In Reply to the Comment on "The Relationship Between Frailty and Emotional Health in Older Patients With Advanced Cancer".
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ABSTRACT:
SUBMITTER: Gilmore N
PROVIDER: S-EPMC9526486 | biostudies-literature | 2022 Oct
REPOSITORIES: biostudies-literature
Publications
In Reply to the Comment on "The Relationship Between Frailty and Emotional Health in Older Patients With Advanced Cancer".
Gilmore Nikesha N Culakova Eva E Mohile Supriya S
The oncologist 20221001 10
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Project description:BackgroundAging-related deficits that eventually manifest as frailty may be associated with poor emotional health in older patients with advanced cancer. This study aimed to examine the relationship between frailty and emotional health in this population.MethodsThis was a secondary analysis of baseline data from a nationwide cluster randomized trial. Patients were aged ≥70 years with incurable stage III/IV solid tumors or lymphomas, had ≥1 geriatric assessment (GA) domain impairment, and had completed the Geriatric Depression Scale, Generalized Anxiety Disorder-7, and Distress Thermometer. Frailty was assessed using a Deficit Accumulation Index (DAI; range 0-1) based on GA, which did not include emotional health variables (depression and anxiety), and participants were stratified into robust, prefrail, and frail categories. Multivariate logistic regression models examined the association of frailty with emotional health outcomes. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported.ResultsFive hundred forty-one patients were included (mean age: 77 years; 70-96). DAI ranged from 0.04 to 0.94; 27% of patients were classified as robust, 42% prefrail, and 31% frail. Compared with robust patients, frail patients had an increased risk of screening positive for depression (aOR = 12.8; 95% CI = 6.1-27.0), anxiety (aOR = 6.6; 95% CI = 2.2-19.7), and emotional distress (aOR = 4.62; 95% CI = 2.9-8.3). Prefrail compared with robust patients also had an increased risk of screening positive for depression (aOR = 2.22; 95% CI = 1.0-4.8) and distress (aOR = 1.71; 95% CI = 1.0-2.8).ConclusionIn older patients with advanced cancer, frailty is associated with poorer emotional health, which indicates a need for an integrated care approach to treating these patients.Implications for practiceA relationship exists between frailty and poor emotional health in older adults with advanced cancer. Identifying areas of frailty can prompt screening for emotional health and guide delivery of appropriate interventions. Alternatively, attention to emotional health may also improve frailty.
| S-EPMC8649062 | biostudies-literature
Project description:Purpose: Elderly patients with ST-segment-elevation myocardial infarction (STEMI) have a high risk of mortality, which is particularly high in the first 30 days. Quality of life (QoL) and risk-benefit assessments are of pivotal importance in the elderly. The objective of this study is to assess the relationship between frailty syndrome (FS) and QoL in patients following acute coronary syndrome (ACS) non-ST elevation myocardial infarction (NSTEMI). Patients and Methods: The study involved 100 patients (61 men, 39 women, the average age: M ± SD =66.12±10.92 years). The study used standardized research tools: a questionnaire to assess QoL (World Health Organization Quality of Life Scale Brief version), and a questionnaire to assess FS (Tilburg Frailty Indicator). Results: FS occurred in 80% of patients after ACS. FS has a negative impact on the QoL of patients with ACS. The most important domain of FS in the studied group was the psychological: M ± SD=2.2±0.75 points. The greater FS in the physical domain, the lower the QoL in all areas. The greater FS in the social domain, the lower the QoL in psychological and social fields. Self-evaluation of patient QoL was M ± SD=3.68±0.71 points. Self-assessment of health was M ± SD=2.59±0.98 points. Conclusion: Patients with a coexisting FS have a poorer QoL in the physical, psychological, social, and environmental fields. For a multidisciplinary team, these findings can help make the therapeutic decision for frail patients who have poor QoL. Frailty among elderly patients with ACS can be considered as a determinant of high risk of adverse outcomes.
