Frailty in older adults

2017 ◽  
pp. 429-436
Author(s):  
Jeremy Walston
Keyword(s):  
Older Adults ◽  
Environmental Drivers ◽  
Geriatric Syndrome ◽  
Geriatric Syndromes ◽  
Multiple Measurement ◽  
Adverse Health Outcomes ◽  
Age Related ◽  
Measurement Tools ◽  
Novel Approaches

Frailty is most often conceptualized as an age-related medical syndrome with a biological basis that results in substantial vulnerability stressors and adverse health outcomes. It is increasingly thought of as the geriatric syndrome that underlies all other geriatric syndromes. Multiple measurement tools have been developed that have helped to differentiate frail from more robust or resilient older adults; and these tools enabling the characterization of and consequences of frailty, as well as its underlying biology. The recognition of frailty as a condition of advanced vulnerability has led to the development of interventions and novel approaches to integrate frailty into clinical practice. The following chapter describes the conceptualization of frailty, surveys the vast array of tools used to identify frailty, provides demographic information and epidemiological characterizations of causes and consequences of frailty, identifies important biological and environmental drivers of frailty, and describes the clinical efforts underway to better utilize frailty tools.

scholarly journals Sleep in Normal Aging, Homeostatic and Circadian Regulation and Vulnerability to Sleep Deprivation

2021 ◽  
Vol 11 (8) ◽  
pp. 1003
Author(s):  
Jacques Taillard ◽  
Claude Gronfier ◽  
Stéphanie Bioulac ◽  
Pierre Philip ◽  
Patricia Sagaspe
Keyword(s):  
Older Adults ◽  
Sleep Deprivation ◽  
Health Management ◽  
Nrem Sleep ◽  
Early Morning ◽  
Subcortical Structures ◽  
Wake Time ◽  
Adverse Health Outcomes ◽  
Neurobehavioral Function ◽  
Age Related

In the context of geriatric research, a growing body of evidence links normal age-related changes in sleep with many adverse health outcomes, especially a decline in cognition in older adults. The most important sleep alterations that continue to worsen after 60 years involve sleep timing, (especially early wake time, phase advance), sleep maintenance (continuity of sleep interrupted by numerous awakenings) and reduced amount of sigma activity (during non-rapid eye movement (NREM) sleep) associated with modifications of sleep spindle characteristics (density, amplitude, frequency) and spindle–Slow Wave coupling. After 60 years, there is a very clear gender-dependent deterioration in sleep. Even if there are degradations of sleep after 60 years, daytime wake level and especially daytime sleepiness is not modified with age. On the other hand, under sleep deprivation condition, older adults show smaller cognitive impairments than younger adults, suggesting an age-related lower vulnerability to extended wakefulness. These sleep and cognitive age-related modifications would be due to a reduced homeostatic drive and consequently a reduced sleep need, an attenuation of circadian drive (reduction of sleep forbidden zone in late afternoon and wake forbidden zone in early morning), a modification of the interaction of the circadian and homeostatic processes and/or an alteration of subcortical structures involved in generation of circadian and homeostatic drive, or connections to the cerebral cortex with age. The modifications and interactions of these two processes with age are still uncertain, and still require further investigation. The understanding of the respective contribution of circadian and homeostatic processes in the regulation of neurobehavioral function with aging present a challenge for improving health, management of cognitive decline and potential early chronobiological or sleep-wake interventions.

The Association Between Sarcopenia and Postoperative Outcomes Among Older Adults With Hip Fracture: A Systematic Review

2021 ◽  
pp. 073346482110065
Author(s):  
Ming-Hsiu Chiang ◽  
Yi-Jie Kuo ◽  
Yu-Pin Chen
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Hip Fracture ◽  
Postoperative Mortality ◽  
Clinical Event ◽  
High Morbidity ◽  
Adverse Health Outcomes ◽  
Age Related ◽  
Study Selection ◽  
And Function

Hip fracture is a serious clinical event with high morbidity and mortality. Sarcopenia is characterized by age-related loss of muscle mass and function, leading to several adverse health outcomes. In this systematic review, no limitation criteria were used for study selection and 327 studies were identified in the initial search. Of these, 11 studies comprising a total of 2,314 patients were selected. The overall proportion of older adults with hip fracture having sarcopenia was 44%, with a disparity of approximately 10% between men and women. Most studies have indicated that older adults with sarcopenia had poorer postoperative functional recovery than those without sarcopenia; the association between sarcopenia and high postoperative mortality or long hospital stay was heterogeneous. Well-organized studies with longer follow-up periods are warranted.

