Frailty is a geriatric syndrome characterized by a reduced ability to maintain homeostasis due to age-related declines in physiological reserves.It increases the risk of adverse health outcomes such as falls,hospitali...Frailty is a geriatric syndrome characterized by a reduced ability to maintain homeostasis due to age-related declines in physiological reserves.It increases the risk of adverse health outcomes such as falls,hospitalization,disability,and mortality,especially in older adults.Key risk factors for frailty include cancer,chronic obstructive pulmonary disease,and cerebrovascular disease.Several models of frailty exist,including the physical frailty phenotype,the deficit accu-mulation model,and mixed physical-psychosocial models.Numerous tools are available for assessment.Cognitive dysfunction is closely related to frailty,sharing underlying mechanisms such as oxidative stress,inflammation,and vascular pathologies.Additionally,social frailty,which can be exacerbated by isolation and limited social support,further complicates the challenges faced by frail individuals.It is recommended that frailty screening,particularly through gait speed assessment,can be conducted in primary healthcare settings.Despite existing guidelines,there is still no consensus on the definition,screening,and diagnosis of frailty.This emphasizes the necessity for additional research to conduct a conceptual diagnosis and screen the older population.Artificial intel-ligence approaches show promise in identifying frail patients and managing their care.展开更多
BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential t...BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.展开更多
Objective Burning solid cooking fuel contributes to household air pollution and is associated with frailty.However,how solid cooking fuel use contributes to the development of frailty has not been well illustrated.Met...Objective Burning solid cooking fuel contributes to household air pollution and is associated with frailty.However,how solid cooking fuel use contributes to the development of frailty has not been well illustrated.Methods This study recruited 8,947 participants aged≥45 years from the China Health and Retirement Longitudinal Study,2011–2018.Group-based trajectory modeling was employed to identify frailty trajectories.Multinomial logistic regression was used to assess the association between solid cooking fuel use and frailty trajectories.Population-attributable fractions were used to estimate the frailty burden from solid fuel use.Results We identified three frailty trajectories:low-stable(n=5,789),moderate-increasing(n=2,603),and fast-increasing(n=555).Solid fuel use was associated with higher odds of being in the moderate-increasing(OR:1.24,95%CI:1.08–1.42)and fast-increasing(OR:1.48,95%CI:1.14–1.92)trajectories.These associations were strengthened by longer solid fuel use(P for trend<0.001).Switching to clean fuel significantly reduced the risk of being in these trajectories compared with persistent solid fuel users.Without solid fuel,8%of moderate-and 19%of fast-increasing trajectories demonstrated frailty development like the low-stable group.Conclusion Solid cooking fuel use is associated with frailty trajectories in middle-aged and older Chinese populations.展开更多
Frailty has emerged as a pivotal determinant of post-liver transplant(LT)outcomes,yet its integration into clinical practice remains inconsistent.Defined by functional impairments and reduced physiologic reserve,frail...Frailty has emerged as a pivotal determinant of post-liver transplant(LT)outcomes,yet its integration into clinical practice remains inconsistent.Defined by functional impairments and reduced physiologic reserve,frailty transcends traditional metrics like the model for end-stage liver disease(MELD)score,demonstrating increasing predictive value for mortality beyond the immediate postoperative period.Recent findings suggest that frail recipients experience significantly higher mortality within the first 12 months following transplantation—a period when traditional monitoring often wanes.This raises critical questions about the adequacy of current assessment and follow-up protocols.The observed dissociation between MELD scores and long-term survival underscores the limitations of existing selection criteria.Frailty,as a dynamic and modifiable condition,represents an opportunity for targeted intervention.Prehabilitation programs focusing on nutritional optimization,physical rehabilitation,and psychosocial support could enhance resilience in transplant candidates,reducing their risk profile and improving post-transplant outcomes.Furthermore,these findings call for an expanded approach to post-transplant monitoring.Extending surveillance for frail recipients beyond standard timelines may facilitate early detection of complications,mitigating their impact on survival.Incorporating frailty into both pre-and post-transplant protocols could redefine how transplant centers evaluate and manage risk.This editorial advocates for a paradigm shift:Frailty must no longer be viewed as a secondary consideration but as a core element in LT care.By addressing frailty comprehensively,we can move toward more personalized,effective strategies that improve survival and quality of life for LT recipients.展开更多
Objectives:This study aimed to develop a mobile frailty management platform for Chinese communitydwelling older adults and evaluate its effectiveness,usability and safety.Methods:Based on literature research,the resea...Objectives:This study aimed to develop a mobile frailty management platform for Chinese communitydwelling older adults and evaluate its effectiveness,usability and safety.Methods:Based on literature research,the research team combined the frailty cycle and integration models,self-determination theory,and technology acceptance models and determined the frailty interventions through expert discussion,then transformed it into multimedia resources,finally,engineers developed the mobile management platform.A cluster sampling,parallel,single-blind,controlled quasiexperimental trial was conducted.Sixty older adults from two community health service centers were recruited from March to August 2023.The control group received routine community care,while the intervention group used the mobile frailty management platform.The incidence of frailty,scores of quality of life,depression,sleep quality,and grip strength within 12 weeks were compared between the two groups,and the availability and safety of the platform were assessed.Results:A total of 52 participants completed the study,27 in the intervention group and 25 in the control group.At 12 weeks after the intervention,the frailty state of the intervention group was reversed to prefrailty.There were no significant differences in the scores of quality of life,depression,sleep quality,and grip strength between the two groups before and 4 weeks after intervention.At 8 weeks and 12 weeks after the intervention,the quality of life,depression,and grip strength of the intervention group were improved with statistical significance(P<0.05).Sleep quality was statistically significant only 12 weeks after the intervention(P<0.05).System Usability Scale score for the platform was(87.96±5.88),indicating a highly satisfactory user experience.Throughout the intervention,no adverse events were reported among the older adults.Conclusions:The mobile frailty management platform effectively improved frailty status,depressive mood,sleep quality,grip strength,and quality of life for Chinese community-dwelling older adults.It holds clinical application value and is an effective tool for strengthening frailty management among Chinese community-dwelling older adults.展开更多
This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter...This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.展开更多
Cirrhosis represents the end stage of chronic liver disease,significantly reducing life expectancy as it progresses from a compensated to a decompensated state,leading to serious complications.Recent improvements in m...Cirrhosis represents the end stage of chronic liver disease,significantly reducing life expectancy as it progresses from a compensated to a decompensated state,leading to serious complications.Recent improvements in medical treatment have created a shift in cirrhosis management.Various causes,including hepatitis viruses,alcohol consumption,and fatty liver disease,contribute to cirrhosis and are closely linked to liver cancer.The disease develops through hepatocyte necrosis and regeneration,resulting in fibrosis and sinusoidal capillarization,leading to portal hypertension and complications such as ascites,hepatic encephalopathy,and organ dysfunction.Cirrhosis also holds an increased risk of hepatocellular carcinoma.Diagnosing cirrhosis involves assessing fibrosis scores through blood tests and measuring liver stiffness through elastography.Liver transplantation is the definitive treatment for endstage liver disease and acute liver failure.展开更多
