WT 104 P993 (disponible) - Monographie
Frailty : biological risk factors, negative consequences and quality of life / PUTS, Maria Theresia Elisabeth.
Amsterdam : Vrije Universiteit, 2006, 215 p. (03-05-2006)
Format de fichier : Adobe Acrobat PDF
Droits d'auteur : Cette oeuvre est protégée par un droit d'auteur. Elle ne peut être reproduite qu'à des fins d'études privées ou de recherche et seulement si la source est mentionnée.

Mots-clés principaux
Écrit académique, mémoire, thèse
Facteur de risque
Clientèle vulnérable
Qualité de vie
Analyse causale
Vieillissement réussi

Mots-clés secondaires : Définition ; Facteur lié au sexe ; Maladie chronique ; Marqueur biologique ; Méthodologie ; Mortalité ; Qualité de vie ; Vie à domicile ; Vieillissement réussi

Résumé :

Frailty is an increasing health problem in the elderly. The number of older adults is increasing in the Netherlands and the older persons become slightly older. This leads to an increasing number of frail older persons in the future. Frailty is a term that has not been often used before the past fifteen years. At this moment, multiple definitions of frailty are available, but there is lack of evidence about the causes and pathways leading to frailty. There is no consensus about the definition of frailty and therefore the estimates of the number of older persons suffering from frailty vary from 6 percent to 40 percent. Although there is no consensus yet about the definition, the concept of frailty includes a state of reduced physiologic reserve combined with increased risk of adverse outcomes. Most studies so far used a physical definition of frailty, neglecting the more psychological factors. Frailty is considered a consequence of changes in the neuroendocrine and immune system and musculoskeletal functioning. However, there is little empirical evidence yet.
Although frailty is conceived to be a dynamic state with high risk of adverse outcomes, most investigators studied a single moment definition of frailty, a static definition.
In this thesis, frailty is defined as present when a subject has three or more out of nine frailty markers. These frailty markers are low body weight, low peak expiratory flow, impaired cognition, vision and hearing impairments, incontinence, low sense of mastery, depressive symptoms and low physical activity. Frailty is defined in a static and dynamic way. The static definition includes low functioning at one moment and the dynamic definition is based on the change in the frailty markers between two moments.
The research questions of this thesis are:
1) What is the relationship between frailty and adverse health outcomes of frailty; physical decline, institutionalization and mortality?
2) What is the association between endocrine and inflammatory markers and prevalent and incident frailty?
3) What is the meaning of quality of life to older frail and non-frail adults and are these important aspects of quality of life different for frail and non-frail older adults?
4) What is the meaning of frailty and successful aging to older frail and non-frail persons?

The studies of this thesis were performed within the Longitudinal Aging Study Amsterdam (LASA), an ongoing multidisciplinary cohort study on predictors and consequences of changes in physical, cognitive, emotional and social functioning of the elderly.
The main findings of this thesis are the increased risk of frailty for adverse outcomes and the association between frailty and biological risk factors. Older frail persons have an increased risk for physical decline, institutionalization, and death. Furthermore, a low serum level of 25-hydroxyvitamin D (25(OH)D) was strongly associated with prevalent and incident frailty. In addition, moderately increased serum CRP was also associated with incident frailty. In this thesis we examined a static and dynamic definition of frailty and both definitions increased the risk for negative health consequences. Static frailty meant that a low level of functioning was related to adverse outcomes, which is not a new finding. However, dynamic frailty meant that decline in functioning in three or more areas of functioning, not always decline to the lowest level, also increased the risk for adverse outcomes. This has not been examined in other studies. Differences were found in the prevalence of frailty between men and women. Women were more often frail and suffered more often from the negative health consequences of frailty. Older frail persons rated their quality of life on average lower than non-frail older persons. Despite of their frailty, most older person still rated their quality of life as satisfactory and most reported to age successfully.

Langue : Anglais ; Néerlandais
Doc n° : 21201 ISBN / ISSN : 9056691015
NumRec : 2120103


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