How To Prevent the Elderly From Falling?

MedicalResearch.com Interview with:

Dr. Alex Krist

Dr. Krist

Dr. Alex Krist, M.D., M.P.H.

Dr. Krist is is a professor of family medicine and population health at Virginia Commonwealth University and active clinician and teacher at the Fairfax Family Practice residency.

What is the background for these recommendation statements? What are the main findings?

Response: Falls are the leading cause of injuries in adults age 65 and older and can lead to serious disability and even death. Bone fractures—which may result from a fall—can also cause serious disability and death in older adults.

The U.S. Preventive Services Task Force looked into the most recent evidence on the best ways to prevent falls and fractures in older adults. We found that clinicians should recommend exercise or physical therapy to help prevent falls by older adults who live at home and are at higher risk for falling.

Additionally, we concluded that taking a low dose of vitamin D and calcium does not help prevent fractures due to osteoporosis, but we don’t know if taking a higher dose is effective or not, so we are calling for more research.

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Poor Functional Status Predicts Increased Mortality After Dialysis Initiation

MedicalResearch.com Interview with:

Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH

Dr. Shah

Silvi Shah, MD, FACP, FASN|
Assistant Professor
Division of Nephrology
University of Cincinnati
Cincinnati, OH

MedicalResearch.com: 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.

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Elderly Frail Patients At Higher Risk Of Mortality After Dialysis Initiation

MedicalResearch.com Interview with:

Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH

Dr. Shah

Silvi Shah, MD, FACP, FASN
Assistant Professor, Division of Nephrology
University of Cincinnati
Cincinnati, OH

MedicalResearch.com: 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.

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Inactivity Plus Frailty Predict Mortality

MedicalResearch.com 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

Dr. Theou

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 

MedicalResearch.com: 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

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Blood Pressure Medications In Elderly Require Personalized Approach

MedicalResearch.com Interview with:

Dr. Rathi Ravindrarajah PhD Division of Health and Social Care Research Faculty of Life Sciences & Medicine  Guy’s Campus King’s College London

Dr. Ravindrarajah

Dr. Rathi Ravindrarajah PhD
Division of Health and Social Care Research
Faculty of Life Sciences & Medicine
Guy’s Campus
King’s College London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Clinical trials show that it is beneficial to lower systolic blood pressure (SBP) in adults aged 80 and over, but non-randomized epidemiological studies suggest that lower systolic blood pressure may be associated with a higher risk of mortality.

Our main findings were that there was a terminal decline in systolic blood pressure in the final 2 years of life suggesting that the higher mortality in those with a low SBP shown in non-randomized epidemiological studies might be due to reverse causation.

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Walking 900 Steps Can Prevent Functional Decline in Hospitalized Patients

MedicalResearch.com Interview with:

Maayan Agmon, PhD The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Studies University of Haifa Haifa, Israel

Dr. Maayan Agmon

Maayan Agmon, PhD
The Cheryl Spencer Department of Nursing
Faculty of Social Welfare and Health Studies
University of Haifa
Haifa, Israel

MedicalResearch.com: 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.

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Frailty Screening Can Predict Postoperative Survival

MedicalResearch.com 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

Dr. Daniel E. Hall

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

MedicalResearch.com: 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.

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Health and Economic Burden of Falls Expected To Surge

MedicalResearch.com Interview with:

Gwen Bergen, PhD Division of Unintentional Injury National Center for Injury Prevention and Control CDC

Dr. Gwen Bergen

Gwen Bergen, PhD
Division of Unintentional Injury
National Center for Injury Prevention and Control
CDC

MedicalResearch.com: 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.

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Patients Remain On High Risk Drugs Even After A Fragility Fracture

MedicalResearch.com 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

Dr. Jeffrey Munson

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

MedicalResearch.com: 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.

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Self-Reported Assessment Provides Reliable Measure of Frailty

MedicalResearch.com Interview with

Oleg Zaslavsky PhD Assistant Professor at the department of Biobehavioral Nursing and Health System School of Nursing University of Washington

Dr. Oleg Zaslavsky

Oleg Zaslavsky PhD
Assistant Professor at the department of Biobehavioral Nursing and Health System
School of Nursing
University of Washington

MedicalResearch.com: 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.

