BACKGROUND Frailty has become a significant public health issue.The recent increase in the number of frail older adults has led to increased attention being paid to psycho-logical care services in communities.The soci...BACKGROUND Frailty has become a significant public health issue.The recent increase in the number of frail older adults has led to increased attention being paid to psycho-logical care services in communities.The social isolation of pre-frail older adults can impact their psychological distress.AIM To explore the mediating effect of health literacy between social isolation and psychological distress among communitydwelling older adults with pre-frailty.METHODS This descriptive cross-sectional study was conducted with 254 pre-frail older individuals aged 60 years and over.Social isolation,health literacy,and psycholo-gical distress were comprehensively measured using the Lubben Social Network Scale-6,12-item Short-Form Health Literacy Questionnaire,and the Kessler Psy-chological Distress Scale-10.Data were evaluated using the SPSS 27.0 package program and the PROCESS macro tool.Descriptive statistical analyses,correlation analyses,and bootstrap mediation tests were used to assess associations between the variables.RESULTS The results showed that social isolation had an effect on health literacy among pre-frail older adults(β=0.240,P<0.001),social isolation impact on psycho-logical distress pre-frail older adults(β=-0.415,P<0.001);health literacy was identified effect on psychological distress among pre-frail older persons(β=-0.307,P<0.001).Health literacy partially mediated the relationship between social isolation and psychological distress among community-dwelling older adults with pre-frailty,with a mediation effect of-0.074,accounting for 17.83%of the total effect.展开更多
BACKGROUND Colorectal cancer is a major global health challenge that predominantly affects older people.Surgical management,despite advancements,requires careful consideration of preoperative patient status for optima...BACKGROUND Colorectal cancer is a major global health challenge that predominantly affects older people.Surgical management,despite advancements,requires careful consideration of preoperative patient status for optimal outcomes.AIM To summarize existing evidence on the association of frailty with short-term postoperative outcomes in patients undergoing colorectal cancer surgery.METHODS A literature search was conducted using PubMed,EMBASE and Scopus databases for observational studies in adult patients aged≥18 years undergoing planned or elective colorectal surgery for primary carcinoma and/or secondary metastasis.Only studies that conducted frailty assessment using recognized frailty assess-ment tools and had a comparator group,comprising nonfrail patients,were included.Pooled effect sizes were reported as weighted mean difference or relative risk(RR)with 95%confidence intervals(CIs).RESULTS A total of 24 studies were included.Compared with nonfrail patients,frailty was associated with an increased risk of mortality at 30 d(RR:1.99,95%CI:1.47-2.69),at 90 d(RR:4.76,95%CI:1.56-14.6)and at 1 year(RR:5.73,95%CI:2.74-12.0)of follow up.Frail patients had an increased risk of any complications(RR:1.81,95%CI:1.57-2.10)as well as major complications(Clavien-Dindo classification grade≥III)(RR:2.87,95%CI:1.65-4.99)compared with the control group.The risk of reoperation(RR:1.18,95%CI:1.07-1.31),readmission(RR:1.70,95%CI:1.36-2.12),need for blood transfusion(RR:1.67,95%CI:1.52-1.85),wound complications(RR:1.49,95%CI:1.11-1.99),delirium(RR:4.60,95%CI:2.31-9.16),risk of prolonged hospitalization(RR:2.09,95%CI:1.22-3.60)and discharge to a skilled nursing facility or rehabilitation center(RR:3.19,95%CI:2.0-5.08)was all higher in frail patients.CONCLUSION Frailty in colorectal cancer surgery patients was associated with more complications,longer hospital stays,higher reoperation risk,and increased mortality.Integrating frailty assessment appears crucial for tailored surgical management.展开更多
BACKGROUND The impact of frailty on postoperative outcomes in patients undergoing hepatectomy is still unclear.AIM To study the influence of frailty on postoperative outcomes,such as mortality,rate of complications,an...BACKGROUND The impact of frailty on postoperative outcomes in patients undergoing hepatectomy is still unclear.AIM To study the influence of frailty on postoperative outcomes,such as mortality,rate of complications,and length of hospitalization,following hepatectomy.METHODS PubMed,EMBASE,and Scopus databases were searched for observational studies with adult(≥18 years)patients after planned/elective hepatectomy.A randomeffects model was used for all analyses,and the results are expressed as weighted mean difference(WMD),relative risk(RR),or hazards ratio(HR)with 