Association of socioeconomic and clinical variables with the state of frailty among older inpatients

Objectives: to identify the prevalence of frailty among inpatient older adults in a clinical hospital and check the association of the socioeconomic and clinical characteristics with the state of frailty. Method: observational, cross-sectional and analytical study, conducted with 255 hospitalized patients. Materials used: structured instrument for the economical and clinical data and frailty phenotype of Fried. Descriptive and bivariate statistical analysis was carried out and, by means of chi-square tests and ANOVA One-way (p<0.05). Results: the prevalence of frailty corresponded to 26.3%, while pre-frailty represented 53.3%. The highest proportion of frail seniors was identified for 80 years or older (p = 0.004), widowed (p = 0.035) and with the highest average length of stay (p = 0.006). Conclusion: inpatient older adults presented high percentages of frail states associated with socioeconomic variables and hospitalization period. The identification of the health conditions related to pre-frailty and frailty can foster the planning and implementation of the assistance to older adults in this context.

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Analisis Kepuasan Pasien Dilihat dari Minat untuk Dirawat Kembali Terhadap Pelayanan Dokter dan Perawat

Jurnal Manajemen Kesehatan Indonesia ◽

10.14710/jmki.7.2.2019.81-87 ◽

2019 ◽

Vol 7 (2) ◽

pp. 81-87

Author(s):

Lailil Masruron ◽

Tjahjono Kuntjoro ◽

Martha Irene Kartasurya

Keyword(s):

Patient Satisfaction ◽

Average Length ◽

Chi Square ◽

Cross Sectional ◽

Average Length Of Stay ◽

Positive Attitudes ◽

Preliminary Study ◽

Cross Sectional Design ◽

Turn Over ◽

Social Security Agency

Title :Patient Satisfaction To Doctor’s And Nurse’s Care Associated To The Interest To Be Rehospitalized (A study at RSUD Dolopo, Madiun Regency). AbstractBed Occupancy Rate (BOR) at Dolopo Public Hospital had decreased from 56.16% in 2013 to 35.86% in 2104 and 35.2% in 2015, and the average ALOS (Average Length of Stay) and Turn over Interval (TOI) increased. The preliminary study on patients of Social Security Agency (BPJS Non PBI) showed a dissatisfaction to nurse’s and doctor’s services. The aim of this study was to analyze the associations between patient satisfaction toward doctor’s & nurse’s services to the interest to be rehospitalized.This study was conducted in a cross sectional design. The subjects were 95 patients of BPJS with Non PBI in inpatient room for class I, II, III, which was choosen by using accidental sampling. Data were gathered through interviews using structured questionnaires. Data analysis was conducted by Chi-square tests and logistic regression.Results showed that the patient satisfaction based on aspects of tangibles, reliability, responsiveness, assurance, and empathy were lower than the expectations. Most of the subjects have positive attitudes, negative subjective norms and perceptions of behavior control and had a poor accesibility to the hospital. However 75.8% of the respondents were interested to be rehospitalized at Dolopo Hospital. There were correlations between patient satisfaction (p=0.009), attitude (p=0.000), subjective norm (p=0.002) with the interest to be rehospitalized. There was no correlation between control perception behavior (p=0.103), and access (p = 0.454) with the interest to be rehospitalized. After controlled for the attitude toward doctors’ and nurses’ services, the patients who were satisfied to the doctor’ and nurses’ services had 3.84 times to be interested to be rehospitalized than the patients who were not satifsfied (OR = 3.84 ; CI 95% : 0.98-15.12, p=0.054).Keywords : Patient Satisfaction, Rehospitalized, BPJS.

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Dairy Product Intake and Long-Term Risk for Frailty among French Elderly Community Dwellers

Nutrients ◽

10.3390/nu13072151 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2151

Author(s):

Berna Rahi ◽

Hermine Pellay ◽

Virginie Chuy ◽

Catherine Helmer ◽

Cecilia Samieri ◽

...

