Promoting access to innovation for frail old persons

Berrut, Gilles; Andrieu, Sandrine; Carvalho, Islène Araujo de; Baeyens, Jean-Pierre; Bergman, Howard; Cassim, Bilkish; Cerreta, Francesca; Cesari, Matteo; B., H.; Chen, Liang Kung; Cherubini, Antonio; Chou, Ming Yueh; Cruz-Jentoft, Alfonso J.; Decker, Laure de; Du, Peijun; Forette, B.; Forette, Françoise; Franco, Alain; Guimarães, Renato Maia; Robledo, Luis Miguel Gutiérrez; Jáuregui, José Ricardo; Khavinson, V. Kh.; Lee, Wei Ju; Peng, Li Ning; Perret‐Guillaume, Christine; Petrovic, Mirko; Rétornaz, F.; Rockwood, Kenneth; Rodríguez-Mañas, L.; Sieber, Cornel; Spatharakis, G.; Theou, Olga; Topinková, Eva; Vellas, Bruno; Bénétos, Athanase

doi:10.1007/s12603-013-0039-2

Cited by 56 publications

(22 citation statements)

References 50 publications

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“…Simple and rapid (<10 minutes) assessment 10 with one of the following tools: the Fried Frailty Scale 11 (frail if presence of Ն3 of the following: weight loss, exhaustion, weakness, decreased gait speed, diminished physical activity), gait speed, 12 the Geriatric 8 (G8), 13 the Groningen Frailty Indicator, 6 open-label extension of HYVET showed sustained differences in reductions of total mortality and cardiovascular mortality in the active treatment group.…”

Section: Box Frailty: Concept and Clinical Assessmentmentioning

confidence: 99%

Polypharmacy in the Aging Patient

Bénétos

Rossignol

Cherubini

et al. 2015

JAMA

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119

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IMPORTANCE Hypertension treatment is beneficial for most hypertensive patients. The benefits for patients who are very old and frail, especially those taking numerous medications, are less certain.OBJECTIVE To provide recommendations for the evaluation and treatment of hypertension among patients aged 80 years and older.EVIDENCE ACQUISITION MEDLINE, PubMed Central, and the Cochrane Database of Systematic Reviews were searched from inception through April 2015, with an emphasis on 2010-2015. Manual cross-referencing of review articles and meta-analyses was also performed to identify randomized controlled trials (RCTs) examining antihypertensive use in octogenarians. The search strategy included the following Medical Subject Headings: hypertension or high blood pressure and trials and oldest old or very old or very elderly.FINDINGS Six post hoc analyses of the previously published Hypertension in the Very Elderly Trial (HYVET) met the inclusion criteria. In the only placebo-controlled RCT on hypertension management in patients older than 80 years (HYVET; N = 3845), the treatment was associated with lower total mortality and key cardiovascular end points but the effect on stroke (fatal and nonfatal), which was the primary outcome, failed to reach the significance level (P = .06). Post hoc analyses of HYVET suggested that active hypertension treatment in very elderly patients was beneficial by reducing blood pressure in individuals with white coat hypertension, showed moderate benefits of the active treatment for cognition, a possible effect for fractures prevention, and sustained differences in reductions of total mortality and cardiovascular mortality in those receiving active treatment. However, patients were community dwelling and less disabled than individuals of the same age in general. CONCLUSIONS AND RELEVANCEHypertensive patients who are healthy, functionally independent, and aged 80 years and older should be treated according to current recommendations for people older than 65 years. There is insufficient evidence regarding the benefits of hypertension treatment for frail polymedicated octogenarians, for whom treatment should be individualized.

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Section: Box Frailty: Concept and Clinical Assessmentmentioning

confidence: 99%

Polypharmacy in the Aging Patient

Bénétos

Rossignol

Cherubini

et al. 2015

JAMA

Self Cite

119

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“…Frailty in older adults usually refers to a physiological vulnerability medical that expose to adverse health, functional and social outcomes [24] . Despite the lack of consensus on the definition of frailty, there is a broad agreement that frailty is characterized by an accumulation of deficits related to a combined action of aging and morbidities [25] – [27] . Under the action of the morbidities and/or ageing that generate disabilities, this dynamic process, occurring from reduced physiological resources, results in impaired adaptation to stress such as a hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Screening for Older Emergency Department Inpatients at Risk of Prolonged Hospital Stay: The Brief Geriatric Assessment Tool

et al. 2014

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BackgroundThe aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS.MethodsBased on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry.ResultsArea under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (P<0.003). Prognostic value for prolonged LHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4) and a low likelihood ratio of positive test under 5.6.ConclusionCombinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients.

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“…(22) Frailty is defined as a biological syndrome with low reserve and low resistance to biomedical stressors; frailty results from cumulative declines across multiple biological systems, and worsening frailty is associated with disability. (23) Physical frailty and sarcopenia are closely linked. (24) While limited protein intake predicts incident frailty, it also predicts low bone mass.…”

Section: Consequences Of Malnutrition and Negative Nitrogen Balancementioning

confidence: 99%

Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group

et al. 2014

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The aging process is associated with gradual and progressive loss of muscle mass along with lowered strength and physical endurance. This condition, sarcopenia, has been widely observed with aging in sedentary adults. Regular aerobic and resistance exercise programs have been shown to counteract most aspects of sarcopenia. In addition, good nutrition, especially adequate protein and energy intake, can help limit and treat age-related declines in muscle mass, strength, and functional abilities. Protein nutrition in combination with exercise is considered optimal for maintaining muscle function. With the goal of providing recommendations for health care professionals to help older adults sustain muscle strength and function into older age, the European Society for Clinical Nutrition and Metabolism (ESPEN) hosted a Workshop on Protein Requirements in the Elderly, held in Dubrovnik on November 24 and 25, 2013. Based on the evidence presented and discussed, the following recommendations are made: (1) for healthy older people, the diet should provide at least 1.0 to 1.2 g protein/kg body weight/day (2) for older people who are malnourished or at risk of malnutrition because they have acute or chronic illness, the diet should provide 1.2 to 1.5 g protein/kg body weight/day, with even higher intake for individuals with severe illness or injury, and (3) daily physical activity or exercise (resistance training, aerobic exercise) should be undertaken by all older people, for as long as possible.

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Promoting access to innovation for frail old persons

Cited by 56 publications

References 50 publications

Polypharmacy in the Aging Patient

Polypharmacy in the Aging Patient

Screening for Older Emergency Department Inpatients at Risk of Prolonged Hospital Stay: The Brief Geriatric Assessment Tool

Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group

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