Aging, Author Interviews, Frailty, Infections / 18.11.2023 Interview with: Hira Mohyuddin, PGY-2 Psychiatry Residency Training Program The George Washington University What is the background for this study? Response: Frailty has become increasingly significant as the global population grows older, as this syndrome is linked with a higher mortality and morbidity in aging. Causes contributing to frailty are poorly understood, but it seems that the role of inflammation is very likely. While other chronic infections were shown to precipitate and perpetuate inflammation that contributes to the development of frailty, no prior study has previously focused on possible links between Toxoplasma gondii and geriatric frailty. Benefiting from a collaboration with Spanish and Portuguese researchers, we have now tested, for the first time to our knowledge, this possible association. (more…)
Aging, Author Interviews, Brigham & Women's - Harvard, Frailty, Geriatrics, JAMA / 22.09.2022 Interview with: Ariela Orkaby, MD, MPH Geriatrics & Preventive Cardiology Associate Epidemiologist Division of Aging, Brigham and Women's Hospital Assistant Professor of Medicine, Harvard Medical School What is the background for this study? Response: As the population is living longer, there is increased risk of frailty and vulnerability. Frailty is defined as reduced physiological reserve and decreased ability to cope with even an acute stress. Up to half of adults over the age of 85 are living with frailty and preventative measures are greatly needed. We tested the effect of vitamin D and marine omega-3 fatty acid supplementation on the risk of developing frailty in healthy older adults in the US enrolled in the VITamin D and OmegA-3 TriaL (VITAL) trial. (more…)
Aging, Author Interviews, Brigham & Women's - Harvard, Frailty, Geriatrics, JAMA, Medical Research Centers, Supplements / 15.09.2022 Interview with: Ariela Orkaby, MD, MPH Geriatrics & Preventive Cardiology Associate Epidemiologist Division of Aging, Brigham and Women's Hospital Assistant Professor of Medicine, Harvard Medical School What is the background for this study? Response: As the population is living longer, there is increased risk of frailty and vulnerability. Frailty is defined as reduced physiological reserve and decreased ability to cope with even an acute stress. Up to half of adults over the age of 85 are living with frailty and preventative measures are greatly needed. We tested the effect of vitamin D and marine omega-3 fatty acid supplementation on the risk of developing frailty in healthy older adults in the US enrolled in the VITamin D and OmegA-3 TriaL (VITAL) trial. (more…)
Aging, Author Interviews, Cancer Research, Dermatology, Frailty, JAMA / 08.09.2021 Interview with: Marieke van Winden MD MSc PhD candidate Dermatology Radboud Institute for Health Sciences Department of Dermatology Radboud University Medical Center Nijmegen, the Netherlands What is the background for this study? What underlying conditions would factor in a decision for Watchful Waiting?  Response: Basal cell carcinomas are frequently treated because of the risk for progression, which can cause a significant morbidity due to local tissue invasion and destruction. However, most BCCs are characterized by a relatively indolent nature, growing slowly and frequently asymptomatically. Because patients with a limited life expectancy might not live long enough to develop symptoms from basal cell carcinoma progression, they might not live long enough to benefit from treatment. Underlying conditions that determine life expectancy should therefore be considered when weighing BCC management options. When life expectancy is expected to be relatively short, and the consequences of  watchful waiting (WW) are relatively low risk (low tumor burden expected within the remaining lifespan), WW should be considered. (more…)
Author Interviews, Frailty, Genetic Research, Geriatrics, University of Pittsburgh / 13.10.2020 Interview with: Caterina Rosano, M.D., M.P.H. Professor of Epidemiology University of Pittsburgh Graduate School of Public Health What is the background for this study? What are the main findings? Response: Most people think about dopamine’s role in mobility in the context of Parkinson’s disease, but not in normal aging. We were curious to see if a genetic predisposition to produce more or less dopamine was related to mobility in individuals who had some level of frailty, yet did not have dementia, parkinsonism or any other neurological condition. While several genetic elements control dopamine signaling, my team and I focused on a gene called COMT, which breaks down dopamine to control its levels within the brain. We