Predictors of transitions in frailty severity and mortality among people aging with HIV

Kirkland, Susan; Theou, Olga; Zona, Stefano; Malagoli, Andrea; Wallace, Lindsay; Stentarelli, Chiara; Mussini, Cristina; Falutz, Julian; Guaraldi, Giovanni; Rockwood, Kenneth

doi:10.1371/journal.pone.0185352

Cited by 35 publications

(23 citation statements)

References 56 publications

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“…An NI, constructed using the deficit accumulation approach, was a stronger prediction of frailty and mortality risk than were single nutritional parameters. This study, similarly to previous studies [ 76 , 77 ], highlights that the accumulation of small deficits, even those that may not result in clinically detectable problems, corresponds to the ability of the organism to respond and recover from stressors [ 78 ]. A recent report noted the benefit to considering 11 nutrition-related parameters in mortality prediction, but did not evaluate frailty [ 40 ].…”

Section: Discussionsupporting

confidence: 86%

Frailty, nutrition-related parameters, and mortality across the adult age spectrum

Jayanama

Theou

Blodgett

et al. 2018

BMC Med

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BackgroundNutritional status and individual nutrients have been associated with frailty in older adults. The extent to which these associations hold in younger people, by type of malnutrition or grades of frailty, is unclear. Our objectives were to (1) evaluate the relationship between individual nutrition-related parameters and frailty, (2) investigate the association between individual nutrition-related parameters and mortality across frailty levels, and (3) examine whether combining nutrition-related parameters in an index predicts mortality risk across frailty levels.MethodsThis observational study assembled 9030 participants aged ≥ 20 years from the 2003–2006 cohorts of the National Health and Nutrition Examination Survey who had complete frailty data. A 36-item frailty index (FI) was constructed excluding items related to nutritional status. We examined 62 nutrition-related parameters with established cut points: 34 nutrient intake items, 5 anthropometric measurements, and 23 relevant blood tests. The 41 nutrition-related parameters which were associated with frailty were combined into a nutrition index (NI). All-cause mortality data until 2011 were identified from death certificates.ResultsAll 5 anthropometric measurements, 21/23 blood tests, and 19/34 nutrient intake items were significantly related to frailty. Although most nutrition-related parameters were directly related to frailty, high alcohol consumption and high levels of serum alpha-carotene, beta-carotene, beta-cryptoxanthin, total cholesterol, and LDL-c were associated with lower frailty scores. Only low vitamin D was associated with increased mortality risk across all frailty levels. Seventeen nutrition-related parameters were associated with mortality in the 0.1–0.2 FI group, 11 in the 0.2–0.3 group, and 16 in the > 0.3 group. Overall, 393 (5.8%) of the participants had an NI score less than 0.1 (abnormality in ≤ 4 of the 41 parameters examined). Higher levels of NI were associated with higher mortality risk after adjusting for frailty and other covariates (HR per 0.1: 1.19 [95%CI 1.133–1.257]).ConclusionsMost nutrition-related parameters were correlated to frailty, but only low vitamin D was associated with higher risk for mortality across levels of frailty. As has been observed with other age-related phenomena, even though many nutrition-related parameters were not significantly associated with mortality individually, when combined in an index, they strongly predicted mortality risk.

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Section: Discussionsupporting

confidence: 86%

Frailty, nutrition-related parameters, and mortality across the adult age spectrum

Jayanama

Theou

Blodgett

et al. 2018

BMC Med

Self Cite

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“…Members of our collaborative led foundational work examining reasons for referral, and effectiveness of rehabilitation interventions, specifically the role and impact of physiotherapy-led models of care for adults living with HIV in the United Kingdom [37], United States [62], Canada [32,33] and South Africa [76][77][78][79]. Better understanding the biological, social and behavioural factors that interact with HIV and aging can help to identify effective rehabilitation interventions that promote wellbeing in this growing population [80]. The Episodic Disability Framework was developed from the perspectives of adults living with HIV, commonly used as a foundation for understanding how multimorbidity may interact with and influence health challenges over time aging with HIV [22,81].…”

