Perspectives of frailty and frailty screening: Protocol for a collaborative knowledge translation approach and qualitative study of stakeholder understandings and experiences

Accompanying the unprecedented growth in the older adult population worldwide is an increase in the prevalence of frailty, an age-related clinical state of increased vulnerability to stressor events. This increased vulnerability results in lower social engagement and quality of life, increased dependency, and higher rates of morbidity, health service utilization and mortality. Early identification of frailty is necessary to guide implementation of interventions to prevent associated functional decline. Consensus is lacking on how to clinically recognize and manage frailty. It is unknown how healthcare providers and healthcare consumers understand and perceive frailty, whether or not they regard frailty as a public health concern; and information on the indirect and direct experiences of consumer and healthcare provider groups towards frailty are markedly limited.We will conduct a qualitative study of consumer, practice nurse, general practitioner, emergency department physician, and orthopedic surgeons' perspectives of frailty and frailty screening in metropolitan and non-metropolitan South Australia. We will use tailored combinations of semi-structured interviews and arts-based data collection methods depending on each stakeholder group, followed by inductive and iterative analysis of data using qualitative description.Using stakeholder driven approaches to understanding and addressing frailty and frailty screening in context is critical as the prevalence and burden of frailty is likely to increase worldwide. We will use the findings from the Perceptions of Frailty and Frailty Screening study to inform a context-driven identification, implementation and evaluation of a frailty-screening tool; drive awareness, knowledge, and skills development strategies across stakeholder groups; and guide future efforts to embed emerging knowledge about frailty and its management across diverse South Australian contexts using a collaborative knowledge translation approach. Study findings will help achieve a coordinated frailty and healthy ageing strategy with relevance to other jurisdictions in Australia and abroad, and application of the stakeholder driven approach will help illuminate how its applicability to other jurisdictions.Mandy M. Archibald, Rachel Ambagtsheer, Justin Beilby, Mellick J. Chehade, Tiffany K. Gill, Renuka Visvanathan, and Alison L. Kitso

Low energy trauma in older persons: where to next?

The global population is increasing rapidly with older persons accounting for the greatest proportion. Associated with this rise is an increased rate of injury, including polytrauma, for which low energy falls has become the main cause. The resultant growing impact on trauma resources represents a major burden to the health system. Frailty, with its related issues of cognitive dysfunction and sarcopenia, is emerging as the unifying concept that relates both to the initial event and subsequent outcomes. Strategies to better assess and manage frailty are key to both preventing injury and improving trauma outcomes in the older population and research that links measures of frailty to trauma outcomes will be critical to informing future directions and health policy. The introduction of “Geriatric Emergency Departments” and the development of “Fracture Units” for frail older people will facilitate increased involvement of Geriatricians in trauma care and aid in the education of other health disciplines in the core principles of geriatric assessment and management. Collectively these should lead to improved care and outcomes for both survivors and those requiring end of life decisions and palliation.Mellick Chehade, Tiffany K Gill, Renuka Visvanatha

The association between sarcopenia and quality of life is different in community dwelling older Australian men and women

Published: June 09, 2018Background: The impact of sarcopenia on health-related quality of life (HRQoL) in community dwelling older people in Australia is not known. The aim of this study was to evaluate the relationship between sarcopenia and HRQoL in older Australian men and women. Methods: 357 men and 370 women aged 65 years and older from the North West Adelaide Health Study at Stage 2 (2002-2004). Sarcopenia was defined as the presence of low muscle mass and low grip strength. HRQoL was assessed using the Short Form-36 (SF-36) questionnaire: physical component summary (PCS) and mental component summary (MCS). Analyses were performed using multiple regression and adjustments were made for age, physical activity, smoking status, co-morbidity and depression. Results: The prevalence of sarcopenia was 10.1% in men and 9.5% in women. Men with sarcopenia was significantly associated with the PCS score in the unadjusted model (P = 0.012) and only model 1 adjusted for age (P = 0.041). No significant association was noted in model 2 (model 1 + physical activity and smoking status) and model 3 (model 2 + Charlson co-morbidity index and depression). In men, a significant association between sarcopenia and MCS score was seen in the unadjusted and all 3 adjusted models. No association was seen between sarcopenia and the PCS or MCS score in women for both the adjusted and unadjusted models. Conclusion: After adjusting for multiple confounders, the association between sarcopenia only remained for the MCS score, in men. No association between sarcopenia and HRQoL was seen in women.Tsung Woo, Solomon Yu, Robert Adams and Renuka Visvanatha

