Discover and read the best of Twitter Threads about #frailty

Most recents (15)

Excited to share thesis: Socioeconomic inequalities in multimorbidity and joint associations with mortality in a general population. @theHUNTstudy
hdl.handle.net/11250/2735980
#socialepi #sdoh #multimorbidity #frailty #publichealth @NTNU_ISM @ANUmedia 🧵(12+thanks)
Multimorbidity(MM), the co-occurrence of multiple, chronic conditions, where none is more central, is the norm worldwide. MM challenges the person and clinicians in a fragmented healthcare system, aided by single disease guidelines. #medtwitter soundcloud.com/bmjpodcasts/wh…
Complexity in MM vary and relate to conditions, individual & social context. I aimed to investigate clinically relevant measures of MM and how socioeconomic position (SEP), a known complicating context, related to these in prevalence distribution and joint impact on mortality.
Read 17 tweets
🚨Today in West Devon🚨 @NHSDevonCCG & @Devon_LMC approved iCOPE (Integrated Care for Older People), the UK's first #populationhealthmanagement strategy for older people to be implemented.
/1
We will proactively identify older people across West Devon with reduced physiological robustness (aka medical diagnosis of #frailty) and offer evidence-based interventions & #Personcentredcare to support patients to achieve their goals (see plan on page below) 👇
/2 Image
It's based on @ageingwell @nhsrightcare Frailty Toolkit & is our local answer to #anticipatorycare spec in the @NHSEngland #longtermplan. It is:
👉Proactive & goal orientated
👉Community-based
👉Focusses on prevention
👉Identifies mild frailty so we can intervene EARLY
/3
Read 10 tweets
1/n
Thread
SOLUTIONS to avoid the disproportionate burden of Covid19 on elderly care.
The vast majority of Covid19 deaths are in nursing homes and to a lesser degree in at home care.
@LTCcovid @SwissScience_TF @keiserolivia @MBattegay @eggersnsf @EicherManuela @curaviva_ch
2a/n nursing homes make up roughly ~1% of the overall population.
It MUST be possible to focus resources on this tiny population minority and achieve better outcomes.

We have 100'000 beds in Switzerland = 1.2% of population. Death share >>50%

gateway.euro.who.int/en/indicators/…
2b/n
we have made multiple threads with data and questions as to how and potentially why elderly care was/is hit so hard by Covid19

First: The patterns are similar all over the Western world and have WORSENED in many countries in the 2nd wave
Read 23 tweets
1/n
#Frailty is the MAIN #Covid19 risk
Swedish per capita excess mortality over 70 is almost EXCLUSIVELY in nursing homes ("särskilt boende") and home care ("hemtjänst").
Almost NO excess in no care ("ej").
@LTCcovid @MBattegay
socialstyrelsen.se/globalassets/1… ImageImage
2/n
baseline of previous years shows
1. per capita mortality risk is always much higher in elderly care settings. that means life expectancy is much shorter.
2. always MILD seasonality in deaths of all causes +/- 12.5%.
this year is different... cont. Image
3/n
Peak excess mortality in Sweden during 1st wave this year +~100% in nursing homes,
+~33% in at home elderly care.
maybe briefly in some weeks ~+25% in no care in 70+ years, this one is difficult to estimate from chart due to low baseline number. Image
Read 15 tweets
Continuing our #KidneyWk virtual e-poster tour! Check out this thread for some interesting research on #exercise, #PhysicalActivity, & #PhysicalFunction in CKD and ESKD!
A comparison of #frailty measures among individuals referred for #KidneyTransplant in Canada (PO1704). #KidneyWk @FilteredDoc @tennankore @CNTN_RCEN
A pilot RCT to embed technology-enabled group-based #Exercise programming in the clinic: The Exercise Is Medicine in Chronic Kidney Disease Trial (PO2057). #KidneyWk @felipelobelo @ahadbootwala @Shuchi_Anand @JasonCobbMD
Read 9 tweets
@DukePallCare SUCCESS! Journal Club Time Machine: Speed Dating with the Classics. Format - everyone in attendance (MS2-Attending) teaches a classic article for 4 minutes, it is put in context by someone old for 1-2 min, and we move on. Here's the list! A #HPC thread:
No 1 - SUPPORT Trial: pubmed.ncbi.nlm.nih.gov/7474243/. 5 AMCs. Docs don't know pt's CPR preference, many DNRs within 2d of death, lots of ICU time and pain. RN led intervention gives docs data. Centers around communication. NO CHANGE IN KEY METRICS.
No 2 - Prognostication: pubmed.ncbi.nlm.nih.gov/10678857/. Docs of pts referred to #hospice asked for assessment of prognosis. Only 20% accurate (+/- 33%) with most over-optimistic. Average miss factor of 5.3! Longer pt/doc relationship = worse prognostication accuracy (#LoveThemTooMuch)
Read 13 tweets
Cool #Senescence paper #2, in @JCI_insight: insight.jci.org/articles/view/….

