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Background/Aims: The optimal systolic blood pressure (SBP) goal for elderly patients with hypertension, especially to reduce cardiovascular disease (CVD) incidence and improve outcome, is unclear. This study aimed to evaluate the beneficial effects of intensive treatment for hypertension on the incidence of CVD in elderly Korean patients.Methods: The HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial is a multicenter, parallel-design, open-label, randomized controlled trial designed to evaluate whether intensive treatment (SBP ≤ 130 mmHg) will provide more benefits in lowering the incidence and mortality associated with CVD than standard treatment (SBP ≤ 140 mmHg) in elderly patients with hypertension aged ≥ 65 years. For this study, eleven university hospitals in Korea will enroll approximately 3,176 elderly patients with hypertension between 2019 and 2022. Patients will be requested to visit the clinic every 4 months for the first year and every 6 months thereafter for 36 months. Parameters, including clinic and home blood pressure, anthropometric and laboratory findings, and frailty assessments, will be collected according to the standardized protocol. The primary outcome is a composite of CVD (acute coronary syndrome, stroke, and heart failure) incidence and cardiovascular deaths.Results: As of December 2021, 1,655 participants had been enrolled in the study, including 831 patients in the standard group and 824 patients in the intensive group.Conclusions: The HOWOLD-BP trial is the first study performed in Korea to evaluate the beneficial effects of intensive blood pressure treatment on CVD in elderly patients with hypertension. The results of this study will help clarify the appropriate target SBP for this population.

Background/Aims: Drugs with anticholinergic properties (DAPs) are associated with adverse health outcomes in older patients. The objective of this study was to evaluate the factors that determine the prescribing of more DAPs in long-term care hospitals (LTCHs) in Korea. In addition, the current patterns of DAP prescription were explored using a novel platform, which can collect data from LTCHs.Methods: This was a Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) sub-study, which is a pragmatic, cluster-randomized, controlled trial. The Health-RESPECT platform was used to collect prescribed medication data of 466 patients (aged ≥ 65 years) from seven LTCHs. DAPs were identified using the Korean Anticholinergic Burden Scale (KABS). Physical frailty, cognitive function, functional status, and quality of life were evaluated.Results: Among 466 LTCH patients, 88.8% (n = 414) were prescribed DAPs, and the prevalence of high KABS (≥ 3) was 70.4% (n = 328). The drugs that contributed most to the total KABS were quetiapine (20.7%), chlorpheniramine (19.5%), tramadol (9.8%), cimetidine (5.8%), and furosemide (3.6%). Polypharmacy, higher body mass index, less dependence, better communication and cognitive functions, and poorer quality of life were associated with high KABS.Conclusions: Although the patients with a high burden of DAPs were less dependent and had better cognitive and communication functions, they had poorer quality of life. DAP use in LTCH patients should be monitored carefully, and the risk/ benefit relationship for their use should be considered.

IntroductionThere is an increased demand for services for hospitalised older patients with acute medical conditions due to rapidly ageing population. The COMPrehensive geriatric AsseSSment and multidisciplinary team intervention for hospitalised older adults (COMPASS) study will test the effectiveness of comprehensive geriatric assessment (CGA) and multidisciplinary intervention by comparing it with conventional care among acute hospitalised older adults in Korea.Methods and analysisA multicentre trial within a cohort comprising three substudies (randomised controlled trials) will be conducted. The intervention includes CGA and CGA-based multidisciplinary interventions by physicians (geriatricians, oncologists), nurses, nutritionists and pharmacists. The multidisciplinary intervention includes nutritional support, medication review and adjustment, rehabilitation, early discharge planning and prevention of geriatric syndromes (falls, delirium, pressure sore and urinary retention). The analysis will be based on an intention-to-treat principle. The primary outcome is living at home 3 months after discharge. In addition to assessing the economic effects of the intervention, a cost-utility analysis will be conducted.Ethics and disseminationThe study protocol was reviewed and approved by the ethics committees of Seoul National University Bundang Hospital and each study site. The study findings will be published in peer-reviewed journals. Subgroup and further in-depth analyses will subsequently be published.Trial registration numberKCT0006270.