Objective:While albumin and the weight-standardized hand grip strength(HGS/W)serve as valuable prognostic indicators for cancer patients,their correlation with the prognosis in frail cancer patients remains inadequate...Objective:While albumin and the weight-standardized hand grip strength(HGS/W)serve as valuable prognostic indicators for cancer patients,their correlation with the prognosis in frail cancer patients remains inadequately explored.This study aimed to investigate the prognostic importance of the albumin level and HGS/W in cancer patients with frailty and to further investigate their combined prognostic value.Moreover,this comprehensive evaluation aimed to facilitate timely intervention and treatment for frail patients.Methods:The research enrolled 5,794 cancer patients identified with frailty from a multicenter research database.The diagnosis of frailty was based on the FRAIL scale.An Albumin-HGS/W score was constructed by combining the albumin and HGS/W values.Cox proportional hazard regression was utilized to examine the association between the albumin level and HGS/W and patient outcomes.Results:Among these patients,2,543 were females and 3,251 were males,with a median age of 60.0 years.Optimal stratification based on patient survival revealed the ideal threshold for HGS/W to be 0.48 for males and 0.39 for females,and for albumin to be 38 for both sexes.The fully adjusted model revealed that higher Albumin-HGS/W scores were correlated with a poorer patient prognosis.Notably,an Albumin-HGS/W score of 2 was associated with a higher risk of mortality compared with a score of 0 in the total population(HR:1.813,95%CI:1.580-2.080,P<0.001).Conclusions:Low albumin or HGS/W values are associated with low survival in cancer patients with frailty.Elevated Albumin-HGS/W scores were linked to decreased survival rates in cancer patients with frailty.展开更多
Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by re...Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging,which significantly complicates their recovery process.To date,no study has investigated burns as a potential risk factor for frailty.This study aimed to determine the short-term prevalence of frailty among burn survivors’months after injury and compare it with that of the general population.Methods:A post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury(RE-ENERGIZE)trial,an international randomized-controlled trial involving 1200 burn injury patients with partial-or full-thickness burns.Participants who did not complete the 36-Item Short Form Health Survey(SF-36)questionnaire were excluded.Data for the general population were obtained from the 2022 National Health Interview Survey(NHIS).Frailty was assessed using the FRAIL(Fatigue,Resistance,Ambulation,Illness,Loss of weight)scale.Due to lack of data on loss of weight,for the purposes of this study,malnutrition was used as the fifth variable.Illness and malnutrition were based on admission data,while fatigue,resistance,and ambulation were determined from post-discharge responses to the SF-36.The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status.Within the burn group,patients were divided into different subgroups based on their frailty status,and the differences in their(instrumental)activities of daily living(iADL and ADL)were compared.A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL.Results:Out of the 1200 burn patients involved in the study,600 completed the required questionnaires[follow-up time:(5.5±2.3)months]and were matched to 1200 adults from the general population in the U.S.In comparison to the general population,burn patients exhibited a significantly higher likelihood of being pre-frail(42.3%vs.19.8%,P<0.0001),or frail(13.0%vs.1.0%,P<0.0001).When focusing on specific components,burn patients were more prone to experiencing fatigue(25.8%vs.13.5%,P<0.0001),limited resistance(34.0%vs.2.7%,P<0.0001),and restricted ambulation(41.8%vs.3.8%,P<0.0001).Conversely,the incidence rate of illness was observed to be higher in the general population(1.2%vs.2.8%,P=0.03),while no significant difference was detected regarding malnutrition(2.3%vs.2.6%,P=0.75).Furthermore,in comparison with robust burn patients,it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL.The frail cohort reported the most pronounced limitation.Conclusions:Our findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury.Burn survivors experience compromised fatigue,resistance,and ambulation,while rates of illness and malnutrition were lower or unchanged,respectively.These results underscore the critical need for early identification of frailty after a burn injury,with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists,community physicians,physiotherapists,nutritionists,and social workers.This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.展开更多
Background1 Currently,there is a scarcity of risk prediction models for frailty in hospitalized patients with chronic heart failure(CHF).This study aimed to investigate the frailty status of hospitalized CHF patients,...Background1 Currently,there is a scarcity of risk prediction models for frailty in hospitalized patients with chronic heart failure(CHF).This study aimed to investigate the frailty status of hospitalized CHF patients,identify independent risk factors significantly associated with frailty,and construct an effective risk prediction model.The goal was to provide a reference for clinical strategies in preventing and managing frailty among CHF patients.Methodss Using convenience sampling,we enrolled 184 hospitalized CHF patients from a tertiary hospital between February 2022 and December 2024.General demographic data were collected via questionnaires,alongside frailty screening using the FRAIL scale and assessment of daily functioning with the Activities of Daily Living(ADL)scale.Clinical data were obtained by reviewing medical records.Participants were categorized into a frail group(n=65)and a non-frail group(n=119)based on frailty status.Clinical risk factors were compared between groups.Multivariate logistic regression was used to identify independent risk factors.A prediction model was constructed,and a receiver operating characteristic(ROC)curve was plotted to evaluate its predictive value.Results A total of 184 hospitalized CHF patients were included,with 65(35.33%)exhibiting frailty.Multivariate logistic regression analysis showed that independent risk factors for frailty included:age,ADL score,N-terminal pro-brain natriuretic peptide(NT-pro-BNP),left ventricular ejection fraction(LVEF),New York Heart Association(NYHA)class II/IV,≥3 comorbidities,comorbid diabetes mellitus(DM),comorbid valvular heart disease(VHD),smoking history,hemoglobin(Hb),albumin,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),creatinine(Cr),and blood urea nitrogen(BUN).The aforementioned factors were incorporated into logistic regression analysis and the prediction model was built.The prediction model showed quite strong predictive performance.Its area under the ROC curve was 0.904(95%CI:0.857-0.951),with a sensitivity of98.5%and a specificity of 85.7%.ConclusionssThe frailty risk prediction model for hospitalized CHF patients demonstrated robust discriminative ability and calibration.It provided substantial reference value for clinical management of CHF,offering a basis for early assessment,risk stratification,and targeted interventions to prevent frailty by identifying high-risk patients.展开更多
Background:While physical frailty(PF)and cognitive impairment(CI)are established independent predictors of adverse outcomes in older adults,the prognostic significance of their co-occurrence(cognitive frailty,CF)remai...Background:While physical frailty(PF)and cognitive impairment(CI)are established independent predictors of adverse outcomes in older adults,the prognostic significance of their co-occurrence(cognitive frailty,CF)remains underexplored in the Chinese population.We aimed to explore the epidemiology of CF and its mortality predictive value among community-dwelling older Chinese adults.Methods:Data from the Chinese Longitudinal Healthy Longevity Survey(2011–2018).PF was assessed with the Osteoporotic Fractures frailty index,while CI was defined by the Chinese Mini-Mental State Examination(MMSE)(<18/21/25).CF was defined as concurrent PF and CI in non-demented.Cox proportional hazard regression models were used to evaluate hazard ratios(HRs)and 95%confidence intervals(CIs).A systematic review and random-effects meta-analysis complemented primary analyses,incorporating data from 9 cohorts study(n=32,088).Results:This cohort study included 8,012 participants(mean age 85.35±11.06 years,54.6%females)with 49.8%all-cause mortality over 7 years.Baseline prevalence of PF,CI,and CF were 15.4%,21.1%,and 8.0%respectively.Kaplan-Meier analysis revealed significantly reduced survival in participants with CF compared to other groups(log-rank P<0.001).Fully adjusted Cox models demonstrated a mortality gradient:Non-PF and Normal Cognition(reference),PF alone(HR 1.397,95%CI 1.218–1.602),CI alone(HR 1.572,1.412–1.749),and CF(HR 1.919,1.666–2.210;P<0.001).Effect modification analyses showed heightened CF-associated mortality in males and the oldest-old adults(P for interaction<0.001).Meta-analysis confirmed these findings(pooled HR 2.45,95%CIs,1.91–3.31;I2=57%),with heterogeneity partly attributable to the CI assessment tool or and covariate adjustment strategies.Conclusion:This dual analytical approach substantiates CF as a critical mortality predictor in Chinese older adults,exceeding the risks associated with isolated PF or CI.The observed heterogeneity across studies underscores the need for standardized CF diagnostic criteria and adjustment protocols in prognostic research.Our findings advocate for routine CF screening in geriatric assessments,particularly for males and the oldest-old.Future investigations should clarify the temporal dynamics of CF progression and evaluate targeted interventions.展开更多
