Frailty评分对枸橼酸伊沙佐米治疗多发性骨髓瘤不良反应的预测价值

目的 探讨Frailty评分对枸橼酸伊沙佐米治疗多发性骨髓瘤(multiple myeloma, MM)不良反应的预测价值。方法 选取MM患者72例,均予以枸橼酸伊沙佐米联合沙利度胺、地塞米松方案治疗,观察治疗效果及不良反应。并根据患者不良反应程度分为Ⅰ～Ⅱ级组和Ⅲ～Ⅳ级组。比较2组Frailty评分;采用Cox回归模型分析化疗相关Ⅲ～Ⅳ级不良反应的影响因素;采用ROC曲线模型分析Frailty评分对化疗相关Ⅲ～Ⅳ级不良反应的预测价值。结果 72例MM患者均实施枸橼酸伊沙佐米治疗,总有效率为80.55%;出现不良反应70例、以乏力占比最高,发生率为72.22%,其次为淋巴细胞降低25.00%、贫血18.06%,未出现任何不良反应2例。Ⅲ～Ⅳ级组Frailty评分高于Ⅰ～Ⅱ级组(P<0.05)。70例出现不良反应患者均随访12个月,其平均生存时间(22.30±2.28)个月。Cox回归分析结果显示,Frailty评分≥2分是MM患者发生Ⅲ～Ⅳ级不良反应的影响因素。ROC曲线分析显示,Frailty评分预测化疗相关Ⅲ～Ⅳ级不良反应AUC值为0.925(95%CI:0.816～1.00...     

老年高血压相关性衰弱的发病机制及运动干预机制的研究进展

随着我国老龄化进程的进一步加剧,衰弱作为常见的老年综合征已成为备受关注的公共卫生问题。高血压与衰弱常共存于老年人,导致出现多种不良健康结局。本文分析了老年高血压相关性衰弱的流行现状及发病机制,包括炎性反应、氧化应激反应、胰岛素抵抗及激素代谢紊乱等,总结了运动干预改善高血压相关性衰弱的可能作用途径,并发现目前关于高血压相关性衰弱的运动作用机制类研究仍然缺乏,而且不同类型的运动干预形式对机体的作用机制也存在一定差异性,未来可以进一步探讨不同的运动干预形式对高血压相关性衰弱的作用靶点及干预效果的不同。     

The Prevalence of Frailty Among Older Adults Living With Dementia: A Systematic Review

ObjectivesTo investigate the prevalence of frailty in older adults living with dementia and explore the differences in medication use according to frailty status.DesignSystematic review of published literature from inception to August 20, 2020.Setting and ParticipantsAdults age ≥65 years living with dementia in acute-care, community and residential care settings.MethodsA systematic search was performed in Embase, Medline, International Pharmaceutical Abstracts, APA PscyInfo, CINAHL, Scopus, and Web of Science. Two reviewers independently screened records and conducted quality assessment using the Newcastle-Ottawa Scale.ResultsSixteen articles met the inclusion criteria, with 7 studies conducted in acute care setting and 9 studies in community-dwelling adults. Five studies recruited people with dementia exclusively, and 11 studies were conducted in older populations that included individuals with dementia diagnosis. Among studies conducted in acute care setting, the prevalence of frailty ranged from 50.8% to 91.8% compared with studies in community-dwelling setting, which reported a prevalence of 24.3% to 98.9%. With respect to medication exposure, 3 studies documented medication use according to frailty status but not dementia status. Higher medications use, measured as total number of medications was reported in frail [7.0 ± 4.0 (SD) ?12.0 ± 9.0 (SD)] compared with nonfrail participants [6.1 ± 3.1(SD) ?10.4 ± 3.8 (SD)].Conclusions and ImplicationsCurrent data suggests a wide range of frailty prevalence in individuals with dementia. Future studies should systematically document frailty in adults living with dementia and its impact on medication use.     

Self-Reported Frailty Screening Tools: Comparing Construct Validity of the Frailty Phenotype Questionnaire and FRAIL

