Determinants of frailty development and progression using a multidimensional frailty index: Evidence from the English Longitudinal Study of Ageing

Objective To identify modifiable risk factors for development and progression of frailty in older adults living in England, as conceptualised by a multidimensional frailty index (FI). Methods Data from participants aged 50 and over from the English Longitudinal Study of Ageing (ELSA) was used to examine potential determinants of frailty, using a 56-item FI comprised of self-reported health conditions, disabilities, cognitive function, hearing, eyesight, depressive symptoms and ability to carry out activities of daily living. Cox proportional hazards regression models were used to measure frailty development (n = 7420) and linear regression models to measure frailty progression over 12 years follow-up (n = 8780). Results Increasing age (HR: 1.08 (CI: 1.08–1.09)), being in the lowest wealth quintile (HR: 1.79 (CI: 1.54–2.08)), lack of educational qualifications (HR: 1.19 (CI: 1.09–1.30)), obesity (HR: 1.33 (CI: 1.18–1.50) and a high waist-hip ratio (HR: 1.25 (CI: 1.13–1.38)), being a current or previous smoker (HR: 1.29 (CI: 1.18–1.41)), pain (HR: 1.39 (CI: 1.34–1.45)), sedentary behaviour (HR: 2.17 (CI: 1.76–2.78) and lower body strength (HR: 1.07 (CI: 1.06–1.08)), were all significant risk factors for frailty progression and incidence after simultaneous adjustment for all examined factors. Conclusion The findings of this study suggest that there may be scope to reduce both frailty incidence and progression by trialling interventions aimed at reducing obesity and sedentary behaviour, increasing intensity of physical activity, and improving success of smoking cessation tools. Furthermore, improving educational outcomes and reducing poverty may also reduce inequalities in frailty

Establishing the Australian National Endometriosis Clinical and Scientific Trials (NECST) Registry: a protocol paper

Endometriosis is a common yet under-recognised chronic inflammatory disease, affecting 176 million women, trans and gender diverse people globally. The National Endometriosis Clinical and Scientific Trials (NECST) Registry is a new clinical registry collecting and tracking diagnostic and treatment data and patient-reported outcomes on people with endometriosis. The registry is a research priority action item from the 2018 National Action Plan for Endometriosis and aims to provide large-scale, national and longitudinal population-based data on endometriosis. Working groups (consisting of patients with endometriosis, clinicians and researchers) developing the NECST Registry data dictionary and data collection platform started in 2019. Our data dictionary was developed based on existing and validated questionnaires, tools, meta-data and data cubes – World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project, endometriosis CORE outcomes set, patient-reported outcome measures, the International Statistical Classification of Diseases-10th Revision Australian Modification diagnosis codes and Australian Government datasets: Australian Institute for Health and Welfare (for sociodemographic data), Medicare Benefits Schedule (for medical procedures) and the Pharmaceutical Benefits Scheme (for medical therapies). The resulting NECST Registry is an online, secure cloud-based database, prospectively collecting minimum core clinical and health data across eight patient and clinician modules and longitudinal data tracking disease life course. The NECST Registry has ethics approval (HREC/62508/ MonH-2020) and is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000987763)

An in-depth study of grid-based asteroseismic analysis

NASA's Kepler mission is providing basic asteroseismic data for hundreds of stars. One of the more common ways of determining stellar characteristics from these data is by so-called "grid based" modelling. We have made a detailed study of grid-based analysis techniques to study the errors (and error-correlations) involved. As had been reported earlier, we find that it is relatively easy to get very precise values of stellar radii using grid-based techniques. However, we find that there are small, but significant, biases that can result because of the grid of models used. The biases can be minimized if metallicity is known. Masses cannot be determined as precisely as the radii, and suffer from larger systematic effects. We also find that the errors in mass and radius are correlated. A positive consequence of this correlation is that log g can be determined both precisely and accurately with almost no systematic biases. Radii and log g can be determined with almost no model dependence to within 5% for realistic estimates of error in asteroseismic and conventional observations. Errors in mass can be somewhat higher unless accurate metallicity estimates are available. Age estimates of individual stars are the most model dependent. The errors are larger too. However, we find that for star-clusters, it is possible to get a relatively precise age if one assumes that all stars in a given cluster have the same age.Comment: ApJ, in pres

