171/2016.2.jns152611 ◽

2017 ◽

Vol 126 (4) ◽

pp. 1201-1211 ◽

Cited By ~ 21

Author(s):

Benjamin Brokinkel ◽

Markus Holling ◽

Dorothee Cäcilia Spille ◽

Katharina Heß ◽

Cristina Sauerland ◽

...

Keyword(s):

General Population ◽

Elderly Patients ◽

Older Patients ◽

The Elderly ◽

Spinal Tumors ◽

Subtotal Resection ◽

High Grade ◽

Younger Patients ◽

Age And Sex

OBJECTIVE The purpose of this study was to compare long-term prognosis after meningioma surgery in elderly and younger patients as well as to compare survival of elderly patients with surgically treated meningioma to survival rates for the general population. METHODS Five hundred meningioma patients (median follow-up 90 months) who underwent surgery between 1994 and 2009 were subdivided into “elderly” (age ≥ 65 years, n = 162) and “younger” (age < 65 years, n = 338) groups for uni- and multivariate analyses. Mortality was compared with rates for the age- and sex-matched general population. RESULTS The median age at diagnosis was 71 in the elderly group and 51 years in the younger group. Sex, intracranial tumor location, grade of resection, radiotherapy, and histopathological subtypes were similar in the 2 groups. High-grade (WHO Grades II and III) and spinal tumors were more common in older patients than in younger patients (15% vs 8%, p = 0.017, and 12% vs 4%, p = 0.001, respectively). The progression-free interval (PFI) was similar in the 2 groups, whereas mortality at 3 months after surgery was higher and median overall survival (OS) was shorter in older patients (7%, 191 months) than in younger patients (1%, median not reached; HR 4.9, 95% CI 2.75–8.74; p < 0.001). Otherwise, the median OS in elderly patients did not differ from the anticipated general life expectancy (HR 1.03, 95% CI 0.70–1.50; p = 0.886). Within the older patient group, PFI was lower in patients with high-grade meningiomas (HR 24.74, 95% CI 4.23–144.66; p < 0.001) and after subtotal resection (HR 10.57, 95% CI 2.23–50.05; p = 0.003). Although extent of resection was independent of perioperative mortality, the median OS was longer after gross-total resection than after subtotal resection (HR 2.7, 95% CI 1.09–6.69; p = 0.032). CONCLUSIONS Elderly patients with surgically treated meningioma do not suffer from impaired survival compared with the age-matched general population, and their PFI is similar to that of younger meningioma patients. These data help mitigate fears concerning surgical treatment of elderly patients in an aging society.

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Mortality in elderly patients with hyperostotic disease of the cervical spine after fracture: an age- and sex-matched study

The Spine Journal ◽

10.1016/j.spinee.2011.01.018 ◽

2011 ◽

Vol 11 (4) ◽

pp. 257-264 ◽

Cited By ~ 22

Author(s):

Andrew J. Schoenfeld ◽

Mitchel B. Harris ◽

Kevin J. McGuire ◽

Natalie Warholic ◽

Kirkham B. Wood ◽

...

Keyword(s):

Cervical Spine ◽

Elderly Patients ◽

Matched Study ◽

Age And Sex

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Influence of age and sex on the pressor response following a spontaneous burst of muscle sympathetic nerve activity

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.01105.2011 ◽

2012 ◽

Vol 302 (11) ◽

pp. H2419-H2427 ◽

Cited By ~ 54

Author(s):

Lauro C. Vianna ◽

Emma C. Hart ◽

Seth T. Fairfax ◽

Nisha Charkoudian ◽

Michael J. Joyner ◽

...