Keyword(s):

Older Adults ◽

Dairy Product ◽

Food Group ◽

Community Dwelling ◽

Physical Frailty ◽

Frailty Phenotype ◽

Cross Sectional ◽

Sectional Analysis ◽

Community Dwelling Older Adults

Dairy products (DP) are part of a food group that may contribute to the prevention of physical frailty. We aimed to investigate DP exposure, including total DP, milk, fresh DP and cheese, and their cross-sectional and prospective associations with physical frailty in community-dwelling older adults. The cross-sectional analysis was carried out on 1490 participants from the Three-City Bordeaux cohort. The 10-year frailty risk was examined in 823 initially non-frail participants. A food frequency questionnaire was used to assess DP exposure. Physical frailty was defined as the presence of at least 3 out of 5 criteria of the frailty phenotype: weight loss, exhaustion, slowness, weakness, and low physical activity. Among others, diet quality and protein intake were considered as confounders. The baseline mean age of participants was 74.1 y and 61% were females. Frailty prevalence and incidence were 4.2% and 18.2%, respectively. No significant associations were observed between consumption of total DP or DP sub-types and frailty prevalence or incidence (OR = 1.40, 95%CI 0.65–3.01 and OR = 1.75, 95%CI 0.42–1.32, for a total DP consumption >4 times/d, respectively). Despite the absence of beneficial associations of higher DP consumption on frailty, older adults are encouraged to follow the national recommendations regarding DP.

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What is the impact of multimorbidity on the risk of hospitalisation in older adults? A systematic review study protocol

BMJ Open ◽

10.1136/bmjopen-2021-049974 ◽

2021 ◽

Vol 11 (6) ◽

pp. e049974

Author(s):

Luciana Pereira Rodrigues ◽

Andréa Toledo de Oliveira Rezende ◽

Letícia de Almeida Nogueira e Moura ◽

Bruno Pereira Nunes ◽

Matias Noll ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Study Protocol ◽

Average Length ◽

Length Of Hospital Stay ◽

Case Control Studies ◽

Cross Sectional ◽

Increased Risk ◽

Review Study ◽

The Impact

IntroductionThe development of multiple coexisting chronic diseases (multimorbidity) is increasing globally, along with the percentage of older adults affected by it. Multimorbidity is associated with the concomitant use of multiple medications, a greater possibility of adverse effects, and increased risk of hospitalisation. Therefore, this systematic review study protocol aims to analyse the impact of multimorbidity on the occurrence of hospitalisation in older adults and assess whether this impact changes according to factors such as sex, age, institutionalisation and socioeconomic status. This study will also review the average length of hospital stay and the occurrence of hospital readmission.Methods and analysisA systematic review of the literature will be carried out using the PubMed, Embase and Scopus databases. The inclusion criteria will incorporate cross-sectional, cohort and case–control studies that analysed the association between multimorbidity (defined as the presence of ≥2 and/or ≥3 chronic conditions and complex multimorbidity) and hospitalisation (yes/no, days of hospitalisation and number of readmissions) in older adults (aged ≥60 years or >65 years). Effect measures will be quantified, including ORs, prevalence ratios, HRs and relative risk, along with their associated 95% CI. The overall aim of this study is to widen knowledge and to raise reflections about the association between multimorbidity and hospitalisation in older adults. Ultimately, its findings may contribute to improvements in public health policies resulting in cost reductions across healthcare systems.Ethics and disseminationEthical approval is not required. The results will be disseminated via submission for publication to a peer-reviewed journal when complete.PROSPERO registration numberCRD42021229328.