The association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study

BACKGROUND: Benzodiazepines are commonly prescribed in residential aged care facilities (RACFs) for their sedative and anxiolytic effects. The objective of this study was to investigate the association between benzodiazepine use and sleep quality in residents of RACFs. METHODS: A cross-sectional study involving 383 participants was conducted in six Australian RACFs. Night-time sleep quality, day-time drowsiness and day-time napping behavior were assessed using a validated questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the association between benzodiazepine use and sleep quality. Covariates included pain, dementia severity, depression, insomnia and other sedative use. RESULTS: Of the 383 residents (mean age 87.5 years, 77.5% female), 96(25.1%) used a benzodiazepine on a regular basis. Residents who used long-acting benzodiazepines on a regular basis had higher night-time sleep quality than non-users (AOR = 4.00, 95%CI 1.06 - 15.15). Residents who used short-acting benzodiazepines on a PRN only basis had longer daytime napping times than non-users (AOR = 1.77, 95%CI 1.01 - 3.08). No benzodiazepine category was associated with day-time drowsiness. CONCLUSIONS: The association between benzodiazepine use and sleep quality is dependent on the half-life and prescribing pattern of the benzodiazepine. Short-acting PRN benzodiazepines were associated with lower night time sleep quality and longer day-time napping compared to long-acting regular benzodiazepines. Longitudinal studies are needed to determine whether these findings reflect channeling of short-acting agents to residents at higher risk of sleep disorders.Lynna Chen, J. Simon Bell, Renuka Visvanathan, Sarah N. Hilmer, Tina Emery, Leonie Robson, Jessica M. Hughes and Edwin C. K. Ta

The Frailty In Residential Sector over Time (FIRST) study: methods and baseline cohort description

Published online: 03 February 2021Background: The Frailty In Residential Sector over Time (FIRST) Study is a 3-year prospective cohort study investigating the health of residents living in residential aged care services (RACS) in South Australia. The study aims to examine the change in frailty status and associated health outcomes. Methods: This interim report presents data from March 2019–October 2020. The study setting is 12 RACS from one organisation across metropolitan and rural South Australia involving 1243 residents. All permanent (i.e. respite or transition care program excluded) residents living in the RACS for at least 8 weeks were invited to participate. Residents who were deemed to be medically unstable (e.g. experiencing delirium), have less than 3 months to live, or not fluent in English were excluded. Data collected included frailty status, medical diagnoses, medicines, pain, nutrition, sarcopenia, falls, dementia, anxiety and depression, sleep quality, quality of life, satisfaction with care, activities of daily living, and life space use at baseline and 12-months. Data Linkage will occur over the 3 years from baseline. Results: A total of 561 permanent residents (mean age 87.69 ± 7.25) were included. The majority of residents were female (n = 411, 73.3%) with 95.3% (n = 527) being classified as either frail (n = 377, 68.2%) or most-frail (n = 150, 27.1%) according to the Frailty Index (FI). Most residents were severely impaired in their basic activities of daily living (n = 554, 98.8%), and were at-risk of malnutrition (n = 305, 55.0%) and at-risk of sarcopenia (n = 492, 89.5%). Most residents did not experience pain (n = 475, 85.4%), had normal daytime sleepiness (n = 385, 69.7%), and low anxiety and depression scores (n = 327, 58.9%). Conclusion: This study provides valuable information on the health and frailty levels of residents living in RACS in South Australia. The results will assist in developing interventions that can help to improve the health and wellbeing of residents in aged care services. Trial registration: Prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN1261 9000500156).Agathe Daria Jadczak, Leonie Robson, Tina Cooper, J. Simon Bell, Renuka Visvanathan, on behalf of the FIRST Study Collaborator

The Hubble Space Telescope Key Project on the Extragalactic Distance Scale XXIV: The Calibration of Tully-Fisher Relations and the Value of the Hubble Constant

This paper presents the calibration of BVRIH$ Tully-Fisher relations based on Cepheid distances to 21 galaxies within 25 Mpc, and 23 clusters within 10,000 km/s. These relations have been applied to several distant cluster surveys in order to derive a value for the Hubble constant, H0, mainly concentrating on an I-band all-sky survey by Giovanelli and collaborators which consisted of total I magnitudes and 50% linewidth data for ~550 galaxies in 16 clusters. For comparison, we also derive the values of H0 using surveys in B-band and V-band by Bothun and collaborators, and in H-band by Aaronson and collaborators. Careful comparisons with various other databases from literature suggest that the H-band data, whose magnitudes are isophotal magnitudes extrapolated from aperture magnitudes rather than total magnitudes, are subject to systematic uncertainties. Taking a weighted average of the estimates of Hubble constants from four surveys, we obtain H0 = 71 +- 4 (random) +- 7 (systematic) km/s/Mpc. We have also investigated how various systematic uncertainties affect the value of H0 such as the internal extinction correction method used, Tully-Fisher slopes and shapes, a possible metallicity dependence of the Cepheid period-luminosity relation and cluster population incompleteness bias.Comment: 34 pages, 13 figure