Abstract 251: Geriatric Syndromes Associated With Reduced Anticoagulant Use in Older Adults With Atrial Fibrillation

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Sachin J Shah ◽  
Margaret C Fang ◽  
Sun Jeon ◽  
Steven Gregorich ◽  
Kenneth Covinsky
Keyword(s):  
Atrial Fibrillation ◽  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Stroke Risk ◽  
Geriatric Syndrome ◽  
Fee For Service ◽  
Geriatric Syndromes ◽  
Cross Sectional ◽  
Representative Study

Background: While guidelines recommend focusing primarily on stroke risk when considering anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls, disability) are important when considering anticoagulants. However, little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use. Methods: We performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older adults. We included patients ≥67 years with 2 years of continuous Medicare fee-for-service enrollment and 1 inpatient or 2 outpatient AF diagnosis claims. We evaluated five geriatric syndromes: falls, activities of daily living impairment (ADL), instrumental activities of daily living impairment (IADL), cognitive impairment, and incontinence. We measured their prevalence and associations with anticoagulant use via log-binomial regression models adjusting for CHA2DS2-VASc score. Results: In this study of 779 patients with AF (median age 80 years, median CHA2DS2-VASc score 4), 83% (CI 79-86%) had ≥1 geriatric syndrome. Adjusting for stroke risk, lower rates of anticoagulant use were reported in those with ADL dependency (RR 0.87, CI 0.79-99), IADL dependency (RR 0.86, CI 0.77-0.98), and dementia (RR 0.72, CI 0.60-0.86). Conclusion: Most older patients with AF have at least one geriatric syndrome, and geriatrics syndromes are associated with less anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulants use in older adults. Since the benefits and harms of anticoagulants in this group are ill-defined, it is unclear if lower anticoagulant use is appropriate.

Sarcopenia—definitions and epidemiology

2017 ◽  
pp. 409-414
Author(s):  
José A. Morais
Keyword(s):  
Older Adults ◽  
Skeletal Muscle ◽  
Muscle Mass ◽  
Protein Intake ◽  
Skeletal Muscle Mass ◽  
Handgrip Strength ◽  
Resistance Exercise Training ◽  
Adverse Health Outcomes ◽  
Age Related ◽  
Underlying Mechanisms

Sarcopenia is a progressive and inevitable loss of skeletal muscle mass and strength associated with ageing that places older adults at high risk for adverse health outcomes. Up to of 15% of older adults suffer negative healthcare consequences because of sarcopenia. Furthermore, it is responsible for two to four times greater risk of disability. Expert groups have proposed clinical oriented criteria based on gait speed <0.8 m/s and low handgrip strength before performing muscle mass assessment. Multiple aetiologies are implicated in the development of sarcopenia including age-related, lifestyle, neurodegeneration, hormonal, and inflammation factors. Resistance exercise training and higher than recommended protein intake are two accessible means to counteract sarcopenia. Hormonal interventions, despite amelioration in muscle and fat masses, have not led to significant gains in function. Sarcopenia shares many features with frailty and can be considered as one of its underlying mechanisms.

A Practical Guide to Geriatric Syndromes in Older Adults With Cancer: A Focus on Falls, Cognition, Polypharmacy, and Depression

2019 ◽  
pp. e96-e109 ◽  
Author(s):  
Allison Magnuson ◽  
Schroder Sattar ◽  
Ginah Nightingale ◽  
Rebecca Saracino ◽  
Emily Skonecki ◽  
...  
Keyword(s):  
Older Adults ◽  
Cancer Treatment ◽  
Screening Tools ◽  
Therapeutic Interventions ◽  
Geriatric Syndrome ◽  
Geriatric Syndromes ◽  
Geriatric Population ◽  
Multiple Systems ◽  
Patients At Risk ◽  
Cognitive Problems

Geriatric syndromes are multifactorial conditions that are prevalent in older adults. Geriatric syndromes are believed to develop when an individual experiences accumulated impairments in multiple systems that compromise their compensatory ability. In older adults with cancer, the presence of a geriatric syndrome is common and may increase the complexity of cancer treatment. In addition, the physiologic stress of cancer and cancer treatment may precipitate or exacerbate geriatric syndromes. Common geriatric syndromes include falls, cognitive syndromes and delirium, depression, and polypharmacy. In the oncology setting, the presence of geriatric syndromes is relevant; falls and cognitive problems have been shown to be predictive of chemotherapy toxicity and overall survival. Polypharmacy and depression are more common in older adults with cancer compared with the general geriatric population. Multiple screening tools exist to identify falls, cognitive problems, polypharmacy, and depression in older adults and can be applied to the oncology setting to identify patients at risk. When recognized, several interventions exist that could be considered for this vulnerable population. We review the available evidence of four geriatric syndromes in the oncology setting, including clinical implications, validated screening tools, potential supportive care, and therapeutic interventions.