also considered the frailty status of participants, which is a common consequence of aging marked by a decline in physiological function, poor adjustment to stressors and a susceptibility toward adverse health outcomes. We suspected that frail participants could be particularly vulnerable to COMT-driven differences in dopamine levels. We examined this gene in more than 500 adults above the age of 65 in Pennsylvania, North Carolina, California and Maryland, excluding any participants taking dopamine-related medications or diagnosed with Parkinson’s disease. We then looked for potential links between genotype, frailty and speed. We discovered that frail participants with a high-dopamine COMT genotype had a 10% faster walking speed compared with participants with the low-dopamine COMT genotype.  (more…)
Author Interviews, Frailty, Geriatrics / 30.09.2019 Interview with: Brian Clark, Ph.D. Executive Director, Ohio Musculoskeletal and Neurological Institute Osteopathic Heritage Foundation Harold E. Clybourne, D.O. Endowed Research Chair Professor of Physiology OHIO University What is the background for this study? Response: Muscle weakness strongly contributes to mobility limitations and physical disability. Over 40% of the 46 million older adults in the U.S. have one or more physical limitations when performing daily tasks essential for maintaining independence. Preserving physical function is a major public health priority as it will drastically reduce health care costs and improve quality of life. Over the past several decades, the scientific and medical communities have recognized that muscle weakness is a major factor in determining the incidence of physical limitations and general poor health in older adults. It has long been presumed by many that age-related weakness is principally caused by loss of muscle mass (i.e., sarcopenia). However, over the past 10-20 years the presumption has been questioned. For instance, a 2009 study reported that the decline in leg extensor muscle strength in older adults —observed longitudinally over 5 years—occurs more rapidly than the concomitant loss of quadriceps mass, and that in a subset of older adults that actually gained muscle mass there was still a substantial loss of strength. Findings of this nature clearly illustrate that that the loss of strength is only modestly associated with loss of mass in older adults. The mechanisms of muscle strength, however, are multifactorial and determined by a combination of both neurological and muscular factors (of which muscle mass is one of the factors). (more…)
Author Interviews, Frailty, Geriatrics, Heart Disease / 29.07.2019 Interview with: Dr-Dalgaard What is the background for this study? Response: We know that having atrial fibrillation puts you at a higher risk of falls, especially if you are elderly and frail. Additionally, some of the medications used to treat it can cause bradycardia (low heart rate), which could itself increase the risk of falls. Therefore, the aim of this study was to investigate if common medications used to treat atrial fibrillation in older patients were associated with fall-related injuries and syncope (fainting). The medications investigated were rate-lowering drugs (beta-blockers, digoxin, verapamil, diltiazem) and the anti-arrhythmic drugs (amiodarone, propafenone, and flecainide). (more…)
Author Interviews, Frailty, Hospital Readmissions, JAMA, Stanford, Surgical Research / 27.05.2019 Interview with: hospital-frailty-surgeryKara Anne Rothenberg.MD Postdoctoral Research Fellow, Vascular Surgery Shipra Arya, MD SM FACS Associate Professor of Surgery Stanford University School of Medicine What is the background for this study? Response: There is a growing body of literature showing that frailty, a syndrome where patients have increased vulnerability to a stressor (such as surgery), is associated with increased postoperative complications, failure to rescue, and hospital readmissions. The Risk Analysis Index (RAI), is an easy to use frailty measurement tool that better predicts postoperative mortality than age or comorbidities alone. As the rates of outpatient surgeries rise nationwide, we noted that most of the surgical frailty studies focus only on inpatient surgeries. Elective, outpatient surgery is generally considered low risk for complications and unplanned readmissions, however we hypothesized that for frail patients, it might not be. (more…)
