Sleep–Wake Disturbances and Frailty in Community-Living Older Persons

OBJECTIVES: To evaluate the association between sleep–wake disturbances and frailty.
DESIGN: Cross-sectional.
SETTING: New Haven, Connecticut.
PARTICIPANTS: Three hundred seventy-four community-living persons aged 78 and older.
MEASUREMENTS: Frailty was based on the Fried phenotype, and sleep–wake disturbances were defined as daytime drowsiness, based on an Epworth Sleepiness Scale (ESS) score of 10 or greater, and as subthreshold and clinical insomnia, based on Insomnia Severity Index (ISI) scores of 8 to 14 and greater than 14, respectively.
RESULTS: Mean age was 84.3; 87 (23.8%) participants were drowsy, 122 (32.8%) had subthreshold insomnia, 38 (10.2%) had clinical insomnia, and 154 (41.2%) were frail. There was a significant association between drowsiness and frailty, with unadjusted and adjusted odds ratios (ORs) of 3.79 (95% confidence interval (CI)=2.29–6.29) and 3.67 (95% CI=2.03–6.61), respectively. In contrast, clinical insomnia was significantly associated with frailty in the unadjusted analysis (OR=2.77, 95% CI=1.36–5.67) but not the adjusted analysis (OR=1.93, 95% CI=0.81–4.61)), and subthreshold insomnia was not associated with frailty in the unadjusted or adjusted analysis.
CONCLUSION: In older persons, sleep–wake disturbances that present with daytime drowsiness, but not insomnia, are independently associated with frailty. Because drowsiness is potentially remediable, future studies should determine whether there is a temporal relationship between drowsiness and frailty, with the ultimate goal of informing interventions to reverse or prevent the progression of frailty.     

Prevalence and 10‐Year Outcomes of Frailty in Older Adults in Relation to Deficit Accumulation

OBJECTIVES: To evaluate the prevalence and 10‐year outcomes of frailty in older adults in relation to deficit accumulation. DESIGN: Prospective cohort study. SETTING: The National Population Health Survey of Canada, with frailty estimated at baseline (1994/95) and mortality follow‐up to 2004/05. PARTICIPANTS: Community‐dwelling older adults (N=2,740, 60.8% women) aged 65 to 102 from 10 Canadian provinces. During the 10‐year follow‐up, 1,208 died. MEASUREMENTS: Self‐reported health information was used to construct a frailty index (Frailty Index) as a proportion of deficits accumulated in individuals. The main outcome measure was mortality. RESULTS: The prevalence of frailty increased with age in men and women (correlation coefficient=0.955–0.994, P<.001). The Frailty Index estimated that 622 (22.7%, 95% confidence interval (CI)=21.0–24.4%) of the sample was frail. Frailty was more common in women (25.3%, 95% CI=23.2–27.5%) than in men (18.6%, 95% CI=15.9–21.3%). For those aged 85 and older, the Frailty Index identified 39.1% (95% CI=31.3–46.9%) of men as frail, compared with 45.1% (95% CI=39.7–50.5%) of women. Frailty significantly increased the risk of death, with an age‐ and sex‐adjusted hazard ratio for the Frailty Index of 1.57 (95% CI=1.41–1.74). CONCLUSION: The prevalence of frailty increases with age and at any age lessens survival. The Frailty Index approach readily identifies frail people at risk of death, presumably because of its use of multiple health deficits in multidimensional domains.     

慢性阻塞性肺疾病认知衰弱危险因素及预后分析

目的分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)认知衰弱危险因素,探讨预后及意义。 方法选择2022年1月至2023年7月我院收治的59例COPD患者为对象,其中无认知衰弱18例为对照组,认知衰弱41例为观察组。采用一般资料调查表、衰弱表型量表(frailty phenotype scale)、医院焦虑抑郁量表(hospital anxiety and depression scale)、主观认知下降问卷(subjective cognitive decline)、简易精神状态评估量表(mini-mental state examination scale)搜集资料,收集出院后6个月生存状况。使用卡方检验、秩和检验、t检验、Logistic回归分析、Cox生存分析等对数据进行分析。 结果观察组平均年龄(61.25±9.86)岁,吸烟12例(66.67%)较对照组(56.74±8.53)岁,吸烟14例(34.15%)差异有统计学意义(P<0.05)。两组教育程度、共病指数、生活能力差异有统计学意义(P＝0.004,0.000,0.016)。Logistic回归分析显示,年龄(OR＝0.005,95%CI：0～0.108)、教育程度(OR＝0.004,95%CI：0～0.102)和生活能力(OR＝0.093,95%CI：0.011～0.784)是COPD患者认知衰弱的影响因素(P<0.05)。随访6个月生存者51例(86.44%),死亡者8例(13.56%)。Cox生存分析显示,COPD患者认知衰弱预后不良是认知正常的2.48倍(95%CI：1.548～4.395,P＝0.001)。 结论高龄、教育程度低、生活能力低下是COPD患者认知衰弱的危险因素。尽早干预,延缓认知衰弱进展,以期降低COPD认知衰弱患者病死率具有临床意义。     

