Frailty in Nursing Homes—A Prospective Study Comparing the FRAIL-NH and the Clinical Frailty Scale

ObjectivesFrailty is common in nursing home (NH) residents, but its prevalence in German institutions is unknown. Valid and easy-to-use screening tools are needed to identify frail residents. We used the FRAIL-NH scale and the Clinical Frailty Scale (CFS) to (1) obtain the prevalence of frailty, (2) investigate the agreement between both instruments, and (3) evaluate their predictive validity for adverse health events in German NH residents.DesignProspective cohort study.Setting and participantsGerman NH residents (n = 246, age 84 ± 8 years, 67% female).MethodsFrailty status was categorized according to FRAIL-NH (nonfrail, frail, most frail) and CFS (not frail, mild to moderately frail, severely frail). Agreement between instruments was examined by Spearman correlation, an area under the receiver operating characteristic curve (AUC) with 95% CI, and sensitivity and specificity using the “most frail” category of FRAIL-NH as reference standard. Adverse health events (death, hospital admissions, falls) were recorded for 12 months, and multivariate cox and logistic regression models calculated.ResultsAccording to FRAIL-NH, 71.1% were most frail, 26.4% frail, and 2.5% nonfrail. According to CFS, 66.3% were severely frail, 26.8% mild to moderately frail, and 6.9% not frail. Both scales correlated significantly (r = 0.78; R² = 60%). The AUC was 0.92 (95% CI 0.88-0.96). Using a CFS cutoff of 7 points, sensitivity was 0.90 and specificity 0.92. The frailest groups according to both instruments had an increased risk of death [FRAIL-NH hazard ratio (HR) 2.19, 95% CI 1.21-3.99; CFS HR 2.56, 95% CI 1.43-4.58] and hospital admission [FRAIL-NH odds ratio (OR) 1.95, 95% CI 1.06-3.58; CFS OR 1.79, 95% CI 1.01-3.20] compared to less frail residents. The FRAIL-NH predicted recurrent faller status (OR 2.57, 95% CI 1.23-5.39).Conclusions and implicationsFrailty is highly prevalent in German NH residents. Both instruments show good agreement despite different approaches and are able to predict adverse health outcomes. Based on our findings and because of its simple administration, CFS may be an alternative to FRAIL-NH for assessing frailty in NHs.     

Continuity of primary care and prenatal care adequacy among women with disabilities in Ontario: A population-based cohort study

BackgroundWomen with disabilities experience elevated risks for pregnancy complications and report barriers accessing prenatal care. Emerging evidence highlights the significant role primary care providers play in promoting preventive services like prenatal care.ObjectiveTo examine the relationship between continuity of primary care (COC) and prenatal care adequacy among women with disabilities.MethodsWe conducted a population-based study using health administrative data in Ontario, Canada. The study population included 15- to 49-year-old women with physical (n = 106,555), sensory (n = 32,194), intellectual/developmental (n = 1515), and multiple (n = 6543) disabilities who had a singleton livebirth or stillbirth in 2003–2017 and ≥ 3 primary care visits < 2 years before conception. COC was measured using the Usual Provider of Care Index. Nominal logistic regression was used to compute adjusted odds ratios (aOR) for prenatal care adequacy, measured using the Revised-Graduated Prenatal Care Utilization Index, for women with low versus moderate/high COC, controlling for other social and medical characteristics.ResultsWomen with disabilities with low COC, versus those with moderate/high COC, had increased odds of no (aOR 1.42, 95% CI 1.29–1.56), inadequate (aOR 1.19, 95% CI 1.16–1.23), and intensive prenatal care (aOR 1.22, 95% CI 1.19–1.25) versus adequate. In additional analyses, women with low COC and no/inadequate prenatal care were the most socially disadvantaged among the cohort, and those with low COC and intensive prenatal care had the greatest medical need.ConclusionImproving primary care access for women with disabilities, particularly those experiencing social disadvantage, could lead to better prenatal care access.     