Objective: To explore the association between cardiometabolic multimorbidity and frailty among middle- aged and older adults in China. Methods: Data were derived from the 2013 wave of the China Longitudinal Healthy Lo...Objective: To explore the association between cardiometabolic multimorbidity and frailty among middle- aged and older adults in China. Methods: Data were derived from the 2013 wave of the China Longitudinal Healthy Longevity Survey, including a total of 6,179 individuals aged 45 years and above with complete follow-up records. Basic demographic information was collected, and frailty status was assessed using a physical frailty scale. Generalized linear models were employed to analyze the association between the number and combinations of cardiometabolic conditions- such as hypertension, diabetes, heart disease, and stroke-and frailty. Results: The prevalence of cardiometabolic multimorbidity among middle-aged and older adults was 14.23%. After adjusting for sociodemographic covariates, individuals with cardiometabolic multimorbidity had a significantly increased risk of frailty compared to those without such conditions (OR = 1.78, 95% CI: 1.45-2.19), along with higher frailty scale scores (β = 0.26, 95% CI: 0.19-0.34). Compared to individuals without cardiometabolic diseases, those with both hypertension and stroke (OR = 1.18, 95% CI: 1.06-1.31) and those with hypertension, heart disease, and stroke (OR = 1.46, 95% CI: 1.24-1.73) exhibited notably higher frailty risks. Conclusion: There is a significant association between cardiometabolic multimorbidity and frailty in middle- aged and older adults in China, particularly for comorbidity patterns involving hypertension. These findings provide evidence for developing targeted health interventions for aging populations.展开更多
BACKGROUND Cognitive frailty,characterized by the coexistence of cognitive impairment and physical frailty,represents a multifaceted challenge in the aging population.The role of cardiovascular risk factors in this co...BACKGROUND Cognitive frailty,characterized by the coexistence of cognitive impairment and physical frailty,represents a multifaceted challenge in the aging population.The role of cardiovascular risk factors in this complex interplay is not yet fully understood.AIM To investigate the relationships between cardiovascular risk factors and older persons with cognitive frailty by pooling data from two cohorts of studies in Malaysia.METHODS A comprehensive approach was employed,with a total of 512 communitydwelling older persons aged 60 years and above,involving two cohorts of older persons from previous studies.Datasets related to cardiovascular risks,namely sociodemographic factors,and cardiovascular risk factors,including hypertension,diabetes,hypercholesterolemia,anthropometric characteristics and biochemical profiles,were pooled for analysis.Cognitive frailty was defined based on the Clinical Dementia Rating scale and Fried frailty score.Cardiovascular risk was determined using Framingham risk score.Statistical analyses were conducted using SPSS version 21.RESULTS Of the study participants,46.3%exhibited cognitive frailty.Cardiovascular risk factors including hypertension(OR:1.60;95%CI:1.12-2.30),low fat-free mass(OR:0.96;95%CI:0.94-0.98),high percentage body fat(OR:1.04;95%CI:1.02-1.06),high waist circumference(OR:1.02;95%CI:1.01-1.04),high fasting blood glucose(OR:1.64;95%CI:1.11-2.43),high Framingham risk score(OR:1.65;95%CI:1.17-2.31),together with sociodemographic factors,i.e.,being single(OR 3.38;95%CI:2.26-5.05)and low household income(OR 2.18;95%CI:1.44-3.30)were found to be associated with cognitive frailty.CONCLUSION Cardiovascular-risk specific risk factors and sociodemographic factors were associated with risk of cognitive frailty,a prodromal stage of dementia.Early identification and management of cardiovascular risk factors,particularly among specific group of the population might mitigate the risk of cognitive frailty,hence preventing dementia.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 Frailty is a common condition in elderly patients who receive percutaneous coronary intervention(PCI).However,how frailty affects clinical outcomes in this group is unclear.AIM To assess the link between fr...BACKGROUND Frailty is a common condition in elderly patients who receive percutaneous coronary intervention(PCI).However,how frailty affects clinical outcomes in this group is unclear.AIM To assess the link between frailty and the outcomes,such as in-hospital complic-ations,post-procedural complications,and mortality,in elderly patients post-PCI.METHODS The PubMed/MEDLINE,EMBASE,Cochrane Library,and Web of Science databases were screened for publications up to August 2023.The primary outcomes assessed were in-hospital and all-cause mortality,major adverse cardiovascular events(MACEs),and major bleeding.The Newcastle-Ottawa Scale was used for quality assessment.RESULTS Twenty-one studies with 739693 elderly patients undergoing PCI were included.Frailty was consistently associated with adverse outcomes.Frail patients had significantly higher risks of in-hospital mortality[risk ratio:3.45,95%confidence interval(95%CI):1.90-6.25],all-cause mortality[hazard ratio(HR):2.08,95%CI:1.78-2.43],MACEs(HR:2.92,95%CI:1.85-4.60),and major bleeding(HR:4.60,95%CI:2.89-7.32)compared to non-frail patients.CONCLUSION Frailty is a pivotal determinant in the prediction of risk of mortality,development of MACEs,and major bleeding in elderly individuals undergoing percutaneous coronary intervention.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic diseases.Frail and elderly patients,especially those aged≥90 years are generally considered a...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic diseases.Frail and elderly patients,especially those aged≥90 years are generally considered a higher-risk population for ERCP-related complications.AIM To investigate outcomes of ERCP in the Non-agenarian population(≥90 years)concerning Frailty.METHODS This is a cohort study using the 2018-2020 National Readmission Database.Patients aged≥90 were identified who underwent ERCP,using the international classification of diseases-10 code with clinical modification.Johns Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and non-frail.The primary outcome was mortality,and the secondary outcomes were morbidity and the 30 d readmission rate related to ERCP.We used univariate and multivariate regression models for analysis.RESULTS A total of 9448 patients were admitted for any indications of ERCP.Frail and non-frail patients were 3445(36.46%)and 6003(63.53%)respectively.Indications for ERCP were Choledocholithiasis(74.84%),Biliary pancreatitis(9.19%),Pancreatico-biliary cancer(7.6%),Biliary stricture(4.84%),and Cholangitis(1.51%).Mortality rates were higher in frail group[adjusted odds ratio(aOR)=1.68,P=0.02].The Intra-procedural complications were insigni-ficant between the two groups which included bleeding(aOR=0.72,P=0.67),accidental punctures/lacerations(aOR=0.77,P=0.5),and mechanical ventilation rates(aOR=1.19,P=0.6).Post-ERCP complication rate was similar for bleeding(aOR=0.72,P=0.41)and post-ERCP pancreatitis(aOR=1.4,P=0.44).Frail patients had a longer length of stay(6.7 d vs 5.5 d)and higher mean total charges of hospitalization($78807 vs$71392)compared to controls(P<0.001).The 30 d all-cause readmission rates between frail and non-frail patients were similar(P=0.96).CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared to non-frail.Larger studies are warranted to investigate and mitigate modifiable risk factors.展开更多
