FOCUS : frailty management optimisation through EIPAHA commitments and utilisation of stakeholders’ input – an innovative European project in elderly care

The goal of FOCUS, which stands for Frailty Management Optimization through EIPAHA Commitments and Utilization of Stakeholders’ Input, is to reduce the burden of frailty in Europe. The partners are working on advancing knowledge of frailty detection, assessment, and management, including biological, clinical, cognitive and psychosocial markers, in order to change the paradigm of frailty care from acute intervention to prevention. FOCUS partners are working on ways to integrate the best available evidence from frailty-related screening tools, epidemiological and interventional studies into the care of frail people and their quality of life. Frail citizens in Italy, Poland and the UK and their caregivers are being called to express their views and their experiences with treatments and interventions aimed at improving quality of life. The FOCUS Consortium is developing pathways to leverage the knowledge available and to put it in the service of frail citizens. In order to reach out to the broadest audience possible, the FOCUS Platform for Knowledge Exchange and the platform for Scaling Up are being developed with the collaboration of stakeholders. The FOCUS project is a development of the work being done by the European Innovation Partnership on Active and Healthy Ageing (EIPAHA), which aims to increase the average healthy lifespan in Europe by 2020 while fostering sustainability of health/social care systems and innovation in Europe. The knowledge and tools developed by the FOCUS project, with input from stakeholders, will be deployed to all EIPAHA participants dealing with frail older citizens to support activities and optimize performance.

[gait Speed, Grip Strength And Self-rated Health Among The Elderly: Data From The Fibra Campinas Network, São Paulo, Brazil].

The article seeks to investigate patterns of performance and relationships between grip strength, gait speed and self-rated health, and investigate the relationships between them, considering the variables of gender, age and family income. This was conducted in a probabilistic sample of community-dwelling elderly aged 65 and over, members of a population study on frailty. A total of 689 elderly people without cognitive deficit suggestive of dementia underwent tests of gait speed and grip strength. Comparisons between groups were based on low, medium and high speed and strength. Self-related health was assessed using a 5-point scale. The males and the younger elderly individuals scored significantly higher on grip strength and gait speed than the female and oldest did; the richest scored higher than the poorest on grip strength and gait speed; females and men aged over 80 had weaker grip strength and lower gait speed; slow gait speed and low income arose as risk factors for a worse health evaluation. Lower muscular strength affects the self-rated assessment of health because it results in a reduction in functional capacity, especially in the presence of poverty and a lack of compensatory factors.

Autopercepção da saúde bucal em idosos e fatores associados em Campinas, SP, 2008-2009

OBJETIVO: Descrever a autopercepção de saúde bucal em idosos e analisar fatores sociodemográficos e clínicos associados. MÉTODOS: Estudo transversal com 876 participantes em amostra representativa de idosos (65 anos ou mais) de Campinas, SP, em 2008-2009. Os exames odontológicos seguiram critérios padronizados pela Organização Mundial da Saúde para levantamentos epidemiológicos de saúde bucal. A autopercepção da saúde bucal foi avaliada pelo índice Geriatric Oral Health Assessment Index (GOHAI). Os indivíduos foram classificados segundo características sociodemográficas, odontológicas e prevalência de fragilidade biológica. O estudo de associações utilizou análise de regressão de Poisson; a análise considerou os pesos amostrais e a estrutura complexa da amostra por conglomerados. RESULTADOS: A média de idade dos indivíduos foi de 72,8 anos; 70,1% eram mulheres. A proporção de indivíduos com mais de 20 dentes presentes foi 17,2%; 38,2% usavam prótese dentária total em ambos os arcos; 8,5% necessitavam desse recurso em ao menos um arco dentário. Em média, o índice GOHAI foi elevado: 33,9 (máximo possível 36,0). Manter 20 dentes ou mais, usar prótese total nos dois arcos, não necessitar desse tratamento, não apresentar alterações de mucosa oral e não apresentar fragilidade biológica foram os fatores significantemente associados com melhor autopercepção de saúde bucal (p < 0,05). CONCLUSÕES: A avaliação de autopercepção em saúde bucal permitiu identificar os principais fatores associados a esse desfecho. Esse instrumento pode contribuir para o planejamento de serviços odontológicos, orientando estratégias de promoção em saúde voltadas à melhora da qualidade de vida das pessoas desse grupo etário.