Section: Discussionmentioning

confidence: 99%

Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC)

et al. 2020

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Background: People living with HIV are living longer, and can experience physical, mental and social health challenges associated with aging and multimorbidity. Rehabilitation is well positioned to address disability and maximize healthy aging. An international collaborative network, called the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), works to guide this emerging field. In this article, we report findings from CIHRRC's aim to identify emerging research priorities in HIV, aging and rehabilitation from the perspectives of people living with HIV, clinicians, researchers, representatives from community organizations and policy stakeholders. Methods: We conducted a multi-stakeholder multi-method international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations to identify research priorities in HIV, aging and rehabilitation. Stakeholders identified research priorities during a one-day International Forum comprised of presentations and facilitated discussion. We collated and analyzed data using content analytical techniques, resulting in a framework of research priorities. Results: Sixty-nine stakeholders from countries including Canada (n = 62; 90%), the United Kingdom (n = 5; 7%), United States (n = 1; 1%) and Australia (n = 1; 1%) attended the International Forum on HIV, Aging and Rehabilitation Research. Stakeholders represented community-based organizations (n = 20; 29%), academic institutions (n = 18; 26%), community or institutional healthcare organizations (n = 11; 16%), research or knowledge production organizations (n = 10; 14%), and organizations representing government or industry (n = 10; 14%). The Framework of Research Priorities in HIV, Aging and Rehabilitation includes seven research priorities: (1) nature, extent and impact of disability, concurrent health conditions and chronic inflammation with HIV; (2) prevalence, severity and impact of frailty; (3) community and social participation aging with HIV; (4) strategies for chronic disease management and healthy aging with HIV; (5) facilitators and barriers to access and engagement in, rehabilitation; (6) effectiveness of rehabilitation

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“…Members of our collaborative led foundational work examining reasons for referral, and effectiveness of rehabilitation interventions, specifically the role and impact of physiotherapy-led models of care for adults living with HIV in the United Kingdom (37), United States (62), Canada (32,33) and South Africa (76)(77)(78)(79). Better understanding the biological, social and behavioural factors that interact with HIV and aging can help to identify effective rehabilitation interventions that promote well-being in this growing population (80). The Episodic Disability Framework was developed from the perspectives of adults living with HIV, commonly used as a foundation for understanding how multimorbidity may interact with and influence health challenges over time aging with HIV (22, 81).…”

Section: Discussionmentioning

confidence: 99%

Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC)

O’Brien

Ibáñez-Carrasco²,

Solomon³

et al. 2020

Preprint

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Background: People living with HIV are living longer, and can experience physical, mental and social health challenges associated with aging and multimorbidity. Rehabilitation is well positioned to address disability and maximize healthy aging. An international collaborative network, called the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), works to guide this emerging field. In this article, we report findings from CIHRRC’s aim to identify emerging research priorities in HIV, aging and rehabilitation from the perspectives of people living with HIV, clinicians, researchers, representatives from community organizations and policy stakeholders. Methods: We conducted a multi-stakeholder multi-method international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations to identify research priorities in HIV, aging and rehabilitation. Stakeholders identified research priorities during a one-day International Forum comprised of presentations and facilitated discussion. We collated and analyzed data using content analytical techniques, resulting in a framework of research priorities. Results: Sixty-nine stakeholders from countries including Canada (n=62;90%), the United Kingdom (n=5;7%), United States (n=1;1%) and Australia (n=1;1%) attended the International Forum on HIV, Aging and Rehabilitation. Stakeholders represented community-based organizations (n=20;29%), academic institutions (n=18;26%), community or institutional healthcare organizations (n=11;16%), research or knowledge production organizations (n=10;14%), and organizations representing government or industry (n=10;14%). The Framework of Research Priorities in HIV, Aging and Rehabilitation includes seven research priorities: 1) nature, extent and impact of disability, concurrent health conditions and chronic inflammation with HIV; 2) prevalence, severity and impact of frailty; 3) community and social participation aging with HIV; 4) strategies for chronic disease management and healthy aging with HIV; 5) facilitators and barriers to access to and engagement in, rehabilitation; 6) effectiveness of rehabilitation interventions for healthy aging with HIV; and 7) advancing development and use of patient reported outcome measures in HIV and aging. The Framework highlights methodological considerations to approach the priorities and the importance of knowledge translation and exchange to apply research knowledge into practice, programs and policy. Conclusions: These priorities offer a foundation for collaboration among international and multidisciplinary teams to advance the field of HIV, aging and rehabilitation in order to promote healthy aging with HIV.

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Predictors of transitions in frailty severity and mortality among people aging with HIV

Cited by 35 publications

References 56 publications

Frailty, nutrition-related parameters, and mortality across the adult age spectrum

Frailty, nutrition-related parameters, and mortality across the adult age spectrum

Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC)

Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC)

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