Hypoglykémia v starobe je spojená s významnými chorobnosťami vedúcimi k fyzickej aj kognitívnej dysfunkcii. Opakované hospitalizácie v dôsledku častých hypoglykémií sú tiež spojené s ďalším zhoršovaním celkového zdravotného stavu pacientov. Tento negatívny vplyv hypoglykémie pravdepodobne nakoniec povedie ku krehkosti, invalidite. Zdá sa, že vzťah medzi hypoglykémiou a krehkosťou je obojsmerný a je sprostredkovaný radom vplyvov vrátane podvýživy. Preto je potrebné venovať pozornosť manažmentu podvýživy u geriatrických pacientov zlepšením energetického príjmu a udržaním svalovej hmoty. Dôležité je zamerať sa na zvýšenie fyzickej aktivity a konzervatívnejší prístup ku glykemickým cieľom u krehkých starších diabetikov.
Hypoglycemia in elderly 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 and disability. 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 geriatric patients with diabetes may be worthwhile.
Transplantace ledviny představuje optimální terapeutickou možnost nezvratného renálního selhání. S přibývajícím počtem kandidátů vyššího věku narůstá také pozornost věnovaná frailty, resp. funkčnímu stavu kandidátů. K hodnocení frailty lze použít různé metody. Na příkladu studie CoGeriaTx je ukázáno využití komplexního geriatrického hodnocení (comprehensive geriatric assessment, CGA) v hodnocení frailty u kandidátů transplantace ledviny. Dva příklady porovnávají metodu a výsledky hodnocení frailty podle epidemiologických kritérií fenotypu frailty podle Friedové a podle komplexního geriatrického hodnocení. Další výzkum může přinést nové poznatky ohledně prediktivní hodnoty CGA u této cílové skupiny. Korespondenční adresa: MUDr. Hana Vaňková, Ph.D. Interní klinika 3. LF UK a FNKV Šrobárova 50 100 34 Praha 10 e-mail: hana.vankova@lf3.cuni.cz
Kidney transplantation represents the best therapeutical option in patients in end-stage kidney disease. At present, increasing number of older patients are referred for kidney transplantation. The comprehensive geriatric assessment (CGA) of functional status in older kidney transplant candidates might play an important and supportive role in the pre-transplant evaluation process. In the CoGeriaTx study, frailty is evaluated by CGA while Fried Frailty Phenotype (FFP) criteria are considered as one part of the comprehensive evaluation. Two examples compare the method and the results of frailty evaluation according to CGA and when using FFP alone. Further research may provide new insights into the predictive value of CGA in this target group.
- MeSH
- geriatrické hodnocení metody MeSH
- křehkost * diagnóza MeSH
- lidé MeSH
- senioři MeSH
- transplantace ledvin * MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
Krehkosť je najproblematickejším prejavom starnutia populácie, má vysokú predikčnú schopnosť pre zdravotné postihnutie u starších ľudí. Syndróm frailty si žiada multimodálny preventívno-intervenčný prístup, depistáž aj aktívnu dispenzarizáciu frail-pacientov. Mnohé štúdie spájajú pozitívne účinky pravidelného cvičenia so zníženým rizikom pádu, zlepšenou rovnováhou, pohyblivosťou, svalovou silou a znížením markerov krehkosti. Dôležitá je adekvátna nutrícia, kognitívna stimulácia a efektívny denný režim.
Frailty is the most problematic manifestation of population aging, it has a high predictive ability for disability in elerly people. The frailty syndrome requires a multimodal preventive-intervention approach, screening and active dispensary of frail patients. Many studies have linked the positive effects of regular exercise to a reduced risk of falls, improved balance, mobility, muscle strength and reduced markers of frailty. Adequate nutrition, cognitive stimulation and an effective daily regimen are important.