Grade of deceased donor liver macrovesicular steatosis impacts graft and recipient outcomes more than the Donor Risk Index

Background and Aim: Donor liver steatosis can impact on liver allograft outcomes. The aim of the present study was to comprehensively report on the impact of type and grade of donor steatosis, as well as donor and recipient factors, including the reported Donor Risk Index (DRI), on liver allograft outcomes. Methods: A review of unit data for all adult liver transplant procedures from 2001 to 2007, as well as donor offers. Donor liver biopsies were regraded for steatosis by an experienced histopathologist. Results: Steatosis was detected in 184/255 (72%) of biopsies, of which 114 (62%) had microvesicular steatosis (MiS; 68 mild, 22 moderate, 24 severe) and 70 (38%) macrovesicular steatosis (MaS; 59 mild, 7 moderate, 4 severe). The majority (66/70, 94%) of biopsies with MaS also contained MiS. Allograft steatosis was associated with increasing donor body mass index (P = 0.000), plus donor male sex (P < 0.05). Primary non function (P = 0.002), early renal failure (P = 0.040), and requirement for retransplantation (P = 0.012) were associated only with severe MaS. Early biliary complications were associated with moderate MaS (P = 0.039). Only severe MaS was significantly associated with inferior allograft survival at 3 months (relative risk = 12.09 [8.75–19.05], P = 0.000) and 1 year (P = 0.000). Conclusions: MiS is a common finding and frequently coexists with MaS on liver allograft biopsy, while isolated MaS is uncommon. Only the presence of moderate to severe MaS is associated with inferior early allograft outcomes. The impact of severe MaS on allograft survival appears greater than other donor factors, including the calculated DRI.     

Catheter-based fixation of the mitral valve after acute papillary muscle rupture: A new technique for temporary hemodynamic stabilization

We describe a new, catheter-based method for temporary management of hemodynamic instability after papillary muscle rupture in a patient with an acute myocardial infarction. Cathet. Cardiovasc. Intervent. 46:446–449, 1999. © 1999 Wiley-Liss, Inc.     

老年危重症患者预后预测模型的研究进展

急性生理学与慢性健康状况评分(APACHE)和简化急性生理评分(SAPS)等传统模型虽然预测危重症患者的死亡较可靠,但预测老年危重症患者的预后却可能会出现预测偏移或群体校准不良,而针对老年人研发出的专用预测模型不具有足够的准确性和可靠性。因此,衰弱综合征成为了目前老年综合评估的核心,研究表明衰弱指数(FI)、衰弱分级(CFS)可作为衡量衰弱综合征的客观模型,已成为老年危重症预后评估的研究热点。本文综述了这些评估模型的发展进程及研究进展,以期临床医师能够更好地应用它们。     

A comparison of three health status measures in primary care outpatients

Our objective was to compare a brief, relatively new global health status measure, the Health Utilities Index Mark II (HUI), to two commonly applied health status measures (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36] and the Sickness Jgipact Profile [SIP] in a general medical outpatient population. Using a cross-sectional survey, we surveyed 160 patients in the General Medical Clinic of the Durham Veterans Affairs Medical Center. Each subject answered demographic questions and then completed the three health status measures. The mean tJgie taken to complete the measures was 3, 10, and 20 minutes for the HUI, SF-36, and SIP, respectively (p <.0001). The HUI exhibited a modest "floor" effect; that is, scores were concentrated near the sicker of the scale. In contrast, responses to the SIP were heavily concentrated near the healthier end of the scale. Spearman correlation coefficients between the HUI and scales within the other two measures ranged from. 54 (SF-36 mental health) to 0.69 (SF-36 physical functioning). Subjects accepted all measures well. These three health service measures varied in their distribution of responses and ttime required to complete. Users should consider the degree of sickness of the population to be assessed when choosing a measure.     

踝臂指数与动脉硬化及其危险因素的关系

目的了解踝臂指数与动脉硬化及其危险因素的关系。方法对174例住院患者行选择性冠状动脉造影,用冠状动脉病变血管的数量和Gensini积分系统评价冠状动脉病变的严重程度。并进行踝臂指数测定、眼底动脉检查及动脉硬化的危险因素分析。结果冠状动脉正常组与冠状动脉病变组踝臂指数差异显著(P<0.001),冠状动脉造影积分和踝臂指数的Pearson积距相关系数为-0.768(P<0.001),冠状动脉造影积分越高,踝臂指数越低。眼底动脉正常组与眼底动脉病变组踝臂指数差异显著(P<0.001),眼底动脉病变越严重踝臂指数越小。眼底动脉正常组与眼底动脉病变组冠状动脉造影积分差异显著(P<0.001),眼底动脉病变越严重冠状动脉造影积分越高。以踝臂指数<0.9为二分类变量做Logistic回归分析,发现踝臂指数与年龄、性别、甘油三酯、低密度脂蛋白、吸烟量、糖尿病和遗传因素相关。结论踝臂指数是动脉硬化的一个简便可靠的预测因素,低踝臂指数与传统的动脉硬化危险因素如年龄、性别、甘油三酯、低密度脂蛋白、吸烟量、糖尿病和遗传因素有相关性。