Older age and a higher EHRA score allow higher levels of frailty syndrome to be predicted in patients with atrial fibrillation

Background: There is no research that evaluates the relationship between the severity of the symptoms of atrial fibrillation (AF), the presence of frailty syndrome and acceptance of the illness.

Methods: The study included 132 patients aged 72.7?±?6.73 with diagnosed AF. The severity of the symptoms of AF was determined according to European Heart Rhythm Association (EHRA) guidelines, frailty syndrome was assessed using the Tilburg frailty indicator (TFI) and the acceptance of the illness was assessed using the acceptance of illness scale (AIS). A standard statistical comparison and multiple regression analysis using the stepwise method were performed.

Results: In patients with AF, frailty was 5.31?±?2.69 (TFI). Frailty syndrome was diagnosed in 59.8% of the AF patients who had a score of 7.17?±?1.72. A higher level of EHRA score was connected with a smaller degree of the acceptance of the illness p?=?0.0000. The multiple regression model indicated that age (p?=?0.0009) and the severity of the symptoms (p?=?0.0001) are important predictors of frailty syndrome.

Conclusions: There is a relationship between the presence of frailty syndrome and the intensity of the symptoms and the acceptance of AF. Age and the EHRA score permitted higher levels of frailty syndrome to be predicted.     

Physiological complexity, aging, and the path to frailty

Healthy physiological processes require the complex interaction of multiple control systems operating over multiple time scales. The output of these processes (for example, heart rate, blood pressure, hormonal rhythms, or postural sway) demonstrates complex variability that can be quantified using the concept of fractals, derived from the field of nonlinear dynamics. Complex physiological dynamics enable an organism to rapidly respond to the internal and external perturbations of everyday life. Aging and disease are associated with a loss of complexity in the dynamics of many physiological systems. This loss of complexity may reduce the ability to adapt to stress and lead to the syndrome of frailty.     

Association of low serum 25-hydroxyvitamin D levels with the frailty syndrome in Mexican community-dwelling elderly

Objective: Since vitamin D is an important regulator of muscle function, the effect of vitamin D deficiency on frailty syndrome has been recently studied. This cross-sectional study aimed to determine the association between 25(OH)-vitamin D levels and frailty status in Mexican community-dwelling elderly.

Methods: Sample of 331 community-dwelling elderly aged 70 or older, a subset of those included in the “Coyoacán cohort” were included. 25(OH)-vitamin D assay and frailty status were measured.

Results: Mean age was 79.3 years and 54.1% were women. Those classified as frail were more likely to have lower Mini-Mental State Examination score (p?=?0.015), more disability for instrumental activities of daily living (p?p?p?Conclusion: These results suggest that older adults with low 25(OH)-vitamin D levels are associated with the probability to being frail compared with those with sufficient vitamin D levels.     

Serum sex steroid hormones and frailty in older American men of the Third National Health and Nutrition Examination Survey (NHANES III)

Objective: To determine whether frailty is associated with circulating total and free testosterone, total and free estradiol, and sex hormone-binding globulin (SHBG) in older men. Methods: With NHANES III data of 461 men aged 60 years and older, we used logistic regression to analyze the associations between serum concentrations of sex steroid hormones, SHBG and frailty. Participants meeting any three or more of the five frailty criteria were classified as “frail”, all others were considered as non-frail. Results: 2.5% of men were frail. Men with SHBG ≥66 nmol/L had three times the odds of frailty (OR = 2.97; 95% CI 1.28–6.86) compared to men with SHBG <66 nmol/L. Men with free testosterone levels below 243 pmol/L had an increased odds of frailty (OR = 3.92; 95% CI 1.29–11.89). None of these associations was statistically significant after additionally adjusting for body mass index, smoking and history of cardiovascular diseases (CVD). Total testosterone, and total and free estradiol serum levels were not statistically significantly associated with frailty. Conclusions: In this US nationally representative study of older men, low free testosterone and high SHBG serum levels were associated with a significantly increased odds of frailty after adjustment for age and race/ethnicity. These associations may, however, be explained by confounding due to obesity, smoking, and the higher prevalence of CVD in frail men or by low hormones or high SHBG mediating the association between obesity, smoking, CVD and frailty.     