BACKGROUND: Frailty is one of the key syndromes in geriatric medicine and an important factor for post-transplant outcomes. We aimed to describe the prevalence of frailty and examine the correlates of frailty and depressive symptoms in older kidney transplant recipients (KTRs). METHODS: This cross-sectional study involved 112 kidney transplant recipients (KTRs) aged 70 and above. Frailty syndrome was assessed using the Fried frailty criteria, and patients were categorized as frail, pre-frail, or non-frail based on five frailty components: muscle weakness, slow walking speed, low physical activity, self-reported exhaustion, and unintentional weight loss. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS). The relationship between frailty and depressive symptoms was evaluated using multinomial logistic regression, with the three frailty categories as the dependent variable and the severity of depressive symptoms as the independent variable, while controlling for age, gender, renal graft function, and time since transplant surgery. RESULTS: The participants had a mean age of 73.3 ± 3.3 years, and 49% were female. The prevalence of frailty syndrome was 25% (n = 28), pre-frailty was 46% (n = 52), and 29% (n = 32) of the KTRs were non-frail. The mean score for depressive symptoms was 3.1 ± 2.4 points, with 18% scoring above the clinical depression cutoff. Depressive symptoms were positively correlated with frailty (r = .46, p < .001). Among the frailty components, self-reported exhaustion (r = .43, p < .001), slow walking speed (r = .26, p < .01), and low physical activity (r = .44, p < .001) were significantly positively correlated with depressive symptoms, while muscle strength (p = .068) and unintentional weight loss (p = .050) were not. A multinomial logistic regression adjusted for covariates indicated that, compared to being non-frail, each additional point on the GDS increased the odds of being pre-frail by 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] 1.01-1.96) and roughly doubled the odds of being frail (OR = 2.01, 95% CI 1.39-2.89). CONCLUSION: There is a strong association between frailty and depression in KTRs aged 70 years and older. Targeted detection has opened up a new avenue for collaboration between geriatricians and transplant nephrologists.
- MeSH
- deprese * epidemiologie psychologie diagnóza MeSH
- geriatrické hodnocení metody MeSH
- geriatrie metody trendy MeSH
- křehkost * epidemiologie diagnóza psychologie MeSH
- křehký senior psychologie MeSH
- lidé MeSH
- nefrologové trendy MeSH
- prevalence MeSH
- příjemce transplantátu psychologie MeSH
- průřezové studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- transplantace ledvin * psychologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: After an acute infection, older persons may benefit from geriatric rehabilitation (GR). OBJECTIVES: This study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether frailty is associated with recovery. DESIGN: Multicentre prospective cohort study. SETTING: 59 GR facilities in 10 European countries. PARTICIPANTS: Post-COVID-19 patients admitted to GR between October 2020 and October 2021. METHODS: Patients' characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6 weeks and 6 months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL. RESULTS: 723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median [interquartile range] CFS 6.0 [5.0-7.0]) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P < 0.001) points per month and stabilised around 17.0 (quadratic slope: -0.26, SE 0.02, P < 0.001). Similarly, EQ-5D-5L first steeply increased from 0.569 with 0.126 points per month (SE 0.008, P < 0.001) and stabilised around 0.8 (quadratic slope: -0.014, SE 0.001, P < 0.001). Functional recovery rates were independent of frailty level at admission. QoL was lower at admission for frailer participants, but increased faster, stabilising at almost equal QoL values for frail, pre-frail and fit patients. CONCLUSIONS: Post-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR.
