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Journal of Hepatology Jul 2021In patients with decompensated cirrhosis, sarcopenia and frailty are prevalent. Although several definitions exist for these terms, in the field of hepatology,... (Review)
Review
In patients with decompensated cirrhosis, sarcopenia and frailty are prevalent. Although several definitions exist for these terms, in the field of hepatology, sarcopenia has commonly been defined as loss of muscle mass, and frailty has been broadly defined as the phenotypic manifestation of the loss of muscle function. Prompt recognition and accurate assessment of these conditions are critical as they are both strongly associated with morbidity, mortality, poor quality of life and worse post-liver transplant outcomes in patients with cirrhosis. In this review, we describe the complex pathophysiology that underlies the clinical phenotypes of sarcopenia and frailty, their association with decompensation, and provide an overview of tools to assess these conditions in patients with cirrhosis. When available, we highlight data focusing on patients with acutely decompensated cirrhosis, such as inpatients, as this is an area of unmet clinical need. Finally, we discuss management strategies to reverse and/or prevent the development of sarcopenia and frailty, which include adequate nutritional intake of calories and protein, as well as regular exercise of at least moderate intensity, with a mix of aerobic and resistance training. Key knowledge gaps in our understanding of sarcopenia and frailty in decompensated cirrhosis remain, including best methods to measure muscle mass and function in the inpatient setting, racial/ethnic variation in the development and presentation of sarcopenia and frailty, and optimal clinical metrics to assess response to therapeutic interventions that translate into a reduction in adverse outcomes associated with these conditions.
Topics: Disease Progression; Frailty; Humans; Liver Cirrhosis; Preventive Health Services; Sarcopenia
PubMed: 34039486
DOI: 10.1016/j.jhep.2021.01.025 -
Clinics in Geriatric Medicine Feb 2018Frailty is recognized as a cornerstone of geriatric medicine. It increases the risk of geriatric syndromes and adverse health outcomes in older and vulnerable... (Review)
Review
Frailty is recognized as a cornerstone of geriatric medicine. It increases the risk of geriatric syndromes and adverse health outcomes in older and vulnerable populations. Although multiple screening instruments have been developed and validated to improve feasibility in clinical practice, frequent lack of agreement between frailty instruments has slowed broad implementation of these tools. Despite this, interventions to improve frailty-related health outcomes developed to date include exercise, nutrition, multicomponent interventions, and individually tailored geriatric care models. Possible strategies to prevent frailty include lifestyle or behavioral interventions, proper nutrition, and increased activity levels and social engagement.
Topics: Aged; Early Medical Intervention; Frailty; Geriatric Assessment; Healthy Lifestyle; Humans; Patient Care Planning
PubMed: 29129215
DOI: 10.1016/j.cger.2017.09.004 -
Blood Feb 2018The majority of blood cancers occur in the elderly. This fact conspires with an aging population in many countries to make rigorous assessment for frailty increasingly... (Review)
Review
The majority of blood cancers occur in the elderly. This fact conspires with an aging population in many countries to make rigorous assessment for frailty increasingly important for hematologic oncologists. In this review, we first define frailty and its relevance for patients with hematologic malignancy. Next, we review current data regarding the effect of domains of frailty on outcomes for blood cancers including myelodysplastic syndromes, acute leukemia, non-Hodgkin lymphomas such as chronic lymphocytic leukemia, and multiple myeloma. Finally, after presenting assessment and treatment options for the practicing hematologist, we propose elements of a new research agenda for geriatric hematology: the exchange of age limits for rigorous frailty screening, development of disease-specific measures, and inclusion of functional and patient-reported outcomes alongside survival.
Topics: Aged; Aged, 80 and over; Frail Elderly; Frailty; Hematologic Neoplasms; Humans; Late Onset Disorders
PubMed: 29141942
DOI: 10.1182/blood-2017-09-746420 -
Journal of Neurology, Neurosurgery, and... Apr 2022To optimise dementia prevention strategies, we must understand the complex relationships between lifestyle behaviours, frailty and genetics.
