RESUMEN
The objective of this study was to evaluate the association between frailty, evaluated by the Clinical Frailty Scale (CFS) and FRAIL scale, and C-terminal agrin fragment (CAF) levels with 3-month mortality following ST-segment elevation myocardial infarction (STEMI). This was a prospective observational study that included patients over the age of 18â¯years with STEMI admitted to the coronary intensive care unit. Within 48â¯h of admission, the CFS and FRAIL scale were applied and blood samples collected for serum CAF evaluation. Patients were followed for 3â¯months after hospital discharge, and mortality was recorded. One hundred and eleven patients were included; mean age was 62.3⯱â¯12.4â¯years, 61.3% were male and 11.7% died during the 3â¯months of follow-up. According to the CFS, 79.3% of the patients were classified as not frail, 12.6% as pre-frail and 8.1% as frail. According to the FRAIL scale, 31.5% of the patients were classified as not frail, 53.2% as pre-frail and 15.3% as frail. In univariate analysis, the CFS but not FRAIL scale was associated with mortality. In multiple logistic regression analysis, pre-frail/frail according to CFS (odds ratio [OR]: 6.118; CI 95%: 1.344-27.848; pâ¯=â¯0.019) and CAF levels (OR: 0.943; CI 95%: 0.896-0.992; pâ¯=â¯0.024) were associated with increased 3-month mortality. In a sub-analysis of 53 patients ≥65â¯years, CFS and CAF levels were associated with 3-month mortality. In conclusion, CAF levels and frailty determined by the CFS were associated with 3-month mortality after STEMI in the general and older population.
Asunto(s)
Fragilidad , Infarto del Miocardio con Elevación del ST , Adulto , Anciano , Agrina , Anciano Frágil , Fragilidad/diagnóstico , Fragilidad/epidemiología , Mortalidad Hospitalaria , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos , Estudios ProspectivosRESUMEN
BACKGROUND: Data supporting a link between frailty and risk of falls is mostly confined to individuals living in urban centers, where risk factors and lifestyles are different from that of rural settings. OBJECTIVE: To assess the association between frailty and risk of falls in older adults living in rural Ecuador. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Community-dwellers aged ≥60 years living in a rural Ecuadorian village, in whom frail status and risk of falls were assessed. MEASUREMENTS: Frailty was evaluated by the Edmonton Frailty Scale (EFS) and risk of falls by the Downton Fall Risk Index (DFRI). Multivariate models were fitted to evaluate whether frailty was associated with risk of falls (dependent variable), after adjusting for demographics, alcohol intake, cardiovascular risk factors, sleep quality, symptoms of depression, and history of an overt stroke. Correlation coefficients were constructed to assess confounders modifying this association. RESULTS: A total of 324 participants (mean age: 70.5±8 years) were included. The mean EFS score was 4.4±2.5 points, with 180 (56%) participants classified as robust, 76 (23%) as pre-frail and 68 (21%) as frail. The DFRI was positive in 87 (27%) participants. In univariate analysis, the EFS score was higher among participants with a positive DFRI (p<0.001). The number of frail individuals was higher (p<0.001), while that of robust individuals was lower (p<0.001) among those with a positive DFRI. Adjusted logistic regression models showed no association between frailty and the DFRI. Correlation coefficients showed that age, high glucose levels, and history of an overt stroke tempered the association between frailty and the risk of falls found in univariate analyses. CONCLUSIONS: Frailty is not independently associated with risk of falls in older adults living in a remote rural setting. Further studies are needed to assess the impact of frailty on the risk of falls in these populations.
Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Anciano Frágil/estadística & datos numéricos , Fragilidad/epidemiología , Vida Independiente/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Anciano , Estudios Transversales , Ecuador/epidemiología , Humanos , Persona de Mediana Edad , Medición de RiesgoRESUMEN
Oily fish are recommended as part of a healthy diet due to their high content of long-chain omega-3 polyunsaturated fatty acids (ω-3 PUFAs), proteins, and other nutrients. There is preliminary evidence of beneficial effects of ω-3 PUFAs in the prevention of sarcopenia (a major component of frailty). In this study, we aimed to assess the relationship between dietary oily fish intake and a measure of frailty - the Edmonton Frail Scale (EFS) score - in community-dwelling older adults living in rural coastal Ecuador. A total of 363 Atahualpa residents were enrolled. The mean fish servings per week were 8.8 ± 5.2 and mean EFS score was 5 ± 2.8 points. A linear regression model showed no association between the amount of oily fish intake and EFS scores. However, an interaction model, with participants stratified according to their median age and fish intake in quintiles, showed a significant effect for both variables on the EFS score (ß coefficient = 0.104; 95% C.I.: 0.003-0.206; p = 0.044). At the lowest quintile of fish intake, younger individuals have lower EFS scores than their older counterparts. As the consumption of oily fish increases, mean EFS scores margins were found to be progressively reduced in subjects aged 60-69 years but were largely unaffected in persons aged ≥70 years. It appears that oily fish intake has a positive effect on the frailty status of younger subjects but is superseded by the effects of age in the older population.
Asunto(s)
Dieta , Ácidos Grasos Omega-3/administración & dosificación , Peces , Fragilidad/epidemiología , Anciano , Animales , Estudios Transversales , Ecuador , Femenino , Humanos , Vida Independiente , Masculino , Persona de Mediana Edad , Factores de Riesgo , Población Rural , Alimentos Marinos/estadística & datos numéricosRESUMEN
OBJECTIVE: To assess the influence of frailty on cognitive decline. DESIGN: Population-based prospective cohort study. SETTINGS/PARTICIPANTS: Community-dwelling older adults living in a rural Ecuadorian village, fulfilling the following criteria: age ≥60 years at baseline Montreal Cognitive Assessment (MoCA) and frailty assessment, a baseline brain magnetic resonance imaging, and a follow-up MoCA performed at least 12 months after the baseline. MEASURES: Frailty was evaluated by the Edmonton Frailty Scale (EFS) and cognitive performance by MoCA. The relationship between baseline EFS and MoCA decline was assessed by longitudinal linear and fractional polynomial models, adjusted for relevant confounders. The score of the cognitive component of the EFS was subtracted, and an alternative fractional polynomial model was fitted to settle the impact of such cognitive question on the model. RESULTS: A total of 252 individuals, contributing 923.7 person-years of follow-up (mean: 3.7 ± 0.7 years) were included. The mean EFS score was 4.7 ± 2.5 points. The mean baseline MoCA score was 19.5 ± 4.5 points, and that of the follow-up MoCA was 18.1 ± 4.9 points (P = .001). Overall, 154 (61%) individuals had lower MoCA scores in the follow-up. The best fitted longitudinal linear model showed association between baseline EFS score and MoCA decline (P = .027). There was a continuous increase in MoCA decline in persons with an EFS ≥7 points (nonlinear relationship). Fractional polynomials explained the effect of the EFS on MoCA decline. For the complete EFS score, the ß coefficient was 2.43 (95% confidence interval 1.22-3.63). For the effect of the EFS (without its cognitive component) on MoCA decline, the relationship was still significant (ß 4.86; 95% confidence interval 2.6-7.13). CONCLUSIONS/IMPLICATIONS: Over a 3.7-year period, 61% of older adults living in Atahualpa experienced cognitive decline. Such decline was significantly associated with frailty status at baseline. Region-specific risk factors influencing this relationship should be further studied to reduce its burden in rural settings.
Asunto(s)
Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/etiología , Fragilidad/psicología , Población Rural , Anciano , Estudios de Cohortes , Femenino , Humanos , Modelos Lineales , Masculino , Pruebas de Estado Mental y DemenciaRESUMEN
OBJECTIVES: The objectives of this study were to cross-culturally adapt and validate the FRAIL scale in Mexican community-dwelling adults. DESIGN: Cross-sectional analysis of a prospective cohort. SETTING: The FraDysMex study, a 2-round evaluation of community-dwelling adults from 2 municipalities in Mexico City. PARTICIPANTS: Participants were 606 men and women living in the designated area in Mexico City. MEASUREMENTS: Interviewers obtained data regarding demographics, comorbidities, mental status, nutritional status, dependency in activities of daily living, quality of life, mobility, balance, and strength. The FRAIL scale translated to Spanish and the Fried criteria were applied to screen frailty. RESULTS: The Mexican Spanish version of the FRAIL scale showed internal consistency (4 of 5 items in the scale correlated to the scale's total score, rho = 0.41-0.74), external consistency (interrater correlation CCI = 0.82), known-group validity based on age (9.6% of frailty in persons ≥50 years × 3.2% in persons <50 years, P = .001), convergent validity with the Fried criteria (CCI = 0.63), and the scale was also correlated with other measures related to frailty (such as age, quality of life, self-rated health status, cognition, dependency, nutritional status, depression, and physical performance). CONCLUSION: The FRAIL scale was successfully adapted to Mexican Spanish and validated in community-dwelling Mexican adults.