While We Waited: Incidence and Predictors of Falls in Older Adults With Cataract

Purpose: Strong evidence indicates an increased fall risk associated with cataract. Although cataract surgery can restore sight, lengthy wait times are common for public patients in many high-income countries. This study reports incidence and predictors of falls in older people with cataract during their surgical wait. Methods: Data from a prospective study of falls in adults aged ≥65 years who were awaiting cataract surgery in public hospitals in Australia were analyzed. Participants underwent assessment of vision, health status, and physical function, and recalled falls in the previous 12 months. Falls were self-reported prospectively during the surgical wait. Results: Of 329 participants, mean age was 75.7 years; 55.2% were female. A total of 267 falls were reported by 101 (30.7%) participants during the surgical wait (median observation time, 176 days): an incidence of 1.2 falls per person-year (95% confidence interval [CI] 1.0–1.3). Greater walking activity (incidence rate ratio [IRR] 1.06, 95% CI 1.01–1.10; P = 0.02, per additional hour/week), poorer health-related quality of life (IRR 1.12, 95% CI 1.05–1.20; P < 0.001, per 5-unit decrease), and a fall in the prior 12 months (IRR 2.48, 95% CI 1.57–3.93; P < 0.001) were associated with incident falls. No visual measure independently predicted fall risk. More than one-half (51.7%) of falls were injurious. Conclusions: We found a substantial rate of falls and fall injury in older adults with cataract who were awaiting surgery. Within this relatively homogenous cohort, measures of visual function alone inadequately predicted fall risk. Assessment of exposure to falls through physical activity frequency may prove valuable in identifying those more likely to fall during the surgical wait

While We Waited: Incidence and Predictors of Falls in Older Adults With Cataract.

PURPOSE: Strong evidence indicates an increased fall risk associated with cataract. Although cataract surgery can restore sight, lengthy wait times are common for public patients in many high-income countries. This study reports incidence and predictors of falls in older people with cataract during their surgical wait. METHODS: Data from a prospective study of falls in adults aged ≥65 years who were awaiting cataract surgery in public hospitals in Australia were analyzed. Participants underwent assessment of vision, health status, and physical function, and recalled falls in the previous 12 months. Falls were self-reported prospectively during the surgical wait. RESULTS: Of 329 participants, mean age was 75.7 years; 55.2% were female. A total of 267 falls were reported by 101 (30.7%) participants during the surgical wait (median observation time, 176 days): an incidence of 1.2 falls per person-year (95% confidence interval [CI] 1.0-1.3). Greater walking activity (incidence rate ratio [IRR] 1.06, 95% CI 1.01-1.10; P = 0.02, per additional hour/week), poorer health-related quality of life (IRR 1.12, 95% CI 1.05-1.20; P < 0.001, per 5-unit decrease), and a fall in the prior 12 months (IRR 2.48, 95% CI 1.57-3.93; P < 0.001) were associated with incident falls. No visual measure independently predicted fall risk. More than one-half (51.7%) of falls were injurious. CONCLUSIONS: We found a substantial rate of falls and fall injury in older adults with cataract who were awaiting surgery. Within this relatively homogenous cohort, measures of visual function alone inadequately predicted fall risk. Assessment of exposure to falls through physical activity frequency may prove valuable in identifying those more likely to fall during the surgical wait

Preliminary Studies on the Feasibility of Addition of Vertex View to Conventional Brain SPECT

We have investigated the improvement in resolution and sensitivity for brain imaging which would result by the addition of a single stationary vertex view to the tomographic data. This method has the practical advantage of being relatively inexpensive and easy to implement. The uniform Cramer Rao bound is a plot of the minimum achievable standard deviation for estimating the pixel intensity as a function of the bias gradient length. Uniform CR bound analysis indicated an improvement in performance when the vertex detector is added, especially for centrally located pixels for which improvement is seen over the useful depth for brain imaging. Simulation experiments were done with a simple six slice phantom and with the Hoffman brain phantom. Visual inspection of the reconstructed images showed improved resolution and noise characteristics over reconstructed images without the vertex data. Quantitatively, substantial reduction in mean square error was observed for a plane close to the vertex detector. Improvement reduced as distance from the vertex detector is increased. Background activities inside the field of view of the vertex detector but not the tomograph were represented by several blobs of activity on a plane lying outside the reconstruction volume. This activity was estimated by 3D spline fitting jointly with the image reconstruction process. Adding the vertex view to conventional brain SPECT should lead to improved cortical imaging, and to moderate improvement for deep structures.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85857/1/Fessler142.pd

A service evaluation of FIT and anaemia for risk stratification in the two week wait pathway for colorectal cancer