Author Interviews, Beth Israel Deaconess, Brigham & Women's - Harvard, Frailty, Heart Disease, Surgical Research / 05.02.2019 Interview with: Dae Hyun Kim, MD, MPH, ScD Assistant Professor of Medicine, Harvard Medical School Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center What is the background for this study? What are the main findings? Response: The number of older adults undergoing aortic valve replacement is increasing.  Since these patients are at high risk for complications and functional decline due to preexisting multimorbidity and frailty, the latest guideline (Otto et al. J Am Coll Cardiol 2017;69:1313–46) emphasizes shared decision-making based on patient-centered outcomes.  Despite this recommendation, we witness many decision-making processes are cardio-centric—mainly informed by expected benefit in terms of cardiac-specific measures.  Many patients are not adequately informed about what their daily life would be like after the procedure. In this single-center prospective cohort study, we examined functional status trajectories via assessments of global functional status at 1, 3, 6, 9, and 12 months in 246 patients who underwent transcatheter and surgical aortic valve replacement.  We identified 5 clinically meaningful functional trajectories, ranging from high baseline function-early complete recovery to low baseline function-large and persistent decline.  We were able to predict most likely trajectory as well as best possible and worse possible trajectories using the preoperative frailty index.  Delirium and postoperative complications were also strongly associated with undesirable functional trajectories.  (more…)
Aging, Author Interviews, Exercise - Fitness, Frailty / 04.02.2019 Interview with: "DSC08418" by Debs (\xf2\u203f\xf3)\u266a is licensed under CC BY 2.0. To view a copy of this license, visit: Sherrington FAHMS Professor, NHMRC Senior Research Fellow Institute for Musculoskeletal Health The University of Sydney What is the background for this study? What types of exercise were tested or indicated? Response: Falls are a very common problem with at least one in three people aged 60+ falling each year. This review included all types of exercises delivered to people aged 60+ in the general community i.e., not those living in supported accommodation and not among people with particular health conditions such as a stroke or Parkinson’s disease. (more…)
Author Interviews, Exercise - Fitness, Frailty, Geriatrics, JAMA / 13.11.2018 Interview with: "COUCHair for physical therapy" by ewa garniec is licensed under CC BY-NC-ND 3.0Mikel Izquierdo PhD Head and Full professor Department of Health Sciences Public University Navarra, Spain What is the background for this study? What are the main findings?  Response: Acute hospital admissions are a major contributor to disability in the elderly. Despite resolution of the reason for hospitalization, patients (especially those who are frail) are often discharged with a new major disability. This is a problem that providers of health care and policy makers should prioritize given the expectations of further growth of the population segment composed by old people.  Traditional models of acute hospitalization for older adults seldom include a comprehensive approach to prevent hospitalization-associated impairment in functional and cognitive capacity. In contrast, exercise and early rehabilitation protocols applied during acute hospitalization can prevent functional and cognitive decline in older patients and are associated with a reduced length of stay and lower costs. Yet, patients with cognitive impairment or multimorbidity at baseline are commonly excluded from exercise intervention trials and only ‘conservative’ or ‘traditional’ programs (i.e., focusing on light walking while avoiding resistance training) have been typically applied to elders who are acutely hospitalized. Our intervention proved safe and effective to reverse the aforementioned impairment. We therefore propose that an individualized prescription of multicomponent exercise should become an inherent part of the routine management of hospitalized older adults.  (more…)
Aging, Author Interviews, Frailty, Geriatrics, Nutrition, Protein / 05.11.2018 Interview with: ""Trash Fish" Sustanable Seafood Dinner" by Edsel Little is licensed under CC BY-SA 2.0Nuno Mendonça RD, PhD Campus for Ageing and Vitality Newcastle‐upon –Tyne United Kingdom What is the background for this study? What are the main findings?  