@marissa_schafer, Xu Zhang, @NKLeBRASSEUR & team dive into the details of SASP, the Senescence Associated Secretory Phenotype first discovered in the Campisi lab @BuckInstitute.
SASP is a prime suspect for how #Senescent cells cause #Inflammation, #Cancer and #Fibrosis. But SASP is a mix of many secreted proteins, so the @MayoClinic looked closely at 24 factors.
1st, they show which factors are secreted by different cell types (in culture).
Next, and more exciting, they measured which SASP factors increase with age in human blood. #ChronicInflammation is an important mechanism of aging, but really defining #ChronicInflammation is hard and often not even attempted. So this detailed analysis is great.
Read 4 tweets
Our new meta analysis led by @SylvieAucoin now out in @_Anesthesiology. Seems like a good time for a thread on choosing a frailty instrument for #periop care 1/
2/ There are dozens of frailty instruments (big problem) but in reality 4 are commonly used: Frailty Index, Frailty Phenotype, Clinical Frailty Scale, Edmonton Frail Scale
3/ All 4 Frailty instruments predict/are associated with bad outcomes. Effective sizes vary but are not substantively different. Discrimination generally moderate, calibration WAY under-reported
Read 9 tweets
I hear the words “Population Health Management” (PHM) MIS-used a lot. The clue is in all 3 words esp. the middle one. The goal is to focus on population HEALTH NOT getting older people out of hospital as fast as possible- that would be called Service Utilisation Management /1
The central tenant of PHM is that healthy people do not utilise healthcare—> reduction in healthcare utilisation. If we ask older people what matters to them, they nearly always say: to be happy, healthy and independent in a dwelling of their choosing for as long as possible /2
When designing a service based on PHM principles all we then have to do is work out the evidenced based interventions that support older people to be happy healthy and independent for as long as possible /3
Read 10 tweets
So grateful to @TheFangGroupUiO and impressed with @NoAge100. Months ago, I told Evandro that @HorizonsHK invited me to beautiful #Norway. He responded with a request to keynote noage100.com/2019/08/17/nad… Image
At this conf, there were presentations on clinical testing of #nicotinamideriboside in #ataxiatelangiectasia, #Parkinsonsdisease, #frailty, #chemotherapyinducedcardiomyopathy & #amyotrophiclateralsclerosis, all premised on sound preclinical data and all based in beautiful Norway Image
Beyond that, they have strong interest/plans in #alcoholicliverdisease, #mildcognitiveimpairment & more. So impressed with the scientists, physicians & institutions in Norway that make this possible @Ahus_no @oslouniversity @ChromaDex #NR #NAD #Bergen #Tromsø #thebestisyettocome
Read 3 tweets
Hoy en el CAP Sagrada Familia (Barcelona) @consorcsanitari, empezamos con las pruebas funcionales del programa @vivifrail (Programa Multicomponente de ejercicio físico para prevención de la #fragilidad y el riesgo de caídas) 🏃🏻‍♀️🏃🏻‍♂️

