scholarly journals Comparison of Sarcopenia with Modified Frailty Index as a Predictor of Adverse Outcomes in Critically Ill Elderly Patients

2021 ◽  
pp. 200-206
Author(s):  
Shrirang Bhurchandi ◽  
Sachin Agrawal ◽  
Sunil Kumar ◽  
Sourya Acharya
Keyword(s):  
Elderly Patients ◽  
Critically Ill ◽  
Health Care Cost ◽  
Frailty Index ◽  
The Elderly ◽  
Time Frame ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Parametric Data ◽  
Modified Frailty Index

Background: Ageing is a global fact affecting both developed and developing countries.It brings out various catabolic changes in body resulting in frailty(i.e. the person is not able to with stand minor stresses of the environment, due to reduced reserves in psychologicalreserve of several organ system).Thus causing a great burden of disease, dependence & health care cost. Sarcopenia is the leading component for frailty in the elderly population, but very few studies have been done in India for correlating frailty with sarcopenia. Aim: To compare sarcopenia with modified frailty index (MFI) as a predictor of adverse outcomes in critically ill elderly patients. Methodology: Cross-sectional study will be performed on all the critically ill geriatric subjects/patients coming to all the ICU's of AVBRH, Sawangi (M), Wardha who will satisfy various inclusion and exclusion criteria for selection and all standard parametric & non-parametric data will be assessed by using standard descriptive & inferential statistics. Expected Results: In our study, we are anticipating that the Modified frailty index to be a better predictor of adverse outcomes in terms of mortality as compared to sarcopenia in the critically ill elderly patients. Also, we are anticipating that sarcopenia to be the most important contributor of frailty in critically ill elderly patients and the prevalence of frailty will be high in critically ill elderly patients. Limitation: Due to limited time frame & resources we will not be able to follow up the patients.

Frailty as a marker of adverse outcomes during cystectomy for urothelial cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 374-374
Author(s):  
Max Kates ◽  
Hiten Patel ◽  
Nikolai Sopko ◽  
Jen-Jane Liu ◽  
Phillip M Pierorazio ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Frailty Index ◽  
The Elderly ◽  
Adverse Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Modified Frailty Index ◽  
Clinical Rule ◽  
Inform Decision Making ◽  
Overall Mortality

374 Background: Frailty has been identified as a marker of physiologic reserve, and a more accurate predictor of adverse postoperative outcomes compared with age. Although many definitions of frailty exist, recently a clinical predictive rule, the “modified frailty index”(mFI), has been developed utilizing administrative data to predict adverse outcomes in the lung cancer population undergoing lobectomy. Our goal was to validate this clinical rule among patients with bladder cancer undergoing cystectomy. Methods: Patients undergoing cystectomy were identified from the National Surgical Quality Improvement Program (NSQIP) participant use files (2006-2011). The mFI was defined as in prior studies with 11 variables based on mapping the Canadian Study of Health and Aging Frailty Index to NSQIP comorbidities and activities of daily living (ADL)s. These 11 variables each received 1 point, and the sum was divided by 11 for a fraction between 0 and 1. Univariate χ2, independent sample t-test, and logistic regression analyses were performed where appropriate. Results: Of the 1,302 cystectomy patients identified, 30% had mFI of 0, 40% had mFI of 0.09, 21% had mFI of 0.18, and 9% had mFI ≥0.27. Overall, 56% of patients experienced a Clavien complication. Patients with mFI ≥0.27 were older ( 72 vs 64 yrs)and more likely to be smokers (54%) compared with mFI of 0 (30%, p<0.01). Mean operative times (342-349 minutes) were similar across mFI indices. Reoperation (5% vs 8.5%) and readmission (20.5% vs 25%) were higher when mFI =0 compared with mFI≥0.27 (P<0.01). Clavien 4 and above complications occurred in 9.1% (36/396), 10.1% (53/526), 12.9 % (35/270) and 13.6% (15/110) among patients with an mFI of 0, 0.09, 0.18, and ≥0.27, respectively (p=0.05). Similarly, the overall mortality rate increased from 2.5% in the lowest frailty index group to 5.4% in the highest. Conclusions: Among patients undergoing cystectomy, the modified frailty index can identify those patients at greater risk for severe complications, readmissions, and mortality. Given that bladder cancer is increasing in prevalence particularly among the elderly, pre-operative risk stratification is crucial to inform decision-making.

scholarly journals Nitrogen Balance and Its relation with Energy and Protein Intake in Criticaly Ill Elderly Patients