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Therapeutic Target To Reverse Muscle Wasting in Aging Identified

MedicalResearch.com Interview with: Dr. David Sebastián IRB Barcelona and CIBERDEM researcher

Dr. David Sebastián

MedicalResearch.com Interview with:
Dr. David Sebastián
IRB Barcelona and CIBERDEM researcher

MedicalResearch.com: 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.

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Impaired Gait Speed Predicts Adverse Events in Heart Failure

MedicalResearch.com Interview with:
Giovanni Pulignano, MD, FANMCO
Dirigente Cardiologo/ Senior Cardiologist
I UO Cardiologia /UTIC/Gruppo Operativo Interdisciplinare Scompenso Cardiaco
Heart Failure Unit/ Cardiology Unit/CCU
Azienda Ospedaliera San Camillo-Forlanini, Roma
S.Camillo-Forlanini Hospital, Rome, Italy

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Pulignano:  As the population ages, heart failure (HF)is becoming increasingly common, with a high burden of disability, morbidity, and mortality. A significant proportion of patients with heart failure are frail and have impairments in gait speed.

The prognosis of older patients depends not only on cardiac diseases or comorbidities but also on geriatric conditions, such as disability, cognitive impairment, and frailty, as a consequence of their biological heterogeneity. We chose gait speed as a marker of frailty for its high feasibility – requiring just a corridor and a digital stopwatch – and added it to the 3C-HF score, a well validated heart failure model with a high predictive performance for including comorbidities, in order to improves risk stratification in older patients.

In our study nearly 35% of patients showed severely reduced gait speeds that were significantly associated with an increased 1-year event rate, independent of conventional heart failure prognostic factors.

Besides confirming the association with mortality and hospitalizations, when added to the 3C-HF score, indeed, gait speed improved its prognostic accuracy, allowing us to reclassify patients in more appropriate risk categories.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Pulignano:  This is the first study to test the incremental value of gait speed in predicting prognosis in older patients with heart failure in combination with a validated clinical risk score, the 3C-HF. Frailty assessment using gait speed is simple and inexpensive, and its measurement could be easily incorporated in the routine clinical evaluation of older patients with HF. In times of financial restraints affecting national health services, an accurate assessment of the individual risk for adverse outcomes focused on a tailored therapy and informed shared decision making is warranted. Early detection of frailty in patients with heart failure may lead to interventions to prevent or reverse the development of frailty itself, such as regular physical exercise and balanced nutrition, to improve not only function and quality of life but also survival, if possible

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Pulignano:  According to our results, we can speculate that frail patients with heart failure may be enrolled in long-term management programs that incorporate geriatric assessment, HF clinics, and exercise, aimed at the prevention of functional decline and clinical events. However, it has yet to be determined whether targeting frailty with interventions may actually improve patient-centered and clinical outcomes. Thus, the optimal design of these interventions and their impact on outcomes is still an area of investigation; further studies should address this issue.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Pulignano G, Del Sindaco D, Di Lenarda A, et al. Incremental Value of Gait Speed in Predicting Prognosis of Older Adults With Heart Failure: Insights From the IMAGE-HF Study.JCHF. 2016;():. doi:10.1016/j.jchf.2015.12.017.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

Dr. Giovanni Pulignano (2016). Impaired Gait Speed Predicts Adverse Events in Heart Failure MedicalResearch.com

Frail Patients Much More Likely To Die After Surgery

More on Frailty on MedicalResearch.com
MedicalResearch.com Interview with:

Dr. Daniel I McIsaac

Dr. Daniel McIsaac

Dr. Daniel I McIsaac, MD, MPH, FRCPC
Assistant Professor of Anesthesiology
Department of Anesthesiology
The Ottawa Hospital, Civic Campus
Ottawa, ON

Medical Research: What is the background for this study?

Dr. McIsaac: Older age is a well-known risk factor for adverse outcomes after surgery, however, many older patients have positive surgical outcomes. Frailty is a syndrome that encompasses the negative health attributes and comorbidities that accumulate across the lifespan, and is a strong discriminating factor between high- and low-risk older surgical patients.  By definition, frail patients are “sicker” than non-frail patients, so their higher rates of morbidity and mortality after surgery aren’t surprising. However, frailty increases in prevalence with increasing age, so as our population ages we expect to see more frail people presenting for surgery.  Our goal was to evaluate the impact of frailty on postoperative mortality at a population-level, and over the first year after surgery to provide insights that aren’t available in the current literature, which largely consists of single center studies limited to in-hospital and 30-day outcome windows.

