This study examines the adequacy of the dietary intake based on age, sex, and level of nutritional risk among 98 frail elderly persons receiving home care through Community Care Access Centres. The dietary intakes were measured using 24-hour recalls and were compared with the dietary reference intake. The participants' intakes of both macronutrients and micronutrients were found to be inadequate. On average, elderly persons were consuming more than the recommended amount of protein, but the average intakes of many vitamins and minerals were less than optimal based on the average intakes. Paradoxically, more than half of elderly participants were overweight or obese. The results highlight the need for appropriate nutrition, education, and support for elderly persons receiving home care.
The objective of this study was to broaden our understanding of the specific characteristics of community-dwelling seniors who are at increased risk of falling and becoming injured, by paying particular attention to gender and veteran status. The 137 respondents included 69 senior male veterans and 68 seniors in the general population. Results indicated that the veterans were at higher risk of falling than the general senior population, and were at higher risk of becoming injured after falling. Senior women were at less risk of falling and becoming injured than the veterans, but were at higher risk than the senior nonveteran men. It is imperative to target screening and falls prevention activities at these and other specific subgroups in the senior population that are at high risk of falling and becoming injured.
To evaluate the potential of an artificial neural network (ANN) in predicting survival in elderly Canadians, using self-report data.
Cohort study with up to 72 months follow-up.
Forty self-reported characteristics were obtained from the community sample of the Canadian Study of Health and Aging. An individual frailty index score was calculated as the proportion of deficits experienced. For the ANN, randomly selected participants formed the training sample to derive relationships between the variables and survival and the validation sample to control overfitting. An ANN output was generated for each subject. A separate testing sample was used to evaluate the accuracy of prediction.
A total of 8,547 Canadians aged 65 to 99, of whom 1,865 died during 72 months of follow-up.
The output of an ANN model was compared with an unweighted frailty index in predicting survival patterns using receiver operating characteristic (ROC) curves.
The area under the ROC curve was 86% for the ANN and 62% for the frailty index. At the optimal ROC value, the accuracy of the frailty index was 70.0%. The ANN accuracy rate over 10 simulations in predicting the probability of individual survival mean+/-standard deviation was 79.2+/-0.8%.
An ANN provided more accurate survival classification than an unweighted frailty index. The data suggest that the concept of biological redundancy might be operationalized from health survey data.
Postoperative delirium (PD) after transcatheter aortic valve implantation (TAVI) remains to be explored. We sought to (1) determine the incidence of PD in octogenarians who underwent TAVI or surgical aortic valve replacement (SAVR), (2) identify its risk factors, and (3) describe possible differences in the onset and course of PD between treatment groups. A prospective cohort study of consecutive patients aged =80 years with severe aortic stenosis who underwent elective TAVI or SAVR (N = 143) was conducted. The incidence of PD was assessed for 5 days using the Confusion Assessment Method (CAM). Risk factors for PD were studied with logistic regression. Patients treated with TAVI were older (p =0.001), had lower cognitive scores (p = 0.007), and more co-morbidities (p = 0.003). Despite this, significantly fewer (p = 0.013) patients treated with TAVI (44%) experienced PD compared to patients treated with SAVR (66%). Undergoing SAVR (p = 0.02) and having lower cognitive function (p = 0.03) emerged as risk factors for PD, whereas gender, activities of daily living, frailty, atrial fibrillation, and postoperative use of opioids and anxiolytics did not. Patients treated with TAVI and without PD during the first 2 postoperative days were unlikely to experience PD on subsequent days. The onset of PD after SAVR could occur at any time during the postoperative evaluation. In conclusion, SAVR in octogenarian patients with aortic stenosis might be considered as a predisposing factor for PD. Our data also suggest that the onset of PD was more unpredictable after SAVR.
This article describes a quasi-experimental study on falls prevention for clients of home support services in British Columbia, Canada. The study tested a nurse-designed multifactorial intervention, delivered by community health workers. The intervention consisted of 1 day of falls surveillance and prevention training for 51 community health workers, followed by 6 months of evidence-based interventions with their clients (n = 70) using a pretested Checklist and Action Plan. Study findings showed a 43% reduction (chi2 = 8.742, p
For the large population of elderly patients with cardiovascular disease, it is crucial to identify clinically relevant measures of biological age and their contribution to risk. Frailty is denoting decreased physiological reserves and increased vulnerability. We analysed the manner in which the variable frailty is associated with 1-year outcomes for elderly non-ST-segment elevation myocardial infarction (NSTEMI) patients.
Patients aged 75 years or older, with diagnosed NSTEMI were included at three centres, and clinical data including judgment of frailty were collected prospectively. Frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale. Of 307 patients, 149 (48.5%) were considered frail. By Cox regression analyses, frailty was found to be independently associated with 1-year mortality after adjusting for cardiovascular risk and comorbid conditions (hazard ratio 4.3, 95% CI 2.4-7.8). The time to the first event was significantly shorter for frail patients than for nonfrail (34 days, 95% CI 10-58, p?=?0.005).