Organiza: Fundacio Salut i envelliment @fsie_uab ImageImage
La actividad se realizará en el @caprogerflor como parte del proyecto de prescripción social del barrio Sagrada Familia #prescripciosocialSF #placomunitari @silviasimo72 @AlbaGili1 @gelesmm @BlancafortSergi gracias por vuestra confianza!
Test VIVIFRAIL 2.0, mucho más fácil de aplicar con los nuevos recursos del Folleto Programa de Entrenamiento Físico vivifrail.com/resources #vivifrail #frailty
Animo a todos los profesionales sanitarios a aplicarlo! 👩🏻‍⚕️👨🏻‍⚕️🏃🏻‍♂️🏃🏻‍♀️💪🏻👴🏻👵🏼
Read 3 tweets
On the cover—#Frailty as an emerging global health burden

With prevalence of this complex age-related clinical condition expected to rise alongside a rapidly ageing population, a new Series calls for evidence-based, feasible & cost-effective interventions hubs.ly/H0lc7Mh0 Image
@EmielHoogendijk @ElsaDent Burden of #frailty: global prevalence is not yet known, partly because research has mainly been done in high-income countries. Some studies have observed that prevalence is higher in women than in men and rises with age hubs.ly/H0ldMDc0 ImageImage
@EmielHoogendijk @ElsaDent #Frailty in daily practice: By considering a patient’s degree of frailty, clinicians can deliver more patient-centred care, leading to better outcomes & avoidance of harm in primary, secondary & tertiary prevention of disease, but more research is needed hubs.ly/H0ldMDc0 ImageImage
Read 5 tweets
Thread: Decreasing muscle mass in aging: The harmful effects and how to counteract ––

Tags: #sarcopenia #aging #ageing #HealthyAging #MSKover50 #resistance training, #weights #physicalmobility #muscle, #protein
#osteoporosis #bone #fracture #falls

Image: iofbonehealth.org/what-sarcopenia
Thread: 🔽muscle in #aging ––#Sarcopenia RX, prevention –––

#MSKover50 #resistance #physicalmobility #osteoporosis #bone #fracture #falls

Lifespan vs. Healthspan: Why We Need Muscle for #HealthyAging.
runnersworld.com/health-injurie…
+
Live Strong and Prosper...
link.springer.com/article/10.100…
Thread: Sarcopenia in #Aging: RX, prevention –––
🔽
Biochemical Pathways of #Sarcopenia &Their Modulation by Physical #Exercise: A Narrative Review
frontiersin.org/articles/10.33…
H/T @MathewPiasecki Tags: #MSKover50
LT: Key RE: onset & progress
RT: Rec. of @ACSMNews & @American_Heart
Read 19 tweets
Had a chance to take a deep dive into a recent paper on #frailty in #TAVR by @glen_martin1 @mmamas1973 et al so I figured I'd share some thoughts tweetorial-style
🅿️ Patients: 2,624 TAVRs from the population-based UK registry... lucky them - 95 prospectively collected variables on all TAVRs in the land
ℹ️ Independent var: F-R-A-I-L-T-Y as measured by 3 scales - CSHA Clinical Frailty Scale, Katz activities of daily living scale, poor mobility per MD's impression... I personally like all of these but *caveat* they reflect disability > frailty
Read 11 tweets
In Hong Kong at Hospital Authority conf, speaking on frailty & illness acuity. As with work from @CamGeris the frailer someone is, the more lethal is illness acuity. And the longer the recovery time. It’s almost as if frailty degree estimates resilience. Or intrinsic capacity.
Of course there’s more to it than that. Social vulnerability (in relation to education, occupation, safe environment, supportive community) and personal health practices (exercise, not smoking, etc.) explain variability in the relationship between FI and mortality.
And more yet. Where do biomarkers come in? (As predictors, likely as a package.) And as @dr_shibley warns, how do we put all this together in ways that do not stigmatize, but still allow the complexity of #frailty to be taken seriously? (vs common sense? or harmful stereotype?)
Read 3 tweets

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