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Screening for frailty in older adults using a self-reported instrument

Revista de Saúde Pública ◽

10.1590/s0034-8910.2015049005516 ◽

2015 ◽

Vol 49 (0) ◽

Cited By ~ 25

Author(s):

Daniella Pires Nunes ◽

Yeda Aparecida de Oliveira Duarte ◽

Jair Lício Ferreira Santos ◽

Maria Lúcia Lebrão

Keyword(s):

Physical Activity ◽

Older Adults ◽

Walking Speed ◽

Screening Instrument ◽

The Self ◽

Southeastern Brazil ◽

Frailty Phenotype ◽

Cross Sectional ◽

Predictive Values ◽

Physical Strength

OBJECTIVE To validate a screening instrument using self-reported assessment of frailty syndrome in older adults.METHODS This cross-sectional study used data from the Saúde, Bem-estar e Envelhecimento study conducted in Sao Paulo, SP, Southeastern Brazil. The sample consisted of 433 older adult individuals (≥ 75 years) assessed in 2009. The self-reported instrument can be applied to older adults or their proxy respondents and consists of dichotomous questions directly related to each component of the frailty phenotype, which is considered the gold standard model: unintentional weight loss, fatigue, low physical activity, decreased physical strength, and decreased walking speed. The same classification proposed in the phenotype was utilized: not frail (no component identified); pre-frail (presence of one or two components), and frail (presence of three or more components). Because this is a screening instrument, “process of frailty” was included as a category (pre-frail and frail). Cronbach’s α was used in psychometric analysis to evaluate the reliability and validity of the criterion, the sensitivity, the specificity, as well as positive and negative predictive values. Factor analysis was used to assess the suitability of the proposed number of components.RESULTS Decreased walking speed and decreased physical strength showed good internal consistency (α = 0.77 and 0.72, respectively); however, low physical activity was less satisfactory (α = 0.63). The sensitivity and specificity for identifying pre-frail individuals were 89.7% and 24.3%, respectively, while those for identifying frail individuals were 63.2% and 71.6%, respectively. In addition, 89.7% of the individuals from both the evaluations were identified in the “process of frailty” category.CONCLUSIONS The self-reported assessment of frailty can identify the syndrome among older adults and can be used as a screening tool. Its advantages include simplicity, rapidity, low cost, and ability to be used by different professionals.

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INDICATORS OF MORBIDITY AND MORTALITY BY FEMUR FRACTURES IN OLDER PEOPLE: A DECADE-LONG STUDY IN BRAZILIAN HOSPITALS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220202803228393 ◽

2020 ◽

Vol 28 (3) ◽

pp. 142-148

Author(s):

VIVIANE CRISTINA ULIANA PETERLE ◽

JOÃO CARLOS GEBER JUNIOR ◽

WILLIAN DARWIN JUNIOR ◽

ALEXANDRE VASCONCELOS LIMA ◽

PAULO EMILIANO BEZERRA JUNIOR ◽

...

Keyword(s):

Older Adults ◽

Mortality Rate ◽

Average Length ◽

Federal District ◽

Population Based ◽

Northern Region ◽

Level Of Evidence ◽

Average Length Of Stay ◽

Femur Fractures ◽

Unified Health System

ABSTRACT Objective: To evaluate the profile of femur fractures in older adults in Brazil between 2008 and 2018. Methods: Population-based time series study with data from the Department of Informatics of the Unified Health System (Datasus), including 480,652 hospitalizations, of adults from 60 years and over, with hip fracture (ICD10-S72). Results: There was an increase of 76.9% in the hospitalization register (mean 5.87%/year) and an average incidence rate of 19.46 fractures for every 10,000 older adults. In total, 68% of hospitalizations were female, 28% from São Paulo. The average length of stay was 8.9 days, being higher in the Northern Region (11.8) and in the Federal District (18.7). Average mortality rate was 5%, being higher in men (5.45%) and over 80 years old. Northeast Region had the lowest mortality rate (3.54%). Southeast Region had the highest rate (5.53%). Total cost of hospitalizations was R$ 1.1 billion, with an average of R$ 100 million/year. Average cost per hospitalization was higher in the Southern Region (R$ 2,491.00). Conclusion: Femoral fracture is an important cause of mortality among older adults, with a higher incidence in women but higher mortality in men, with high cost to the system and regional differences. Level of Evidence II, Economic and decision analyses - developing an economic or decision model.