Exercise and health in frail elderly people: a review of randomized controlled trials

Frailty is a physiological syndrome that increases the risk of poor health. Although some research has been conducted to study the benefits of physical exercise in frail elderly populations, different operational definitions of frailty have been used, and this makes the studies difficult to compare. The present review was aimed at examining the influence of exercise on health in frail older adults. Studies using randomized controlled trials that administered an exercise program to a frail elderly population and that had an operational definition of frailty were selected from publications between January 2000 and October 2008. Information about the study population, frailty criteria, exercise program, principles of exercise training, randomization procedures, main and secondary outcome measures, study follow-up, and control group characteristics was taken from these studies, and the results from a final sample of 28 articles are discussed. Exercise training seems to be a safe and effective tool for promoting and maintaining optimal health levels in a wide variety of vulnerable older adults. However, the lack of studies on a well-defined frail older adult sample with selection procedures based on current knowledge in this field does not allow us, at the present time, to conclude that exercise influences health in this population. Further research is needed to confirm the benefits of exercise on health in frail older adults. The study population must be selected based on current knowledge in the area of frailty, and the design of the exercise program must be based on principles of training.     

Frailty in self-neglecting older adults: A secondary analysis

ABSTRACT

Self-neglect (SN) and frailty in older adults is associated with increased disability and mortality. Despite these commonalities, there have been no studies objectively assessing frailty in older adults who SN. This secondary analysis classified frailty in N = 37 older adults with Adult Protective Services validated SN using the Fried Frailty Phenotype (FFP) of weight loss, weakness, exhaustion, activity level, and walking speed. Overall, 3% were classified as robust, 62% as prefrail, and 35% as frail. Most (72%) were overweight/obese, with clinically significant decreases in activity level (60%) and walking speed (97%). Compared to the original FFP population, older adults who SN exhibit important differences in frailty phenotypes, and finding that the largest percentage of older adults who SN were prefrail may indicate a critical opportunity for intervening in this population to reduce future functional decline and mortality.     

Assessment of frailty syndrome using Edmonton frailty scale in Polish elderly sample

The aim of the study was to assess the incidence and severity of the frailty syndrome assessed with the Edmonton Frailty Scale. This is a cross-sectional study conducted among 382 patients (236 men and 146 women, mean age 71.9?years). The Edmonton Frailty Scale was administered during the patient’s admission to the hospital. The Polish adaptation was performed using the standard methodology. The Cronbach’s alpha coefficient for the whole Edmonton Frailty Scale was 0.709. The mean correlation between positions and the overall result was r?=?0.180. There were no statistically significant differences between women and men in the area of Edmonton Frailty Scale mean score (p?70?years than for those?<70?years (p?相似文献   

The meaning of frailty according to Dutch older frail and non-frail persons

Frailty is a term often used by researchers and clinicians to describe a state in which older persons are at risk for adverse outcomes such as falls, disability, institutionalization and mortality. However, no study so far examined what frailty means to older persons. Therefore the aim of this study was to describe the meaning that older community-dwelling persons attach to frailty. Twenty-five semi-structured interviews were conducted. The interviews were analyzed using the grounded theory method. Frailty was described as being in poor health, having walking difficulties, feeling down, being anxious, having few social contacts and not being able to do the things one likes to do. Men described in more detail the physical dimension whereas women elaborated in more depth on the psychological and social component. Existing definitions of frailty should be adjusted to better reflect the meaning of frailty for older persons.     

Biomechanical aspects of dynamic stability

Walking is a fundamental motor skill that significantly affects the level of independence in older adults. The amount of variability present in a walking pattern reflects the quality of neuromuscular control. It is well established that a large proportion of falls in older people occurs when walking. The prevention of falls is vital for minimizing disability, preventing injury, and impeding the development of frailty and subsequent deterioration in quality of life. The present literature review focuses on dynamic stability. In dynamic stability, both the base of support and the center of mass are in motion, and effective balance function is required. In general, older adults are expected to have different movement patterns from younger adults, expressed by differences in limb kinematics and kinetics. A better understanding of the biomechanical variables involved can help anticipate and prevent potential falls.     