scholarly journals Discussing age-related functional decline in family medicine: a qualitative study that explores both patient and physician perceptions

2019 ◽  
Vol 49 (2) ◽  
pp. 292-299
Author(s):  
Ophélie Viret ◽  
Joëlle Schwarz ◽  
Nicolas Senn ◽  
Yolanda Mueller
Keyword(s):  
Qualitative Study ◽  
Older People ◽  
Functional Limitations ◽  
Functional Decline ◽  
Management Tool ◽  
Geriatric Syndrome ◽  
Geriatric Syndromes ◽  
Age Related ◽  
Normal Ageing ◽  
Primary Care Practices

Abstract Background evaluating a patient’s functional status and screening for geriatric syndromes by general practitioners (GPs) are increasingly encouraged. This study aimed to explore how older people and GPs define and perceive autonomy and functional decline, patients’ propensity to discuss age-related issues and integration of such topics into routine medical consultations. Methods this qualitative study was conducted in Western Switzerland with older people followed in primary care practices and who participated in a trial assessing the effectiveness of a screening and management tool for geriatric syndromes to prevent functional decline. We interviewed 15 participants (patients ≥75 years old) and five GPs about their screening experience. We used semi-structured grids for data collection and an inductive thematic approach for data analysis. Results participants gave several definitions of autonomy, directly depending on their health status and functional limitations. Implementing various coping strategies, participants also expressed contrasted feelings related to functional decline such as fear, inability to accept and resilience. Functional decline was often perceived as normal ageing; participants were therefore not prompt at discussing age-related issues with their GP. However, screening was perceived positively by both participants and GPs, making addressing sensitive issues and detecting new problems possible. Conclusions a geriatric syndrome-screening intervention was well accepted by both patients and physicians. This type of initiative may be an opportunity to address various age-related issues and to inform patients of existing solutions.

scholarly journals Characterizing the Heterogeneity of Aging: A Vision for a Staging System for Aging

2021 ◽  
Vol 9 ◽  
Author(s):  
Efraim Jaul ◽  
Jeremy Barron
Keyword(s):  
Older Adults ◽  
Functional State ◽  
Disease Burden ◽  
Clinical Care ◽  
Primary Care Providers ◽  
Chronological Age ◽  
Anticipatory Guidance ◽  
Geriatric Syndromes ◽  
Age Related ◽  
The Impact

Introduction: Older adulthood encompasses several decades of change and heterogeneity. Primary care providers need a geriatric comprehensive vision for defining older adult subpopulations.Methods: Using PubMed and Google searches, we reviewed the literature on epidemiology of age-related physiological changes, age-related diseases and geriatric syndromes, functional state, and emotional and social changes. We divided old age into strata based on chronological age and strata based on functional state, disease burden, and geriatric syndromes.Results: We describe 4 chronological-age strata beginning at age 60, and 4 functional-age strata based on frailty according to a modified clinical frailty scale. We provide clinical considerations and anticipatory guidance topics for each of the age strata and functional strata.Conclusion: Chronological age, functional status, chronic disease burden and geriatric syndromes, and life expectancy are all important domains that impact clinical care and appropriate anticipatory guidance for individual older adults. Better knowledge for differentiating subpopulations of older adults may improve clinical care, reduce medical overuse, improve personalized anticipatory guidance, and focus on the impact of functional state on the quality of life.

scholarly journals Geriatric Syndromes and Atrial Fibrillation: Prevalence and Association with Anticoagulant use in a National Cohort of Older Americans

2020 ◽  
Author(s):  
Sachin J. Shah ◽  
Margaret C. Fang ◽  
Sun Y. Jeon ◽  
Steven E. Gregorich ◽  
Kenneth E. Covinsky
Keyword(s):  
Atrial Fibrillation ◽  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Stroke Risk ◽  
Geriatric Syndrome ◽  
Marginal Effect ◽  
Geriatric Syndromes ◽  
Cross Sectional ◽  
Older Americans

AbstractBackgroundWhile guidelines recommend focusing primarily on stroke risk to recommend anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls, disability) are important when considering anticoagulants. Little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use.MethodsWe performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older Americans. Participants were asked questions to assess domains of aging, including function, cognition, and medical conditions. We included participants ≥65 years with two years of continuous Medicare enrollment who met AF diagnosis criteria by claims codes. We examined five geriatric syndromes: one or more falls within the last two years, receiving help with activities of daily living (ADL) or instrumental activities of daily living (IADL), experienced incontinence, and cognitive impairment. We determined the prevalence of geriatric syndromes and their association with anticoagulant use adjusting for ischemic stroke risk (i.e., CHA2DS2-VASc score).ResultsIn this study of 779 participants with AF (median age 80 years, median CHA2DS2-VASc score 4), 82% had ≥1 geriatric syndrome. Geriatric syndromes were common: 49% reported falls, 38% had ADL impairments, 42% had IADL impairment, 37% had cognitive impairments, and 43% reported incontinence. Overall, 65% reported anticoagulant use; guidelines recommend anticoagulant use for 97% of participants. Anticoagulant use rate decreased for each additional geriatric syndrome (average marginal effect −3.7%; 95% CI −1.4% to −5.9%). Lower rates of anticoagulant use were reported in participants with ADL dependency, IADL dependency, and dementia.ConclusionMost older adults with AF had at least one geriatric syndrome, and geriatric syndromes were associated with reduced anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulant use in older adults.