OBJECTIVE
To optimise dementia prevention strategies, we must understand the complex relationships between lifestyle behaviours, frailty and genetics.
METHODS
We explored relationships between frailty index, healthy lifestyle and polygenic risk scores (all assessed at study entry) and incident all-cause dementia as recorded on hospital admission records and death register data.
RESULTS
The analytical sample had a mean age of 64.1 years at baseline (SD=2.9) and 53% were women. Incident dementia was detected in 1762 participants (median follow-up time=8.0 years). High frailty was associated with increased dementia risk independently of genetic risk (HR 3.68, 95% CI 3.11 to 4.35). Frailty mediated 44% of the relationship between healthy lifestyle behaviours and dementia risk (indirect effect HR 0.95, 95% CI 0.95 to 0.96). Participants at high genetic risk and with high frailty had 5.8 times greater risk of incident dementia compared with those at low genetic risk and with low frailty (HR 5.81, 95% CI 4.01 to 8.42). Higher genetic risk was most influential in those with low frailty (HR 1.31, 95% CI 1.22 to 1.40) but not influential in those with high frailty (HR 1.09, 95% CI 0.92 to 1.28).
CONCLUSION
Frailty is strongly associated with dementia risk and affects the risk attributable to genetic factors. Frailty should be considered an important modifiable risk factor for dementia and a target for dementia prevention strategies, even among people at high genetic risk.
Topics: Dementia; Female; Frailty; Humans; Life Style; Male; Middle Aged; Risk Factors
PubMed: 34933996
DOI: 10.1136/jnnp-2021-327396 -
BMJ Open Dec 2018To review the association between hypertension and frailty in observational studies. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To review the association between hypertension and frailty in observational studies.
DESIGN
A systematic review of the PubMed, Web of Science and Embase databases was performed. A meta-analysis was performed if at least three studies used the same definition of frailty and a dichotomous definition of hypertension.
SETTING, PARTICIPANTS AND MEASURES
Studies providing information on the association between frailty and hypertension in adult persons, regardless of the study setting, study design or definition of hypertension and frailty were included.
RESULTS
Among the initial 964 articles identified, 27 were included in the review. Four longitudinal studies examined the incidence of frailty according to baseline hypertension status, providing conflicting results. Twenty-three studies assessed the cross-sectional association between frailty and hypertension: 13 of them reported a significantly higher prevalence of frailty in hypertensive participants and 10 found no significant association. The pooled prevalence of hypertension in frail individuals was 72% (95% CI 66% to 79%) and the pooled prevalence of frailty in individuals with hypertension was 14% (95% CI 12% to 17%). Five studies, including a total of 7656 participants, reported estimates for the association between frailty and hypertension (pooled OR 1.33; 95% CI 0.94 to 1.89).
CONCLUSIONS
Frailty is common in persons with hypertension. Given the possible influence of frailty on the risk-benefit ratio of treatment for hypertension and its high prevalence, it is important to assess the presence of this condition in persons with hypertension.
TRIAL REGISTRATION NUMBER
CRD42017058303.
Topics: Aged; Frailty; Geriatric Assessment; Humans; Hypertension; Prevalence; Treatment Outcome
PubMed: 30593554
DOI: 10.1136/bmjopen-2018-024406 -
Clinics in Geriatric Medicine Nov 2021Frailty is an important clinical syndrome of age-related decline in physiologic reserve and increased vulnerability. In older adults, frailty leads to progressive... (Review)
Review
Frailty is an important clinical syndrome of age-related decline in physiologic reserve and increased vulnerability. In older adults, frailty leads to progressive multisystem decline and increased adverse clinical outcomes. The pathophysiology of frailty is hypothesized to be driven by dysregulation of neuroendocrine, inflammatory, and metabolic pathways. Sex-specific differences in the prevalence of frailty have been observed. Treatment interventions of geriatric care can be applied to the care of frail older women with these differences in mind. As additional evidence regarding sex-specific differences in frailty emerges, research efforts should encompass the development of screening tools and therapeutic interventions that optimize outcomes.