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IS POOR QUALITY SLEEP PRESENT IN OLDER ADULTS WITH WORSE SOCIAL AND HEALTH STATUS?

Texto & Contexto - Enfermagem ◽

10.1590/1980-265x-tce-2020-0614 ◽

2021 ◽

Vol 30 ◽

Author(s):

Sonia Gonçalves da Mota ◽

Isabela Thaís Machado de Jesus ◽

Keika Inouye ◽

Marcela Naiara Graciani Fumagale Macedo ◽

Tábatta Renata Pereira de Brito ◽

...

Keyword(s):

Older Adults ◽

Sleep Quality ◽

Sleep Disorders ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Poor Quality ◽

Frailty Phenotype ◽

Cross Sectional ◽

Significance Level ◽

Quality Sleep

ABSTRACT Objective: to analyze the relationship among sleep and sociodemographic aspects, health, frailty, performance in activities of daily living, cognitive performance and depressive symptoms of older residents in the community. Method: a cross-sectional, quantitative study was conducted with 81 older adults residents in the area covered by a Family Health Unit in the city of São Carlos (SP), Brazil. Data collection occurred in 2019, through the application of the following instruments: questionnaire for socioeconomic and health characterization of the older adult, Pittsburgh Sleep Quality Index, Frailty Phenotype proposed by Linda Fried, Mini Mental State Examination, Geriatric Depression Scale, Katz Index and Lawton Scale. Participants were divided into comparative groups according to sleep quality scores. Fisher's exact and Pearson's χ2 were used. A significance level of 5% was adopted. Results: 50.6% of the older adults had poor quality sleep (n=41), followed by 33.3% of older adults with good quality sleep (n=27) and 16.1% had sleep disorders (n=13). There was a relationship between sleep quality and sex (p=0.008), work status (p=0.001), self-assessment of health (p=0.013), falls (p=0.034), pain (p=0.012), frailty level (p=0.026) and the slow gait criterion (p<0.001). Conclusion: there was a higher prevalence of poor quality sleep and sleep disorders in older patients, who do not work outside the home, who evaluated their health as regular or poor, who suffered falls in the last year and who complained of pain, frailty and slow gait.

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Potential associated factors of functional disability in Chinese older inpatients: A multicenter cross-sectional study

10.21203/rs.2.21887/v1 ◽

2020 ◽

Author(s):

Hongpeng Liu ◽

Jing Jiao ◽

Chen Zhu ◽

Minglei Zhu ◽

Xianxiu Wen ◽

...

Keyword(s):

Older Adults ◽

Activities Of Daily Living ◽

Daily Living ◽

Functional Disability ◽

Age Groups ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Older Inpatients ◽

Hospital Wards

Abstract Background: Older adults are vulnerable to a decline in physical functioning, including basic activities of daily living (ADL) and higher-level instrumental activities of daily living (IADL). The causes of functional disability in older adults are multifactorial. A comprehensive understanding of these factors will contribute toward future health service planning. However, studies of ADL and IADL in Chinese older adults are insufficient. The aim of this study is to describe the level of ADL and IADL in different age groups and explore the factors associated with functional disability in Chinese older inpatients. Methods: We conducted a cross-sectional study consisted of 9,996 Chinese older inpatients aged 65 years and older. Participants were recruited from six provinces or municipality city in southwest (Sichuan province), northeast (Heilongjiang), south central (Hubei province), northern (Beijing municipality city), northwest (Qinghai province), and eastern China (Zhejiang province) from October 2018 to February 2019. The levels of ADL and IADL were measured by scores of the Barthel index and Instrumental Activities of Daily Living Scale in consecutive intervals from 65 years of age. After controlling for the cluster effect of hospital wards, a mixed-effect generalized linear model was used to examine the association between functional disability and covariates. Results: The average ADL score was 27.68±4.59 and the mean IADL score 6.76±2.01 for all participants. A negative correlation between scores and age was observed, and there was a significant difference in ADL and IADL scores among different age groups. The top negatively influential factor in ADL and IADL was stair climbing and shopping, respectively. After controlling for the cluster effect of hospital wards, aging, emaciation, frailty, depression, falling accidents in past 12 months, hearing dysfunction, cognitive dysfunction, urinary dysfunction, and defecation dysfunction were associated with ADL and IADL. Patients transitioned from the emergency department and other hospitals were also affected by ADL disability. Former smoking was associated with lower IADL scores. Higher level of education, living in a building without elevators, and current alcohol consumption were correlated with better IADL performance. Conclusion: Decreased functional ability was associated with the increasing age. Sociodemographic characteristics (such as age), physical health variables (frailty, emaciation, hearing dysfunction, urinary dysfunction, defecation dysfunction, falling accidents in past 12 months), and mental health variables (cognitive dysfunction, depression) were associated with functional disability. These findings potentially have major importance for the planning of hospital services, discharge planning, and post-discharge care.