From bedside to bench: research agenda for frailty

The American Geriatrics Society sponsored a working conference in January 2004, funded by the National Institute on Aging, to establish the state of the art in frailty research and to set a research agenda for the future. The invited participants included senior basic biologists, epidemiologists, geneticists, and clinical investigators who study aging-related issues. This article summarizes the central theoretical observations on frailty and research needs and opportunities presented and discussed at this conference, and lays out an agenda for future research on frailty.     

Substance Abuse Among Puerto Rican and Dominican Gang Members in a Small City Setting

SUMMARY

Joining a gang increases an adolescent's risk for substance abuse. To better understand the contextual development of drug use behavior, this retrospective ethnographic study describes a sample of 76 young small-city mainland Puerto-Rican and Dominican males who joined gangs when they were younger. Data is presented and discussed on the drug abuse behavior including their drug using progression and the context in which such use occurs. The young average age of onset 11.2 (sd = 2.6) combined with the rapid progression to more dangerous drugs, which generally occurs within six years, demonstrates the elevated risk associated with small city gang membership. Differences in the patterns of drug use were also found between the English and Spanish speaking groups. The authors discuss the implications of the study findings on the development of interventions. Recommendations address future research possibilities on drug abuse within Latino gangs.     

The effect of functional circuit training on physical frailty in frail older adults: a randomized controlled trial

The purpose of this study was to evaluate whether a 12-wk functional circuit-training program (FCT) could alter markers of physical frailty in a group of frail community-dwelling adults. Fifty-one individuals (31 women, 20 men), mean age (± SD) 84 (± 2.9) yr, met frailty criteria and were randomly assigned into groups (FCT = 26, control group [CG] = 25). FCT underwent a 12-wk exercise program. CG met once a week for health education meetings. Measures of physical frailty, function, strength, balance, and gait speed were assessed at Weeks 0, 12, and 36. Physical-frailty measures in FCT showed significant (p < .05) improvements relative to those in CG (Barthel Index at Weeks 0 and 36: 73.41 (± 2.35) and 77.0 (± 2.38) for the FCT and 70.79 (± 2.53) and 66.73 (± 2.73) for the CG. These data indicate that an FCT program is effective in improving measures of function and reducing physical frailty among frail older adults.     

THE ACCUMULATION OF HUMAN CAPITAL DURING MARRIAGE BY MALES

Married males have significantly higher wage rates than never-married, widowed, or divorced males, even when differences in educational attainment, experience, race, and so on are controlled for. Evidence presented in this paper suggests that most of the unexplained wage differential associated with marital status in earnings regressions results from males accumulating human capital more rapidly when they are married than when those same males are not married. The hypothesis that married males earn more than unmarried males because marriage facilitates the financing of human capital accumulation is supported by this and other evidence.     

"Take Me Along"-A Marital Syndrome

The work-identity-marriage relationship for females and males is examined. Physicians and their wives illustrate some of the patterns of a "take me along" marital syndrome involving contingent identity for the females. Implications are discussed.     

Association of the modified frailty index with adverse outcomes after penile prosthesis implantation

Objectives: To investigate frailty as a predictor of surgical outcome in elderly patients undergoing penile prosthesis implantation.

Material and methods: A total of 54 elderly patients, above 60 years of age, underwent penile prosthesis implantation between 2012 and 2014. Their data were collected and retrospectively analyzed. A modified frailty index (mFI) was calculated for each patient based on 11 risk factors from the Canadian Study of Health and Aging Frailty Index. The 1-year adverse outcomes were correlated with mFI, patients’ and procedure’s risk factors.