| S-EPMC6511650 | biostudies-other
Project description:ObjectivesTo evaluate relationships between frailty and cognition longitudinally in adults 50 years and older with breast cancer receiving chemotherapy.DesignSecondary analysis of a prospective longitudinal observational study.SettingUniversity of Rochester NCI Community Oncology Research Program community oncology clinics.ParticipantsPatients with breast cancer age 50 and older receiving adjuvant/neoadjuvant chemotherapy (n = 376) and age-matched controls without cancer (n = 234).MeasurementsFrailty was assessed using a modified frailty score from self-reported assessments (weakness, exhaustion, physical activity, and gait speed). Cognition was assessed by patient report (Functional Assessment of Cancer Therapy-Cognition [FACT-Cog]) and objective measures. Frailty and cognition were measured at three time points (prechemotherapy [A1], postchemotherapy [A2], and 6 months postchemotherapy [A3]; similar time interval for controls). Linear regression models evaluated associations between frailty and cognition adjusting for covariates.ResultsThe average age was 59 years (standard deviation = 6.4 y). At baseline, patients with cancer had a higher mean frailty score (1.21 vs .73; P < .001) and lower mean FACT-Cog score (158.4 vs 167.3; P < .001) compared with controls. Objective cognitive measures were not statistically different. Longitudinal decline in FACT-Cog between A1 and A2 (P < .05) and between A1 and A3 (P < .01) was associated with increased frailty score in patients compared with controls. Longitudinal worsening in Controlled Oral Word Association (P < .05) and Trail-Making Test (P < .01) were associated with an increase in frailty between A1 and A2 in patients compared with controls; longitudinal decline in the Delayed Match to Sample test was associated with an increase in frailty between A1 and A3 (P < .05) in patients compared with controls. This finding remained significant for a subset analysis of those aged 65 and older.ConclusionIn patients with breast cancer aged 50 and older, longitudinal decline in FACT-Cog and objective measures of attention and memory were associated with increased frailty during treatment and up to 6 months posttreatment. Overall, our study suggests cognition and frailty are both important factors to assess in breast cancer patients. J Am Geriatr Soc 67:928-936, 2019.
| S-EPMC6490967 | biostudies-literature
Project description:IntroductionThe relationship between cognitive function and frailty in older, long-term breast cancer survivors was examined.Materials and methodsBreast cancer survivors who were diagnosed and treated at 60 years of age or above and were 5-15 year disease-free survivors and non-cancer controls matched on age and education were evaluated with neuropsychological tests and the Comprehensive Geriatric Assessment which was used to assess frailty based on a deficit accumulation frailty index (DAFI).ResultsUnadjusted regression analyses revealed that cancer survivors scored significantly lower on the Language (P = 0.015), Attention, Processing Speed, Executive Function (APE) (P = 0.015), and Learning and Memory (LM) (P = 0.023) domains compared to controls. However, only the LM domain remained significantly different (P = 0.002) in the adjusted analysis. Survivors had significantly higher DAFI scores compared to controls (p = 0.006) and significantly more survivors were categorized as pre-frail or frail (35%) compared to controls (23%, P = 0.009). Increasing frailty scores were associated with worse cognitive performance across all domains (all Ps ≤ 0.004). For the LM domain, there was a significant interaction (P = 0.019) between DAFI score and survivorship vs control status. Survivors demonstrated a significant linear decline in LM scores as DAFI scores increased, whereas controls demonstrated comparable scores between the robust and pre-frail DAFI groups, demonstrating decline in the frailty group only.ConclusionOlder, long-term breast cancer survivors had lower cognitive performance and higher levels of frailty compared to controls. For the Learning and Memory domain, the decline in performance began in the pre-frail range for survivors, but not controls.
| S-EPMC9262141 | biostudies-literature
Project description:AimsFrailty is a complex geriatric syndrome resulting in decreased physiological reserves. Frailty and polypharmacy are common in older adults and the focus of extensive studies, although little is known about the impact they may have on each other. This is the first systematic review analysing the available evidence on the relationship between frailty and polypharmacy in older adults.MethodsSystematic review of quantitative studies. A comprehensive literature search for publications in English or Spanish was performed on MEDLINE, CINAHL, the Cochrane Database and PsycINFO in September 2017 without applying restrictions on the date of publication. Studies reporting any relationship between frailty and polypharmacy in older adults were considered.ResultsA total of 25 publications were included, all of them observational studies. Evaluation of Fried's frailty criteria was the most common approach, followed by the Edmonton Frail Scale and FRAIL scale. Sixteen of 18 cross-sectional analyses and five of seven longitudinal analyses demonstrated a significant association between an increased number of medications and frailty. The causal relationship is unclear and appears to be bidirectional. Our analysis of published data suggests that polypharmacy could be a major contributor to the development of frailty.ConclusionsA reduction of polypharmacy could be a cautious strategy to prevent and manage frailty. Further research is needed to confirm the possible benefits of reducing polypharmacy in the development, reversion or delay of frailty.