BACKGROUND Frailty is a complex aging-related syndrome characterized by a cumulative loss of physiological reserve and increased vulnerability to adverse clinical outcomes,including falls,disability,incapacity and dea...BACKGROUND Frailty is a complex aging-related syndrome characterized by a cumulative loss of physiological reserve and increased vulnerability to adverse clinical outcomes,including falls,disability,incapacity and death.While an increasing number of studies suggest that the gut microbiota may play a key role in the pathophy-siology of frailty,direct evaluation of the association between gut microbiome alterations and frailty in older adults remains limited.AIM Seven electronic databases(China National Knowledge Infrastructure,VIP,SinoMed,Wanfang,PubMed,Web of Science and EMBASE)were searched for articles published before October 31,2023 to identify observational studies that compared the microbiomes of older adults with and without frailty.The diversity and composition of the gut microbiota were the main outcomes used to analyze the associations of changes in the gut microbiota with frailty in older adults.The quality of the included studies was assessed via the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality.RESULTS Eleven observational studies with 912 older adults were included in this review.Consistent results revealed a significant difference in the gut microbiota composition between frail and non-frail older adults,with a significant decrease inαdiversity and a significant increase inβdiversity in frail older adults.The pooled results revealed that at the phylum level,four microbiota(Actinobacteria,Proteo-bacteria,Verrucomicrobia and Synergistetes)were significantly enriched,and two microbiota(Firmicutes and Fusobacteria)were significantly depleted in frail older adults.At the family level,the results consistently revealed that the abundances of 6 families,most of which belong to the Actinobacteria or Proteo-bacteria phylum,were greater in frail than in non-frail older adults.At the genus or species level,consistent results from more than two studies revealed that the abundances of the genera Prevotella,Faecalibacterium,and Roseburia were significantly lower in frail older adults;individual studies revealed that the abundances of some genera or species(e.g.,Megamonas,Blautia,and Megasphaera)were significantly lower,whereas those of other genera or species(e.g.,Bifidobacterium,Oscillospira,Ruminococcus and Pyramidobacter)were significantly greater in frail older adults.CONCLUSION This systematic review suggests that changes in the gut microbiota are associated with frailty in older adults,which is commonly reflected by a reduction in beneficial species and an increase in pathogenic species.However,further studies are needed to confirm these findings.展开更多
Background:Themortality burden of patients with gastrointestinalmalignancies is increasing worldwide,suggesting the need formore effective prognostic indicators.This study utilized a prospective cohort to(1)analyze th...Background:Themortality burden of patients with gastrointestinalmalignancies is increasing worldwide,suggesting the need formore effective prognostic indicators.This study utilized a prospective cohort to(1)analyze the relationship between frailty and malnutrition and their association with the overall survival(OS)in adults with gastrointestinal cancer and(2)explore which specific frailty-related factors most significantly affect the OS.Methods:Participants diagnosed with gastrointestinal cancer from 2013 to 2018 who were enrolled in the Investigation on Nutrition Status and Clinical Outcome of Common Cancers study were identified.Malnutrition was determined using the Patient-Generated Subjective Global Assessment,whereas frailty was assessed using the FRAIL scale.The main outcome measured was the all-cause mortality.Multivariable-adjusted logistic regression was used to analyze the cross-sectional link between the nutritional status and frailty.Univariate and multivariate Cox regression analyses were conducted to explore the longitudinal association of these with the OS.Results:Among the 4,361 patients enrolled in the study,1,136 deaths were observed over a median follow-up of 43.4 months.Malnourished patients had a significantly higher risk of frailty than well-nourished patients(OR=6.25,95%CI=5.23–7.51).Frailty and malnutrition independently predicted the OS,with frailty showing an HR of 1.50(95%CI=1.33–1.69)and malnutrition showing an HR of 1.51(95%CI=1.31–1.74).Patientswith both frailty andmalnutrition had the highest all-causemortality risk(HR=1.82,95%CI=1.55–2.14)compared with patients with neither risk factor.Mortality rates rose with the accumulation of additional frailty-related factors.Conclusions:Malnutrition and frailty are interrelated prognostic factors in patients with gastrointestinalmalignancies,and their simultaneous presence worsens the patient outcomes.Higher scores for resistance and ambulation are major factors associated with a poorer outcome.Future large-scale prospective studies with repeated measurements are necessary to further explore the complex associations among frailty,malnutrition,and the prognosis in patients with gastrointestinal cancer.展开更多
Wang and Liu's systematic review of frailty among elderly patients undergoing percutaneous coronary intervention(PCI)revealed that patients with frailty have significantly higher risks of all-cause and in-hospital...Wang and Liu's systematic review of frailty among elderly patients undergoing percutaneous coronary intervention(PCI)revealed that patients with frailty have significantly higher risks of all-cause and in-hospital death,major undesirable cardiovascular events,and major haemorrhage.Frailty is associated with adverse events,prolonged hospital stays,increased complications,and elevated mortality risk due to diminished physiological reserves.Integrating frailty into risk assessment tools is crucial,and gait speed has emerged as a key predictor of frailty.Recognizing the impact of frailty leads to personalized and informed decisionmaking,and frailty assessments should be performed.This holistic approach can inform tailored interventions,thereby optimizing outcomes for this vulnerable population undergoing PCI.展开更多
In developed countries,the average life expectancy has been increasing and is now well over 80 years.Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later...In developed countries,the average life expectancy has been increasing and is now well over 80 years.Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups.Acute appendicitis is one of the most common surgical diseases,with a lifetime risk of 8%.A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups(>80 years).Among patients>50-year-old who present to the emergency department for acute abdominal pain,15%have acute appendicitis.In these patients,emergency surgery for acute appendicitis is challenging,and some important aspects must be considered.In the elderly,surgical treatment outcomes are influenced by sarcopenia.Sarcopenia must be considered a precursor of frailty,a risk factor for physical function decline.Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity.Aside from morbidity and mortality,the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance.Therefore,prediction of function decline is critical.In emergency surgery,preoperative interventions are difficult to implement because of the narrow time window before surgery.In this editorial,we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.展开更多
文摘Frailty is a geriatric syndrome characterized by a reduced ability to maintain homeostasis due to age-related declines in physiological reserves.It increases the risk of adverse health outcomes such as falls,hospitalization,disability,and mortality,especially in older adults.Key risk factors for frailty include cancer,chronic obstructive pulmonary disease,and cerebrovascular disease.Several models of frailty exist,including the physical frailty phenotype,the deficit accu-mulation model,and mixed physical-psychosocial models.Numerous tools are available for assessment.Cognitive dysfunction is closely related to frailty,sharing underlying mechanisms such as oxidative stress,inflammation,and vascular pathologies.Additionally,social frailty,which can be exacerbated by isolation and limited social support,further complicates the challenges faced by frail individuals.It is recommended that frailty screening,particularly through gait speed assessment,can be conducted in primary healthcare settings.Despite existing guidelines,there is still no consensus on the definition,screening,and diagnosis of frailty.This emphasizes the necessity for additional research to conduct a conceptual diagnosis and screen the older population.Artificial intel-ligence approaches show promise in identifying frail patients and managing their care.