Modelling the Distribution of Ischaemic Stroke-Specific Survival Time Using an EM-based Mixture Approach with Random Effects Adjustment

A two-component survival mixture model is proposed to analyse a set of ischaemic stroke-specific mortality data. The survival experience of stroke patients after index stroke may be described by a subpopulation of patients in the acute condition and another subpopulation of patients in the chronic phase. To adjust for the inherent correlation of observations due to random hospital effects, a mixture model of two survival functions with random effects is formulated. Assuming a Weibull hazard in both components, an EM algorithm is developed for the estimation of fixed effect parameters and variance components. A simulation study is conducted to assess the performance of the two-component survival mixture model estimators. Simulation results confirm the applicability of the proposed model in a small sample setting. Copyright (C) 2004 John Wiley Sons, Ltd.

Abnormalities in arterial-ventricular coupling in older healthy persons are attenuated by sodium nitroprusside

Chantler PD, Nussbacher A, Gerstenblith G, Schulman SP, Becker LC, Ferrucci L, Fleg JL, Lakatta EG, Najjar SS. Abnormalities in arterial-ventricular coupling in older healthy persons are attenuated by sodium nitroprusside. Am J Physiol Heart Circ Physiol 300: H1914-H1922, 2011. First published March 4, 2011; doi:10.1152/ajpheart.01048.2010.-The coupling between arterial elastance (E(A); net afterload) and lea ventricular elastance (E(LV); pump performance), known as E(A)/E(LV), is a key determinant of cardiovascular performance and shifts during exercise due to a greater increase in E(LV) versus E(A). This normal exercise-induced reduction in E(A)/E(LV) decreases with advancing age. We hypothesized that sodium. nitroprusside (SNP) can acutely ameliorate the age-associated deficits in E(A)/E(LV). At rest and during graded exercise to exhaustion, EA was characterized as end-systolic pressure/stroke volume and E(LV) as end-systolic pressure/end-systolic volume. Resting E(A)/E(LV): did not differ between old (70 +/- 8 yr. n = 15) and young (30 +/- 5 yr. n = 17) subjects because of a tandem increase in E(A) and E(LV) in older subjects. During peak exercise, a blunted increase in E(LV) in old (7.8 +/- 3.1 mmHg/ml) versus young (11.4 +/- 6.5 mmHg/ml) subjects blunted the normal exercise-induced decline in E(A)/E(LV) in old (0.25 +/- 0.11) versus young (0.16 +/- 0.05) subjects. SNP administration to older subjects lowered resting E(A)/E(LV) by 31% via a reduction E(A) (10%) and an increase in E(LV) (47%) and lowered peak exercise E(A)/E(LV) (36%) via an increase in E(LV) (68%) without a change in E(A). Importantly, SNP attenuated the age-associated deficits in E(A)/E(LV) and E(LV) during exercise, and at peak exercise E(A)/E(LV) in older subjects on drug administration did not differ from young subjects without drug administration. In conclusion, some age-associated deficiencies in E(A)/E(LV), E(A), and E(LV), in older subjects can be acutely abolished by SNP infusion. This is relevant to common conditions in older subjects associated with a significant impairment of exercise performance such as frailty or heart failure with preserved ejection fraction.

Long-term survivor mixture model with random effects: application to a multi-centre clinical trial of carcinoma

A mixture model incorporating long-term survivors has been adopted in the field of biostatistics where some individuals may never experience the failure event under study. The surviving fractions may be considered as cured. In most applications, the survival times are assumed to be independent. However, when the survival data are obtained from a multi-centre clinical trial, it is conceived that the environ mental conditions and facilities shared within clinic affects the proportion cured as well as the failure risk for the uncured individuals. It necessitates a long-term survivor mixture model with random effects. In this paper, the long-term survivor mixture model is extended for the analysis of multivariate failure time data using the generalized linear mixed model (GLMM) approach. The proposed model is applied to analyse a numerical data set from a multi-centre clinical trial of carcinoma as an illustration. Some simulation experiments are performed to assess the applicability of the model based on the average biases of the estimates formed. Copyright (C) 2001 John Wiley & Sons, Ltd.

