Inflammation and frailty measures in older people

Hubbard, Ruth E.; O'Mahony, M Sinead; Savva, George M.; Calver, Brian L.; Woodhouse, Ken

doi:10.1111/j.1582-4934.2009.00733.x

Cited by 330 publications

(219 citation statements)

References 43 publications

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“…falls, disability, hospitalization, mortality) (25)(26)(27)(28), and has further been associated with biological abnormalities (e.g. biomarkers of inflammation) regardless of the definition used to assess frailty (29). These findings clearly suggest that frailty is influenced by a number of pathophysiological modifications involving the body's diverse physiological systems.…”

Section: Theoretical and Operational Definitions Of Frailtymentioning

confidence: 72%

Cognitive frailty: Rational and definition from an (I.A.N.A./I.A.G.G.) International Consensus Group

Kelaiditi

Cesari

Canevelli

et al. 2013

The Journal of nutrition, health and aging

762

550

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Abstract:The frailty syndrome has recently attracted attention of the scientific community and public health organizations as precursor and contributor of age-related conditions (particularly disability) in older persons. In parallel, dementia and cognitive disorders also represent major healthcare and social priorities. Although physical frailty and cognitive impairment have shown to be related in epidemiological studies, their pathophysiological mechanisms have been usually studied separately. An International Consensus Group on "Cognitive Specific aim of this approach was to facilitate the design of future personalized preventive interventions in older persons. Finally, the Group discussed the use of multidomain interventions focused on the physical, nutritional, cognitive and psychological domains for improving the well-being and quality of life in the elderly. The consensus panel proposed the identification of the so-called "cognitive frailty" as an heterogeneous clinical manifestation characterized by the simultaneous presence of both physical frailty and cognitive impairment. In particular, the key factors defining such a condition include: 1) presence of physical frailty and cognitive impairment (CDR=0.5); and 2) exclusion of concurrent AD dementia or other dementias. Under different circumstances, cognitive frailty may represent a precursor of neurodegenerative processes. A potential for reversibility may also characterize this entity. A psychological component of the condition is evident and concurs at increasing the vulnerability of the individual to stressors.

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Section: Theoretical and Operational Definitions Of Frailtymentioning

confidence: 72%

Cognitive frailty: Rational and definition from an (I.A.N.A./I.A.G.G.) International Consensus Group

Kelaiditi

Cesari

Canevelli

et al. 2013

The Journal of nutrition, health and aging

762

550

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“…Low albumin (<3.0g/dL) has independently predicted the development of new onset disability at discharge amongst 885 patients ≥ 70 years old who had been independent at hospital admission [69]. Also, albumin correlated inversely with the Frailty Index (r-0.545, P < 0.01) in another study [70]. Therefore, frailty or decline in functional reserve may be an intermediate stage between poor nutrition, manifested by low albumin and recurrent hypoglycemia, and poor outcomes in older people (Figure 2).…”

Section: Hypoglycemia and Frailty-prognostic Significancementioning

confidence: 87%

Hypoglycemia in Older People - A Less Well Recognized Risk Factor for Frailty

et al. 2015

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Recurrent hypoglycemia is common in older people with diabetes and is likely to be less recognized and under reported by patients and health care professionals. Hypoglycemia in this age group is associated with significant morbidities leading to both physical and cognitive dysfunction. Repeated hospital admissions due to frequent hypoglycemia are also associated with further deterioration in patients' general health. This negative impact of hypoglycemia is likely to eventually lead to frailty, disability and poor outcomes. It appears that the relationship between hypoglycemia and frailty is bidirectional and mediated through a series of influences including under nutrition. Therefore, attention should be paid to the management of under nutrition in the general elderly population by improving energy intake and maintaining muscle mass. Increasing physical activity and having a more conservative approach to glycemic targets in frail older people with diabetes may be worthwhile.

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“…As body fat increases and total body water decreases, the apparent volume of distribution of polar drugs (such as digoxin and lithium) will decrease [21] while that of lipophilic drugs (such as diazepam) will increase [22]. While albumin levels do not change with "healthy ageing", frail older people have significantly lower levels of serum albumin [23]. Acidic drugs (such as phenytoin, warfarin, digoxin, naproxen, ceftriaxone, lorazepam, valproic acid) are usually bound extensively to albumin, with unbound drug available for passive diffusion to extravascular or tissue sites where the pharmacologic effects of the drug occur.…”

Section: Distributionmentioning

confidence: 97%

Prescribing appropriately in frail older people

2015

Healthy Aging Res

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Frailty is one of the most important aspects associated with the elderly. It is defined as a state of increased vulnerability to poor resolution of homeostasis after a stressor event, which increases the risk of adverse outcomes such as falls, institutionalization and death. Frail older adults are more likely to have several concurrent disorders, requiring multiple treatments and hence, considerable medication consumption. The functional reserve of multiple organs deteriorates with ageing and this often leads to changes in drug pharmacokinetics and metabolism. As a result, prescribing medications for frail older people is often complex and challenging. Furthermore, there is a paucity of evidence from clinical trials on the effects of multiple drug consumption in patients aged above 80 years since people from this age group tend to be excluded from such studies. Because of the changes in the pharmacokinetics and pharmacodynamics of drugs in older people, especially in those who are frail, there is an increased risk of adverse drug events for these patients, which can result in hospitalization, increased morbidity and mortality. In this review, appropriate prescribing for frail older people is explored. Consideration will be given to the impact of frailty on medication prescribing and how individualized prescribing could reduce the risk of adverse drug events in at-risk older patients. Tools used to enhance prescribing practice are examined, including those aimed at reducing polypharmacy, underprescribing and inappropriate prescribing. These tools use either explicit (criterion-based) or implicit (judgment-based) criteria. However, most of the current therapeutic guidelines are applicable mainly for the fit older population and cannot be directly applied where frail individuals are concerned. Approaches to improving appropriate prescribing among frail elderly patients, including those with limited life expectancy, are also reviewed.

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Inflammation and frailty measures in older people

Cited by 330 publications

References 43 publications

Cognitive frailty: Rational and definition from an (I.A.N.A./I.A.G.G.) International Consensus Group

Cognitive frailty: Rational and definition from an (I.A.N.A./I.A.G.G.) International Consensus Group

Hypoglycemia in Older People - A Less Well Recognized Risk Factor for Frailty

Prescribing appropriately in frail older people

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