Keyword(s):

Postmenopausal Women ◽

Sympathetic Nerve ◽

Healthy Aging ◽

Sympathetic Nerve Activity ◽

Pressor Response ◽

Muscle Sympathetic Nerve Activity ◽

Older Men ◽

Nerve Activity ◽

Arterial Blood ◽

Age And Sex

The sympathetic nervous system is critical for the beat-to-beat regulation of arterial blood pressure (BP). Although studies have examined age- and sex-related effects on BP control, findings are inconsistent and limited data are available in postmenopausal women. In addition, the majority of studies have focused on time-averaged responses without consideration for potential beat-to-beat alterations. Thus we examined whether the ability of muscle sympathetic nerve activity (MSNA) to modulate BP on a beat-to-beat basis is affected by age or sex. BP and MSNA were measured during supine rest in 40 young (20 men) and 40 older (20 men) healthy subjects. Beat-to-beat fluctuations in mean arterial pressure (MAP) were characterized for 15 cardiac cycles after each MSNA burst using signal averaging. The rise in MAP following an MSNA burst was similar between young men and women (+2.64 ± 0.3 vs. +2.57 ± 0.3 mmHg, respectively). However, the magnitude of the increase in MAP after an MSNA burst was reduced in older compared with young subjects ( P < 0.05). Moreover, the attenuation of the pressor response was greater in older women (+1.20 ± 0.1 mmHg) compared with older men (+1.72 ± 0.2 mmHg; P < 0.05). Interestingly, in all groups, MAP consistently decreased after cardiac cycles without MSNA bursts (nonbursts) with the magnitude of fall greatest in older men. In summary, healthy aging is associated with an attenuated beat-to-beat increase in BP after a spontaneous MSNA burst, and this attenuation is more pronounced in postmenopausal women. Furthermore, our nonburst findings highlight the importance of sympathetic vasoconstrictor activity to maintain beat-to-beat BP, particularly in older men.

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Triazolam and Nitrazepam Use in Elderly Outpatients

Annals of Pharmacotherapy ◽

10.1177/106002809302700420 ◽

1993 ◽

Vol 27 (4) ◽

pp. 506-509 ◽

Cited By ~ 16

Author(s):

Naoko Takami ◽

Akira Okada

Keyword(s):

Elderly Patients ◽

Adverse Reactions ◽

Control Group ◽

Primary Reason ◽

Control Groups ◽

Telephone Interviews ◽

Elderly Outpatients ◽

Appropriate Therapy ◽

Study Participants ◽

And Control

OBJECTIVE: To determine adverse reactions and effects on sleep among three groups of patients: those taking triazolam, those taking nitrazepam, and a control group. DESIGN: Telephone interviews. PATIENTS: Forty-seven patients taking triazolam, 36 taking nitrazepam, and 40 control patients. All study participants were outpatients over 60 years of age. RESULTS: The rate of awakening in the middle of sleep was not significantly different among patients taking triazolam (61.7 percent) and those taking nitrazepam (69.4 percent). Incidence of nocturia, the primary reason for awakening, was not significantly different between triazolam- (36.2 percent) and nitrazepam-taking patients (41.7 percent). The rate of having difficulty falling back to sleep was significantly different among triazolam (62.1 percent) and nitrazepam (8 percent), and triazolam and control (11.1 percent) groups (p<0.01). No difference was evident, however, between nitrazepam and control groups. CONCLUSIONS: Patients taking nitrazepam have less difficulty returning to sleep compared with those who take triazolam. Thus, for elderly patients who awaken because of nocturia, nitrazepam may be more appropriate therapy.

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Pengaruh kemampuan metakognitif terhadap kemampuan pemecahan masalah pada mahasiswa program akademik dan profesi Fakultas Kedokteran

YARSI Medical Journal ◽

10.33476/jky.v15i1.1006 ◽

2019 ◽

Vol 15 (1) ◽

Author(s):

Eti Poncorini Pamungkasari ◽

Bhisma Murti ◽

Haris Mudjiman

Keyword(s):