文摘BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.
基金supported by the National Natural Science Foundation of China(82222064,81973147)the National Key Research and Development Program(2022YFC2010100)the Shandong University Distinguished Young Scholars。
文摘Objective Burning solid cooking fuel contributes to household air pollution and is associated with frailty.However,how solid cooking fuel use contributes to the development of frailty has not been well illustrated.Methods This study recruited 8,947 participants aged≥45 years from the China Health and Retirement Longitudinal Study,2011–2018.Group-based trajectory modeling was employed to identify frailty trajectories.Multinomial logistic regression was used to assess the association between solid cooking fuel use and frailty trajectories.Population-attributable fractions were used to estimate the frailty burden from solid fuel use.Results We identified three frailty trajectories:low-stable(n=5,789),moderate-increasing(n=2,603),and fast-increasing(n=555).Solid fuel use was associated with higher odds of being in the moderate-increasing(OR:1.24,95%CI:1.08–1.42)and fast-increasing(OR:1.48,95%CI:1.14–1.92)trajectories.These associations were strengthened by longer solid fuel use(P for trend<0.001).Switching to clean fuel significantly reduced the risk of being in these trajectories compared with persistent solid fuel users.Without solid fuel,8%of moderate-and 19%of fast-increasing trajectories demonstrated frailty development like the low-stable group.Conclusion Solid cooking fuel use is associated with frailty trajectories in middle-aged and older Chinese populations.
文摘Frailty has emerged as a pivotal determinant of post-liver transplant(LT)outcomes,yet its integration into clinical practice remains inconsistent.Defined by functional impairments and reduced physiologic reserve,frailty transcends traditional metrics like the model for end-stage liver disease(MELD)score,demonstrating increasing predictive value for mortality beyond the immediate postoperative period.Recent findings suggest that frail recipients experience significantly higher mortality within the first 12 months following transplantation—a period when traditional monitoring often wanes.This raises critical questions about the adequacy of current assessment and follow-up protocols.The observed dissociation between MELD scores and long-term survival underscores the limitations of existing selection criteria.Frailty,as a dynamic and modifiable condition,represents an opportunity for targeted intervention.Prehabilitation programs focusing on nutritional optimization,physical rehabilitation,and psychosocial support could enhance resilience in transplant candidates,reducing their risk profile and improving post-transplant outcomes.Furthermore,these findings call for an expanded approach to post-transplant monitoring.Extending surveillance for frail recipients beyond standard timelines may facilitate early detection of complications,mitigating their impact on survival.Incorporating frailty into both pre-and post-transplant protocols could redefine how transplant centers evaluate and manage risk.This editorial advocates for a paradigm shift:Frailty must no longer be viewed as a secondary consideration but as a core element in LT care.By addressing frailty comprehensively,we can move toward more personalized,effective strategies that improve survival and quality of life for LT recipients.
文摘Objectives:This study aimed to develop a mobile frailty management platform for Chinese communitydwelling older adults and evaluate its effectiveness,usability and safety.Methods:Based on literature research,the research team combined the frailty cycle and integration models,self-determination theory,and technology acceptance models and determined the frailty interventions through expert discussion,then transformed it into multimedia resources,finally,engineers developed the mobile management platform.A cluster sampling,parallel,single-blind,controlled quasiexperimental trial was conducted.Sixty older adults from two community health service centers were recruited from March to August 2023.The control group received routine community care,while the intervention group used the mobile frailty management platform.The incidence of frailty,scores of quality of life,depression,sleep quality,and grip strength within 12 weeks were compared between the two groups,and the availability and safety of the platform were assessed.Results:A total of 52 participants completed the study,27 in the intervention group and 25 in the control group.At 12 weeks after the intervention,the frailty state of the intervention group was reversed to prefrailty.There were no significant differences in the scores of quality of life,depression,sleep quality,and grip strength between the two groups before and 4 weeks after intervention.At 8 weeks and 12 weeks after the intervention,the quality of life,depression,and grip strength of the intervention group were improved with statistical significance(P<0.05).Sleep quality was statistically significant only 12 weeks after the intervention(P<0.05).System Usability Scale score for the platform was(87.96±5.88),indicating a highly satisfactory user experience.Throughout the intervention,no adverse events were reported among the older adults.Conclusions:The mobile frailty management platform effectively improved frailty status,depressive mood,sleep quality,grip strength,and quality of life for Chinese community-dwelling older adults.It holds clinical application value and is an effective tool for strengthening frailty management among Chinese community-dwelling older adults.
基金Supported by National High Level Hospital Clinical Research Funding Project,No.BJ-2023-206.
文摘This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.
文摘Cirrhosis represents the end stage of chronic liver disease,significantly reducing life expectancy as it progresses from a compensated to a decompensated state,leading to serious complications.Recent improvements in medical treatment have created a shift in cirrhosis management.Various causes,including hepatitis viruses,alcohol consumption,and fatty liver disease,contribute to cirrhosis and are closely linked to liver cancer.The disease develops through hepatocyte necrosis and regeneration,resulting in fibrosis and sinusoidal capillarization,leading to portal hypertension and complications such as ascites,hepatic encephalopathy,and organ dysfunction.Cirrhosis also holds an increased risk of hepatocellular carcinoma.Diagnosing cirrhosis involves assessing fibrosis scores through blood tests and measuring liver stiffness through elastography.Liver transplantation is the definitive treatment for endstage liver disease and acute liver failure.