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Abstract P411: Longitudinal Association Between Frailty and Arterial Stiffness in Community-dwelling Older Adults: The Atherosclerosis Risk in Communities Study

Circulation ◽

10.1161/circ.141.suppl_1.p411 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Alvin G Thomas ◽

Anna Kucharska-Newton ◽

Jingkai Wei ◽

Priya Palta ◽

Sheila Burgard ◽

...

Keyword(s):

Older Adults ◽

Community Dwelling ◽

Frailty Phenotype ◽

Cross Sectional ◽

Arterial Stiffening ◽

Atherosclerosis Risk In Communities ◽

Loss To Follow Up ◽

Frailty Status ◽

Longitudinal Association ◽

Aortic Stiffening

Introduction: Frailty is predictive of cardiovascular disease and is suggested to co-occur with arterial stiffening, the hallmark of vascular aging. However, the temporal relationship is uncertain. Using the ARIC study, we examine the association of baseline frailty with cross-sectional and 5-year change in carotid-femoral pulse wave velocity (cfPWV) in older adults. Methods: Participants at visit 5 (2011-2013) were classified as frail (≥3 criteria), prefrail (1-2 criteria), or robust using the Fried frailty phenotype criteria (unintentional weight loss, exhaustion, grip strength, slow walking speed, and low physical activity). We measured cfPWV at visits 5 and 6/7 (2016-2019). We used linear regression with inverse-probability of attrition weights to estimate the association between frailty and 5-year change in cfPWV while accounting for loss-to-follow-up among survivors. Models were adjusted for age, sex, race-center, mean arterial pressure, height, heart rate, smoking, and time between visits. Results: Of 5,096 participants at visit 5 (58% female, 21% black, mean age 75 [SD 5.1] years), 296 (6%) were frail and 2403 (47%) prefrail. In adjusted analyses at visit 5, frail participants had 30 cm/s (95% CI: -9, 69; p=0.1) higher cfPWV and prefrail participants had 12 cm/s (95% CI: -5, 30; p=0.2) higher cfPWV than those classified as robust (Table 1). In longitudinal analyses adjusted for attrition, we observed a 3 cm/s (95% CI: -11, 19; p=0.6) and 6 cm/s (95% CI: 0, 12; p=0.05) greater annualized increase in cfPWV over ~5 years among frail and prefrail participants, respectively, relative to the rate of arterial stiffening among robust participants (26 cm/s per year). Conclusions: Compared to robust older adults, greater aortic stiffness was observed among frail community-dwelling adults. Changes in aortic stiffening over the course of 5 years were not materially influenced by frailty status at baseline. Frail older adults may present with greater arterial aging and its associated hemodynamic effects on target organs.

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Pre-frailty, frailty and associated factors in older caregivers of older adults

Revista de Saúde Pública ◽

10.11606/s1518-8787.2020054001655 ◽

2020 ◽

Vol 54 ◽

pp. 17

Author(s):

Roberta De Oliveira Máximo ◽

Ingrid Cristina Lopes ◽

Allan Gustavo Brigola ◽

Bruna Moretti Luchesi ◽

Aline Cristina Martins Gratão ◽

...