血管紧张素1转化酶基因多态性与Ⅱ型糖尿病合并心肌梗死的关系

为探讨血管紧张素 1转化酶 (ACE)基因插入 /缺失多态性与Ⅱ型糖尿病合并心肌梗死 (MI)及无并发症的Ⅱ型糖尿病 (DM2 )的相关情况 ,同时观察血清ACE水平与ACE基因多态性及疾病的关系。对 82例MI、86例DM2和 84例健康人 (对照组 )用PCR方法进行了ACE基因内含子 1 6插入 /缺失多态性的检测 ,用紫外分光光度法测定了血清ACE水平。结果MI组D等位基因频率 0 .52 ,DD基因型频率 0 .32 ,与对照组 ( 0 .36,0 .1 5)比较有显著差异 (P <0 .0 5) ,DD基因型对MI的比数比为 3.0 1 ( 95%可信区间为 1 .2 8～ 7.0 4 ,P <0 .0 1 ) ;DM2组基因型频率分布与对照组比较无显著差异 (P >0 .0 5) ;各组中DD基因型个体血清ACE水平最高 ,II基因型最低 ,基因多态性与血清ACE水平呈相关性 (r=0 .65,P <0 .0 1 )。说明ACE基因缺失多态性参与中国人DM2合并MI的发病 ,是其发病的危险因素     

抗心脏β_1和M_2受体自身抗体与老年扩张型心肌病(英文)

目的　观测抗心脏 β1和M2 受体的自身抗体和老年扩张型心肌病 (EDCM)的相关性。方法　分别以 β1和M2 受体细胞外第二环 197- 2 2 2和 16 9- 173氨基酸序列的合成肽作为抗原 ,来检测老年扩张型心肌病患者的血清 (EDCM组 ,n =32 ) ,以健康人血清为正常对照 (NC组 ,n =2 0 )。结果　EDCM组抗 β1受体自身抗体的阳性率为 37.5 % (12 / 32 ) ,NC组为 5 .0 %(1/ 2 0 ) (P <0 .0 5 ) ;EDCM组抗M2 受体自身抗体的阳性率为 40 .6 % (13/ 32 ) ,NC组为 10 .0 % (2 / 2 0 ) (P <0 .0 5 ) ;心功能II-III级患者两种受体的阳性率是心功能IV级的 2倍或以上。结论　抗心脏 β1与M2 受体自身抗体的产生与老年EDCM有关 ,推测这两种自身抗体可能参与老年EDCM患者心肌重构和 /或心力衰竭的病理生理过程。     

胺碘酮合用小剂量β受体阻滞剂治疗老年阵发房颤临床观察

目的 比较胺碘酮与小剂量β受体阻滞剂合用对老年阵发性房颤的疗效。方法 回顾分析30名老年阵发房颤患者,根据房颤复律后维持用药的不同,分为3组：单用胺碘酮组（n=11);单用β阻滞剂组（n=9);胺碘酮与小剂量β阻滞剂合用组（n=10)。比较3组患者用药后12个月中房颤控制情况及心室率、心脏传导情况。结果 单用胺碘酮组显效率54．5％,有效率45．5％,无效率0％;单用β受体阻滞剂组显效率22．2％,有效率44．5％,无效率33．3％;胺碘酮与小剂量β受体阻滞剂合用治疗房颤,显效率90％,有效率10％,其疗效明显优于单用胺碘酮（P＜0．05）或单用β阻滞剂（P＜0．01）组,且未见明显副作用：3组间心室率未见显著差别。结论 胺碘酮与小剂β受体阻滞剂合用可有效地控制老年阵发性心房纤颤的发作。     

重庆市北碚主城区老年医疗需求现状、对策和模式的研究

目的：了解重庆老人的需求状况以及老人的建议和希望。方法：以重庆市北碚主城区4893名60岁以上的老人进行问卷调查。结果：79．81％的老人患病时就近医疗;86．53％的老人感到看病不方便;86．37％的老人不参加保健咨询;65．48％的老人不听保健讲座;1．02％的老人因心理问题到医院就诊;55．69％的老人愿意参加群众性老年体育活动,随着年龄的增长,希望得到更好的医疗,预防,保健,康复的人数增多。结论：需改善老人看病难的现象,提供多渠道,多形式的老年医疗保健咨询,讲座,组织群众性老年体育活动,使老人的医疗服务需进一步提高和得到重视,争取探索一条以家庭为基础,社区医疗服务为依托,以综合性医院为技术保障,老年医疗康复为中心的模式。     