Results: Mean age was 64.9?±?5.2 years. No mortality was reported in our patients, however, one-year adverse outcomes were encountered in 43 (79.6%) patients. Among all studied variables, the 1-year adverse outcomes was not significantly association with mFI, but with preoperative glycosylated hemoglobin A1c (HbA1c) (p?=?0.031) and associated Peyronie’s disease (PD) (p?=?0.000). HbA1c, dyslipidemia, hypertension, PD and duration of the procedure were predictive of infection complications (p?Conclusions: mFI is not a predictive of post-penile prosthesis implantation adverse outcomes in elderly patients with impotence. Degree of diabetic control and association with PD was associated with the 1-year adverse outcomes and infection complications.     

Being disabled: towards a critical social ontology for disability studies

In Disability Studies the question of ontology is establishing itself as a live issue. Whilst there are many arguments and tendencies emerging from this literature, this paper identifies and critically examines an approach to the ontological question in disability studies that is based on an appeal to frailty as a universal characteristic of humanity. The argument builds on the relatively familiar claim that everyone is only temporarily able-bodied. This approach is exemplified in recent work by Bryan Turner and by Tom Shakespeare and Nick Watson. I argue that their universalistic approach is problematic. While it may constitute a theoretical means of ameliorating the existential negativity associated with being disabled it does so at the expense of disability identity. What is required is a critical social ontology that problematises non-disablement and exposes the forms of invalidation that lie at the heart of disabling culture.     

Impact of metabolic syndrome and its components on kidney stone in aging Taiwanese males

Objectives: Metabolic syndrome (MtS) and kidney stone are two common aging diseases with male dominant. This is the first study regarding the potential impact of MtS and its components on kidney stone in aging Chinese population.

Methods: A total of 694 males with a mean age of 55.6 years were enrolled. The definition of MtS was according to the modified criteria developed by the Bureau of Health Promotion in Taiwan. Subjects were classified as having a disease of kidney stones according to diagnosis by a physician with available medical records or evidence from ultrasonography judged by an investigator of urologist.

Results: Using age-adjusted multivariate logistic regression analysis, our results showed that subjects with kidney stone had significantly higher prevalence of MtS (p?=?0.04, OR?=?1.74, 95% CI: 1.0 1–3.00). The presence of MtS had significant correlation with kidney stone (p?=?0.01, OR?=?1.83, 95% CI: 1.1 4–2.93), which were associated with the increment of MtS components (p?p?Conclusions: In aging Taiwanese males, the presence of MtS and its components are strongly associated with kidney stone. Abnormal BP is the most significant risk component of MtS for kidney stone.     

The contextual and social locations of older women's experiences of disability and decline

Understandings of disability and decline within health and social care seem to focus mainly on the bodies and function of older persons. However, the way that older people's experiences of disability and decline are fixed into rigid functional classifications such as ‘frailty’ are problematic. Drawing on the narratives of twelve diverse older English-speaking women in Montreal, Canada, I will argue that older women's experiences are more connected with the contexts within which they experience disability and decline, and the social locations they bring to these experiences, than the functional limitations of their bodies. Older women's stories – particularly those related to the home and the bus – reveal the clash between dominant understandings of ‘frailty’ and older women's contextual and social experiences of disability and decline; expose tensions within health and social care practices; and highlight the potential which exists in both context and social location.     

Stalking as a variant of intimate violence: implications from a young adult sample

There is a limited but growing literature which suggests that stalking is a variant of intimate violence. The purpose of this study was to examine physical, psychological, and stalking victimization and perpetration among males and females. Alcohol use was also examined. The sample was 46 male and 84 female undergraduate students who reported stalking victimization and perpetration after a difficult breakup, and psychological and physical victimization and perpetration during that specific relationship. Overall, 27% of the sample study was classified into the stalking victimization group, which is consistent with other stalking prevalence rates among college samples. For females, stalking victimization was significantly associated with physical and psychological abuse victimization. For males, stalking victimization was significantly associated with psychological abuse victimization. However, there was also a strong significant reciprocal relationship of stalking and psychological abuse victimization and perpetration, especially for males. Also, alcohol use was significantly associated with victimization and perpetration of stalking and psychological abuse for males. The data from this study contribute to the hypothesis that stalking is a variant of or extension of intimate violence, especially for females. Implications and recommendations for future research are discussed.