基金supported by a Henan Province Science and Technology Research Project(No.252102311033)the National Key Research and Development Program(No.2022YFC2009600 and No.2022YFC2009601).
文摘Objective:While albumin and the weight-standardized hand grip strength(HGS/W)serve as valuable prognostic indicators for cancer patients,their correlation with the prognosis in frail cancer patients remains inadequately explored.This study aimed to investigate the prognostic importance of the albumin level and HGS/W in cancer patients with frailty and to further investigate their combined prognostic value.Moreover,this comprehensive evaluation aimed to facilitate timely intervention and treatment for frail patients.Methods:The research enrolled 5,794 cancer patients identified with frailty from a multicenter research database.The diagnosis of frailty was based on the FRAIL scale.An Albumin-HGS/W score was constructed by combining the albumin and HGS/W values.Cox proportional hazard regression was utilized to examine the association between the albumin level and HGS/W and patient outcomes.Results:Among these patients,2,543 were females and 3,251 were males,with a median age of 60.0 years.Optimal stratification based on patient survival revealed the ideal threshold for HGS/W to be 0.48 for males and 0.39 for females,and for albumin to be 38 for both sexes.The fully adjusted model revealed that higher Albumin-HGS/W scores were correlated with a poorer patient prognosis.Notably,an Albumin-HGS/W score of 2 was associated with a higher risk of mortality compared with a score of 0 in the total population(HR:1.813,95%CI:1.580-2.080,P<0.001).Conclusions:Low albumin or HGS/W values are associated with low survival in cancer patients with frailty.Elevated Albumin-HGS/W scores were linked to decreased survival rates in cancer patients with frailty.
基金supported by the U.S.Department of Defense(W81XWH-09-2-0194 for the pilot phase)the Canadian Institutes of Health Research(MCT-94834 for the pilot phase and 14238 for the definitive phase).
文摘Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging,which significantly complicates their recovery process.To date,no study has investigated burns as a potential risk factor for frailty.This study aimed to determine the short-term prevalence of frailty among burn survivors’months after injury and compare it with that of the general population.Methods:A post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury(RE-ENERGIZE)trial,an international randomized-controlled trial involving 1200 burn injury patients with partial-or full-thickness burns.Participants who did not complete the 36-Item Short Form Health Survey(SF-36)questionnaire were excluded.Data for the general population were obtained from the 2022 National Health Interview Survey(NHIS).Frailty was assessed using the FRAIL(Fatigue,Resistance,Ambulation,Illness,Loss of weight)scale.Due to lack of data on loss of weight,for the purposes of this study,malnutrition was used as the fifth variable.Illness and malnutrition were based on admission data,while fatigue,resistance,and ambulation were determined from post-discharge responses to the SF-36.The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status.Within the burn group,patients were divided into different subgroups based on their frailty status,and the differences in their(instrumental)activities of daily living(iADL and ADL)were compared.A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL.Results:Out of the 1200 burn patients involved in the study,600 completed the required questionnaires[follow-up time:(5.5±2.3)months]and were matched to 1200 adults from the general population in the U.S.In comparison to the general population,burn patients exhibited a significantly higher likelihood of being pre-frail(42.3%vs.19.8%,P<0.0001),or frail(13.0%vs.1.0%,P<0.0001).When focusing on specific components,burn patients were more prone to experiencing fatigue(25.8%vs.13.5%,P<0.0001),limited resistance(34.0%vs.2.7%,P<0.0001),and restricted ambulation(41.8%vs.3.8%,P<0.0001).Conversely,the incidence rate of illness was observed to be higher in the general population(1.2%vs.2.8%,P=0.03),while no significant difference was detected regarding malnutrition(2.3%vs.2.6%,P=0.75).Furthermore,in comparison with robust burn patients,it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL.The frail cohort reported the most pronounced limitation.Conclusions:Our findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury.Burn survivors experience compromised fatigue,resistance,and ambulation,while rates of illness and malnutrition were lower or unchanged,respectively.These results underscore the critical need for early identification of frailty after a burn injury,with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists,community physicians,physiotherapists,nutritionists,and social workers.This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.
基金supported by Guangdong Medical Science and Technology Research Fund Project(No.A2022458)Guangdong Provincial People's Medical Climbing Plan(Nursing Research Project)(No.DFJH2020011)。
文摘Background1 Currently,there is a scarcity of risk prediction models for frailty in hospitalized patients with chronic heart failure(CHF).This study aimed to investigate the frailty status of hospitalized CHF patients,identify independent risk factors significantly associated with frailty,and construct an effective risk prediction model.The goal was to provide a reference for clinical strategies in preventing and managing frailty among CHF patients.Methodss Using convenience sampling,we enrolled 184 hospitalized CHF patients from a tertiary hospital between February 2022 and December 2024.General demographic data were collected via questionnaires,alongside frailty screening using the FRAIL scale and assessment of daily functioning with the Activities of Daily Living(ADL)scale.Clinical data were obtained by reviewing medical records.Participants were categorized into a frail group(n=65)and a non-frail group(n=119)based on frailty status.Clinical risk factors were compared between groups.Multivariate logistic regression was used to identify independent risk factors.A prediction model was constructed,and a receiver operating characteristic(ROC)curve was plotted to evaluate its predictive value.Results A total of 184 hospitalized CHF patients were included,with 65(35.33%)exhibiting frailty.Multivariate logistic regression analysis showed that independent risk factors for frailty included:age,ADL score,N-terminal pro-brain natriuretic peptide(NT-pro-BNP),left ventricular ejection fraction(LVEF),New York Heart Association(NYHA)class II/IV,≥3 comorbidities,comorbid diabetes mellitus(DM),comorbid valvular heart disease(VHD),smoking history,hemoglobin(Hb),albumin,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),creatinine(Cr),and blood urea nitrogen(BUN).The aforementioned factors were incorporated into logistic regression analysis and the prediction model was built.The prediction model showed quite strong predictive performance.Its area under the ROC curve was 0.904(95%CI:0.857-0.951),with a sensitivity of98.5%and a specificity of 85.7%.ConclusionssThe frailty risk prediction model for hospitalized CHF patients demonstrated robust discriminative ability and calibration.It provided substantial reference value for clinical management of CHF,offering a basis for early assessment,risk stratification,and targeted interventions to prevent frailty by identifying high-risk patients.
基金supported by The Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine(ZYYCXTD-C-202006)the 2025 High-level traditional Chinese medicine key subject construction project of National Administration of Traditional Chinese Medicine–Evidence-based Traditional Chinese Medicine.