老年冠心病心功能不全患者血浆白细胞介素-6浓度的变化

目的 :观察老年冠心病心功能不全患者血浆白细胞介素 6 (interleukin - 6 ,IL - 6 )浓度的变化。方法 :选择老年冠心病心功能不全患者 48例、心功能正常者 15例及健康老年人 30例 ,采用酶联免疫吸附法测定其血浆IL - 6浓度。结果 :冠心病心功能不全组血浆IL - 6浓度较冠心病心功能正常组及健康对照组明显增高 (均P <0 .0 5 ) ,而冠心病心功能正常组与健康对照组之间无明显差异 (P >0 .0 5 ) ;血浆IL - 6浓度与左室射血分数呈负相关 (r =- 0 .6 0 ,P <0 .0 1) ;因心功能不全恶化再入院患者血浆IL - 6浓度高于未再入院患者 (P <0 .0 1)。结论 :IL - 6具有判断病情、评价预后的价值     

上海市长宁区中老年妇女慢性病现况调查

目的 了解中老年女慢性病患病状况,为社区中老年妇女的疾病预防、健康促进及制定中老年卫生政策提供科学依据。方法 采用入户调查的方式,对上海市长宁区75368名40－69岁中老年妇女常见慢性病患病率及常见关联因素,进行了结构式问卷调查。结果 在长宁区中老年妇女中,各种常见慢性病患病率居前5位的依次为高血压（23．9％）、慢性胃炎（19．7％）、冠心病（7．4％）、肿瘤（6．5％）和糖尿病（4．4％）。常见恶性肿瘤中,乳腺癌患病率最高（750／10万）,其次是胃癌（130／10万）。影响慢性病患病率的因素包括年龄、婚姻状况、吸烟、饮酒及饮茶等。结论 社区卫生工作应从健康教育入手,积极开展老年病防治工作。卫生部门应关注人口老龄化带来的新问题,积极提高中老年妇女的健康状况。     

老年颈椎病临床分型及CT诊断价值

目的　分析老年人颈椎病临床特点及CT表现 ,为临床治疗提供依据。方法　分析 4 83例老年颈椎病患者进行椎体及椎间盘CT自由扫描摄片结果。结果　 4 83例患者均患有单纯型颈椎病 (10 0 % ) ;CT表现为骨质增生有 4 4 4例 (占 91.93% ) ,椎间隙变窄、椎间盘变性 2 5 1例 (占 5 1.97% ) ,椎间孔变形 36 2例 (占74 .95 % ) ,生理曲度改变 2 71例 (占 5 6 .11% ) ,小关节及钩椎关节退变 391例 (占 80 .95 % ) ,横突孔狭小145例 (占 30 .0 2 % ) ,椎管狭窄 (中央前后径 <10mm ) 2 90例 (占 6 0 .0 4 % ) ,项韧带钙化 16 9例 (占34.99% )。结论　老年人颈椎经CT检查如有椎间孔变形、钩椎关节退行性改变、椎间隙变窄及椎管狭窄等4种征象中的 2项即可诊断为颈椎病。     

城市居家老年人宜老环境自我报告评估指标的构建

目的 构建城市居家老年人宜老环境自我报告评估指标,为了解城市老年人居家环境的质量水平和相关服务需求提供评价工具.方法 以世界卫生组织老年友好城市指南作为理论框架,在文献回顾和质性访谈的基础上形成草稿.采用德尔菲法对20名专家进行2轮咨询.结果 2轮专家咨询问卷有效回收率分别为90.91％、90.00％;第2轮专家咨询的权威系数为0.865,专家意见协调系数为0.305～0.671;最终确定的指标体系包括户外空间和建筑、交通、家庭住宅、社会交往和参与、社区服务和信息与通讯6项一级指标,84项二级指标.结论 城市居家老年人宜老环境自我报告评估指标有较好的专家认可度,可作为评价中国城市居家老年人环境质量的工具.