Topics: Aged; Female; Frail Elderly; Frailty; Geriatric Assessment; Humans; Male; Prevalence; Sex Characteristics
PubMed: 34600727
DOI: 10.1016/j.cger.2021.05.008 -
Journal of Alzheimer's Disease : JAD 2018Frailty, a critical intermediate status of the aging process that is at increased risk for negative health-related events, includes physical, cognitive, and psychosocial... (Review)
Review
Frailty, a critical intermediate status of the aging process that is at increased risk for negative health-related events, includes physical, cognitive, and psychosocial domains or phenotypes. Cognitive frailty is a condition recently defined by operationalized criteria describing coexisting physical frailty and mild cognitive impairment (MCI), with two proposed subtypes: potentially reversible cognitive frailty (physical frailty/MCI) and reversible cognitive frailty (physical frailty/pre-MCI subjective cognitive decline). In the present article, we reviewed the framework for the definition, different models, and the current epidemiology of cognitive frailty, also describing neurobiological mechanisms, and exploring the possible prevention of the cognitive frailty progression. Several studies suggested a relevant heterogeneity with prevalence estimates ranging 1.0-22.0% (10.7-22.0% in clinical-based settings and 1.0-4.4% in population-based settings). Cross-sectional and longitudinal population-based studies showed that different cognitive frailty models may be associated with increased risk of functional disability, worsened quality of life, hospitalization, mortality, incidence of dementia, vascular dementia, and neurocognitive disorders. The operationalization of clinical constructs based on cognitive impairment related to physical causes (physical frailty, motor function decline, or other physical factors) appears to be interesting for dementia secondary prevention given the increased risk for progression to dementia of these clinical entities. Multidomain interventions have the potential to be effective in preventing cognitive frailty. In the near future, we need to establish more reliable clinical and research criteria, using different operational definitions for frailty and cognitive impairment, and useful clinical, biological, and imaging markers to implement intervention programs targeted to improve frailty, so preventing also late-life cognitive disorders.
Topics: Aged; Cognitive Aging; Cognitive Dysfunction; Dementia; Frailty; Humans; Models, Biological
PubMed: 29562543
DOI: 10.3233/JAD-170963 -
International Journal of Cardiology Jun 2017There is a growing interest in the intersection of heart failure (HF) and frailty; however, estimates of the prevalence of frailty in HF vary widely. The purpose of this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is a growing interest in the intersection of heart failure (HF) and frailty; however, estimates of the prevalence of frailty in HF vary widely. The purpose of this paper was to quantitatively synthesize published literature on the prevalence of frailty in HF and to examine the relationship between study characteristics (i.e. age and functional class) and the prevalence of frailty in HF.
METHODS
The prevalence of frailty in HF, divided into Physical Frailty and Multidimensional Frailty measures, was synthesized across published studies using a random-effects meta-analysis of proportions approach. Meta-regression was performed to examine the influence of age and functional class (at the level of the study) on the prevalence of frailty.
RESULTS
A total of 26 studies involving 6896 patients with HF were included in this meta-analysis. Despite considerable differences across studies, the overall estimated prevalence of frailty in HF was 44.5% (95% confidence interval, 36.2%-52.8%; z=10.54; p<0.001). The prevalence was slightly lower among studies using Physical Frailty measures (42.9%, z=9.05; p<0.001) and slightly higher among studies using Multidimensional Frailty measures (47.4%, z=5.66; p<0.001). There were no significant relationships between study age or functional class and prevalence of frailty.
CONCLUSIONS
Frailty affects almost half of patients with HF and is not necessarily a function of age or functional classification. Future work should focus on standardizing the measurement of frailty and on broadening the view of frailty beyond a strictly geriatric syndrome in HF.
Topics: Clinical Trials as Topic; Frailty; Heart Failure; Prevalence
PubMed: 28215466
DOI: 10.1016/j.ijcard.2017.01.153 -
Journal of the American Geriatrics... Apr 2021Although frailty status is dynamic, whether improvements in frailty predict mortality is unknown.
