Interventions to prevent, delay or reverse frailty in older people: a journey towards clinical guidelines

Abstract Background Age-related frailty is a multidimensional dynamic condition associated with adverse patient outcomes and high costs for health systems. Several interventions have been proposed to tackle frailty. This correspondence article describes the journey through the development of evidence- and consensus-based guidelines on interventions aimed at preventing, delaying or reversing frailty in the context of the FOCUS (Frailty Management Optimisation through EIP-AHA Commitments and Utilisation of Stakeholders Input) project (664367-FOCUS-HP-PJ-2014). The rationale, framework, processes and content of the guidelines are described. Main text The guidelines were framed into four questions – one general and three on specific groups of interventions – all including frailty as the primary outcome of interest. Quantitative and qualitative studies and reviews conducted in the context of the FOCUS project represented the evidence base. We followed the GRADE Evidence-to-Decision frameworks based on assessment of whether the problem is a priority, the magnitude of the desirable and undesirable effects, the certainty of the evidence, stakeholders’ values, the balance between desirable and undesirable effects, the resource use, and other factors like acceptability and feasibility. Experts in the FOCUS consortium acted as panellists in the consensus process. Overall, we eventually recommended interventions intended to affect frailty as well as its course and related outcomes. Specifically, we recommended (1) physical activity programmes or nutritional interventions or a combination of both; (2) interventions based on tailored care and/or geriatric evaluation and management; and (3) interventions based on cognitive training (alone or in combination with exercise and nutritional supplementation). The panel did not support interventions based on hormone treatments or problem-solving therapy. However, all our recommendations were weak (provisional) due to the limited available evidence and based on heterogeneous studies of limited quality. Furthermore, they are conditional to the consideration of participant-, organisational- and contextual/cultural-related facilitators or barriers. There is insufficient evidence in favour of or against other types of interventions. Conclusions We provided guidelines based on quantitative and qualitative evidence, adopting methodological standards, and integrating relevant stakeholders’ inputs and perspectives. We identified the need for further studies of a higher methodological quality to explore interventions with the potential to affect frailty.

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Efficacy and efficiency of fracture liaison services to reduce the risk of recurrent osteoporotic fractures

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01844-9 ◽

2021 ◽

Author(s):

M. K. Javaid

Keyword(s):

Patient Outcomes ◽

Observational Studies ◽

Primary Outcome ◽

Osteoporotic Fractures ◽

Evidence Base ◽

Models Of Care ◽

Care Gap ◽

Fracture Liaison Services ◽

Randomised Control Trials ◽

Fracture Liaison

Abstract Background Acting to prevent the next fracture after a sentinel fracture is support by the evidence base and brings benefits for patients, clinicians and healthcare systems. However, more patients after a fragility fracture remain untreated and vulnerable to future potentially life-changing fractures. Fracture liaison services (FLS) are models of care that can close this care gap. Methods A narrative review of the key evidence for the efficacy and effectiveness of FLS was performed Results There are few randomised control trials of FLSs and none with fracture as the primary outcome. Several observational studies have also demonstrated reductions in fracture, but most were limited by potential bias. Several studies have highlighted that not every FLS is automatically effective. Conclusion Further research should focus on implementing effective FLS using published standards and only then exploring impacts on patient outcomes such as refracture rates.

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Impact of Polyphenolic-Food on Longevity: An Elixir of Life. An Overview

Antioxidants ◽

10.3390/antiox10040507 ◽

2021 ◽

Vol 10 (4) ◽

pp. 507

Author(s):

Rosaria Meccariello ◽

Stefania D’Angelo

Keyword(s):

Oxidative Stress ◽

Food Sources ◽

Preventive Action ◽

Nutritional Interventions ◽

Beneficial Effects ◽

Age Related ◽

Macromolecular Damage ◽

And Oxidative Stress

Aging and, particularly, the onset of age-related diseases are associated with tissue dysfunction and macromolecular damage, some of which can be attributed to accumulation of oxidative damage. Recently, growing interest has emerged on the beneficial effects of plant-based diets for the prevention of chronic diseases including obesity, diabetes, and cardiovascular disease. Several studies collectively suggests that the intake of polyphenols and their major food sources may exert beneficial effects on improving insulin resistance and related diabetes risk factors, such as inflammation and oxidative stress. They are the most abundant antioxidants in the diet, and their intake has been associated with a reduced aging in humans. Polyphenolic intake has been shown to be effective at ameliorating several age-related phenotypes, including oxidative stress, inflammation, impaired proteostasis, and cellular senescence, both in vitro and in vivo. In this paper, effects of these phytochemicals (either pure forms or polyphenolic-food) are reviewed and summarized according to affected cellular signaling pathways. Finally, the effectiveness of the anti-aging preventive action of nutritional interventions based on diets rich in polyphenolic food, such as the diets of the Blue zones, are discussed.