文摘Background:While physical frailty(PF)and cognitive impairment(CI)are established independent predictors of adverse outcomes in older adults,the prognostic significance of their co-occurrence(cognitive frailty,CF)remains underexplored in the Chinese population.We aimed to explore the epidemiology of CF and its mortality predictive value among community-dwelling older Chinese adults.Methods:Data from the Chinese Longitudinal Healthy Longevity Survey(2011–2018).PF was assessed with the Osteoporotic Fractures frailty index,while CI was defined by the Chinese Mini-Mental State Examination(MMSE)(<18/21/25).CF was defined as concurrent PF and CI in non-demented.Cox proportional hazard regression models were used to evaluate hazard ratios(HRs)and 95%confidence intervals(CIs).A systematic review and random-effects meta-analysis complemented primary analyses,incorporating data from 9 cohorts study(n=32,088).Results:This cohort study included 8,012 participants(mean age 85.35±11.06 years,54.6%females)with 49.8%all-cause mortality over 7 years.Baseline prevalence of PF,CI,and CF were 15.4%,21.1%,and 8.0%respectively.Kaplan-Meier analysis revealed significantly reduced survival in participants with CF compared to other groups(log-rank P<0.001).Fully adjusted Cox models demonstrated a mortality gradient:Non-PF and Normal Cognition(reference),PF alone(HR 1.397,95%CI 1.218–1.602),CI alone(HR 1.572,1.412–1.749),and CF(HR 1.919,1.666–2.210;P<0.001).Effect modification analyses showed heightened CF-associated mortality in males and the oldest-old adults(P for interaction<0.001).Meta-analysis confirmed these findings(pooled HR 2.45,95%CIs,1.91–3.31;I2=57%),with heterogeneity partly attributable to the CI assessment tool or and covariate adjustment strategies.Conclusion:This dual analytical approach substantiates CF as a critical mortality predictor in Chinese older adults,exceeding the risks associated with isolated PF or CI.The observed heterogeneity across studies underscores the need for standardized CF diagnostic criteria and adjustment protocols in prognostic research.Our findings advocate for routine CF screening in geriatric assessments,particularly for males and the oldest-old.Future investigations should clarify the temporal dynamics of CF progression and evaluate targeted interventions.
文摘Objective: To explore the association between cardiometabolic multimorbidity and frailty among middle- aged and older adults in China. Methods: Data were derived from the 2013 wave of the China Longitudinal Healthy Longevity Survey, including a total of 6,179 individuals aged 45 years and above with complete follow-up records. Basic demographic information was collected, and frailty status was assessed using a physical frailty scale. Generalized linear models were employed to analyze the association between the number and combinations of cardiometabolic conditions- such as hypertension, diabetes, heart disease, and stroke-and frailty. Results: The prevalence of cardiometabolic multimorbidity among middle-aged and older adults was 14.23%. After adjusting for sociodemographic covariates, individuals with cardiometabolic multimorbidity had a significantly increased risk of frailty compared to those without such conditions (OR = 1.78, 95% CI: 1.45-2.19), along with higher frailty scale scores (β = 0.26, 95% CI: 0.19-0.34). Compared to individuals without cardiometabolic diseases, those with both hypertension and stroke (OR = 1.18, 95% CI: 1.06-1.31) and those with hypertension, heart disease, and stroke (OR = 1.46, 95% CI: 1.24-1.73) exhibited notably higher frailty risks. Conclusion: There is a significant association between cardiometabolic multimorbidity and frailty in middle- aged and older adults in China, particularly for comorbidity patterns involving hypertension. These findings provide evidence for developing targeted health interventions for aging populations.
基金Supported by Long-term Research Grant Scheme provided by Ministry of Education Malaysia,No.LRGS/1/2019/UM-UKM/1/4Grand Challenge Grant Project 1 and Project 2,No.DCP-2017-002/1,No.DCP-2017-002/2.
文摘BACKGROUND Cognitive frailty,characterized by the coexistence of cognitive impairment and physical frailty,represents a multifaceted challenge in the aging population.The role of cardiovascular risk factors in this complex interplay is not yet fully understood.AIM To investigate the relationships between cardiovascular risk factors and older persons with cognitive frailty by pooling data from two cohorts of studies in Malaysia.METHODS A comprehensive approach was employed,with a total of 512 communitydwelling older persons aged 60 years and above,involving two cohorts of older persons from previous studies.Datasets related to cardiovascular risks,namely sociodemographic factors,and cardiovascular risk factors,including hypertension,diabetes,hypercholesterolemia,anthropometric characteristics and biochemical profiles,were pooled for analysis.Cognitive frailty was defined based on the Clinical Dementia Rating scale and Fried frailty score.Cardiovascular risk was determined using Framingham risk score.Statistical analyses were conducted using SPSS version 21.RESULTS Of the study participants,46.3%exhibited cognitive frailty.Cardiovascular risk factors including hypertension(OR:1.60;95%CI:1.12-2.30),low fat-free mass(OR:0.96;95%CI:0.94-0.98),high percentage body fat(OR:1.04;95%CI:1.02-1.06),high waist circumference(OR:1.02;95%CI:1.01-1.04),high fasting blood glucose(OR:1.64;95%CI:1.11-2.43),high Framingham risk score(OR:1.65;95%CI:1.17-2.31),together with sociodemographic factors,i.e.,being single(OR 3.38;95%CI:2.26-5.05)and low household income(OR 2.18;95%CI:1.44-3.30)were found to be associated with cognitive frailty.CONCLUSION Cardiovascular-risk specific risk factors and sociodemographic factors were associated with risk of cognitive frailty,a prodromal stage of dementia.Early identification and management of cardiovascular risk factors,particularly among specific group of the population might mitigate the risk of cognitive frailty,hence preventing dementia.
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 Frailty is a common condition in elderly patients who receive percutaneous coronary intervention(PCI).However,how frailty affects clinical outcomes in this group is unclear.AIM To assess the link between frailty and the outcomes,such as in-hospital complic-ations,post-procedural complications,and mortality,in elderly patients post-PCI.METHODS The PubMed/MEDLINE,EMBASE,Cochrane Library,and Web of Science databases were screened for publications up to August 2023.The primary outcomes assessed were in-hospital and all-cause mortality,major adverse cardiovascular events(MACEs),and major bleeding.The Newcastle-Ottawa Scale was used for quality assessment.RESULTS Twenty-one studies with 739693 elderly patients undergoing PCI were included.Frailty was consistently associated with adverse outcomes.Frail patients had significantly higher risks of in-hospital mortality[risk ratio:3.45,95%confidence interval(95%CI):1.90-6.25],all-cause mortality[hazard ratio(HR):2.08,95%CI:1.78-2.43],MACEs(HR:2.92,95%CI:1.85-4.60),and major bleeding(HR:4.60,95%CI:2.89-7.32)compared to non-frail patients.CONCLUSION Frailty is a pivotal determinant in the prediction of risk of mortality,development of MACEs,and major bleeding in elderly individuals undergoing percutaneous coronary intervention.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic diseases.Frail and elderly patients,especially those aged≥90 years are generally considered a higher-risk population for ERCP-related complications.AIM To investigate outcomes of ERCP in the Non-agenarian population(≥90 years)concerning Frailty.METHODS This is a cohort study using the 2018-2020 National Readmission Database.Patients aged≥90 were identified who underwent ERCP,using the international classification of diseases-10 code with clinical modification.Johns Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and non-frail.The primary outcome was mortality,and the secondary outcomes were morbidity and the 30 d readmission rate related to ERCP.We used univariate and multivariate regression models for analysis.RESULTS A total of 9448 patients were admitted for any indications of ERCP.Frail and non-frail patients were 3445(36.46%)and 6003(63.53%)respectively.Indications for ERCP were Choledocholithiasis(74.84%),Biliary pancreatitis(9.19%),Pancreatico-biliary cancer(7.6%),Biliary stricture(4.84%),and Cholangitis(1.51%).Mortality rates were higher in frail group[adjusted odds ratio(aOR)=1.68,P=0.02].The Intra-procedural complications were insigni-ficant between the two groups which included bleeding(aOR=0.72,P=0.67),accidental punctures/lacerations(aOR=0.77,P=0.5),and mechanical ventilation rates(aOR=1.19,P=0.6).Post-ERCP complication rate was similar for bleeding(aOR=0.72,P=0.41)and post-ERCP pancreatitis(aOR=1.4,P=0.44).Frail patients had a longer length of stay(6.7 d vs 5.5 d)and higher mean total charges of hospitalization($78807 vs$71392)compared to controls(P<0.001).The 30 d all-cause readmission rates between frail and non-frail patients were similar(P=0.96).CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared to non-frail.Larger studies are warranted to investigate and mitigate modifiable risk factors.