scholarly journals Identifying vulnerable older adult populations by contextualizing geriatric syndrome information in clinical notes of electronic health records

2019 ◽  
Vol 26 (8-9) ◽  
pp. 787-795 ◽  
Author(s):  
Tao Chen ◽  
Mark Dredze ◽  
Jonathan P Weiner ◽  
Hadi Kharrazi
Keyword(s):  
Older Adults ◽  
Electronic Health Records ◽  
Older Adult ◽  
Contextual Information ◽  
Geriatric Syndrome ◽  
Geriatric Syndromes ◽  
Health Records ◽  
Clinical Notes ◽  
Diagnosis Codes ◽  
Electronic Health

Abstract Objective Geriatric syndromes such as functional disability and lack of social support are often not encoded in electronic health records (EHRs), thus obscuring the identification of vulnerable older adults in need of additional medical and social services. In this study, we automatically identify vulnerable older adult patients with geriatric syndrome based on clinical notes extracted from an EHR system, and demonstrate how contextual information can improve the process. Materials and Methods We propose a novel end-to-end neural architecture to identify sentences that contain geriatric syndromes. Our model learns a representation of the sentence and augments it with contextual information: surrounding sentences, the entire clinical document, and the diagnosis codes associated with the document. We trained our system on annotated notes from 85 patients, tuned the model on another 50 patients, and evaluated its performance on the rest, 50 patients. Results Contextual information improved classification, with the most effective context coming from the surrounding sentences. At sentence level, our best performing model achieved a micro-F1 of 0.605, significantly outperforming context-free baselines. At patient level, our best model achieved a micro-F1 of 0.843. Discussion Our solution can be used to expand the identification of vulnerable older adults with geriatric syndromes. Since functional and social factors are often not captured by diagnosis codes in EHRs, the automatic identification of the geriatric syndrome can reduce disparities by ensuring consistent care across the older adult population. Conclusion EHR free-text can be used to identify vulnerable older adults with a range of geriatric syndromes.

scholarly journals Autonomic dysregulation and sleep homeostasis in insomnia

SLEEP ◽  
2020 ◽  
Author(s):  
Daniela Grimaldi ◽  
Kathryn J Reid ◽  
Nelly A Papalambros ◽  
Rosemary I Braun ◽  
Roneil G Malkani ◽  
...  
Keyword(s):  
Older Adults ◽  
Sleep Quality ◽  
Underlying Mechanism ◽  
Sleep Cycle ◽  
Activity Levels ◽  
Subjective Sleep Quality ◽  
Subjective Sleep ◽  
Adverse Health Outcomes ◽  
Mechanistic Pathway ◽  
Age Related

Abstract Study objectives Insomnia is common in older adults, and is associated with poor health, including cognitive impairment and cardio-metabolic disease. Although the mechanisms linking insomnia with these comorbidities remain unclear, age-related changes in sleep and autonomic nervous system (ANS) regulation might represent a shared mechanistic pathway. In this study, we assessed the relationship between ANS activity with indices of objective and subjective sleep quality in older adults with insomnia. Methods Forty-three adults with chronic insomnia, and 16 age-matched healthy sleeper controls were studied. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), objective sleep quality by electroencephalogram spectral components derived from polysomnography, and ANS activity by measuring 24-h plasma cortisol and norepinephrine (NE). Results Sleep cycle analysis displayed lower slow oscillatory (SO: 0.5-1.25 Hz) activity in the first cycle in insomnia compared to controls. In insomnia, 24-h cortisol levels were higher and 24-h NE levels were lower than controls. In controls, but not in insomnia, there was a significant interaction between NE level during wake and SO activity levels across the sleep cycles, such that in controls but not in insomnia, NE level during wake was positively associated with the amount of SO activity in the first cycle. In insomnia, lower 24-h NE level and SO activity in the first sleep cycle were associated with poorer subjective sleep quality. Conclusion Dysregulation of autonomic activity may be an underlying mechanism that links objective and subjective measures of sleep quality in older adults with insomnia, and potentially contribute to adverse health outcomes.

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