Regression Analysis ◽

Medical Students ◽

Problem Solving ◽

Linear Regression ◽

Multiple Linear Regression Model ◽

Confounding Factors ◽

Metacognitive Skill ◽

Medical Graduates ◽

Age And Sex ◽

Academic Programme

Problem solving ability is one of several competences that should be mastered by medical graduates. Metacognitive skill, which refers to skills of thinking about thinking, is presumed in the literature to have some relation with problem solving ability. This study aims to investigate the effect ofmetacognitive skill on problem solving ability among medical students of academic and professional programmes at the Faculty of Medicine. This study is analytic and observational, conducted at the Faculty of Medicine, Sebelas Maret University. The study subjects are medical students currentlyundertaking academic or professional programme at the Faculty of Medicine, Sebelas Maret University. Subject were selected purposively by distinguishing sub populations undertaking academic and professional programmes. From each sub population, 20 subjects were selected atrandom to result in a total of 40 subjects for this study. The data were collected by use of a questionnaire that has been previously designed by researchers abroad. The questionnaire was translated from English to Indonesian, modified accordingly, and subsequently tested for its validityand reliability, before use. The data were analyzed employing multiple linear regression model. The results of the regression analysis show that one score in metacognitive skill increases 0.71 score in problem solving ability (?= 0.71; 95%CI 0.37 to 1.06). In addition, students at the professional programme on average have problem solving ability 11.36 scores higher than those at the academic programme (?= 11.36; 95%CI 2.00 to 20.71). This study concludes that there is a statisticallysignfificant effect of metacognitive skill on problem solving ability among medical students at the Faculty of Medicine. After controlling for confounding factors such as learning stages, age, and sex, an increase in metacognitive skill will signficantly increase problem solving ability.

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Regular Sports Participation as a Potential Predictor of Better Clinical Outcome in Adult Patients With COVID-19: A Large Cross-Sectional Study

Journal of Physical Activity and Health ◽

10.1123/jpah.2020-0392 ◽

2020 ◽

pp. 1-5

Author(s):

Farzin Halabchi ◽

Reza Mazaheri ◽

Khashayar Sabeti ◽

Masoud Yunesian ◽

Zahra Alizadeh ◽

...

Keyword(s):

Clinical Outcome ◽

Patient Outcomes ◽

Sports Participation ◽

Signs And Symptoms ◽

Cross Sectional Study ◽

Adult Patients ◽

Confounding Factors ◽

Sectional Study ◽

Cross Sectional ◽

Age And Sex

Purpose: To compare the severity outcomes of COVID-19 disease between patients with and without regular sports participation. Methods: In a cross-sectional study, the authors investigated all patients who visited the emergency department of Imam Khomeini hospital with signs and symptoms of COVID-19 from February 20 to April 20, 2020. Then the authors assessed all patient outcomes (outpatient vs hospitalization or death). Finally, the authors compared the outcomes between athletes with regular sports participation and others, adjusting for confounding factors of age and sex. Results: Of all 4694 adult patients, 249 individuals (137 males and 112 females with mean [SD] age of 36.45 [9.77] y) had regular participation in different sport disciplines. Overall, 30 (12%) athletes were hospitalized or died (30 and 0, respectively) compared with 957 (21.5%) nonathletes (878 and 79, respectively). Athletes with regular sports participation were 1.49 times less likely to be hospitalized (P = .044). Conclusions: Regular sports participation may positively affect the clinical outcome, regardless of confounding factors of age and sex. The probability of hospitalization in athletes with regular sports participation was 33% lower than nonathletes. However, more longitudinal studies are needed to determine the causal effects.

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Adherence to Anti-coagulant therapy in elderly patients with Atrial fibrillation in the Kyrgyzstan

Biomedicine ◽

10.51248/.v41i3.1207 ◽

2021 ◽

Vol 41 (3) ◽

pp. 682-685

Author(s):

Kanat kyzy Bazira ◽

Nazgul Kinderbaeva ◽

Gulnora Karataeva ◽

Sabira Mamatova ◽

Ulan Kundashev ◽

...