95%confidence interval(CI).RESULTS Analysis of the 13 included studies showed a significant association of frailty with elevated risk of in-hospital mortality(RR=2.76,95%CI:2.10-3.64),mortality at 30 d(RR=4.60,95%CI:1.85-11.40),and mortality at 90 d(RR=2.52,95%CI:1.70-3.75)in the postoperative period.Frail patients had a poorer long-term survival(HR=2.89,95%CI:1.84-4.53)and higher incidence of“any”complications(RR=1.69,95%CI:1.40-2.03)and major(grade III or higher on the Clavien-Dindo scale)complications(RR=2.69,95%CI:1.85-3.92).Frailty was correlated with markedly lengthier hospital stay(WMD=3.65,95%CI:1.45-5.85).CONCLUSION Frailty correlates with elevated risks of mortality,complications,and prolonged hospitalization,which need to be considered in surgical management.Further research is essential to formulate strategies for improved outcomes in this vulnerable cohort.展开更多
This paper aims to identify the prevalence of frailty syndrome and its association with demographic, economic, health, psychological and functional variables in Brazilian population. The study was cross-sectional and ...This paper aims to identify the prevalence of frailty syndrome and its association with demographic, economic, health, psychological and functional variables in Brazilian population. The study was cross-sectional and composed of 385 elderly aged from 65 years, an average age of 73.92 years. A multivariate Poisson regression was used to check for conditions associated with frailty and to determine the prevalence (α = 0.05). The prevalence of frailty was 8.7% and pre-frailty of 50.4%. The frail and pre-frail older adults showed larger and increasing prevalence ratios for marital status, difficulty performing instrumental activities of daily living, old age, involuntary loss of feces, depression and negative affections. These results can guide the establishment of preventive measures and the development of intervention strategies aimed at minimizing the adverse effects of frailty in elderly people.展开更多
Background Frailty and orthostatic hypotension (OH),which is common in older adults,is associated with morbidity and mortality.The relationship between them remains unclear.The aim of the study is to determine whether...Background Frailty and orthostatic hypotension (OH),which is common in older adults,is associated with morbidity and mortality.The relationship between them remains unclear.The aim of the study is to determine whether there is a relationship between frailty and OH.Methods A total of 496 patients who were admitted to the geriatric clinic and underwent comprehensive geriatric assessment were retrospectively reviewed.In a cross-sectional and observational study,OH was measured by the Head-up Tilt Table test at 1,3,and 5 min (respectively,OH1,OH3,and OH5) and the frailty was measured by the Fried’s frailty scale.Results The mean age of all patients was 75.4 ± 7.38.The prevalence of females was 69.8%.When the frail people were compared with the pre-frail and the robust ones,the frailty was associated with OH1.There was no relationship between the groups in terms of OH1 when the pre-frail group was compared with the robust group.OH3 were higher in the frail group than in the pre-frail group (P < 0.05) and the OH5 were higher in the frail group than in the pre-frail and robust group (P < 0.05),but OH3 and OH5 were not associated with frailty status when they were adjusted for age (P > 0.05).Slowness and weakness were associated with OH1 (P < 0.05),whereas the other components of the Fried’s test were not.Conclusions Frailty may be a risk factor for OH1.The 1^st min measurements of OH should be routinely evaluated in frail older adults to prevent OH-related poor outcomes.展开更多
Transcatheter aortic valve replacement （TAVR） has revolutionised the treatment of patients with aortic stenosis （AS） over the last 15 years.TAVR is a well-established procedure for the treatment of patients consid...Transcatheter aortic valve replacement （TAVR） has revolutionised the treatment of patients with aortic stenosis （AS） over the last 15 years.TAVR is a well-established procedure for the treatment of patients considered high risk for open surgery. Results from the PARTNER （Placement of AoRTic traNscathetER） trial showed that inoperable patients randomly assigned to TAVR, had a 20% reduction in all-cause mortality, as well as hospitalisation, at one year compared to best medical management.展开更多