ObjectivesWe examined the construct validity of 2 self-reported frailty questionnaires, the Frailty Phenotype Questionnaire (FPQ) and FRAIL, against the Cardiovascular Health Study frailty phenotype (CHS-FP).DesignCross-sectional data analysis of longitudinal prospective cohort study.Settings and ParticipantsWe included data from 230 older adults (mean age: 67.2 ± 7.4 years) from the “Longitudinal Assessment of Biomarkers for characterization of early Sarcopenia and Osteosarcopenic Obesity in predicting frailty and functional decline in community-dwelling Asian older adults Study” (GeriLABS 2) recruited between December 2017 and March 2019.MethodsWe compared area under receiver operating characteristic curves (AUC), agreement, correlation, and predictive validity against outcome measures [Short Physical Performance Battery, 5 times repeat chair stand (RCS-5), Frenchay activities index, International Physical Activity Questionnaire, life-space assessment, Social Functioning Scale 8 (SFS-8), EuroQol-5 dimensions (utility value)] using logistic regression adjusted for age, gender, and vascular risk factors. We examined concurrent validity across robust versus prefrail/frail for inflammatory blood biomarkers [tumor necrosis factor receptor 1 and C-reactive protein (CRP)] and dual-energy x-ray absorptiometry body composition [bone mineral density (BMD); appendicular lean mass index (ALMI), and fat mass index (FMI)].ResultsPrevalence of prefrail/frail was 25.7%, 14.8%, and 48.3% for FPQ, FRAIL, and CHS-FP, respectively. Compared with FRAIL, FPQ had better diagnostic performance (AUC = 0.617 vs 0.531, P = .002; sensitivity = 37.8% vs 18.0%; specificity = 85.6% vs 88.2%) and agreement (AC1-Stat = 0.303 vs 0.197). FPQ showed good predictive validity [RCS-5: odds ratio (OR) 2.38; 95% CI: 1.17–4.86; International Physical Activity Questionnaire: OR 3.62; 95% CI:1.78–7.34; SFS-8: OR 2.11; 95% CI: 1.64–5.89 vs FRAIL: all P > .05]. Only FRAIL showed concurrent validity for CRP, compared with both FPQ and FRAIL for TNF-R1. FRAIL showed better concurrent validity for BMD, FMI, and possibly ALMI, unlike FPQ (all P > .05).Conclusions and ImplicationsOur results support complementary validity of FPQ and FRAIL in independent community-dwelling older adults. FPQ has increased case detection sensitivity with good predictive validity, whereas FRAIL demonstrates concurrent validity for inflammation and body composition. With better diagnostic performance and validity for blood biomarkers and clinical outcomes, FPQ has utility for early frailty detection in the community setting.     

Transitions Between Frailty States and Its Predictors in a Cohort of Community-Dwelling Spaniards

ObjectivesStudy the frequency and determinants of frailty transitions in a community-dwelling older population.DesignPopulation-based prospective longitudinal study [The Toledo Study of Healthy Ageing (TSHA)].Setting and Participants1748 community-dwelling individuals aged >65 years living in Toledo, a Spanish province.MethodsFrailty was measured with the Fried phenotype. Logistic models were used to assess the associations of sociodemographic, clinical, life-habits, functional, physical performance, and analytical variables with frailty transitions (losing robustness, transitioning from prefrailty to robustness, and from prefrailty to frailty) over a median of 5.2 years.ResultsMean age on enrolment was 75 years, and 55.8% were females. At baseline, 10.3% were frail and 43.1% prefrail. At follow-up, 35.8% of the frail individuals recovered to a prefrail and 15.1% to a robust state. In addition, 43.7% of the prefrail participants became robust, but 14.5% developed frailty. Of those robust at baseline, 32.9% became prefrail and 4.2% frail. In multivariate logistic models, chair-stands had a predictive role in all transitions studied: linearly in keeping robustness and with a floor effect (5 stands) in transitions from prefrailty to robustness and (inversely) from prefrailty to frailty. More depressive symptoms were associated with unfavorable transitions. Not declaring the amount of alcohol drunk and low grip strength were associated with loss of robustness. Hearing and cognitive impairment, low physical activity and smoking with transitioning from prefrailty to frailty. Autonomy for instrumental activities of daily living and uricemia were associated with transitions between robustness and prefrailty in both directions. Increasing body mass index in the range of moderate to severe obesity hampered regaining robustness.Conclusions and ImplicationsSpontaneous improvement of frailty measured with the Fried phenotype is frequent, mainly to prefrailty. Most of the variables associated with transitions are modifiable and suggest research topics and interventions to reduce frailty in clinical and social care settings.     

Internet use and cognitive frailty in older adults: a large-scale multidimensional approach

Although research on sociodemographic correlates of internet use in older adults without and with pronounced cognitive impairment is already quite extensive, much less is known about the relationship between cognitive frailty (CF) and this behaviour. As CF is associated to multidimensional frailty aspects, this study explored the relationship between internet use and CF, operationalised as Subjective Cognitive Impairment, in older adults by means of a comprehensive explanatory model including sociodemographic factors and multiple frailty measures. The dataset included a sample of community-dwelling 60 + older adults that were included in the Belgian Ageing Studies (BAS) and that completed survey questions on (i) internet use frequency and (ii) internet activities. Multidimensional frailty was measured with the CFAI-Plus. The analysis comprised a structural equation modelling (SEM) procedure. Internet use was frequent; however, it became less frequent with higher CF. Moreover, the latter used less tablets as compared to the no-low CF group. Navigating the web, sharing email and online banking were the most frequently reported activities. Tele-communicating with Skype, online shopping and using e-government services were the least frequent. Age, female gender, lower income and living with a partner were also negatively associated with internet use. To conclude, CF, along with other frailty and sociodemographic factors, was negatively related to internet use in older adults. Future research should focus, amongst others, on the dynamic processes underlying internet use in the population of older adults affected by CF.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10433-022-00686-2.     