| S-EPMC6005607 | biostudies-literature
Project description: Not available
| S-EPMC7834497 | biostudies-literature
Project description:ObjectiveActive participation of the older adults in the society is crucial; however, frailty prevents social participation. Meanwhile, many older adults participate daily in social activities, even with frailty. This study aims to examine whether older adults with frailty have lower social participation than those without frailty in Japan. We also investigated whether older adults with frailty and higher subjective health participate in society to the same extent as the general older population. This study included 1,082 Japanese individuals aged 65 years and older participating in the online survey. Participants answered questions on social participation, frailty, subjective health, and demographics.ResultsParticipants in the robust group had higher social participation rates than those in the frailty and pre-frailty groups. Meanwhile, frail older participants with higher subjective health had similar social participation as the robust participants. Many older adults acquire frailty despite their individual effort. Meanwhile, improving subjective health may be effective, even with frailty. The relationship between subjective health, frailty, and social participation is primitive and further studies are needed.
| S-EPMC10294298 | biostudies-literature
Project description:BackgroundFrailty contributes to adverse outcomes in older adults and places a heavy burden on healthcare resources. Dysphagia is associated with frailty, but the mechanisms by which dysphagia affects frailty in older adults are unclear. This study aimed to investigate a serial mediating effect of self-perceived oral health and self-reported nutritional status in the relationship between dysphagia and frailty among hospitalized older patients in China.MethodsThis cross-sectional study included 1200 patients aged ≥ 65 years in the Department of Geriatrics, Shaanxi Provincial People's Hospital. A structured face-to-face interview was used to survey the following questionnaires: General Information Questionnaire, Tilburg Frailty Indicators (TFI), Eating Assessment Tool-10 (EAT-10), 30mL Water Swallow Test (WST), Geriatric Oral Health Assessment Index (GOHAI), and Short-Form Mini-Nutritional Assessment (MNA-SF). A total of 980 participants with complete data were included in the analysis. Statistical analysis was performed using SPSS 26.0 and Amos 28.0 software. Spearman's correlation analysis was used for correlation analysis of study variables. The results of the multivariate linear regression analysis for frailty were used as covariates in the mediation analysis, and the structural equation model (SEM) was used to analyze the mediating effects among the study variables.ResultsDysphagia, self-perceived oral health, self-reported nutritional status, and frailty were significantly correlated (P<0.001). Dysphagia was found to directly affect frailty (β = 0.161, 95%CI = 0.089 to 0.235) and through three significant mediation pathways: (1) the path through self-perceived oral health (β = 0.169, 95%CI = 0.120 to 0.221), accounting for 36.98% of the total effect; (2) the path through self-reported nutritional status (β = 0.050, 95%CI = 0.023 to 0.082), accounting for 10.94% of the total effect; (3) the path through self-perceived oral health and self-reported nutritional status (β = 0.077, 95%CI = 0.058 to 0.102), accounting for 16.85% of the total effect. The total mediation effect was 64.77%.ConclusionsThis study indicated that dysphagia was significantly associated with frailty. Self-perceived oral health and self-reported nutritional status were serial mediators of this relationship. Improving the oral health and nutritional status of hospitalized older patients may prevent or delay the frailty caused by dysphagia.
| S-EPMC10826207 | biostudies-literature
Project description: Not available
| S-EPMC5627218 | biostudies-literature
Project description:I thank Drs. Littlechild and Isupov for their recent comments, which are considered below. Before addressing these specifically, their correspondence raises two more general issues which require initial clarification.[...].
| S-EPMC5620646 | biostudies-literature