The incidence of frailty gradually increases with age.This condition places a heavy burden on modern society,of which the aging population is increasing.Frailty is one of the most complicated clinical syndromes;thus,i...The incidence of frailty gradually increases with age.This condition places a heavy burden on modern society,of which the aging population is increasing.Frailty is one of the most complicated clinical syndromes;thus,it is difficult to uncover its underlying mechanisms.Oxidative stress(OS)is involved in frailty in multiple ways.The association between the gut microbiota(GM)and frailty was recently reported.Herein,we propose that OS is involved in the association between the GM and the occurrence of frailty syndrome.An imbalance between oxidation and antioxidants can eventually lead to frailty,and the GM probably participates in this process through the production of reactive oxygen species.On the other hand,OS can disturb the GM.Such dysbiosis consequently induces or exacerbates tissue damage,leading to the occurrence of frailty syndrome.Finally,we discuss the possibility of improving frailty by intervening in the vicious cycle between the imbalance of OS and dysbiosis.展开更多
This study aimed to summarize the outcome measures and the significant outcome of effective integrated community care for frail elderly people through a literature review. A literature search was conducted using the C...This study aimed to summarize the outcome measures and the significant outcome of effective integrated community care for frail elderly people through a literature review. A literature search was conducted using the Cochrane Library and PubMed for articles published up to November 2016 with the following search terms: Integrated community care, primary care, community, frail elderly, and effectiveness. A total of 106 articles were identified, of which eight with an interventional research design the inclusion criteria. All outcome measures were classified into the three categories: Functional abilities, quality of life, and health. As the significant effect, the physical function was perceived in four references, the quality of life in one reference, and the mental health in one reference. The evidence of the effectiveness of integrated community care seemed to be lacking. More studies will need to be conducted.展开更多
This exploratory study investigated the circumstances of falls and fall-related injuries among frail elderly people under home care.A convenience sample of 500 frail elderly(60 e99 years old)from the Wanshoulu and Yuy...This exploratory study investigated the circumstances of falls and fall-related injuries among frail elderly people under home care.A convenience sample of 500 frail elderly(60 e99 years old)from the Wanshoulu and Yuyuantan communities in Beijing's Haidian District during February 2013 and March 2014.Fall circumstances and related injuries were characterized by detailed interviews and questionnaires.The article reports the results of a study that the overall fall incidence was 41.5%,and higher for females than males.Falls mainly occurred in individuals who were over 80 years old(50.0%)and indoors(67.9%).The percentage of subjects who experienced a combined injury after the fall was 56.3%,whereas 19.0%fell causes a fracture.Approximately 35%of the subjects were hospitalized,and 27.6%of the subjects recovered more than 30 days.Results indicate that,falls in the frail elderly caused serious damage,and fall-related circumstances should be a great concern in this population.展开更多
Background:?Treatment of frail elderly patients with pancreatic cancer is still a major problem due to intolerance to standard chemotherapy doses. Aim:?This study aims to compare the low-dose gemcitabine over 6 hours ...Background:?Treatment of frail elderly patients with pancreatic cancer is still a major problem due to intolerance to standard chemotherapy doses. Aim:?This study aims to compare the low-dose gemcitabine over 6 hours (LD6H) to the standard gemcitabine protocol in terms of clinical benefit, survival, and safety in the frail elderly patients with advanced pancreatic adenocarcinoma. Methods:?Patients enrolled in this trial were randomly assigned by in a 1:1 fashion via closed envelope method to either receive gemcitabine of 1000 mg/m2?over 30-minute infusion on days 1, 8, and 15 of every 4-week cycle (standard protocol arm) or gemcitabine as a weekly low-dose (250 mg/m2) over 6-hour infusion (LD6H arm). Results:?We enrolled eighty-two eligible frail elderly patients with advanced pancreatic cancer. The patients were randomly assigned to receive either standard gemcitabine protocol (40 patients) or low-dose (250 mg/m2) gemcitabine over 6-hour infusion, given weekly (42 patients). There was no significant difference between the standard group and low-dose group as regard of the overall response rate (p = 0.654), the disease control rate (DCR) (p = 0.845), the median progression-free survival (PFS) (p = 0.908) and the overall survival (OS) (p = 0.331). The low-dose regimen had a significantly lower incidence of adverse effects grades 3 or 4 when compared to the standard regimen: (p = 0.024 for fatigue, p = 0.027 for hypotension, p = 0.012 for each anemia as well as thrombocytopenia, and p = 0.006 for neutropenia). Conclusion:?Low-dose gemcitabine over 6-hour infusion is equally effective and less toxic when compared to standard gemcitabine protocol in frail elderly patients with advanced pancreatic adenocarcinoma. So, we recommend the low-dose gemcitabine for frail elderly patients with advanced pancreatic cancer.展开更多