Response: Very old adults, those aged 85 and older, are the fastest growing age group in most western societies and are more likely to develop disability. Dietary protein is a sensible candidate because it may slow decreases in muscle mass and functional decline with aging. Although we know that protein intake is, on average, lower in older adults (a mean of 66 grams per day) compared to younger adults (a mean of 91 grams per day), research exploring protein intake and disability progression in very old adults is limited. We found that our participants from North-East England had four different disability trajectories between the ages of 85 and 90: a) a constant very low disability trajectory (difficulty with none or 1 activity of daily living (ADL))  over the 5 years; b) a low disability trajectory (difficulty with 2 ADLs) that steadily progressed to mild disability (5 ADLs); c) a mild disability score (4 ADLs) at 85 that increased to moderate disability (10 ADLs) by age 90; and d) a moderate disability score (9 ADLs) at baseline that progressed to severe disability (14 ADLs) after 5 years. We found that those with higher protein intake, especially those at or above 1 g per kg of body weight per day (70g of protein per day for a 70 kg person), were less likely to belong to a worse disability trajectory. (more…)
Author Interviews, Frailty, Heart Disease / 23.07.2018 Interview with: Rakesh Arora MD PhD Department of Surgery, Max Rady College of Medicine University of Manitoba, Winnipeg, Canada Cardiac Sciences Program St Boniface Hospital Winnipeg, Manitoba, Canada What is the background for this study? What are the main findings? Response: It is increasingly understood that patients with heart disease are getting older and sicker. In Canada, over 5.7 million people are estimated to be aged over 65 years and as a result a greater number of older adults often complex other health issues are now require cardiac procedures.  This places some patients, particular those who are more frail at a higher vulnerability to poorer postoperative outcomes and a complicated recovery process after cardiac surgery.  In addition, such patients experience a reduced quality of life as a result of loss of the ability to independently perform activities of daily living (i.e. as cooking, cleaning, bathing activities, toileting etc). During the preoperative waiting period, the cardiac symptoms and anxiety induces inactivity that in turn compounds the physical and mental deconditioning. In order to improve the functional capacity and enhance postoperative recovery, prehabilitation (“prehab”), a component of the Enhanced Recovery Protocols (ERPs), may be of particular importance. Prehabilitation (a.k.a. “prehab”) has been described as a preoperative cardiac rehabilitation intervention, a combination of exercise training, education, and social support, affecting patients’ physical and psychological readiness for surgery with the overarching goal to reduce postoperative complications and hospital length of stay as well as ideally improving the transition from the hospital to the community.   (more…)
Author Interviews, Frailty, Hospital Readmissions, Surgical Research / 04.03.2018 Interview with: Rachel Khadaroo, MD, PhD, FRCSC Associate Professor of Surgery Department of Surgery & Division of Critical Care Medicine University of Alberta What is the background for this study? What are the main findings? Response: The elderly are the fastest growing population in North America. There are very few studies that have examined the impact of frailty and age on outcomes following abdominal surgery. Readmissions are expensive have been considered an important quality indicator for surgical care. This study examined 308 patients 65 years and older who were admitted for emergency abdominal surgery in two hospitals in Alberta and followed them for 6 months for readmission or death. Patients were classified into 3 categories: Well, pre-frail (no apparent disability), and frail. (more…)
Accidents & Violence, Author Interviews, Exercise - Fitness, Frailty, Geriatrics, JAMA, Osteoporosis / 07.11.2017 Interview with: Andrea C. Tricco PhD, MSc Scientist and Lead of the Knowledge Synthesis Team Associate Professor Dalla Lana School of Public Health, University of Toronto Associate Editor Journal of Clinical Epidemiology, BMC Medical Research Methodology, Systematic Reviews What is the background for this study? Response: Falls are the leading cause of injury among older adults and account for $2 billion in direct health-care costs annually ($31 billion in costs to Medicare in the United States in 2012). We aimed to determine which types of fall-prevention programs may be effective for reducing falls in older people. What are the main findings? Response: Exercise, along with vision assessment and treatment, as well as an assessment and possible modification of a person’s living environment, reduced the risk of injurious falls by 23% compared to usual care. (more…)