Diane Arbus: the wonderful wizard of odds or the poetics of the i (eye)

Diane Arbus‘ photographs are mainly about difference. Most of the time she is trying ‗[…] to suppress, or at least reduce, moral and sensory queasiness‘ (Sontag 1977: 40) in order to represent a world where the subject of the photograph is not merely the ‗other‘ but also the I. Her technique does not coax her subjects into natural poses. Instead she encourages them to be strange and awkward. By posing for her, the revelation of the self is identified with what is odd. This paper aims at understanding the geography of difference that, at the same time, is also of resistance, since Diane Arbus reveals what was forcefully hidden by bringing it into light in such a way that it is impossible to ignore. Her photographs display a poetic beauty that is not only of the ‗I‘ but also of the ‗eye‘. The world that is depicted is one in which we are all the same. She ―atomizes‖ reality by separating each element and ‗Instead of showing identity between things which are different […] everybody is shown to look the same.‘ (Sontag 1977: 47). Furthermore, this paper analyses some of Arbus‘ photographs so as to explain this point of view, by trying to argue that between rejecting and reacting against what is standardized she does not forget the geography of the body which is also a geography of the self. While creating a new imagetic topos, where what is trivial becomes divine, she also presents the frailty of others as our own.

Integração de um sistema de gestão de informação clínica hospitalar numa unidade de cuidados continuados

O crescimento da população idosa impõe o desenvolvimento de serviços de qualidade orientados para as necessidades comuns desta faixa etária. A área dos cuidados continuados corresponde a um segmento em crescimento com um forte potencial de desenvolvimento no que concerne ao domínio dos sistemas de informação (SI). O presente trabalho pressupõe o acompanhamento do processo de integração de um SI de uma Unidade Hospitalar (UH) numa Unidade de Cuidados Continuados (UCC) para idosos. A análise envolveu o recurso à Teoria Actor-network (ANT), enquanto posicionamento teórico de relevo para o desenvolvimento de SI. Esta teoria coloca, equitativamente, em destaque os factores humano e não humano como concorrentes para o sucesso no desenvolvimento de um SI. O processo em destaque neste trabalho envolveu a análise compreensiva dos SI das unidades de saúde envolvidas; monitorização e descrição do processo de integração do SI de inspiração hospitalar na UCC; avaliação do resultado final; estabelecimento de requisitos fundamentais para o desenho de um SI adaptado a uma organização prestadora de cuidados continuados a idosos. Estas etapas foram desenvolvidas tendo por base a concretização de 3 ciclos, integradores dos conceitos da ANT com o processo de Engenharia de Requisitos: Ciclo 1 - análise do sistema sócio-técnico; Ciclo 2 – desenho do novo sistema sócio-técnico; Ciclo 3 – transformação da rede sócio-técnica. A metodologia inerente ao processo envolveu a análise documental, realização de notas de campo, entrevista e questionário. Os requisitos são apresentados através da conceptualização de um SI denominado Gestão de Cuidados Residenciais (GCR). Conclui-se, que para que um SI resulte com eficácia, eficiência e efetividade para uma organização, deverá revelar-se adaptado ao propósito e missão da organização em causa, sob pena de induzir fragilidade ao ciclo operacional e ao modelo de gestão de informação.

Modelling HIV/AIDS length of stay in Portugal

Tese apresentada como requisito parcial para obtenção do grau de Doutor em Estatística e Gestão de Informação pelo Instituto Superior de Estatística e Gestão de Informação da Universidade Nova de Lisboa