Association between thyroid hormone levels and frailty in the community-dwelling oldest-old: a cross-sectional study

Background:Changes in thyroid hormone levels are commonly recognized characters among the elderly, which were reported to potentially influence incident frailty. Therefore, we examined the cross-sectional associations of thyroid hormones (THs) with frailty as well as the five components characterizing frailty (fatigue, resistance, ambulation, number of illnesses, and loss of weight) among the oldest-old.Methods:Four hundred and eighty-seven community-dwelling oldest-old from a local community in Haidian District, Beijing, participated in our recruitment campaign between April 2019 and May 2020. The primary outcomes were a definitive diagnosis of frailty according to the FRAIL scale (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) and a positive score for each frailty subdomain. Demographic information (age, sex, marital status, and educational status), comorbidities, and details on the participants’ lifestyles were recorded. Serum THs including free triiodothyronin (fT3), triiodothyronine (T3), free thyroxine (fT4), and thyroxine (T4) and thyroid stimulating hormone (TSH) levels were also measured at the beginning of our study. Logistic regressions were conducted to screen for potential risk factors for frailty and its subdomains.Results:Among the total 487 subjects at enrollment, 60 (12.23%) of them were diagnosed with subclinical hypothyroidism and 110 (22.59%) of the total population scored positive for frailty. Logistic regression analyses adjusted for all potential confounders, showed that frailty was significantly associated with the serum TSH concentration (odds ratio [OR]: 1.06), fT3 concentration (OR: 0.54), and subclinical hypothyroidism score (OR: 2.18). The association between fT4 and frailty was absent in our observational study. The fT3/fT4 ratio characterizing peripheral hormone conversion was also tested to be correlated with frailty.Conclusion:Subclinical hypothyroidism, higher TSH level, lower fT3 level, and decreased fT3/fT4 ratio were all associated with frailty assessed by the FRAIL scale among the community-dwelling oldest-old, suggesting a relevant role of thyroid function in aging. Future longitudinal studies are warranted to determine the casual relationship between thyroid dysfunction and frailty in the oldest-old.     

衰弱老年人管理循证指南的质量评价

目的评价国内外衰弱老年人管理相关的循证指南,分析各指南的特点,为国内开展衰弱老年人管理的实践提供参考。方法系统检索国内外权威指南网站、中英文数据库以及老年学医学专业学会网站中老年人衰弱管理的相关指南,检索时限为建库至2018年10月。采用临床研究与评估工具对符合纳入、排除标准的指南进行质量评价,并分析各指南的特点。结果共检索出3篇循证指南,质量评价的6个领域的平均标准化得分分别为:范围和目的97.5%,参与人员68.5%,严谨性65.3%,清晰性95.7%,应用性68.7%,编辑的独立性61.1%,指南总体质量评价为1篇A级,2篇B级。结论国内外衰弱老年人管理的循证指南数量较少,指南的总体质量有待提高,内容有待细化,国内有待形成本土的循证指南,指导衰弱老年人管理实践的开展。     

衰弱对慢性阻塞性肺疾病患者不良健康结局影响的系统评价

目的系统评价衰弱对COPD患者不良健康结局的影响。方法计算机检索Pub Med、Web of Science、Wiley Online Library、Cochrane Library、EBSCO、CINAHL、Springer Link、Scopus、中国期刊全文数据库、万方数据库、中国生物医学文献数据库和中国科技期刊全文数据库,检索时限为建库至2019年8月,收集关于衰弱与COPD患者不良健康结局的队列研究、病例对照研究和横断面研究。根据研究类型选择纽尔卡斯渥太华量表或美国卫生保健质量和研究机构推荐的横断面研究质量评价标准进行质量评价。视纳入研究情况进行Meta合并或描述性分析。结果纳入12项研究,包括7项队列研究和5项横断面研究,总样本量4 196例。基于整合衰弱模式对健康结局进行分类,描述性分析结果显示,衰弱可导致COPD患者失能风险升高,失能程度加重,生活质量下降,医疗资源使用增加和死亡风险升高。结论衰弱与COPD患者多种不良健康结局密切相关,国内学者应提高对衰弱的关注度,早评估、早识别、早干预衰弱,有利于预防或延缓衰弱的进程,改善COPD患者的健康结局。