Author Interviews, Frailty, Kidney Disease / 04.11.2017 Interview with: Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH What is the background for this study? What are the main findings? Response: Elderly represent the fastest growing segment of incident dialysis patients in Unites States. The annual mortality in end stage renal disease (ESRD) patients is very high ~ 20%. Since most of the deaths occur in the first year of dialysis, it is possible that health conditions present prior to initiation of dialysis may impact long-term outcomes. In this study, we determined the impact of poor functional status at the time of dialysis initiation and pre-dialysis health status on type of dialysis modality, type of hemodialysis access and one-year mortality in elderly dialysis patients. We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United Data Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Mean age of our study population was 72 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% has pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. Patients with poor functional status had higher odds of being initiated on hemodialysis than peritoneal dialysis, lower odds of using arteriovenous access as compared to central venous catheter for dialysis and higher risk of one-year mortality. (more…)
Author Interviews, CMAJ, Exercise - Fitness, Frailty, Geriatrics, Lifestyle & Health / 21.08.2017 Interview with: Olga Theou, MSc PhD Assistant Professor, Department of Medicine, Dalhousie University Affiliated Scientist, Geriatric Medicine, Nova Scotia Health Authority Adjunct Senior Lecturer, School of Medicine, University of Adelaide Halifax, Nova Scotia What is the background for this study? What are the main findings? Response: We already know that moderate to vigorous intensity physical activity, such as time accumulated during exercise, is associated with numerous health benefits. More recent studies also have shown that sedentary time, such as time accumulated during prolonged sitting at work, transportation, and leisure, can also increase the risk of adverse outcomes. What was not known was whether prolonged sitting affects people across different levels of frailty similarly. This is what we examined in our study. We found that there were differences. Low frailty levels (people who are extremely healthy; frailty index score < 0.1) seemed to eliminate the increased risk of mortality associated with prolonged sitting, even among people who did not meet recommended physical activity guidelines. Among people with higher frailty levels, sedentary time was associated with mortality but only among those who did not meet recommended physical activity guidelines (more…)
Author Interviews, Frailty, JAMA, Outcomes & Safety, Surgical Research / 01.02.2017 Interview with: Margaret L Schwarze, MD, MPP Associate Professor Division of Vascular Surgery University of Wisconsin What is the background for this study? Response: Surgery can have life-altering consequences for frail older adults, yet many undergo an operation during the last year of life. Surgeons commonly rely on informed consent to disclose risks of discrete complications; however, this information is challenging for patients to interpret with respect to their goals and values. Our research group developed a communication framework, called Best Case/Worst Case, to change how surgeons communicate with patients facing serious illness.  Surgeons use the framework to describe the best, worst, and most likely scenarios to present a choice between valid treatment alternatives and help patients imagine how they might experience a range of possible treatment outcomes. (more…)
Author Interviews, Exercise - Fitness, Frailty, JAMA / 06.12.2016 Interview with: Maayan Agmon, PhD The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Studies University of Haifa Haifa, Israel What is the background for this study? What are the main findings? Response: To address the issue of functional decline during and post hospitalization . Up to 40% of older adults decline in their function at the time of hospitalization and acute illness. Most part of this functional decline is not explained by illness itself. So far, we know that in-hospital mobility is a protective factor but how much walking is required to prevent this decline has yet to be determined. (more…)