Background Frailty and low handgrip strength (HGS) are associated with adverse outcomes after hip fracture (HF) surgery. We aimed to compare the predictive role of frailty and HGS for adverse outcome in HF patients. Methods We included older patients (age ≥ 65 years) who underwent HF surgery to compare the predictive role of HGS and hip-multidimensional frailty score (Hip-MFS) for postoperative complications and mortality. The Hip-MFS was calculated based on comprehensive geriatric assessment (CGA), and HGS was measured with a hand dynamometer. The primary outcome was a composite of postoperative complications (e.g., pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission). The secondary outcomes were 6-month mortality and mortality at the end of follow-up. Results The median observation time was 620.5 days (interquartile range: 367.0–784.8 days). Among the 242 patients (mean age: 81.5 ± 6.7 years, 73.1% women), 106 (43.8%) experienced postoperative complications. The 6-month mortality and mortality at the end of follow-up were 7.4% (n = 18) and 20.7% (n = 50), respectively. The Hip-MFS (odds ratio [OR], 1.250; 95% confidence interval [CI], 1.092–1.432) and HGS (OR, 1.147; 95% CI, 1.082–1.215) could predict postoperative complications. The Hip-MFS could predict both 6-month mortality (hazard ratio [HR], 1.403; 95% CI, 1.027–1.917) and mortality at the end of follow-up (HR, 1.493; 95% CI, 1.249–1.769) after adjustment, while HGS was only associated with mortality at the end of follow-up (HR, 1.080; 95% CI, 1.024–1.139). For mortality at the end of follow-up, predictive models with the Hip-MFS were superior to those with HGS in the time-dependent receiver-operating curve analysis after adjustment (p = 0.017). Furthermore, the addition of Hip-MFS or HGS to the American Society of Anesthesiologists (ASA) classification improved its prognostic ability. Conclusions Both the Hip-MFS and HGS could predict postoperative complications and improve prognostic utility when combined with the ASA classification. The Hip-MFS was a stronger predictor of mortality than HGS after HF surgery. HGS could be a useful pre-screening tool to identify patients at a high risk of postoperative complications and those who may benefit from further CGA.

Background Frail older adults are at increased risk of post‐operative morbidity compared with robust counterparts. Simple methods testing frailty such as grip strength or gait speed have shown promising results for predicting post‐operative outcome, but there is a debate regarding the most appropriate and precise frailty assessment method. We compared the predictive value of multidimensional frailty score (MFS) with grip strength, gait speed, or conventional risk stratification tool for predicting post‐operative complications in older surgical patients. Methods From January 2016 to June 2017, 648 older surgical patients (age ≥ 65 years) were included for analysis. MFS was calculated based on the preoperative comprehensive geriatric assessment. Grip strength and gait speed were measured before surgery. The primary outcome was a composite of post‐operative complications (e.g. pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission). The secondary outcome was the 6 month all‐cause mortality. Results Among 648 patients (mean age 76.6 ± 5.4 years, 52.8% female), 66 (10.2%) patients experienced post‐operative complications, and the 6 month mortality was 3.9% (n = 25). Grip strength, gait speed, MFS, and American Society of Anesthesiologists (ASA) classification could predict post‐operative complication but only MFS (hazard ratio = 1.581, 95% confidence interval 1.276–1.959, P < 0.001) could predict 6 month mortality after adjustment. MFS (C‐index = 0.750) had a superior prognostic utility compared with age (0.638, P = 0.008), grip strength (0.566, P < 0.001), and ASA classification (0.649, P = 0.004). MFS improved the predictive value on age [C‐index of 0.638 (age) vs. 0.758 (age + MFS), P < 0.001] and ASA classification [C‐index of 0.649 (ASA) vs. 0.765 (ASA + MFS), P < 0.001] for post‐operative complication; however, gait speed or grip strength did not provide additional prognostic value in both age and ASA. Conclusions Multidimensional frailty score based on preoperative comprehensive geriatric assessment showed better utility than age, grip strength, gait speed, or ASA classification for predicting post‐operative complication and 6 month mortality. MFS also showed incremental predictive ability for post‐operative complications with the addition of age and ASA classification. Accordingly, MFS is superior to grip strength or gait speed for predicting complications among older surgical patients.

Objectives There are limited data regarding blood pressure (BP) variability among older adults living in long-term care hospitals (LTCHs). We aimed to collect data from LTCH and analyse BP characteristics and its variability among these patients using a novel platform. Methods The Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) platform was used to construct a daily BP dataset using data of 394 older patients from 6 LTCHs. BP variability was expressed as coefficient of variation (CV = standard deviation/mean of BP × 100). Physical frailty and cognitive function were evaluated using the K-FRAIL questionnaire and the Cognitive Performance Scale of the interRAI Long-Term Care Facilities tool, respectively. Results From September 2019 to September 2020, 151,092 BP measurements, 346.5 (IQR 290.8–486.3) measurements per patient, were included. The mean BP was 123.4 ± 10.8/71.3 ± 6.5 mmHg. BP was significantly lower in frail patients (122.2 ± 11.3/70.4 ± 6.8 mmHg) than in pre-frail/robust patients (124.4 ± 10.4/72.1 ± 6.1 mmHg, P Conclusion Older patients with physical or cognitive frailty had lower BP but higher BP variability. Relationship among frailty, increased BP variability and adverse clinical outcomes should be investigated.

Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process to evaluate medical, psychosocial, and functional capability. It is useful to develop a coordinated and integrated plan for frail older patients. This study aimed to examine the current scope of CGA based multidisciplinary team interventions in acute care setting to improve the health outcomes for older adults.We searched electronic databases: PubMed, Ovid, PsychINFO, Scopus, RISS and KoreaMed from 2011 to 2021. The selected articles were extracted by three reviewers and cross checked by the fourth reviewer to resolve any conflicts. Data were synthesized and analyzed descriptively and thematically. Articles are nested three themes: inpatient (IN), emergency room (ER) and oncology patient (ONCO).Of the 1830 articles that were screened, 710 were potentially eligible. Finally, 26 articles were selected and categorized as IN (n=8), ER (n=7) and ONCO (n=11). Geriatricians and nurses participated in most of the multidisciplinary teams followed by other health professionals. The most effective primary outcomes were focused and retrieved across five domains, screening, prevention, treatment, quality of care, and rehabilitation. The subdomains are problem lists which is common and problematic among hospitalized older patients and retrieved from the most commonly used multidisciplinary interventions according to each domain.CGA based multidimensional intervention (MDI) are likely to be an effective in care of older adults. There is remarkable paradigm shift required to improve better health outcomes for hospitalized older adults. It also suggests that there is a need to design the CGA based MDI to build a standardized protocol for older adults to maintain functional capacity and increase likelihood of living in their own home.

Background The recently developed Screening Tool of Older Persons' Prescriptions in Frail adults with a limited life expectancy (STOPPFrail) criteria can be helpful for screening medications (PIMs), but it is yet to be widely used in clinical practice. Herein, we aimed to investigate the prevalence of PIMs based on the STOPPFrail criteria (STOPPFrail-PIM) among frail older adults with limited life expectancy admitted to the geriatric center. Methods This was a retrospective cross-sectional study conducted in the geriatric center at an academic tertiary care hospital in Korea. We evaluated frail older adults with limited life expectancy who received comprehensive geriatric assessment (CGA) admitted between 1 January, 2019 and 30 June, 2020. Frail older adults with limited life expectancy were identified by geriatricians with retrospective records and the prevalence of STOPPFrail-PIMs was analysed by trained pharmacists. Descriptive analysis, t-test, and chi-square test were conducted using IBM SPSS software version 25.0. Results Among 504 older adults who underwent CGA after admission, 171 frail older adults with limited life expectancy were identified by geriatricians and included in the study. An average of 11.3 ± 4.7 medications were administered regularly to each patient before admission. Overall, 97.1% (166/171) had at least one STOPPFrail-PIM, and the mean number of STOPPFrail-PIM was 4.2 ± 2.8. Drugs without clear clinical indication (A2) were the most frequent pre-admission STOPPFrail-PIM, followed by lipid-lowering therapies (B1) and neuroleptic antipsychotics (D1). The number of STOPPFrail-PIM was significantly lower at discharge than that at admission, with the decrease being the highest for A2 at 94.7%. Conclusions Most frail older adults with limited life expectancy had at least one STOPPFrail-PIM at admission, and the rate of STOPPFrail-PIM decreased significantly at discharge after the geriatric multidisciplinary team care. Further studies are needed to investigate the association between the use of STOPPFrail-PIM and adverse consequences in frail older adults.

We analyzed the Korean National Health and Nutrition Examination Survey (KNHANES) database to determine the trends of hypertension treatment and control rate in Korea over the past 10 years. In addition, we tried to investigate the effect of chronic medical conditions on hypertension management. We investigated the hypertension prevalence, awareness, treatment, and control rate from 2008 to 2017. KNHANES, which uses a stratified multistage sampling design, is a cross-sectional, nationally representative survey conducted by the Korean government. A total of 59,282 adults (≥ 20 years) were included, which was representative of the total population of around 40 million Koreans per year. The mean age was 50.7 ± 16.4 years and 42.6% were male. The prevalence of hypertension, hypercholesterolemia, diabetes mellitus, and obesity significantly increased over the 10 years. During this period, the hypertension treatment and control rate significantly improved. Hypertension treatment rate was significantly lower in the younger age group compared to the older age group, but the control rate among the treated patients was not significantly different between age groups. The treatment and control rates of hypertension were higher in patients with multimorbidity, which implies that it has a favorable effect on the treatment and control of hypertension. Hypertension treatment and control rate have improved over the past 10 years. The higher treatment and control rate in patients with multimorbidity suggest that the more aggressive surveillance might be associated with the improvement of hypertension treatment and control rate in Korea.