- MeSH
- činnosti denního života * MeSH
- COVID-19 * rehabilitace epidemiologie psychologie MeSH
- geriatrické hodnocení * metody MeSH
- křehkost * diagnóza rehabilitace psychologie MeSH
- křehký senior * MeSH
- kvalita života * MeSH
- lidé MeSH
- obnova funkce * MeSH
- prospektivní studie MeSH
- SARS-CoV-2 MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
Krehkosť je najproblematickejším prejavom starnutia populácie, má vysokú predikčnú schopnosť pre zdravotné postihnutie u starších ľudí. Syndróm frailty si žiada multimodálny preventívno-intervenčný prístup, depistáž aj aktívnu dispenzarizáciu frail-pacientov. Mnohé štúdie spájajú pozitívne účinky pravidelného cvičenia so zníženým rizikom pádu, zlepšenou rovnováhou, pohyblivosťou, svalovou silou a znížením markerov krehkosti. Dôležitá je adekvátna nutrícia, kognitívna stimulácia a efektívny denný režim.
Frailty is the most problematic manifestation of population aging, it has a high predictive ability for disability in elerly people. The frailty syndrome requires a multimodal preventive-intervention approach, screening and active dispensary of frail patients. Many studies have linked the positive effects of regular exercise to a reduced risk of falls, improved balance, mobility, muscle strength and reduced markers of frailty. Adequate nutrition, cognitive stimulation and an effective daily regimen are important.
AIMS: Literature regarding anticoagulants in older people affected by atrial fibrillation (AF) is limited to retrospective studies, poorly considering the importance of multidimensional frailty. The main objective of this study is to evaluate in hospitalised older persons with AF the benefit/risk ratio of the anticoagulant treatments, considering the severity of frailty, determined by the multidimensional prognostic index (MPI). METHODS: In this European, multicentre, prospective study, older hospitalised patients (≥65 years) with non-valvular AF were followed-up for 12 months. Anticoagulants' use at discharge ascertained using medical records. MPI was calculated using tools derived from comprehensive geriatric assessment, classifying participants in robust, pre-frail or frail. Mortality (primary outcome); vascular events, including ischemic heart disease or ischemic stroke, hemorrhagic stroke or gastrointestinal bleedings (secondary outcomes). RESULTS: 2,022 participants (mean age 82.9 years; females 56.6%) were included. Compared with people not taking anticoagulants (n = 823), people using vitamin K antagonists (n = 450) showed a decreased risk of mortality (hazard ratio, HR = 0.74; 95% CI: 0.59-0.93), more pronounced in patients using direct oral anticoagulants (DOACs) (n = 749) (HR = 0.46; 95% CI: 0.37-0.57). Only people taking DOACs reported a significantly lower risk of vascular events (HR = 0.55; 95% CI: 0.31-0.97). The efficacy of DOACs was present independently from frailty status. The risk of gastrointestinal bleedings and hemorrhagic stroke did not differ based on the anticoagulant treatments and by MPI values. CONCLUSIONS: Anticoagulant treatment, particularly with DOACs, was associated with reduced mortality in older people, without increasing the risk of hemorrhagic events, overall suggesting the importance of treating with anticoagulants older people with AF.
- MeSH
- antikoagulancia * terapeutické užití škodlivé účinky MeSH
- fibrilace síní * farmakoterapie mortalita komplikace diagnóza MeSH
- geriatrické hodnocení * MeSH
- hodnocení rizik MeSH
- křehkost * mortalita diagnóza MeSH
- křehký senior * statistika a číselné údaje MeSH
- lidé MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
Syndrom křehkosti je klinický syndrom, ve kterém jsou přítomny tři nebo více z následujících kritérií: neúmyslný úbytek hmotnosti 4,5 kg (10 liber) za poslední rok, pacientem udávaná vyčerpanost, slabá svalová síla úchopu, pomalá rychlost chůze a snížená fyzická aktivita. Prevalence křehkosti u kardiochirurgických pacientů je podle dostupných studií od 4,1 % do 46 %. Je spojený s výskytem sarkopenie a osteoporózy. Pro diagnostiku v kardiochirurgii je vhodný nástroj Edmonton Frail Scale, který je vyvinut pro negeriatrické specialisty a poskytuje informace ohledně závislosti pacienta na okolí, znalost zvládání běžných denních aktivit a úrovně fyzické zdatnosti. Existuje široká škála dalších nástrojů k hodnocení. Syndrom křehkosti je nezávislý rizikový faktor zvýšené morbidity, mortality a prodloužené doby hospitalizace po kardiochirurgické operaci. Tito pacienti mají vysoké riziko neúspěchu zvoleného terapeutického postupu. Základem péče o rizikové pacienty je screening a prevence vzniku syndromu křehkosti. Dá se mu předejít dostatečnou fyzickou aktivitou, zdravým životním stylem a pravidelným kognitivním tréninkem.