BACKGROUND
Although frailty status is dynamic, whether improvements in frailty predict mortality is unknown.
OBJECTIVE
Describe 1-year changes in a frailty index (FI) and association with 48-month mortality.
DESIGN
Secondary analysis of the National Health in Aging Trends Study.
SETTING
Community.
PARTICIPANTS
Five thousand six hundred and seventy two Medicare beneficiaries 65 and older (3,267 (55.8%) females).
MEASUREMENTS
A 40-item deficit accumulation FI was measured in 2011 and 2012, based on multidomain assessment including comorbidities, activities of daily living, physical tasks, cognition, and performance testing. We categorized 2011 FI into robust (FI < 0.15), pre-frail (FI = 0.15-0.24), mild frailty (FI = 0.25-0.34), and moderate to severe frailty (FI ≥ 0.35). Change in frailty was calculated as the FI change from 2011 to 2012, categorized as either absolute (>0.045 decrease, 0.015-0.045 decrease, ±0.015 change, 0.015-0.045 increase, >0.045 increase) or proportional change (>20% decrease, 5-20% decrease, ±5% change, 5-20% increase, 20% increase). We measured the association of FI change with 4-year mortality using Cox regression.
RESULTS
From 2011 to 2012, mean FI increased by 0.02 (standard deviation 0.07), with 58.6% having an increase. Over 4 years, 1,039 participants (13.6%) died. After adjusting for age and sex, compared to stable frailty (±0.015), both absolute (>0.045) and proportional (>20%) increases in frailty were associated with higher mortality among pre-frail participants (hazard ratio (HR) = 2.35, 95% confidence interval (CI) = (1.45-3.79) and HR (95% CI) = 3.32 (1.76-6.26), respectively), participants with mild frailty (HR (95% CI) = 1.96 (1.35-2.85) and 2.03 (1.37-3.02)) and moderate or severe frailty (HR (95% CI) = 1.99 (1.48-2.67) and 1.94 (1.43-2.63)) but not robust participants (HR (95% CI)= 1.48 (0.86-2.54), HR (95% CI) = 1.62 (0.80-3.28)). However, decreases in FI were not significantly associated with decreased risk of mortality.
CONCLUSIONS
Increasing deficit accumulation FI over 1 year is associated with increased mortality risk. While decreasing FI occurs, we did not find evidence to support reduced mortality risk.
Topics: Activities of Daily Living; Aged; Cognition; Comorbidity; Female; Frail Elderly; Frailty; Functional Status; Geriatric Assessment; Humans; Male; Mortality; Prognosis; Risk Factors; Severity of Illness Index; Task Performance and Analysis; United States
PubMed: 33377190
DOI: 10.1111/jgs.17002 -
JACC. Heart Failure Dec 2019Frailty, a syndrome characterized by an exaggerated decline in function and reserve of multiple physiological systems, is common in older patients with heart failure... (Review)
Review
Frailty, a syndrome characterized by an exaggerated decline in function and reserve of multiple physiological systems, is common in older patients with heart failure (HF) and is associated with worse clinical and patient-reported outcomes. Although several detailed assessment tools have been developed and validated in the geriatric population, they are cumbersome, not validated in patients with HF, and not commonly used in routine management of patients with HF. More recently, there has been an increasing interest in developing simple frailty screening tools that could efficiently and quickly identify frail patients with HF in routine clinical settings. As the burden and recognition of frailty in older patients with HF increase, a more comprehensive approach to management is needed that targets deficits across multiple domains, including physical function and medical, cognitive, and social domains. Such a multidomain approach is critical to address the unique, multidimensional challenges to the care of these high-risk patients and to improve their functional status, quality of life, and long-term clinical outcomes. This review discusses the burden of frailty, the conceptual underpinnings of frailty in older patients with HF, and potential strategies for the assessment, screening, and management of frailty in this vulnerable patient population.
Topics: Aged; Frailty; Heart Failure; Humans; Prevalence; Prognosis
PubMed: 31779921
DOI: 10.1016/j.jchf.2019.10.005