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Management of Sternal Precautions Following Median Sternotomy by Physical Therapists in Australia: A Web-Based Survey

Physical Therapy ◽

10.2522/ptj.20100373 ◽

2012 ◽

Vol 92 (1) ◽

pp. 83-97 ◽

Cited By ~ 16

Author(s):

Lara J. Tuyl ◽

Jennifer H. Mackney ◽

Catherine L. Johnston

Keyword(s):

Patient Outcomes ◽

Physical Therapists ◽

Physical Therapist ◽

Median Sternotomy ◽

Evidence Base ◽

Cross Sectional ◽

Web Based ◽

Wound Breakdown ◽

Observational Design ◽

Midline Sternotomy

Background Sternal precautions are utilized within many hospitals with the aim of preventing the occurrence of sternal complications (eg, infection, wound breakdown) following midline sternotomy. The evidence base for sternal precaution protocols, however, has been questioned due to a paucity of research, unknown effect on patient outcomes, and possible discrepancies in pattern of use among institutions. Objective The objective of this study was to investigate and document the use of sternal precautions by physical therapists in the treatment of patients following median sternotomy in hospitals throughout Australia, from immediately postsurgery to discharge from the hospital. Design A cross-sectional, observational design was used. An anonymous, Web-based survey was custom designed for use in the study. Methods The questionnaire was content validated, and the online functionality was assessed. The senior cardiothoracic physical therapist from each hospital identified as currently performing cardiothoracic surgery (N=51) was invited to participate. Results The response rate was 58.8% (n=30). Both public (n=18) and private (n=12) hospitals in all states of Australia were represented. Management protocols reported by participants included wound support (n=22), restrictions on lifting and transfers (n=23), and restrictions on mobility aid use (n=15). Factors influencing clinical practice most commonly included “workplace practices/protocols” (n=27) and “clinical experience” (n=22). Limitations The study may be limited by response bias. Conclusions Significant variation exists in the sternal precautions and protocols used in the treatment of patients following median sternotomy in Australian hospitals. Further research is needed to investigate whether the restrictions and precautions used are necessary and whether protocols have an impact on patient outcomes, including rates of recovery and length of stay.

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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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Family interventions in psychosis

Psychotic Disorders ◽

10.1093/med/9780190653279.003.0059 ◽

2020 ◽

pp. 531-537

Author(s):

Juliana Onwumere ◽

Elizabeth Kuipers

Keyword(s):

Patient Outcomes ◽

Family Involvement ◽

Lived Experiences ◽

Treatment Guidelines ◽

Well Being ◽

Evidence Base ◽

Family Interventions ◽

Improved Outcomes ◽

The Impact

Families can play an important role in supporting individuals living with psychosis disorders and helping to facilitate their improved outcomes. This chapter, offered by Juliana Onwumere and Elizabeth Kuipers, provides an overview of the literature reporting on family involvement in the care of adults with lived experiences of psychosis, the impact of the caregiving role on carer well-being, and the predictive links between caregiving relationships and key patient outcomes including relapse. The chapter reports on the application of family interventions, the evidence base supporting its application and inclusion in treatment guidelines, and implementation issues.

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Efficacy of postoperative management with 5-fluorouracil injections after XEN Gel Stent implantation

International Ophthalmology ◽

10.1007/s10792-019-01168-8 ◽

2019 ◽

Vol 40 (1) ◽

pp. 235-246 ◽

Cited By ~ 3

Author(s):

Ewa Wałek ◽

Joanna Przeździecka-Dołyk ◽

Iwona Helemejko ◽

Marta Misiuk-Hojło

Keyword(s):

Stent Implantation ◽

Primary Outcome ◽

Open Angle Glaucoma ◽

Postoperative Management ◽

Age Related Macular Degeneration ◽

Glaucoma Progression ◽

Xen Gel Stent ◽

Age Related ◽

First Choice ◽

Bleb Failure

Abstract Purpose To evaluate the efficacy of postoperative management with 5-fluorouracil injections after XEN Gel Stent implantation. Methods Prospective real-world evidence study included 39 eyes (of 36 patients) with primary open-angle glaucoma without previous glaucoma surgery and with uncontrolled intraocular pressure (IOP), glaucoma progression, or intolerance to IOP-lowering therapy. Patients underwent mitomycin C-augmented XEN implantation either as a stand-alone procedure or combined with cataract extraction. 5-Fluorouracil subconjunctival injections were a first-choice therapy for bleb failure and were administered according to predetermined criteria (analogous to pro re nata regimen in age-related macular degeneration treatment). Primary outcome was unqualified success, defined as postoperative IOP < 18 mmHg and > 20% reduction from medicated baseline without any antiglaucoma medications and no detected glaucoma progression. Results At median follow-up of 8 months (range 3–24 months), IOP decreased from a medicated baseline value of 23 mmHg (95% CI 21–24 mmHg) to 13 mmHg (95% CI 12–15 mmHg) and number of medications decreased from 3 (95% CI 2–3) to 0 (p < 0.0001 for both). Median number of 5-fluorouracil injections per eye was 3 (95% CI 2–3), and median time to first injection was 0.5 months (95% CI 0.25–3 months) after surgery. Thirteen eyes (33.3%) underwent ≥ 1 needling, and surgical revision was performed in three cases (7.7%). The primary outcome measure, which allows performing additional procedures, was achieved in 27 eyes (69%). Conclusions 5-Fluorouracil subconjunctival injections are safe and effective in postoperative management of bleb failure after XEN implantation and represent a viable alternative to other methods.