Fragilidade e pré-fragilidade em pessoas idosas residentes na comunidade

RESUMO: Objectivo: Este estudo tem como principal objectivo determinar perfis de fragilidade em pessoas idosas, residentes ma comunidade. Metodologia: Trata-se de um estudo de natureza não experimental, quantitativo, exploratório e descritivo, com uma amostra de conveniência, constituída por pessoas idosas (n=47), residentes na comunidade. As variáveis em análise foram o fenótipo de fragilidade, onde a força de preensão foi avaliada através de um dinamómetro portátil, a percepção de exaustão através da CES-D, a velocidade de marcha foi avaliada pelo Timed Up and Go Test, a actividade física através de uma escala simplificada, com base nos estudos de Grimby, e a perda de peso não intencional através de uma questão sobre perda de peso no último ano. As restantes variáveis foram avaliadas por questionário, à excepção da capacidade funcional, avaliada por uma escala com actividades básicas e instrumentais da vida diária assim como locomoção, e da força de membros inferiores, avaliada pelo teste de sentar e levantar da cadeira durante 30 segundos. Resultados: Verificou-se que a maioria da amostra era pré-frágil, com uma frequência próxima de fragilidade e uma quase inexistência de não fragilidade. Contribui para isto, essencialmente, a velocidade de marcha e perda de peso não intencional. Apesar de se encontrar uma grande presença de comorbilidade e independência com limitação nos indivíduos deste estudo, não se verifica uma relação de significância entre estas variáveis. Verificam-se relações significativas com a Hipertensão arterial e a percepção do estado de saúde. Conclusão: Não foi possível definir um perfil de fragilidade de forma consistente, devido à grande variabilidade de resultados encontrados e à não existência de correlações significativas, no que diz respeito à síndrome de fragilidade. -----------ABSTRACT: Objective: This study aims to determine profiles of fragility in elderly people, living in the community Methodology: This is a study of a non experimental, quantitative, exploratory and descriptive, with a convenience sample, consisting of elderly (n = 47), living in the community. The variables analyzed were the frailty phenotype where grip strength was measured using a handheld dynamometer, the perception of exhaustion through the CES-D, gait speed was assessed by the Timed Up and Go Test, physical activity through a simplified scale based on studies of Grimby and unintentional loss of weight through a question about weight loss in the last year.The remaining variables were assessed by questionnaire, with the exception of functional capacity assessed by a scale with basic and instrumental activities of daily living as well as locomotion, and lower limb strength, evaluated by sitting and rising from a chair for 30-second test. Results: It was found that most of the sample was pre-fragile with a frequency close to the fragility and almost no non-brittleness. Contribute to this, essentially, gait speed and unintentional weight loss. Despite being a large presence of comorbidity and independence in individuals with limitation of this study, no there is a significant relationship between this variables. There are significant relations with hypertension and the perception of health status. Conclusion: It was not possible to define a profile of fragility consistently, due to the great variability of results and the absence of significant correlations, with respect to the frailty syndrome.

Pathological science.

Review of the book : The undergrowth of science: delusion, self-deception and human frailty, by W. Gratzer, Oxford University Press, Oxford, UK

Does falls efficacy predict gait performance in high-functioning older people?

Introduction: Falls efficacy, defined as confidence in performing activities without falling, is a measure of fear of falling associated with gait impairment, falls and functional decline in frail older people. This relationship has not been well studied in high-functioning older people. Objective: To evaluate the relationship between falls efficacy and gait performance in a cohort of high-functioning older people. Methods: Subjects (N = 864) were a subsample of communitydwelling older people aged 65 to 70 years, enrolled in the "Lc65+" cohort, who completed gait assessment at baseline. Data were collected on demographics, functional, cognitive, affective, and health status. Falls efficacy was assessed using the Falls Efficacy Scale- International (FES-I) that measures confidence in performing 16 activities of daily life (ADL) without falling (score from 16 to 64, higher score indicates lower confidence). Gait parameters were measured over a 20 m walk at preferred gait speed using Physilog, an ambulatory gait monitoring system. Results: Participants (mean age 68.0 ± 1.4 years, 55.0% women) had excellent physical (92.2% independent in basic ADL, mean gait speed 1.13 ± 0.16 m/sec) and cognitive (98.0% with MMSE 024) performance. Nevertheless, 22.1% reported depressive symptoms and 16.1% one or more fall in the previous year. Mean FES-I score was 18.8 ± 4.1. Falls efficacy was associated with gait speed (Spearman rho -0.23, P <.001) and gait variability (Spearman rho 0.10, P = .006), measured by the coefficient of variation of stride velocity. These associations remained in multivariate analysis for both gait speed (adj [beta] coeff: -0.008, 95%CI -0.005 to -0.010, P <.001) and gait variability (adj [beta] coeff 0.024, 95%CI 0.003 to 0.045, P = .023) independent of gender, falls, functional, affective, cognitive, and frailty (Fried's criteria) status. On average, compared to subjects with poor confidence in performing one ADL without falling, those with full confidence had a 0.02 m/sec (2%) faster gait speed and a 2% decrease in gait variability. Conclusion: Even in high-functioning older people, poor falls efficacy is associated with reduced gait speed and stability, independent of health, functional, and frailty status. The direction of this relationship needs to be investigated prospectively to determine causality and design interventions to improve gait performance, reduce fall risk, and prevent functional decline.