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Frailty Linked To Lower Survival in Lung Transplant Patients

Cassie Kennedy, M.D. Pulmonology and Critical Care Medicine Mayo Clinic

Dr. Cassie Kennedy

MedicalResearch.com Interview with:
Cassie Kennedy, M.D.
Pulmonology and Critical Care Medicine
Mayo Clinic 

Medical Research: What is the background for this study?

Dr. Kennedy: Lung transplant is a surgical procedure that can offer extended life expectancy and improved quality of life to selected patients with end-stage lung disease. However there are about 1700 patients awaiting lung transplant at any given time in the United States because transplant recipients far exceed potential donors.  In addition, even with carefully chosen candidates, lung transplant recipients live on average about 5.5 years.  It is therefore very important for transplant physicians to choose patients who will receive the most benefit from their lung transplant.

Frailty (defined as an increased vulnerability to adverse health outcomes) has typically been a subjective consideration by transplant physicians when choosing lung transplant candidates.  The emergence of more objective and reproducible frailty measures from the geriatric literature present an opportunity to study the prevalence of frailty in lung transplant (despite that subjective screening) and to determine whether the presence of frailty has any impact on patient outcomes.

Medical Research: What are the main findings?

Dr. Kennedy: Frailty is quite common –46 percent of our patient cohort was frail by the Frailty Deficit Index. We also saw a significant association between frailty and worsened survival following lung transplantation: one-year survival rate for frail patients was 71.7 percent, compared to 92.9 percent for patients who were not frail. At three years this difference in survival persisted–the survival rate for frail patients was 41.3 percent, compared to 66.1 percent for patients who were not frail.

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Study Addresses Dairy Consumption and Frailty in Older Adults

MedicalResearch.com Interview with:
Dr. Alberto Lana
Department of Medicine, Preventive Medicine and Public Health Area
School of Medicine and Health Sciences
University of Oviedo, Oviedo, Spain

Medical Research: What is the background for this study? What are the main findings?

Dr. Lana: Healthy diets are associated with lower risk of frailty among elderly, but we thought that knowing the role of particular foods is essential to establish prevention measures. Dairy products are substantial sources of proteins, vitamins, and minerals, especially for older adults. Thus, dairy products could theoretically reduce the incidence of frailty. But high milk consumption could also have deleterious effects because it adds saturated fatty acids to diet and could increases oxidative stress. So the advice regarding dairy consumption remains unclear.

Medical Research: What should clinicians and patients take away from your report?

Dr. Lana: According to our results, clinicians should recommend replacing whole-fat products with low-fat ones. Generally, patients should be educated to perform always healthy dietetic choices.

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Simplified Frailty Score Predicts Post-Operative Complications

MedicalResearch.com Interview with:
Louis M. Revenig, MD and
Kenneth Ogan MD, Department of Urology

Emory University School of Medicine
Atlanta, Georgia 30322

MedicalResearch: What is the background for this study? What are the main findings?

Response: Numerous groups from a variety of institutions have investigated different methods of quantifying frailty in surgical populations. All have shown that frailty not only can be measured, but more importantly, reliably identifies the patients who are at higher risk for poor postoperative outcomes compared to their peers.  One obstacle to more widespread use of frailty assessments is the extra burden it places on an already busy clinical setting. In our study we chose what we thought was the already simplest and most clinically applicable frailty assessment, the 5-component Fried Frailty Criteria, and prospectively enrolled a large cohort of surgical patients and followed their outcomes. We critically analyzed the data to assess which components of the frailty assessment were most important. Our results showed that of the 5 components (weight loss, grip strength, gait speed, exhaustion, and activity level), weight loss and grip strength alone carried the same prognostic information for post-operative outcomes as the full assessment. Additionally, when combined with two already routinely collected pre-operative variables (serum hemoglobin and ASA score) we created a novel, simple, and easy to use risk stratification system that is more amenable to a busy clinical setting. Continue reading