Frailty is strongly and independently associated with 1-year mortality. The combined use of frailty and comorbidity may constitute an important risk prediction concept in regard to cardiovascular patients with complex needs.
Three important results concerning the shape and the trends of the human mortality rate were discussed recently in demographic and epidemiological literature. These are the deceleration of the mortality rate at old ages, the tendency to rectangularization of the survival curve, and the decline of the old age mortality observed in the second part of the 20th century. In this paper we show that all these results can be explained by using a model with a new type of heterogeneity associated with individual differences in adaptive capacity. We first illustrate the idea of such a model by considering survival in a mixture of two subpopulations of individuals (called "labile" and "stable"). These subpopulations are characterized by different Gompertz mortality patterns, such that their mortality rates cross over. The survival chances of individuals in these subpopulations have different sensitivities to changes in environmental conditions. Then we develop a more comprehensive model in which the mortality rate is related to the adaptive capacity of an organism. We show that the trends in survival patterns experienced by a mixture of such individuals resemble those obtained in an analysis of empirical data on survival in developed countries. Lastly, we present evidence of the existence of subpopulations of phenotypes in both humans and experimental organisms, which were used as prototypes in our models. The existence of such phenotypes provides the possibility that at least part of today's centenarians originated from an initially frail part of the cohort.
Acutely ill elderly medical patients have a higher chance of survival if they are admitted to a specialised geriatric unit instead of a general medical unit. This was shown in a meta-analysis from 2011 which included more than 10,000 elderly patients. The best effect of geriatric intervention is seen when patients are selected carefully. The patients' need for geriatric intervention was assessed to determine if there was a relation between a screening tool and the assessment made by a specialist of geriatrics (SG).
A descriptive cohort study was conducted. Patients = 65 years treated during a 14-day period were included. Their mean age was 78 years. Screening with the Identification of Seniors at Risk (ISAR) was performed (n = 198) by the Mobile Geriatric Team (MGT). The patients' medical journals were assessed retrospectively by the SG to determine any need for assessment and intervention.
53% of the admitted and 77% of the non-admitted patients would have benefitted from assessment by the MGT, and 22% would have benefitted from transfer directly to the Geriatric Unit. The readmitted patients and the patients who died during follow-up had a mean ISAR score of three compared with the non-readmitted patients who had a mean score of two. Patients with either nutritional or cognitive problems, or depression had a mean score of three.
To identify elderly patients with a need for comprehensive geriatric assessment, we recommend that triage be supplemented with the ISAR screening. Furthermore, patients with a score of = 2 should be assessed by the MGT so that a post-discharge plan including treatment/rehabilitation and follow-up may be drawn up.
The study was approved and registered with the Danish Data Protection Agency under the Capital Region of Denmark's joint notification of health research (j. no.: 2007-58-0015, AMH-2013-003, I-Suite no.: 02495).
even older adults who are fit experience adverse health outcomes; understanding their risks for adverse outcomes may offer insight into ambient population health. Here, we evaluated mortality risk in relation to social vulnerability among the fittest older adults in a representative community-dwelling sample of older Canadians.
in this secondary analysis of the Canadian Study of Health and Aging, participants (n = 5,703) were aged 70+ years at baseline. A frailty index was used to grade relative levels of fitness/frailty, using 31 self-reported health deficits. The analysis was limited to the fittest people (those reporting 0-1 health deficit). Social vulnerability was trichotomised from a social vulnerability scale, which consisted of 40 self-reported social deficits.
five hundred and eighty-four individuals had 0-1 health deficit. Among them, absolute mortality risk rose with increasing social vulnerability. In those with the lowest level of social vulnerability, 5-year mortality was 10.8%, compared with 32.5% for those with the highest social vulnerability (adjusted hazard ratio 2.5, 95% CI: 1.5-4.3, P = 0.001).
a 22% absolute mortality difference in the fittest older adults is of considerable clinical and public health importance. Routine assessment of social vulnerability by clinicians could have value in predicting the risk of adverse health outcomes in older adults.
Fracture is a leading cause of disability in the aging population. Because the cost of fracture in terms of medical expenditures and quality of life lost can be substantial, it is essential to identify a complete profile of fracture risk for the development of timely interventions. Risk factors for fracture have most often been identified clinically. Thus, the contribution by Wagner et al. in this issue of the Journal is particularly important, since it demonstrates a robust association between balance impairment and fracture in a population-based setting. It is unclear, however, whether isolating balance as a risk factor can tell us enough about the clustering of risk factors for fracture that accompanies frailty. Indeed, this problem of risk clustering is one that epidemiologists often encounter as we try to locate the mediating processes between exposures and outcomes that lead downstream through complex interacting causal pathways. In this commentary, the author discusses the importance, particularly when studying frailty and fracture, of quantifying risk clustering rather than continuing to rely on solitary risk factors. Moreover, the author suggests the use of Bayesian networks in the expansion of our tool kit in this field of research.
Comment On: Am J Epidemiol. 2009 Jan 15;169(2):143-919064648