Browsing by Subject "Frail elderly"

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    Top Ten Tips Palliative Care Clinicians Should Know About Trauma and Emergency Surgery
    (Mary Ann Liebert, 2021) Haines, Lindsay K.; Cook, Allyson C.; Hatchimonji, Justin S.; Ho, Vanessa P.; Kalbfell, Elle L.; O’Connell, Kathleen M.; Robenstine, Jacinta C.; Schlögl, Mathias; Toevs, Christine C.; Jones, Christopher A.; Krouse, Robert S.; Martin, Niels D.; Surgery, School of Medicine
    There is growing interest in, and need for, integrating palliative care (PC) into the care of patients undergoing emergency surgery and those with traumatic injury. Thus, PC consults for these populations will likely grow in the coming years. Understanding the nuances and unique characteristics of these two acutely ill populations will improve the care that PC clinicians can provide. Using a modified Delphi technique, this article offers 10 tips that experts in the field, based on their broad clinical experience, believe PC clinicians should know about the care of trauma and emergency surgery patients.
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    Urine Cell-Free Mitochondrial DNA as a Marker of Weight Loss and Body Composition in Older Adults with HIV
    (Wolters Kluwer, 2021) Johnston, Carrie D.; Siegler, Eugenia L.; Rice, Michelle C.; Derry, Heather M.; Hootman, Katie C.; Zhu, Yuan-Shan; Burchett, Chelsie O.; Gupta, Samir K.; Choi, Mary E.; Glesby, Marshall J.; Medicine, School of Medicine
    Background: Older adults with HIV (OAH) experience more comorbidities and geriatric syndromes than their HIV-negative peers, perhaps because of chronic inflammation. Cell-free mitochondrial DNA (cfmtDNA) released from cells undergoing necrosis-mediated cell death potentially acts as both a mediator and marker of inflammatory dysregulation. We hypothesized that urinary cfmtDNA would be associated with frailty, body composition, and fall history in OAH. Methods: OAH completed frailty testing, a psychosocial survey, body composition assessment, and measurement of urine cfmtDNA and urine albumin:creatinine in this cross-sectional study. Urine cfmtDNA was measured by quantative polymerase chain reaction and normalized to urinary creatinine. Results: Across 150 participants, the mean age was 61 years (SD 6 years), half identified as Black, one-third were women, and 93% had HIV-1 viral load <200 copies/mL. Two-thirds met criteria for a prefrail or frail state. Those with unintentional weight loss had higher urine cfmtDNA concentrations (P = 0.03). Higher urine cfmtDNA was inversely associated with the skeletal muscle index (β = -0.19, P < 0.01) and fat mass index (β = -0.08, P = 0.02) in separate multiple linear regression models adjusted for age, sex, and presence of moderate-severe albuminuria. Conclusions: In this cross-sectional study of OAH, higher levels of urine cfmtDNA were more common in subjects with less robust physical condition, including unintentional weight loss and less height-scaled body mass of fat and muscle. These findings suggest urine cfmtDNA may reflect pathophysiologic aging processes in OAH, predisposing them to geriatric syndromes. Longitudinal investigation of urine cfmtDNA as a biomarker of geriatric syndromes is warranted.