文摘BACKGROUND Frailty is a complex aging-related syndrome characterized by a cumulative loss of physiological reserve and increased vulnerability to adverse clinical outcomes,including falls,disability,incapacity and death.While an increasing number of studies suggest that the gut microbiota may play a key role in the pathophy-siology of frailty,direct evaluation of the association between gut microbiome alterations and frailty in older adults remains limited.AIM Seven electronic databases(China National Knowledge Infrastructure,VIP,SinoMed,Wanfang,PubMed,Web of Science and EMBASE)were searched for articles published before October 31,2023 to identify observational studies that compared the microbiomes of older adults with and without frailty.The diversity and composition of the gut microbiota were the main outcomes used to analyze the associations of changes in the gut microbiota with frailty in older adults.The quality of the included studies was assessed via the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality.RESULTS Eleven observational studies with 912 older adults were included in this review.Consistent results revealed a significant difference in the gut microbiota composition between frail and non-frail older adults,with a significant decrease inαdiversity and a significant increase inβdiversity in frail older adults.The pooled results revealed that at the phylum level,four microbiota(Actinobacteria,Proteo-bacteria,Verrucomicrobia and Synergistetes)were significantly enriched,and two microbiota(Firmicutes and Fusobacteria)were significantly depleted in frail older adults.At the family level,the results consistently revealed that the abundances of 6 families,most of which belong to the Actinobacteria or Proteo-bacteria phylum,were greater in frail than in non-frail older adults.At the genus or species level,consistent results from more than two studies revealed that the abundances of the genera Prevotella,Faecalibacterium,and Roseburia were significantly lower in frail older adults;individual studies revealed that the abundances of some genera or species(e.g.,Megamonas,Blautia,and Megasphaera)were significantly lower,whereas those of other genera or species(e.g.,Bifidobacterium,Oscillospira,Ruminococcus and Pyramidobacter)were significantly greater in frail older adults.CONCLUSION This systematic review suggests that changes in the gut microbiota are associated with frailty in older adults,which is commonly reflected by a reduction in beneficial species and an increase in pathogenic species.However,further studies are needed to confirm these findings.
基金supported by the National Key Research and Development Program (No. 2022YFC2009600, No. 2022YFC2009601)
文摘Background:Themortality burden of patients with gastrointestinalmalignancies is increasing worldwide,suggesting the need formore effective prognostic indicators.This study utilized a prospective cohort to(1)analyze the relationship between frailty and malnutrition and their association with the overall survival(OS)in adults with gastrointestinal cancer and(2)explore which specific frailty-related factors most significantly affect the OS.Methods:Participants diagnosed with gastrointestinal cancer from 2013 to 2018 who were enrolled in the Investigation on Nutrition Status and Clinical Outcome of Common Cancers study were identified.Malnutrition was determined using the Patient-Generated Subjective Global Assessment,whereas frailty was assessed using the FRAIL scale.The main outcome measured was the all-cause mortality.Multivariable-adjusted logistic regression was used to analyze the cross-sectional link between the nutritional status and frailty.Univariate and multivariate Cox regression analyses were conducted to explore the longitudinal association of these with the OS.Results:Among the 4,361 patients enrolled in the study,1,136 deaths were observed over a median follow-up of 43.4 months.Malnourished patients had a significantly higher risk of frailty than well-nourished patients(OR=6.25,95%CI=5.23–7.51).Frailty and malnutrition independently predicted the OS,with frailty showing an HR of 1.50(95%CI=1.33–1.69)and malnutrition showing an HR of 1.51(95%CI=1.31–1.74).Patientswith both frailty andmalnutrition had the highest all-causemortality risk(HR=1.82,95%CI=1.55–2.14)compared with patients with neither risk factor.Mortality rates rose with the accumulation of additional frailty-related factors.Conclusions:Malnutrition and frailty are interrelated prognostic factors in patients with gastrointestinalmalignancies,and their simultaneous presence worsens the patient outcomes.Higher scores for resistance and ambulation are major factors associated with a poorer outcome.Future large-scale prospective studies with repeated measurements are necessary to further explore the complex associations among frailty,malnutrition,and the prognosis in patients with gastrointestinal cancer.
文摘Wang and Liu's systematic review of frailty among elderly patients undergoing percutaneous coronary intervention(PCI)revealed that patients with frailty have significantly higher risks of all-cause and in-hospital death,major undesirable cardiovascular events,and major haemorrhage.Frailty is associated with adverse events,prolonged hospital stays,increased complications,and elevated mortality risk due to diminished physiological reserves.Integrating frailty into risk assessment tools is crucial,and gait speed has emerged as a key predictor of frailty.Recognizing the impact of frailty leads to personalized and informed decisionmaking,and frailty assessments should be performed.This holistic approach can inform tailored interventions,thereby optimizing outcomes for this vulnerable population undergoing PCI.
文摘In developed countries,the average life expectancy has been increasing and is now well over 80 years.Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups.Acute appendicitis is one of the most common surgical diseases,with a lifetime risk of 8%.A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups(>80 years).Among patients>50-year-old who present to the emergency department for acute abdominal pain,15%have acute appendicitis.In these patients,emergency surgery for acute appendicitis is challenging,and some important aspects must be considered.In the elderly,surgical treatment outcomes are influenced by sarcopenia.Sarcopenia must be considered a precursor of frailty,a risk factor for physical function decline.Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity.Aside from morbidity and mortality,the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance.Therefore,prediction of function decline is critical.In emergency surgery,preoperative interventions are difficult to implement because of the narrow time window before surgery.In this editorial,we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.