Aim: This study aimed to clarify the relationship between depression and aging awareness among older adults living alone with low-level long-term-care needs. Methods: Participants were older adults aged 65 years and o...Aim: This study aimed to clarify the relationship between depression and aging awareness among older adults living alone with low-level long-term-care needs. Methods: Participants were older adults aged 65 years and older in Japan. Data were collected via an anonymous questionnaire. Participants were categorized based on their long-term care need level, from Support 1 to Care 2 according to the care insurance criteria in Japan. The questionnaire included: 1) the Geriatric Depression Scale-Short Version-Japanese (GDS);2) items on aging life satisfaction at present, and positive and negative aging awareness in the past (when they were young);3) the SF-8 to assess health-related quality of life;4) the Lubben Social Network Scale-6 (LSNS-6);and 5) items on the use of care services. Data were analyzed using multiple logistic regression analysis. Results: In total, 457 participants were recruited. Their mean age was 83.9 ± 6.5 years;39.8% of the participants had a GDS score of 6 and above. In the regression analysis, the GDS score significantly correlated with aging life satisfaction at present, negative aging awareness in the past, mental health, and social networks. Conclusion: Older adults living alone who have positive views of their current lives and lacked negative views of aging in their younger years were resistant to depression after being certified as requiring low-level long-term care. Preventing and improving depression in this population requires community-based support to expand their social networks and to help individuals of all ages view the aging process positively.展开更多
Background: Urinary Incontinence is a common symptom among the older and frail older people. Apart from affecting the quality of life and skin complications, the demand on assistance could be too high for any sufferer...Background: Urinary Incontinence is a common symptom among the older and frail older people. Apart from affecting the quality of life and skin complications, the demand on assistance could be too high for any sufferer. While conservative means of treatment do not work, special incontinence apparel could be a good compromise. Objective: To create an absorbent, antiseptic, antiperspirant and deodourant diaper for the older and dependent people suffering from urinary incontinence. Material and Methods: Antiperspirant and antiseptic medicinal materials have been reported in Traditional Chinese Medicine and two herbs were screened out to provide the required effects. A combination of Fraxini Cortex, Calamine and Zinc oxide made in powder forms was impregnated into a pocket of the diaper. Laboratory tests were performed to confirm the antiseptic, antiperspirant and deodourant effects of the materials. A self-control clinical trial on the diaper was organized in an elderly home. Results: Antibacterial effects against Staphylococcus, E. coli and Candida were proven. Antiperspirant effects were confirmed using acetylcholinesterase inhibitor testings. Volunteers using the Sudoscan machine further demonstrated the weak antiperspirant effects of the herbs. A pilot study on 31 dependent diaper users gave positive feedbacks of more comfort, less leakage, odour and better skin conditions. The overall satisfaction reached 79%. Conclusion: A special diaper with antiseptic, antiperspirant and deodourant effects could be created with inexpensive herbal powder impregnated and could be recommended to the older and frail older people with urinary incontinence.展开更多