2017 ◽  
Vol 1 (1) ◽  
pp. 1
Author(s):  
Niken Churrniadita ◽  
Luciana Budiati Sutanto ◽  
Rudyanto Sedono
Keyword(s):  
Elderly Patients ◽  
Critically Ill ◽  
Nitrogen Balance ◽  
Protein Intake ◽  
The Elderly ◽  
Elderly Subjects ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Positive Correlation ◽  
Consecutive Sampling

Introduction:Nitrogen balance in criticaly ill patients has the tendency to be negative due to stress response. In the elderly patients, the metabolic changes risk to worsening nitrogen balance. The aim of this study was to determine nitrogen balance and its correlation with energy and protein intake in critically ill elderly patients within 48 hours in ICU.Methods: The method was cross sectional, consecutive sampling on 26 critically ill elderly subjects. Inclusion criteria were patients admitted to ICU, age >60 years old, male/female, whose family/relatives agreed to join this study. Patients who had urine output <0,5 mL/kg/hours were excluded. Data collected were energy and protein intake, urinary urea nitrogen (UUN), and nitrogen balance during 24 hours I and II of admission.Results: The median age was 70 (61 – 85)  years old, body mass index was 22. 9 ­+  2.7 kg/m2, most of the subjects were surgical patients. In  24 hours I and II, the nitrogen balances were -5.2 (-31.2 − -4.1) and  -4.5 + 4.6 respectively, energy intakes were not significantly different; 78.8 + 45.0% and 91.1 + 50.2% respectively, and protein intakes were significantly different; 34.1 + 19.3 g/d and  41.2 + 21.3 g/d respectively. There was positive correlation between nitrogen balance and energy intake; r=0.6 and r=0.5, and also between protein intake; r=0.5 and r=0.4, in 24 hours I and II respectively.Conclusion: There were significantly positive correlation between nitrogen balance with energy and protein intake.

scholarly journals Elderly victims of falls seen by prehospital care: gender differences

2014 ◽  
Vol 17 (1) ◽  
pp. 3-16 ◽  
Author(s):  
William Campo Meschial ◽  
Dorotéia Fátima Pelissari de Paula Soares ◽  
Nelson Luiz Batista de Oliveira ◽  
Alice Milani Nespollo ◽  
Wesley Alexandre da Silva ◽  
...  
Keyword(s):  
Gender Differences ◽  
Elderly Patients ◽  
Exploratory Study ◽  
Prehospital Care ◽  
The Elderly ◽  
Cross Sectional ◽  
Significance Level ◽  
Care Services ◽  
Preventive Actions ◽  
Type Of Injury

OBJECTIVE: To identify elderly who are victims of falls, according to gender, who received care from prehospital services of Maringá, Paraná. METHODS: A cross-sectional exploratory study carried out with 1,444 elderly patients who suffered falls in Maringá in the period from 2006 to 2008. Data were gathered from prehospital care services, typed and processed using the Epi Info 6.04d(r). The χ² test was used to compare the falls in relation to gender (significance level = 0.05). RESULTS: The number of falls according to gender presented similar percentages, 51.0% for males and 49.0% for females. Significant differences between genders were observed regarding age (p < 0.001), presence of alcohol breath (p < 0.001), type of fall (p < 0.001), place of fall (p < 0.001), treatment at hospital (p = 0.023), number of injuries (p = 0.014), type of injury (p < 0.001) and injury location (p <0.001). CONCLUSION: These results show that falls happen differently among the elderly when considering gender. It highlights the importance of understanding these differences in detail and the circumstances in which the fall occurred, since this knowledge is key to plan preventive actions.

scholarly journals Health Problems of Elderly Patients attending Combined Military Hospital, Dhaka

2017 ◽  
Vol 13 (1) ◽  
pp. 8-12
Author(s):  
SM Humayun Kabir ◽  
Md Ziaul Islam ◽  
Masuda Begum ◽  
Masud Ahmed ◽  
Mohammad Mohsin ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Health Care Providers ◽  
Family Income ◽  
Sampling Technique ◽  
Armed Forces ◽  
The Elderly ◽  
Health Problems ◽  
Military Hospital ◽  
Care Providers ◽  
Cross Sectional