Introduction: New national guidance on urgent referral for investigation for Colorectal Cancer (CRC) included faecal occult blood testing in 2015. We evaluated faecal immunochemical testing (FIT) and anaemia as risk stratification tools in symptomatic patients suspected of having CRC.Methods: Postal FIT was incorporated into the CRC two week wait (2WW) pathway for all patients without rectal bleeding in 2016. Patients were investigated in the 2WW pathway as normal and outcomes of investigations were prospectively recorded. Anaemia was defined as haemoglobin less than 120g/L in women and less than 130g/L in men.Results: FIT kits were sent to 1106 patients with an 80.9% return rate; 810 patients completed investigation with 40 CRCs diagnosed (4.9%). Median FIT results were significantly higher in patients who were anaemic (median 4.8 iqr 0.8-34.1 versus 1.2 iqr 0-6.4, Mann-Whitney p less than 0.001).Some 538 (60.4%) had a result of less than 4 µgHb/gFaeces (limit of detectability) and 621 (69.7%) a result less than 10 µgHb/gFaeces. Sixty per cent of CRCs had a FIT reading of >150 µgHb/gFaeces. Five CRCs diagnosed in patients with a FIT4 µgHb/gFaeces had 97.5% sensitivity and 64.5% specificity for CRC diagnosis. A FIT result of >4 µgHb/gFaeces and/or anaemia had a 100% sensitivity and 45.3% specificity for CRC diagnosis.Conclusion: FIT is most useful at the extremes of detectability; strongly positive readings predict high rates of CRC and other significant pathology, whilst very low readings in the absence of anaemia or palpable rectal mass identify a group with very low risk. High return rates for FIT within this 2WW pathway indicate its acceptability

Interpersonal interactions for haptic guidance during maximum forward reaching

Caregiver-patient interactions rely on interpersonal coordination (IPC) involving the haptic and visual modalities. We investigated in healthy individuals spontaneous IPC during joint maximum forward reaching. A 'contact-provider' (CP; n=2) kept light interpersonal touch (IPT) laterally with the wrist of the extended arm of a forward reaching, blind-folded 'contact-receiver' (CR; n=22). Due to the stance configuration, CP was intrinsically more stable. CR received haptic feedback during forward reaching in two ways: (1) presence of a light object (OBT) at the fingertips, (2) provision of IPT. CP delivered IPT with or without vision or tracked manually with vision but without IPT. CR's variabilities of Centre-of-Pressure velocity (CoP) and wrist velocity, interpersonal cross-correlations and time lags served as outcome variables. OBT presence increased CR's reaching amplitude and reduced postural variability in the reach end-state. CR's variability was lowest when CP applied IPT without vision. OBT decreased the strength of IPC. Correlation time lags indicated that CP retained a predominantly reactive mode with CR taking the lead. When CP had no vision, presumably preventing an effect of visual dominance, OBT presence made a qualitative difference: with OBT absent, CP was leading CR. This observation might indicate a switch in CR's coordinative strategy by attending mainly to CP's haptic 'anchor'. Our paradigm implies that in clinical settings the sensorimotor states of both interacting partners need to be considered. We speculate that haptic guidance by a caregiver is more effective when IPT resembles the only link between both partners

Validity of self-reported height and weight and derived body mass index in middle-aged and elderly individuals in Australia

Background: Body mass index (BMI) is an important measure of adiposity. While BMI derived from self-reported data generally agrees well with that derived from measured values, evidence from Australia is limited, particularly for the elderly. Methods: We compared self-reported with measured height and weight in a random sample of 608 individuals aged ≥45 from the 45 and Up Study, an Australian population-based cohort study. We assessed degree of agreement and correlation between measures, and calculated sensitivity and specificity to quantify BMI category misclassification. Results: On average, in males and females respectively, height was overestimated by 1.24cm (95% CI: 0.75-1.72) and 0.59cm (0.26-0.92); weight was underestimated by 1.68kg (-1.99-1.36) and 1.02kg (-1.24-0.80); and BMI based on self-reported measures was underestimated by 0.90kg/m2 (-1.09-0.70) and 0.60 kg/m2 (-0.75-0.45). Underestimation increased with increasing measured BMI. There were strong correlations between self-reported and measured height, weight and BMI (r=0.95, 0.99 and 0.95, respectively, p<0.001). While there was excellent agreement between BMI categories from self-reported and measured data (kappa=0.80), obesity prevalence was underestimated. Findings did not differ substantially between middleaged and elderly participants. Conclusions: Self-reported data on height and weight quantify body size appropriately in middle-aged and elderly individuals for relative measures, such as quantiles of BMI. However, caution is necessary when reporting on absolute BMI and standard BMI categories, based on self-reported data, particularly since use of such data is likely to result in underestimation of the prevalence of obesity