The main objective of this work is to develop a technological solution to support active aging of frail older individuals. In this perspective, we designed a connected insole in order to encourage frail elderly person...The main objective of this work is to develop a technological solution to support active aging of frail older individuals. In this perspective, we designed a connected insole in order to encourage frail elderly persons to become more active in their daily life. The project presented in this paper, funded by the French National Research Agency, aims to design and evaluate an original solution to follow and encourage walking activity. The evaluation is performed in two stages: adjusting tests in a living-lab with nine healthy elderly, then clinical evaluation of three frail patients followed over one month. We designed a noninvasive wireless insole, which automatically measures gait parameters and transmits information to a remote terminal via a secure Internet connection. The first laboratory tests of this technological solution showed good reliability measurements as well as good user acceptability. The average distance error obtained on volunteers is 3.2% and the accuracy of the average walking speed is 96.8% thanks to design of a calibration system based on a personalized stride length measurement. Finally, the introduction of an induction charging instead of a button cell makes the system perfectly autonomous. In this paper, we present the specifications of the solution, the design of the connected insole, the methods used to measure desired parameters, the results of the living-lab tests, and the work in progress.展开更多
基金Supported by the Scientific Research Fund of Zhejiang Provincial Education Department,No.Y202351104and Huzhou Science and Technology Plan Project,No.2023GZ67。
文摘BACKGROUND Frailty has become a significant public health issue.The recent increase in the number of frail older adults has led to increased attention being paid to psycho-logical care services in communities.The social isolation of pre-frail older adults can impact their psychological distress.AIM To explore the mediating effect of health literacy between social isolation and psychological distress among communitydwelling older adults with pre-frailty.METHODS This descriptive cross-sectional study was conducted with 254 pre-frail older individuals aged 60 years and over.Social isolation,health literacy,and psycholo-gical distress were comprehensively measured using the Lubben Social Network Scale-6,12-item Short-Form Health Literacy Questionnaire,and the Kessler Psy-chological Distress Scale-10.Data were evaluated using the SPSS 27.0 package program and the PROCESS macro tool.Descriptive statistical analyses,correlation analyses,and bootstrap mediation tests were used to assess associations between the variables.RESULTS The results showed that social isolation had an effect on health literacy among pre-frail older adults(β=0.240,P<0.001),social isolation impact on psycho-logical distress pre-frail older adults(β=-0.415,P<0.001);health literacy was identified effect on psychological distress among pre-frail older persons(β=-0.307,P<0.001).Health literacy partially mediated the relationship between social isolation and psychological distress among community-dwelling older adults with pre-frailty,with a mediation effect of-0.074,accounting for 17.83%of the total effect.
基金The authors have read the PRISMA 2009 Checklist,and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
文摘BACKGROUND Colorectal cancer is a major global health challenge that predominantly affects older people.Surgical management,despite advancements,requires careful consideration of preoperative patient status for optimal outcomes.AIM To summarize existing evidence on the association of frailty with short-term postoperative outcomes in patients undergoing colorectal cancer surgery.METHODS A literature search was conducted using PubMed,EMBASE and Scopus databases for observational studies in adult patients aged≥18 years undergoing planned or elective colorectal surgery for primary carcinoma and/or secondary metastasis.Only studies that conducted frailty assessment using recognized frailty assess-ment tools and had a comparator group,comprising nonfrail patients,were included.Pooled effect sizes were reported as weighted mean difference or relative risk(RR)with 95%confidence intervals(CIs).RESULTS A total of 24 studies were included.Compared with nonfrail patients,frailty was associated with an increased risk of mortality at 30 d(RR:1.99,95%CI:1.47-2.69),at 90 d(RR:4.76,95%CI:1.56-14.6)and at 1 year(RR:5.73,95%CI:2.74-12.0)of follow up.Frail patients had an increased risk of any complications(RR:1.81,95%CI:1.57-2.10)as well as major complications(Clavien-Dindo classification grade≥III)(RR:2.87,95%CI:1.65-4.99)compared with the control group.The risk of reoperation(RR:1.18,95%CI:1.07-1.31),readmission(RR:1.70,95%CI:1.36-2.12),need for blood transfusion(RR:1.67,95%CI:1.52-1.85),wound complications(RR:1.49,95%CI:1.11-1.99),delirium(RR:4.60,95%CI:2.31-9.16),risk of prolonged hospitalization(RR:2.09,95%CI:1.22-3.60)and discharge to a skilled nursing facility or rehabilitation center(RR:3.19,95%CI:2.0-5.08)was all higher in frail patients.CONCLUSION Frailty in colorectal cancer surgery patients was associated with more complications,longer hospital stays,higher reoperation risk,and increased mortality.Integrating frailty assessment appears crucial for tailored surgical management.