Keyword(s):

Older Adults ◽

Older Adult ◽

Low Income ◽

Associated Factors ◽

Multinomial Logistic Regression ◽

Community Dwelling ◽

Clinical Aspects ◽

Frailty Phenotype ◽

Cross Sectional ◽

Older Caregivers

INTRODUCTION: Providing care to an older adult is an activity that requires considerable physical effort and can cause stress and psychological strain, which accentuate factors that trigger the cycle of frailty, especially when the caregiver is also an older adult. However, few studies have analyzed the frailty process in older caregivers. OBJECTIVES: To investigate the prevalence of pre-frailty, frailty and associated factors in older caregivers of older adults. METHODS: A cross-sectional study was conducted including 328 community-dwelling older caregivers. Frailty was identified using frailty phenotype. Socio-demographic, behavioral and clinical aspects, characteristics related to care and functioning were covariables in the multinomial logistic regression. RESULTS: The prevalence of pre-frailty and frailty were 58.8% and 21.1%, respectively. An increased age, female sex, not having a conjugal life, depressive symptoms and pain were commonly associated with pre-frailty and frailty. Sedentary lifestyle was exclusively associated with pre-frailty, whereas living in an urban area, low income and the cognitive decline were associated with frailty. A better performance on instrumental activities of daily living reduced the chance of frailty. CONCLUSION: Many factors associated with the frailty syndrome may be related to the act of providing care, which emphasizes the importance of the development of coping strategies for this population.

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Oncologists’ perspectives on medical marijuana for the elderly.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.31_suppl.78 ◽

2019 ◽

Vol 37 (31_suppl) ◽

pp. 78-78

Author(s):

Desiree Rachel Azizoddin ◽

Andrea Catherine Enzinger ◽

Alexi A. Wright ◽

Miryam Yusufov ◽

Fangxin Hong ◽

...

Keyword(s):

Older Adults ◽

Cancer Patients ◽

Medical Marijuana ◽

The Elderly ◽

Cross Sectional Survey ◽

Chi Square ◽

Cross Sectional ◽

Elderly Cancer Patients ◽

Treatment Side Effects ◽

Nationally Representative

78 Background: Cancer patients are increasingly using medical marijuana (MM) to manage symptoms and treatment side effects. Although cancer disproportionately affects the elderly, little is known about oncologists’ attitudes toward MM in this population. We surveyed US oncologists’ beliefs about the benefits of MM for older adults, and examined their associations with oncologists’ perceptions of MM efficacy and safety. Methods: 232 out of 400 randomly selected U.S. oncologists (63% response rate) completed a cross-sectional survey about their beliefs and recommendations regarding MM for cancer patients. Using Chi-square tests, we examined associations between oncologists’ demographics, their perceptions of geriatric MM use, as well as beliefs about comparative effectiveness of MM for cancer related symptoms, and comparative risks of MM to prescription opioids. Results: Among 232 oncologists included in this cohort, 109 (47.0%) reported that MM had at least some benefit for elderly cancer patients, 66 (28.4%) responded it was rarely or never beneficial, and 57 (24.6%) reported not knowing. There were no significant associations between oncologists’ beliefs about MM’s benefit for older adults and their sociodemographic characteristics. Those who believed MM was beneficial for the elderly were significantly more likely to report that MM was at least as effective as standard treatments for the following indications: coping (58.3% vs. 26.6%), appetite (83.3% vs 58.5%), depression (46.3% vs 25.0%), and nausea (66.7% vs 33.9%), respectively ( p < 0.001). In contrast, oncologists’ beliefs about MM for the elderly were not significantly associated with perceptions of the comparative risks of MM ( p > 0.05). Conclusions: In this nationally-representative sample of US oncologists, about half thought MM was beneficial for older adults with cancer. Oncologists’ support of MM for older adults was associated with perceptions of MM’s efficacy but was not associated with perceptions of MM’s risks. More research is needed regarding the safety and efficacy of MM to guide oncologists’ recommendations about its use in older adults.

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