Prefrailty and chronic morbidity in the youngest old: an insight from the Lausanne Cohort Lc65+.

OBJECTIVES: To estimate the prevalence of prefrailty, frailty, comorbidity, and disability in the youngest old and to identify chronic diseases associated with individual frailty criteria. DESIGN: Population-based cohort study of noninstitutionalized elderly adults at baseline; cross-sectional analysis. SETTING: Lausanne, Switzerland. PARTICIPANTS: One thousand two hundred eighty-three individuals with complete data on frailty, aged 65 to 70 (58.5% women). MEASUREMENTS: Frailty was assessed according to an adaptation of Fried's criteria (shrinking, weakness, exhaustion, slowness, and low activity, three criteria needed for the diagnosis of frailty, 1 to 2 for prefrailty). Other outcomes were diseases diagnosed by a doctor (≥ 2 chronic diseases: comorbidity) and limitations in activities of daily living (ADLs, basic and instrumental). RESULTS: At baseline, of 1,283 participants 71.1% were classified as nonfrail, 26.4% as prefrail, and 2.5% as frail. The proportion of women increased across these three groups (56.5%, 62.8%, and 71.9%, respectively; P = .01), as did the proportion of individuals with one or more chronic diseases (68.0%, 82.8%, and 90.6%, respectively; P < .001) and the proportion with basic or instrumental ADL disability (1.6%, 10.3%, and 59.4%, respectively; P < .001). Weakness (low grip strength) was the most frequent criterion (14.3%). Prefrail participants had significantly more comorbidity and ADL disability than nonfrail participants (P < .001). When present in isolation, weakness was associated with two to three times greater prevalence of coronary heart disease, other heart diseases, diabetes mellitus, and arthritis. Similarly, a significant association was identified between exhaustion and depression. CONCLUSION: Prefrailty is common in the youngest old. The most prevalent frailty criterion is weakness, which is associated with cardiovascular diseases. Longitudinal studies of the evolution of prefrailty should explore the role of potential interactions between individual frailty criteria and specific chronic diseases.

Association Study of Common Genetic Variants and HIV-1 Acquisition in 6,300 Infected Cases and 7,200 Controls.

Multiple genome-wide association studies (GWAS) have been performed in HIV-1 infected individuals, identifying common genetic influences on viral control and disease course. Similarly, common genetic correlates of acquisition of HIV-1 after exposure have been interrogated using GWAS, although in generally small samples. Under the auspices of the International Collaboration for the Genomics of HIV, we have combined the genome-wide single nucleotide polymorphism (SNP) data collected by 25 cohorts, studies, or institutions on HIV-1 infected individuals and compared them to carefully matched population-level data sets (a list of all collaborators appears in Note S1 in Text S1). After imputation using the 1,000 Genomes Project reference panel, we tested approximately 8 million common DNA variants (SNPs and indels) for association with HIV-1 acquisition in 6,334 infected patients and 7,247 population samples of European ancestry. Initial association testing identified the SNP rs4418214, the C allele of which is known to tag the HLA-B*57:01 and B*27:05 alleles, as genome-wide significant (p = 3.6×10(-11)). However, restricting analysis to individuals with a known date of seroconversion suggested that this association was due to the frailty bias in studies of lethal diseases. Further analyses including testing recessive genetic models, testing for bulk effects of non-genome-wide significant variants, stratifying by sexual or parenteral transmission risk and testing previously reported associations showed no evidence for genetic influence on HIV-1 acquisition (with the exception of CCR5Δ32 homozygosity). Thus, these data suggest that genetic influences on HIV acquisition are either rare or have smaller effects than can be detected by this sample size.