Asunto(s)
Asistencia Sanitaria Culturalmente Competente , Técnicas y Procedimientos Diagnósticos/normas , Fragilidad/diagnóstico , Encuestas y Cuestionarios/normas , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , México , Persona de Mediana EdadRESUMEN
PURPOSE: To assess the effect of age in the association between poor sleep quality and frailty status. DESIGN AND SETTING: Population-based, cross-sectional study conducted in Atahualpa, a rural village located in coastal Ecuador. METHODS: Out of 351 Atahualpa residents aged ≥ 60 years, 311 (89%) were interviewed with the Pittsburgh Sleep Quality Index (PSQI) and the Edmonton Frail Scale (EFS). The independent association between PSQI and EFS scores was evaluated by the use of a generalized linear model adjusted for relevant confounders. A contour plot with Shepard interpolation was constructed to assess the effect of age in this association. RESULTS: Mean score in the PSQI was 5 ± 2 points, with 34% individuals classified as poor sleepers. Mean score in the EFS was 5 ± 3 points, with 46% individuals classified as robust, 23% as prefrail, and 31% as frail. In the fully adjusted model, higher scores in the PSQI were significantly associated with higher scores in the EFS (ß 0.23; 95% CI 0.11-0.35; P < .0001). Several clusters depicted the strong effect of age in the association between PSQI and EFS scores. Older individuals were more likely to have high scores in the EFS and the PSQI, and younger individuals had low EFS scores and were good sleepers. Clusters of younger individuals who were poor sleepers and had high EFS scores accounted for the independent association between PSQI and EFS scores. CONCLUSIONS: This study shows the strong effect of age in the association between poor sleep quality and frailty status.
Asunto(s)
Anciano Frágil , Trastornos del Sueño-Vigilia/epidemiología , Adulto , Factores de Edad , Anciano de 80 o más Años , Estudios Transversales , Ecuador/epidemiología , Femenino , Humanos , Entrevistas como Asunto , Masculino , Investigación Cualitativa , Población RuralRESUMEN
AIM: To translate the Japanese Kihon Checklist (frailty index) into the Portuguese language, and to validate the use of the checklist for the assessment of the elderly Brazilian population. METHODS: A semantic analysis was carried out, along with pretesting of bilingual participants. The checklist was validated against the Edmonton Frail Scale. RESULTS: A total of 188 Brazilian older adults (mean age 69.5 ± 7.47 years) participated in the present study. In the semantic analysis, six elderly participants reported no difficulty with responding to the Portuguese version of the Kihon Checklist. During pretesting with 21 bilingual participants, we found a strong correlation between the total scores of the original version of the Kihon Checklist in Japanese and the translated version in Portuguese (r = 0.764, P < 0.001). According to the validation process, which involved 161 participants, there was a significant correlation between the total scores of the Kihon Checklist and the Edmonton Frail Scale (r = 0.535, P < 0.001), and between each domain of the checklist with the total score of Edmonton Frail Scale (lifestyle τ = 0.429, P < 0.001; physical strength τ = 0.367, P < 0.001; nutrition τ = 0.211, P = 0.002; eating τ = 0.213, P = 0.001; socialization τ = 0.269, P < 0.001; memory τ = 0.285, P < 0.001; and mood τ = 0.359, P < 0.001). Furthermore, the Portuguese version of the Kihon Checklist showed satisfactory internal consistency (Cronbach's α coefficient: 0.787). CONCLUSIONS: The Portuguese language version of the Kihon Checklist presented good internal consistency and validity. Therefore, we encourage its application in the elderly Brazilian population with an aim of monitoring their frailty to prevent or delay the functional dependence and any other adverse health outcomes. [Correction added on 14 January 2013, after first online publication: the phrase 'loss of' has been deleted from the preceding statement.]