Author Interviews, Frailty, JAMA, Surgical Research, University of Pittsburgh / 01.12.2016 Interview with: Daniel E. Hall, MD, MDiv, MHSc, FACS Associate Professor of Surgery University of Pittsburgh Staff Surgeon VA Pittsburgh Healthcare System Core Investigator VA Center for Health Equity Research and Promotion. PIttsburgh, PA What is the background for this study? What are the main findings? Response: A growing body of research demonstrates that frailty is a more powerful predictor of postoperative outcomes than risk-prediction models based on age or comorbidity alone. However, it has not been clear if surgeons could intervene on frailty to improve outcomes. This study reports what we believe to be the first ever demonstration that it is not only feasible to screen an entire health system for frailty, but that it is possible to act on that information to improve outcomes. Every patient evaluated for elective surgery was screened for frailty with a brief tool that takes 1-2 minutes to complete. Those identified as potentially frail and thus at greater risk for poor surgical outcomes received an ad-hoc administrative review aimed at optimizing perioperative care. After implementing the frailty screening initiative, we observed a 3-fold increase in long-term survival at 6 and 12 months—even after controlling for age, frailty, and predicted mortality. (more…)
Author Interviews, Exercise - Fitness, Frailty, Geriatrics / 27.09.2016 Interview with: Thomas M. Gill, M.D. Humana Foundation Professor of Geriatric Medicine Professor of Medicine, Epidemiology & Investigative Medicine Director, Yale Program on Aging/Pepper Center What is the background for this study? What are the main findings? Response: Maintaining independent mobility is an important goal of clinical medicine and public health, especially among older persons, who are at the greatest risk for disability. By adopting a walking routine and other moderate physical activities, older adults can recover from a major disability more quickly, and maintain their independence over time. (more…)
Author Interviews, CDC, Cost of Health Care, Frailty / 23.09.2016 Interview with: Gwen Bergen, PhD Division of Unintentional Injury National Center for Injury Prevention and Control CDC What is the background for this study? What are the main findings? Response: Older adult falls are the leading cause of injury death and disability for adults aged 65 years and older (older adults). In this study, we analyzed data from the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) survey. Our study found that, in 2014, older Americans reported 29 million falls. Almost a quarter of these or 7 million falls required medical treatment or restricted activity for at least one day. Women reported a higher percentage of falls (30%) compared with men (27%). Whites and American Indian/Alaskan Natives (AI/AN) were more likely to fall compared with Blacks and Asian/Pacific Islanders; and AI/AN were more likely to report a fall injury compared with all other racial/ethnic groups. The percentage of older adults who reported a fall varied by state, ranging from 21% in Hawaii to 34% in Arkansas. (more…)
Author Interviews, Frailty, Geriatrics, Lancet, Technology / 19.09.2016 Interview with: Anat Mirelman, PhD Director- Laboratory of Early Markers of Neurodegeneration (LEMON) Center for the study of Movement , Cognition and Mobility (CMCM) Department of Neurology Tel Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University Tel Aviv 64239, Israel What is the background for this study? What are the main findings? Response: The main aim of this research was to evaluate the efficacy of using a motor cognitive training using virtual reality in reducing fall frequency and fall risk in older adults. Falls are a leading cause of morbidity and mortality in older adults. The prevalence of falls is huge, with one out of every 3 adults aged 65 years or older will fall at least once per year, with approximately half of these fallers suffering multiple falls in this period . These statistics are even higher in neurodegenerative conditions such as in Parkinson’s disease and in people with cognitive impairments. For example, studies have shown that as much as 80% of people with Parkinson’s disease fall each year. So many older adults are falling. The consequences of falls are huge. The most dramatic result is hip fracture. But this is relatively rare. However, even in the absence of a fracture or other injury, falls often lead to fear of falling, social isolation, and depression, which in turn often leads to inactivity, muscle weakness, impaired balance and gait, more falls, more social isolation. In other words, falls often start a vicious cycle, which has many important negative health consequences. Falls are associated with morbidity and mortality and they also have a huge economic impact. In many western countries, 1-2% of healthcare dollars are spent on falls. For many years, age-associated changes in muscle strength, balance and gait were viewed as the key factors that contribute to the risk of falls. However, more recently, we and others showed that certain aspects of cognition are also critical to safe ambulation. For example people with AD often fall, almost to the same amount as people with PD, highlighting the cognitive component of falls. This makes sense intuitively if we Imagine the cognitive skills we need just to cross a busy intersection. These tasks require executive function, specially, planning, the ability to avoid obstacles, and the ability to perform two or more tasks at the same time. (more…)