The Color Magnitude Distribution of Field Galaxies to z~3: the evolution and modeling of the blue sequence

Using deep NIR VLT/ISAAC and optical HST/WFPC2 imaging in the fields of the HDFS and MS1054-03, we study the rest-frame UV-to-optical colors and magnitudes of galaxies to z~3. While there is no evidence for a red sequence at z~3, there does appear to be a well-defined color-magnitude relation (CMR) for blue galaxies at all redshifts, with more luminous galaxies having redder U-V colors. The slope of the blue CMR is independent of redshift d(U-V)/dMV = -0.09 (0.01) and can be explained by a correlation of dust-reddening with luminosity. The average color at fixed luminosity reddens strongly \Delta(U-V) = 0.75 from z~3 to z=0, much of which can be attributed to aging of the stars. The color scatter of the blue sequence is relatively small sigma(U-V) = 0.25 (0.03) and constant to z~3, but notably asymmetrical with a sharp blue ridge and a wing towards redder colors. We explore sets of star formation histories to study the constraints placed by the shape of the scatter at z=2-3. One particular set of models, episodic star formation, reproduces the detailed properties very well. For a two-state model with high and low star formation, the duty cycle is constrained to be > 40% and the contrast between the states must be a factor > 5 (or a scatter in log(SFR) of > 0.35 dex around the mean). However, episodic models do not explain the observed tail of very red galaxies, primarily Distant Red Galaxies (DRGs), which may have ceased star formation altogether or are more heavily obscured. Finally, the relative number density of red, luminous MV < -20.5 galaxies increases by a factor of ~ 6 from z = 2.7 to z = 0.5, as does their contribution to the total rest-frame V-band luminosity density. We are likely viewing the progressive formation of red, passively evolving galaxies.Comment: 29 pages, 24 figures, in emulateapj style. Abstract is abridged. Some postscript figures are compressed. accepted for publication in ApJ (scheduled for August 20, 2007, v665n 2 issue

Utilising digital health technology to support patient-healthcare provider communication in fragility fracture recovery: systematic review and meta-analysis

The objective of this review is to evaluate the effectiveness of digital health supported targeted patient communication versus usual provision of health information, on the recovery of fragility fractures. The review considered studies including older people, aged 50 and above, with a fragility fracture. The primary outcome was prevention of secondary fractures by diagnosis and treatment of osteoporosis, and its adherence. This review considered both experimental and quasi-experimental study designs. A comprehensive search strategy was built to identify key terms including Medical subject headings (MeSH) and applied to the multiple electronic databases. An intention to treat analysis was applied to those studies included in the meta-analysis and odds ratio was calculated with random effects. Altogether, 15 studies were considered in the final stage for this systematic review. Out of these, 10 studies were Randomised controlled trials (RCT) and five were quasi experimental studies, published between the years 2003 and 2016 with a total of 5037 participants. Five Randomised control trails were included in the meta-analysis suggesting that digital health supported interventions were overall, twice as effective when compared with the usual standard care (OR 2.13, 95% CI 1.30-3.48), despite the population sample not being homogeneous. Findings from the remaining studies were narratively interpreted

Planetary Nebulae as standard candles XI. Application to Spiral Galaxies

We report the results of an [O III] lambda 5007 survey for planetary nebulae (PN) in three spiral galaxies: M101 (NGC 5457), M51 (NGC 5194/5195) and M96 (NGC 3368). By comparing on-band/off-band [O III] lambda 5007 images with images taken in H-alpha and broadband R, we identify 65, 64 and 74 PN candidates in each galaxy, respectively. From these data, an adopted M31 distance of 770 kpc, and the empirical planetary nebula luminosity function (PNLF), we derive distances to M101, M51, and M96 of 7.7 +/- 0.5, 8.4 +/- 0.6, and 9.6 +/- 0.6 Mpc. These observations demonstrate that the PNLF technique can be successfully applied to late-type galaxies, and provide an important overlap between the Population I and Population II distance scales. We also discuss some special problems associated with using the PNLF in spiral galaxies, including the effects of dust and the possible presence of [O III] bright supernova remnants.Comment: 38 pages, TeX, with tables included but not figures. Uses epsf.tex and kpnobasic.tex. To be published in the Astophysical Journal. Full paper is available at http://www.astro.psu.edu/users/johnf/Text/research.htm