文摘BACKGROUND The impact of frailty on postoperative outcomes in patients undergoing hepatectomy is still unclear.AIM To study the influence of frailty on postoperative outcomes,such as mortality,rate of complications,and length of hospitalization,following hepatectomy.METHODS PubMed,EMBASE,and Scopus databases were searched for observational studies with adult(≥18 years)patients after planned/elective hepatectomy.A randomeffects model was used for all analyses,and the results are expressed as weighted mean difference(WMD),relative risk(RR),or hazards ratio(HR)with 95%confidence interval(CI).RESULTS Analysis of the 13 included studies showed a significant association of frailty with elevated risk of in-hospital mortality(RR=2.76,95%CI:2.10-3.64),mortality at 30 d(RR=4.60,95%CI:1.85-11.40),and mortality at 90 d(RR=2.52,95%CI:1.70-3.75)in the postoperative period.Frail patients had a poorer long-term survival(HR=2.89,95%CI:1.84-4.53)and higher incidence of“any”complications(RR=1.69,95%CI:1.40-2.03)and major(grade III or higher on the Clavien-Dindo scale)complications(RR=2.69,95%CI:1.85-3.92).Frailty was correlated with markedly lengthier hospital stay(WMD=3.65,95%CI:1.45-5.85).CONCLUSION Frailty correlates with elevated risks of mortality,complications,and prolonged hospitalization,which need to be considered in surgical management.Further research is essential to formulate strategies for improved outcomes in this vulnerable cohort.
基金financial support from the National Research Council—CNPq,the Coordination Development of Higher Education Personnel—CDHEP,the Foundation for Research Support of the State of Sao Paulo—FRSSSP and the Foundation for Research Support of the State of Rio Grande do Sul—FRSSRGS.
文摘This paper aims to identify the prevalence of frailty syndrome and its association with demographic, economic, health, psychological and functional variables in Brazilian population. The study was cross-sectional and composed of 385 elderly aged from 65 years, an average age of 73.92 years. A multivariate Poisson regression was used to check for conditions associated with frailty and to determine the prevalence (α = 0.05). The prevalence of frailty was 8.7% and pre-frailty of 50.4%. The frail and pre-frail older adults showed larger and increasing prevalence ratios for marital status, difficulty performing instrumental activities of daily living, old age, involuntary loss of feces, depression and negative affections. These results can guide the establishment of preventive measures and the development of intervention strategies aimed at minimizing the adverse effects of frailty in elderly people.
文摘Background Frailty and orthostatic hypotension (OH),which is common in older adults,is associated with morbidity and mortality.The relationship between them remains unclear.The aim of the study is to determine whether there is a relationship between frailty and OH.Methods A total of 496 patients who were admitted to the geriatric clinic and underwent comprehensive geriatric assessment were retrospectively reviewed.In a cross-sectional and observational study,OH was measured by the Head-up Tilt Table test at 1,3,and 5 min (respectively,OH1,OH3,and OH5) and the frailty was measured by the Fried’s frailty scale.Results The mean age of all patients was 75.4 ± 7.38.The prevalence of females was 69.8%.When the frail people were compared with the pre-frail and the robust ones,the frailty was associated with OH1.There was no relationship between the groups in terms of OH1 when the pre-frail group was compared with the robust group.OH3 were higher in the frail group than in the pre-frail group (P < 0.05) and the OH5 were higher in the frail group than in the pre-frail and robust group (P < 0.05),but OH3 and OH5 were not associated with frailty status when they were adjusted for age (P > 0.05).Slowness and weakness were associated with OH1 (P < 0.05),whereas the other components of the Fried’s test were not.Conclusions Frailty may be a risk factor for OH1.The 1^st min measurements of OH should be routinely evaluated in frail older adults to prevent OH-related poor outcomes.