Accidents & Violence, Author Interviews, CDC, Cost of Health Care, Frailty, Geriatrics / 30.08.2016 Interview with: Elizabeth Burns, MPH Health Scientist, Division of Unintentional Injury Prevention National Center for Injury Prevention and Control CDC What is the background for this study? Response: Falls are the leading cause of both fatal and non-fatal injuries among Americans aged 65 and older. In 2000, the direct cost of falls were estimated to be $179 million for fatal falls and $19 billion for non-fatal falls. Fall injuries and deaths are expected to rise as more than 10,000 Americans turn 65 each day. Within the next 15 years, the U. S. population of older Americans is anticipated to increase more than 50%, with the total number of older adults rising to 74 million by 2030. (more…)
Author Interviews, Frailty, Hip Fractures, JAMA, Pharmacology / 22.08.2016 Interview with: Jeffrey Munson, MD, MSCE Assistant Professor The Dartmouth Institute for Health Policy & Clinical Practice Assistant Professor, Department of Medicine Geisel School of Medicine at Dartmouth What is the background for this study?  Response: Fragility fractures due to osteoporosis are a common and costly event among older Americans. Patients who experience one fragility fracture are at increased risk to have a second fracture. Our group is interested in exploring ways in which the risk of a second fracture could be reduced. In this paper, we studied prescription drug use both before and after fracture. We know many prescription drugs have been shown to increase the risk of fracture, but we don’t know whether doctors try to reduce the use of these drugs after a fracture has occurred. Our study was designed to answer this question. (more…)
Author Interviews, Frailty, Geriatrics, Nursing / 27.06.2016 Interview with Oleg Zaslavsky PhD Assistant Professor at the department of Biobehavioral Nursing and Health System School of Nursing University of Washington What is the background for this study? What are the main findings? Response: Frailty is a common, but serious medical condition among older adults. It is characterized by weight and muscle loss, fatigue, slow walking and low levels of physical activity. It’s important to accurately diagnose and treat frailty, especially because demographic trends show the percentage of U.S. adults age 65 years and older will increase 19% by 2030. Frailty is commonly assessed by the Cardiovascular Health Study (CHS) frailty phenotype, which includes a set of physical measurements for slowness, weakness, fatigue, low physical activity and body-weight loss. According to the CHS phenotype, individuals with three or more of these characteristics are at increased risk for falls, hip fractures, disability and mortality. Although the CHS phenotype is good for predicting adverse conditions, it requires direct measurement of physical performance. Refining the phenotype so it doesn’t involve physical measurements of patients in a doctor’s office has practical advantages for research and clinical purposes. For this study, University of Washington School of Nursing researchers worked with Fred Hutchinson Cancer Research Center faculty to refine the Women’s Health Initiative (WHI) frailty phenotype, originally developed in 2005. This new phenotype uses self-reporting from patients instead of measurements of physical performance to determine frailty and associated health outcomes. In this report, we show that our newly-proposed WHI measuring scheme performs as well as the more complex CHS phenotype in predicting death, hip fractures and falls in older women. (more…)
Aging, Author Interviews, Frailty, Genetic Research / 22.06.2016 Interview with: Dr. David Sebastián IRB Barcelona and CIBERDEM researcher What is the background for this study? What are the main findings? Response: One of the alterations that most affects the quality of life of the elderly is muscle wastage and the resulting loss of strength, a condition known as sarcopenia. At about 55 years old, people begin to lose muscle mass, this loss continues into old age, at which point it becomes critical. However, the underlying causes of sarcopenia are unknown and thus no treatment is available for this condition. Importantly, we have found that the mitochondrial protein Mitofusin 2 is required to preserve healthy muscles in mice. Mitofusin 2 is a mitochondrial protein involved in ensuring the correct function of mitochondria, and it has several activities related to autophagy, a crucial process for the removal of damaged mitochondria. The loss of Mitofusin 2 impedes the correct function of mitochondrial recycling and consequently damaged mitochondria accumulate in muscle cells. (more…)