Keyword(s):

Atrial Fibrillation ◽

Elderly Patients ◽

Warfarin Therapy ◽

Anticoagulation Therapy ◽

International Normalized Ratio ◽

Adverse Outcomes ◽

Drug Of Choice ◽

Number Of Patients ◽

Elderly Outpatients

Introduction: Anticoagulant therapy can prevent adverse outcomes of Atrial fibrillation (AF), reducing the risk of stroke by 64% and death by 25%. The present study aimed to assess treatment adherence in elderly patients with non-valvular atrial fibrillation (NVAF) who were prescribed the vitamin K antagonist warfarin. Materials and methods: In the present retrospective study, we analyzed the medical records of 202 elderly outpatients with NVAF aged between 65 and 74 years (mean ± SD: 68.7 ± 10.2 years). Results: Problems associated with warfarin arose throughout the follow-up period. After 1 month of treatment, the number of patients taking warfarin had decreased to 71.3% of all patients; less than half of the patients (46%) were still taking the drug. In subsequent periods, the number continued to decrease; of all patients who had been prescribed warfarin with periodic international normalized ratio (INR) control, only 19 (9.4%) remained after 1 year. Our study revealed inadequate anticoagulation therapy in elderly patients, probably because most patients refused warfarin therapy because they could not control their INR. Moreover, significantly more rural residents than urban residents refused therapy (48 vs. 22; p < 0.05). Doctors underprescribed anticoagulants because they feared hemorrhagic complications in their patients. Conclusion: The results of the present study showed that anticoagulants were underprescribed at the outpatient stage in centers of family medicine in our country. The main drug of choice for specialists remains warfarin, which only provides adequate therapy in a small number of patients (9.4%).

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Abstract 15230: Sex and Racial Differences in Normative Reference Ranges and Healthy Aging on Diastolic Function in Ethnic Asians: 2016 Ase Guideline Revisited

Circulation ◽

10.1161/circ.142.suppl_3.15230 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sheng Nan Chang ◽

Kuo-Tzu Sung ◽

Wen-Hung Huang ◽

Jou-Wei Lin ◽

Shih-Chieh Chien ◽

...

Keyword(s):

Diastolic Dysfunction ◽

Racial Differences ◽

Reference Values ◽

Healthy Aging ◽

Population Based ◽

Advanced Age ◽

Healthy Population ◽

Reference Ranges ◽

Using Data ◽

Age And Sex

Introduction: However, the reference ranges for echocardiography might be varying due to ethnicity, gender and age. Therefore, the normal reference ranges obtained from the healthy Asians are important for clinical utility of echocardiography in Asia. Methods: Population-based echocardiography dataset from 6,023 healthy ethnic Asians (47.1±10.9 years, 61.3% men) were divided into 6 age decades: ≤29, 30-39, 40-49, 50-59, 60-69 and ≥70 years. We explored age- and sex-related structural/functional alterations according to 2016 American Society of Echocardiography (ASE) diastolic dysfunction (DD) criteria and their correlates with clinical N-terminal pro-brain natriuretic peptide (NT-proBNP) cut-off for heart failure (HF). Racial comparisons were made using data from London Life Sciences Prospective Population (LOLIPOP) study. Results: Age- and sex-based normative reference ranges (including mean, median, 10% and 90% lower and upper reference values) were extracted from our large healthy population. In fully adjusted models, advanced age (treated as linear) was independently associated with cardiac structural remodeling and worsened diastolic parameters: larger indexed LA volume (LAVi), lower e’, higher E/e’, and higher TR velocity; all p <0.001), and were broadly more prominent in women (P interaction : <0.05). in general, markedly lower e’, higher E/e’ and smaller LAVi were observed in ethnic Asians compared to Whites. DD defined by 2016 ASE criteria, despite at low prevalence (0.42%) in current healthy population, increased drastically with advanced age and performed perfectly in excluding abnormal NT-proBNP (≥125 pg/ml) (Specificity: 99.8%, NPV: 97.6%). Conclusions: This is to date the largest cohort exploring the normative reference values using guideline-centered diastolic parameters from healthy Asians, with senescence process played as central role in diastolic dysfunction. Observed sex and ethnic differences in defining healthy diastolic cut-offs likely impact future clinical definition for DD.

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