Frailty syndrome is a clinical syndrome in which three or more of the following criteria are present: an unintentional weight loss of 4.5 kg (10 lb) in the past year, patient-reported exhaustion, poor muscle grip strength, slow walking speed, and reduced physical activity. The prevalence of frailty in cardiac surgery patients ranges from 4.1% to 46% according to available studies. It is associated with the occurrence of sarcopenia and osteoporosis. The Edmonton Frail Scale tool, developed for non-geriatric specialists, is useful for diagnosis in cardiac surgery and provides information regarding the patient's dependence on the environment, knowledge of coping with normal daily activities and level of physical fitness. A wide range of other assessment tools are available. Frailty syndrome is an independent risk factor for increased morbidity, mortality, and prolonged hospital stay after cardiac surgery. These patients have a high risk of failure of the chosen therapeutic approach. Screening and prevention of frailty syndrome is the cornerstone of care for patients at risk. It can be prevented by sufficient physical activity, a healthy lifestyle, and regular cognitive training. Klíčová slova: Kardiochirurgie Prehabilitace Rehabilitace Sarkopenie Syndrom křehkosti Keywords: Cardiac surgery Frailty syndrome Prehabilitation Rehabilitation Sarcopenia
BACKGROUND: The TOURMALINE-MM4 trial demonstrated a significant and clinically meaningful progression-free survival (PFS) benefit with ixazomib versus placebo as postinduction maintenance in nontransplant, newly-diagnosed multiple myeloma patients, with a manageable and well-tolerated toxicity profile. MATERIALS AND METHODS: In this subgroup analysis, efficacy and safety were assessed by age (< 65, 65-74, and ≥ 75 years) and frailty status (fit, intermediate-fit, and frail). RESULTS: In this analysis, PFS benefit with ixazomib versus placebo was seen across age subgroups, including patients aged < 65 years (hazard ratio [HR], 0.576; 95% confidence interval [CI], 0.299-1.108; P = .095), 65-74 years (HR, 0.615; 95% CI, 0.467-0.810; P < .001), and ≥ 75 years (HR, 0.740; 95% CI, 0.537-1.019; P = .064). PFS benefit was also seen across frailty subgroups, including fit (HR, 0.530; 95% CI, 0.387-0.727; P < .001), intermediate-fit (HR, 0.746; 95% CI, 0.526-1.058; P = .098), and frail (HR, 0.733; 95% CI, 0.481-1.117; P = .147) patients. With ixazomib versus placebo, rates of grade ≥ 3 treatment-emergent adverse events (TEAEs; 28-44% vs. 10-36%), serious TEAEs (15-29% vs. 3-29%), and discontinuation due to TEAEs (7-19% vs. 5-11%) were higher or similar across age and frailty subgroups, and generally somewhat higher in older age groups and intermediate-fit/frail patients in both arms. Treatment with ixazomib versus placebo did not adversely affect patient-reported quality-of-life scores across age and frailty status subgroups. CONCLUSION: Ixazomib is a feasible and effective maintenance option for prolonging PFS across this heterogeneous patient population.
- MeSH
- dexamethason terapeutické užití MeSH
- křehkost * diagnóza MeSH
- lidé MeSH
- mnohočetný myelom * diagnóza farmakoterapie MeSH
- protokoly antitumorózní kombinované chemoterapie škodlivé účinky MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