Author Interviews, Diabetes, Frailty, JAMA, Mayo Clinic / 07.06.2016 Interview with: Rozalina McCoy, M.D Assistant Professor of Medicine Division of Primary Care Internal Medicine Department of Medicine Mayo Clinic Rochester What is the background for this study? Dr. McCoy: Hypoglycemia is a serious potential complication of diabetes treatment; it worsens quality of life and has been associated with cardiovascular events, dementia, and even death. Most professional societies recommend targeting HbA1C levels less than 6.5% or 7%, with individualized treatment targets based on patient age, other medical conditions, and risk of hypoglycemia with therapy. Treating patients to very low HbA1c levels is not likely to improve their health, especially not in the short-term, but can cause serious harms such as hypoglycemia. The goal of our study was to assess how frequently patients with type 2 diabetes are treated intensively, focusing specifically on patients who are elderly or have serious chronic conditions such as dementia, kidney disease including dialysis need, heart disease, stroke, lung disease, and cancer. Moreover, while prior studies have suggested that intensive treatment may be common, there was no strong evidence that intensive treatment does in fact increase risk of hypoglycemia. Our study was designed specifically to assess this risk. We examined medical claims, pharmacy fill data, and laboratory results of 31,542 adults with stable and controlled type 2 diabetes who were included in the OptumLabs™ Data Warehouse between 2001 and 2013. None of the patients were treated with insulin or had prior episodes of severe hypoglycemia, both known risk factors for future hypoglycemic events. None of the patients had obvious indications for very tight glycemic control, such as pregnancy. “Intensive treatment” was defined as being treated with more glucose-lowering medications than clinical guidelines consider to be necessary given their HbA1C level. Patients whose HbA1C was less than 5.6 percent (diabetes is defined by HbA1C 6.5 percent or higher) were considered intensively treated if they were taking any medications. Patients with HbA1C in the “pre-diabetes” range, 5.7-6.4 percent, were considered to be intensively treated if using two or more medications at the time of the test, or if started on additional medications after the test, because current guidelines consider patients with HbA1C less than 6.5 percent to already be optimally controlled. For patients with HbA1C of 6.5-6.9 percent the sole criteria for intensive treatment was treatment intensification with two or more drugs or insulin. The patients were separated by whether they were considered clinically complex (based on the definition by the American Geriatrics Society)—75 years of age or older; or having end-stage kidney disease, dementia; or with three or more serious chronic conditions. This distinction has been made to help identify patients for whom adding glucose-lowering medications is more likely to lead to treatment-related adverse events, including hypoglycemia, while not providing substantial long-term benefit. (more…)
Author Interviews, Frailty, Geriatrics, Mayo Clinic / 18.03.2016 Interview with: Alanna Chamberlain, PhD Assistant Professor of Epidemiology Mayo Clinic College of Medicine What is the background for this study? Dr. Chamberlain: The number of elderly individuals in the US will double by the year 2050 and these individuals will become increasingly frail as they get older. Frailty has been recognized by doctors and researchers as an important contributor to poor health and declines in quality of life among older adults. However, it is difficult to measure frailty because it’s not due to a single condition. Instead, multiple health problems tend to accumulate over time until a person becomes increasingly frail. It is important to understand how frailty develops as patients age and how changes in frailty are related to outcomes. To address these questions, we followed individuals over 8 years to identify changes in frailty over time, to describe how people cluster (follow similar trajectories of frailty over time), and to examine how these changes relate to emergency department visits, hospitalizations, and death in a large population from Olmsted County, MN. (more…)