文摘Transcatheter aortic valve replacement （TAVR） has revolutionised the treatment of patients with aortic stenosis （AS） over the last 15 years.TAVR is a well-established procedure for the treatment of patients considered high risk for open surgery. Results from the PARTNER （Placement of AoRTic traNscathetER） trial showed that inoperable patients randomly assigned to TAVR, had a 20% reduction in all-cause mortality, as well as hospitalisation, at one year compared to best medical management.
基金the National Key Research and Development Program of China,No.2018YFC2002000 and 2018YFC2000500/03Shanghai Natural Science Foundation,No.21ZR1409200
文摘The incidence of frailty gradually increases with age.This condition places a heavy burden on modern society,of which the aging population is increasing.Frailty is one of the most complicated clinical syndromes;thus,it is difficult to uncover its underlying mechanisms.Oxidative stress(OS)is involved in frailty in multiple ways.The association between the gut microbiota(GM)and frailty was recently reported.Herein,we propose that OS is involved in the association between the GM and the occurrence of frailty syndrome.An imbalance between oxidation and antioxidants can eventually lead to frailty,and the GM probably participates in this process through the production of reactive oxygen species.On the other hand,OS can disturb the GM.Such dysbiosis consequently induces or exacerbates tissue damage,leading to the occurrence of frailty syndrome.Finally,we discuss the possibility of improving frailty by intervening in the vicious cycle between the imbalance of OS and dysbiosis.
文摘This study aimed to summarize the outcome measures and the significant outcome of effective integrated community care for frail elderly people through a literature review. A literature search was conducted using the Cochrane Library and PubMed for articles published up to November 2016 with the following search terms: Integrated community care, primary care, community, frail elderly, and effectiveness. A total of 106 articles were identified, of which eight with an interventional research design the inclusion criteria. All outcome measures were classified into the three categories: Functional abilities, quality of life, and health. As the significant effect, the physical function was perceived in four references, the quality of life in one reference, and the mental health in one reference. The evidence of the effectiveness of integrated community care seemed to be lacking. More studies will need to be conducted.
基金The Beijing Municipal Science and Technology Commission(D121100004912004).
文摘This exploratory study investigated the circumstances of falls and fall-related injuries among frail elderly people under home care.A convenience sample of 500 frail elderly(60 e99 years old)from the Wanshoulu and Yuyuantan communities in Beijing's Haidian District during February 2013 and March 2014.Fall circumstances and related injuries were characterized by detailed interviews and questionnaires.The article reports the results of a study that the overall fall incidence was 41.5%,and higher for females than males.Falls mainly occurred in individuals who were over 80 years old(50.0%)and indoors(67.9%).The percentage of subjects who experienced a combined injury after the fall was 56.3%,whereas 19.0%fell causes a fracture.Approximately 35%of the subjects were hospitalized,and 27.6%of the subjects recovered more than 30 days.Results indicate that,falls in the frail elderly caused serious damage,and fall-related circumstances should be a great concern in this population.
文摘Background:?Treatment of frail elderly patients with pancreatic cancer is still a major problem due to intolerance to standard chemotherapy doses. Aim:?This study aims to compare the low-dose gemcitabine over 6 hours (LD6H) to the standard gemcitabine protocol in terms of clinical benefit, survival, and safety in the frail elderly patients with advanced pancreatic adenocarcinoma. Methods:?Patients enrolled in this trial were randomly assigned by in a 1:1 fashion via closed envelope method to either receive gemcitabine of 1000 mg/m2?over 30-minute infusion on days 1, 8, and 15 of every 4-week cycle (standard protocol arm) or gemcitabine as a weekly low-dose (250 mg/m2) over 6-hour infusion (LD6H arm). Results:?We enrolled eighty-two eligible frail elderly patients with advanced pancreatic cancer. The patients were randomly assigned to receive either standard gemcitabine protocol (40 patients) or low-dose (250 mg/m2) gemcitabine over 6-hour infusion, given weekly (42 patients). There was no significant difference between the standard group and low-dose group as regard of the overall response rate (p = 0.654), the disease control rate (DCR) (p = 0.845), the median progression-free survival (PFS) (p = 0.908) and the overall survival (OS) (p = 0.331). The low-dose regimen had a significantly lower incidence of adverse effects grades 3 or 4 when compared to the standard regimen: (p = 0.024 for fatigue, p = 0.027 for hypotension, p = 0.012 for each anemia as well as thrombocytopenia, and p = 0.006 for neutropenia). Conclusion:?Low-dose gemcitabine over 6-hour infusion is equally effective and less toxic when compared to standard gemcitabine protocol in frail elderly patients with advanced pancreatic adenocarcinoma. So, we recommend the low-dose gemcitabine for frail elderly patients with advanced pancreatic cancer.