Introduction: Health problems of elderly are an emerging health burden throughout the world. Bangladesh is currently undergoing a demographic transition and the proportion of the population of 60 years and older is increasing rapidly. Health care providers and policymakers are highly concerned with this burning issue. Objective: To know the disease pattern among the elderly patients in Combined Military Hospital, Dhaka. Materials and Methods: This cross-sectional study was carried out from July 2015 to June 2016 among 152 elderly patients above 60 years of age admitted in Combined Military Hospital (CMH), Dhaka Cantonment. Data were collected by face-to-face interview with semi-structured questionnaire and checklist following purposive sampling technique. Analysis of data was done by Statistical Package for Social Science (SPSS, version 20.0). Results: Mean age of the elderly was 72.06±4.56 years with the range of 60-80 years and majority (90.8%) of the elderly was male. Out of total 152 elderly patients, by occupation majority (31.6%) were in the business group followed by 30.3% in the retired group and 9.2 % in the housewife group. Average monthly family income was BDT 17927.63±7360.75 with the range of BDT 6000-35000. With initial complaints elderly patients reported to doctors in private chamber (38.2%), private hospital (25.6%) and Govt hospital (5.9%). Among all of the elderly patients, majority (21.1%) had Diabetes Mellitus followed by Rheumatoid Arthritis (17.6%), Asthma (12.5%), Cataract (11.2%), ENT problem (6.6%), Malignancy (5.9%) and Benign Enlargement of Prostate 8(5.3%). Conclusion: The number of elderly people is expanding rapidly; it also presents multifaceted health problems and thus creates unique challenges for the national healthcareservices. Early identification of problem and ensuring the availability of health with economic and social support can have a control over the elderly health problems. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 8-12

scholarly journals MEDICATION BURDEN AND INAPPROPRIATE PRESCRIPTION RISK AMONG ELDERLY WITH ADVANCED CHRONIC KIDNEY DISEASE

2019 ◽  
Author(s):  
Clarisse Roux-Marson ◽  
Jean-Baptiste Baranski ◽  
Coraline Fafin ◽  
Guillaume Extermann ◽  
Cecile Vigneau ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Healthcare Providers ◽  
Antihypertensive Agents ◽  
The Elderly ◽  
Anticholinergic Drugs ◽  
Cross Sectional ◽  
French Study ◽  
Sectional Analysis

Abstract Background Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥ 75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take. Methods This is a cross-sectional analysis of medication profiles of individuals aged ≥ 75 years with eGFR < 20 ml/min/1.73m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were analyzed according to route of administration, therapeutic classification, and their potential inappropriateness for these patients, according to Beers' criteria. Results We collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7-11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 88% of patients had at least 1 medication classified as a RIM, and 21% of those were contraindicated drugs. At least 1 PIM was taken by 68.9%. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine. Conclusion We showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here.

scholarly journals Delirium in Critically ill Patients in a Tertiary Care Centre in Western Region of Nepal

2015 ◽  
Vol 12 (2) ◽  
pp. 117-120
Author(s):  
P Thapa ◽  
PK Chakraborty ◽  
JB Khattri ◽  
K Ramesh ◽  
P Sharma
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Significant Proportion ◽  
Adverse Outcomes ◽  
Tube Placement ◽  
Tertiary Care Centre ◽  
Cross Sectional

Background Delirium affects a significant proportion of critically ill patients admitted in hospital. It is associated with various adverse outcomes. Despite its enormous prognostic significance it tends to be underdiagnosed. There is a dearth of studies on risk factors of delirium in our setting.Objectives The main objectives of this study was to find out the prevalence, rate of non recognition and risk factors associated with delirium in hospitalized critically ill patients.Methods A hospital based cross-sectional study was carried out. Data was collected using a predesigned semi-structured proforma and Intensive care delirium screening checklist was used to screen for delirium in patients admitted in various wards of Manipal teaching hospital, Pokhara, Nepal.Results Ninety five cases were included in the analysis. The mean age of study group was 58.9 ± 19.1 years. Delirium was present in 15/95 cases and it was not recognized by treating physician in about one third of cases. Odds ratio (OR) was statistically significantly increased in patients with history of stroke (OR=4.484 95% CI=1.0896;18.459), alcohol use (OR=10.792 95% CI=2.906;40.072), smoking (OR= 4.836 95% CI= 1.411;16.576), use of restraint (OR=17.143 95% CI=4.401;66.766), nasogastric tube placement (OR= 7.731 95% CI=2.348;25.452) and use of Foley’s catheter (OR=12.000 95% CI= 3.072;46.877).Conclusion About 16% of critically ill patients were found to be delirious. In about one third of the cases delirium was not recognized. Both patient related and iatrogenic factors may increase the risk of delirium in hospitalized critically ill patients.Kathmandu University Medical Journal Vol.12(2) 2014: 117-120

The 5-Item Modified Frailty Index Predicts Adverse Outcomes in Trauma

2020 ◽  
Vol 253 ◽  
pp. 167-172
Author(s):  
Brett M. Tracy ◽  
Jacob M. Wilson ◽  
Randi N. Smith ◽  
Mara L. Schenker ◽  
Rondi B. Gelbard
Keyword(s):  
Frailty Index ◽  
Adverse Outcomes ◽  
Modified Frailty Index
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