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Aging and Caloric Restriction Modulate the DNA Methylation Profile of the Ribosomal RNA Locus in Human and Rat Liver

Nutrients ◽

10.3390/nu12020277 ◽

2020 ◽

Vol 12 (2) ◽

pp. 277 ◽

Cited By ~ 1

Author(s):

Noémie Gensous ◽

Francesco Ravaioli ◽

Chiara Pirazzini ◽

Roberto Gramignoli ◽

Ewa Ellis ◽

...

Keyword(s):

Dna Methylation ◽

Caloric Restriction ◽

Ribosomal Rna ◽

Tissue Specificity ◽

Rdna Locus ◽

Nutritional Interventions ◽

Age Related ◽

Dna Methylation Profile ◽

Main Determinants ◽

First Time

A growing amount of evidence suggests that the downregulation of protein synthesis is an adaptive response during physiological aging, which positively contributes to longevity and can be modulated by nutritional interventions like caloric restriction (CR). The expression of ribosomal RNA (rRNA) is one of the main determinants of translational rate, and epigenetic modifications finely contribute to its regulation. Previous reports suggest that hypermethylation of ribosomal DNA (rDNA) locus occurs with aging, although with some species- and tissue- specificity. In the present study, we experimentally measured DNA methylation of three regions (the promoter, the 5′ of the 18S and the 5′ of 28S sequences) in the rDNA locus in liver tissues from rats at two, four, 10, and 18 months. We confirm previous findings, showing age-related hypermethylation, and describe, for the first time, that this gain in methylation also occurs in human hepatocytes. Furthermore, we show that age-related hypermethylation is enhanced in livers of rat upon CR at two and 10 months, and that at two months a trend towards the reduction of rRNA expression occurs. Collectively, our results suggest that CR modulates age-related regulation of methylation at the rDNA locus, thus providing an epigenetic readout of the pro-longevity effects of CR.

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Dietary Antioxidants, Macular Pigment, and Glaucomatous Neurodegeneration: A Review of the Evidence

Nutrients ◽

10.3390/nu11051002 ◽

2019 ◽

Vol 11 (5) ◽

pp. 1002 ◽

Cited By ~ 6

Author(s):

Thomas Lawler ◽

Yao Liu ◽

Krista Christensen ◽

Thasarat S. Vajaranant ◽

Julie Mares

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Visual Field Loss ◽

Evidence Base ◽

Epidemiological Studies ◽

Macular Pigment ◽

Eye Disease ◽

Open Angle ◽

Dietary Antioxidants ◽

Age Related

Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness worldwide, and the prevalence is projected to increase to 112 million worldwide by 2040. Intraocular pressure is currently the only proven modifiable risk factor to treat POAG, but recent evidence suggests a link between antioxidant levels and risk for prevalent glaucoma. Studies have found that antioxidant levels are lower in the serum and aqueous humor of glaucoma patients. In this review, we provide a brief overview of the evidence linking oxidative stress to glaucomatous pathology, followed by an in-depth discussion of epidemiological studies and clinical trials of antioxidant consumption and glaucomatous visual field loss. Lastly, we highlight a possible role for antioxidant carotenoids lutein and zeaxanthin, which accumulate in the retina to form macular pigment, as evidence has emerged supporting an association between macular pigment levels and age-related eye disease, including glaucoma. We conclude that the evidence base is inconsistent in showing causal links between dietary antioxidants and glaucoma risk, and that prospective studies are needed to further investigate the possible relationship between macular pigment levels and glaucoma risk specifically.

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Cognitive behavioural therapy

Oxford Textbook of Old Age Psychiatry ◽

10.1093/med/9780198807292.003.0017 ◽

2020 ◽

pp. 253-260

Author(s):

Ken Laidlaw ◽

Philip Wilkinson

Keyword(s):

Older Adults ◽

Psychological Symptoms ◽

Psychological Treatment ◽

Evidence Base ◽

Behavioural Therapy ◽

Theory And Practice ◽

Behaviour Therapy ◽

Problem Solving Therapy ◽

Case Examples ◽

Dementia Caregiver

Cognitive behaviour therapy (CBT) is a dominant psychological treatment in the management of a range of psychiatric disorders and is increasingly being refined to suit the needs of older adults. This chapter summarizes the theory and practice of CBT, and emphasizes assessment, formulation, and adaptation of treatment with older patients. It describes in detail management of depressive disorder, anxiety disorders and dementia caregiver distress and includes relevant case examples. It also covers problem-solving therapy and behavioural activation. The chapter also describes mindfulness-based cognitive therapy (MBCT), which has potential benefits in the treatment of older adults, and it reviews applications with older people. It outlines newer applications, including treatment of psychological symptoms associated with physical illness, psychosis, and memory impairment. Finally, it describes how the evidence base for CBT-based interventions with older adults is limited and reviews the extent of the current evidence.

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