文摘Aim: This study aimed to clarify the relationship between depression and aging awareness among older adults living alone with low-level long-term-care needs. Methods: Participants were older adults aged 65 years and older in Japan. Data were collected via an anonymous questionnaire. Participants were categorized based on their long-term care need level, from Support 1 to Care 2 according to the care insurance criteria in Japan. The questionnaire included: 1) the Geriatric Depression Scale-Short Version-Japanese (GDS);2) items on aging life satisfaction at present, and positive and negative aging awareness in the past (when they were young);3) the SF-8 to assess health-related quality of life;4) the Lubben Social Network Scale-6 (LSNS-6);and 5) items on the use of care services. Data were analyzed using multiple logistic regression analysis. Results: In total, 457 participants were recruited. Their mean age was 83.9 ± 6.5 years;39.8% of the participants had a GDS score of 6 and above. In the regression analysis, the GDS score significantly correlated with aging life satisfaction at present, negative aging awareness in the past, mental health, and social networks. Conclusion: Older adults living alone who have positive views of their current lives and lacked negative views of aging in their younger years were resistant to depression after being certified as requiring low-level long-term care. Preventing and improving depression in this population requires community-based support to expand their social networks and to help individuals of all ages view the aging process positively.
文摘Background: Urinary Incontinence is a common symptom among the older and frail older people. Apart from affecting the quality of life and skin complications, the demand on assistance could be too high for any sufferer. While conservative means of treatment do not work, special incontinence apparel could be a good compromise. Objective: To create an absorbent, antiseptic, antiperspirant and deodourant diaper for the older and dependent people suffering from urinary incontinence. Material and Methods: Antiperspirant and antiseptic medicinal materials have been reported in Traditional Chinese Medicine and two herbs were screened out to provide the required effects. A combination of Fraxini Cortex, Calamine and Zinc oxide made in powder forms was impregnated into a pocket of the diaper. Laboratory tests were performed to confirm the antiseptic, antiperspirant and deodourant effects of the materials. A self-control clinical trial on the diaper was organized in an elderly home. Results: Antibacterial effects against Staphylococcus, E. coli and Candida were proven. Antiperspirant effects were confirmed using acetylcholinesterase inhibitor testings. Volunteers using the Sudoscan machine further demonstrated the weak antiperspirant effects of the herbs. A pilot study on 31 dependent diaper users gave positive feedbacks of more comfort, less leakage, odour and better skin conditions. The overall satisfaction reached 79%. Conclusion: A special diaper with antiseptic, antiperspirant and deodourant effects could be created with inexpensive herbal powder impregnated and could be recommended to the older and frail older people with urinary incontinence.
文摘The main objective of this work is to develop a technological solution to support active aging of frail older individuals. In this perspective, we designed a connected insole in order to encourage frail elderly persons to become more active in their daily life. The project presented in this paper, funded by the French National Research Agency, aims to design and evaluate an original solution to follow and encourage walking activity. The evaluation is performed in two stages: adjusting tests in a living-lab with nine healthy elderly, then clinical evaluation of three frail patients followed over one month. We designed a noninvasive wireless insole, which automatically measures gait parameters and transmits information to a remote terminal via a secure Internet connection. The first laboratory tests of this technological solution showed good reliability measurements as well as good user acceptability. The average distance error obtained on volunteers is 3.2% and the accuracy of the average walking speed is 96.8% thanks to design of a calibration system based on a personalized stride length measurement. Finally, the introduction of an induction charging instead of a button cell makes the system perfectly autonomous. In this paper, we present the specifications of the solution, the design of the connected insole, the methods used to measure desired parameters, the results of the living-lab tests, and the work in progress.
