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      Self-reported exhaustion, physical activity, and grip strength predict frailty transitions in older outpatients with chronic diseases

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          Abstract

          Effective screening instruments are necessary for evaluating the outcomes of early interventions for the prevention or delay of disability in older persons. This study examined how transitions in frailty items over 1 year and the baseline components of a comprehensive geriatric assessment were associated with improvements in frailty at a 2-year follow-up in a sample of older patients.

          This was a single-center prospective observational study of older patients aged 65 years and over with chronic diseases (n = 103), who were followed through a hospital-based program over 2 years. Frailty was evaluated via the modified Fried Frailty Index and a comprehensive geriatric assessment.

          We noted significant improvements in weight loss ( P = .016) and self-reported exhaustion ( P = .006), and a less decrease in grip strength ( P = .009) at the 1-year follow-up. Furthermore, baseline cerebral vascular accident diagnosis ( P = .022), high polypharmacy ( P = .037), a higher Geriatric Depression Scale score ( P = .033), and a lower Mini Nutritional Assessment score ( P = .039) were significantly associated with improved frailty at the 2-year follow-up. Furthermore, improvement in self-reported exhaustion (odds ratio [OR]: 4.7, 1.4–16.1, P = .014) and physical activity (OR: 3.8, 1.0–13.7, P = .046), and a less decrease in grip strength (OR: 4.0, 1.3–12.5, P = .017) at the 1-year follow-up were significantly associated with improved frailty at the 2-year follow-up.

          Self-reported exhaustion, physical activity, and grip strength are easy, quick, and feasible screening tests for improvements in frailty in clinical practice.

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          Interventions for preventing falls in older people living in the community

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            Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care.

            Three terms are commonly used interchangeably to identify vulnerable older adults: comorbidity, or multiple chronic conditions, frailty, and disability. However, in geriatric medicine, there is a growing consensus that these are distinct clinical entities that are causally related. Each, individually, occurs frequently and has high import clinically. This article provides a narrative review of current understanding of the definitions and distinguishing characteristics of each of these conditions, including their clinical relevance and distinct prevention and therapeutic issues, and how they are related. Review of the current state of published knowledge is supplemented by targeted analyses in selected areas where no current published data exists. Overall, the goal of this article is to provide a basis for distinguishing between these three important clinical conditions in older adults and showing how use of separate, distinct definitions of each can improve our understanding of the problems affecting older patients and lead to development of improved strategies for diagnosis, care, research, and medical education in this area.
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              Hand grip strength: outcome predictor and marker of nutritional status.

              Among all muscle function tests, measurement of hand grip strength has gained attention as a simple, non-invasive marker of muscle strength of upper extremities, well suitable for clinical use. This review outlines the prognostic relevance of grip strength in various clinical and epidemiologic settings and investigates its suitability as marker of nutritional status in cross-sectional as well as intervention studies. Studies investigating grip strength as prognostic marker or nutritional parameter in cross-sectional or intervention studies were summarized. Numerous clinical and epidemiological studies have shown the predictive potential of hand grip strength regarding short and long-term mortality and morbidity. In patients, impaired grip strength is an indicator of increased postoperative complications, increased length of hospitalization, higher rehospitalisation rate and decreased physical status. In elderly in particular, loss of grip strength implies loss of independence. Epidemiological studies have moreover demonstrated that low grip strength in healthy adults predicts increased risk of functional limitations and disability in higher age as well as all-cause mortality. As muscle function reacts early to nutritional deprivation, hand grip strength has also become a popular marker of nutritional status and is increasingly being employed as outcome variable in nutritional intervention studies. Copyright © 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                June 2018
                18 June 2018
                : 97
                : 23
                : e10933
                Affiliations
                [a ]Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu
                [b ]Department of Family Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
                [c ]Division of Geriatrics Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
                Author notes
                []Correspondence: Chin-Ying Chen, Department of Family Medicine, National Taiwan University Hospital and National Taiwan University, No.7 Chung-Shan South Road, Zhongzheng Dist., Taipei City 10048, Taiwan (e-mail: crystalcychen@ 123456ntu.edu.tw ).
                Article
                MD-D-17-07691 10933
                10.1097/MD.0000000000010933
                5999477
                29879035
                c259485f-a527-4d14-83ff-85cad6e9335e
                Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 7 December 2017
                : 9 May 2018
                Categories
                4600
                Research Article
                Observational Study
                Custom metadata
                TRUE

                elders,exhaustion,frailty transition,grip strength,physical activity

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