The CHA2DS2-VASc score is a validated predictor of ischemic stroke in atrial fibrillation (AF) patients. However, data are limited on whether the CHA2DS2-VASc score is associated with subclinical brain structural changes or physical frailty among older AF patients. We assessed the relationship between CHA2DS2-VASc scores and brain structural changes or physical frailty in AF patients without history of stroke. Overall, 117 patients completed a comprehensive geriatric assessment for physical frailty. In brain magnetic resonance imaging sub-study (n = 49), brain volume and white matter hyperintensity lesion burden were automatically quantified using the LESIONQUANT software program. Patients with high risk of CHA2DS2-VASc scores (≥ 2 in men or ≥ 3 in women) tended to be older and had more comorbidities, higher frailty index, and slower gait speed. Total white matter hyperintensity lesion burden was higher in those with high risk of CHA2DS2-VASc score than in those with intermediate risk (score of 1 in men or 2 in women) of CHA2DS2-VASc score (1.67 [interquartile range: 0.70–3.45] vs. 0.64 [0.19–1.44], p = 0.036). Cognitive function was associated with brain volume, but gait speed was related with white matter hyperintensity lesion burden. In conclusion, we showed a positive relationship between CHA2DS2-VASc scores, white matter hyperintensity lesion burden, and physical frailty in older AF patients. Subclinical brain changes associated with high CHA2DS2-VASc scores may predict physical frailty risk.

To determine whether immunogenicity of the herpes zoster live-attenuated vaccine (ZVL) in elderly individuals is influenced by frailty status and cytokine levels, individuals aged at least 65 years were prospectively administered ZVL after their frailty status and cytokine levels were assessed. Humoral and cellular immunogenicity were assessed using enzyme-linked immunosorbent assays for the varicella-zoster virus–specific IgG antibody and varicella-zoster virus–specific enzyme-linked immunospot assays, before and 6 weeks after vaccination. We enrolled 69 participants (mean age, 74.3 years); 31 were non-robust. Thirty-seven participants had a greater than 2 geometric mean fold rise in IgG antibodies, 22 more participants had at least 10 spot-forming cells/106 peripheral blood mononuclear cells (from 35 to 57 participants), and 42 experienced a twofold geometric mean fold rise increase of spot-forming cells 6 weeks after vaccination. The geometric mean fold rises of the antibody titers were similar in the robust and non-robust groups; moreover, the baseline enzyme-linked immunospot assay geometric mean values were not significantly different before or 6 weeks after vaccination. We observed no significant correlations between baseline cytokine levels and immunogenicity. Approximately half of the community-dwelling elderly participants in this study experienced a twofold rise in antibodies and one-third more participants showed at least 10 spot-forming cells after ZVL administration, suggesting that the ZVL can boost immunity in non-robust (especially pre-frail) and robust elderly individuals.

Sarcopenia, defined as loss of skeletal muscle mass and function with age, is an important health issue in aging society. We tried to investigate the relationship between blood pressure variability and skeletal muscle mass in nation-wide large population cohort. This cross-sectional study was based on data acquired in the Korea National Health and Nutrition Examination Survey (KNHANES), conducted from 2009 to 2011 by the Korean Centers for Disease Control and Prevention. We included 14,481 participants (age ≥ 20 years, male 6,302) for the analysis who had both blood pressure and whole-body dual energy X-ray absorptiometry (DXA) scan data. As an intra-individual within-visit blood pressure variability index, we calculated standard deviation (SD), coefficient of variation (CV), and maximum minus minimum BP difference (MMD) of systolic and diastolic blood pressure, which was measured 3 times. Appendicular skeletal muscle mass (ASM) was the sum of lean masses of both arms and legs. We adjusted ASM by body mass index. Significant inverse relationship was observed between blood pressure variability index (SD, CV, and MMD) and adjusted ASM. Blood pressure variability index were significantly higher in the lowest ASM quintile group both in male and female participants (p0.001). In multivariate analysis, blood pressure variability index were significantly associated with ASM, even after adjusting confounding factors (p0.001). In conclusion, hemodynamic influence may play an important role in the development of sarcopenia.

Objectives Detecting frailty in older adults scheduled for surgery is important to predict the occurrence of adverse outcomes, but because of its complexity, frailty screening is not commonly performed. The objective of the current study was to assess whether frailty can be screened for using automatically measured usual gait speed (UGS) and mid‐arm circumference (MAC) in the outpatient clinic. Design Prospective, cross‐sectional study. Setting Geriatric center of a tertiary hospital. Participants Outpatients aged 65 and older (N = 113). Measurements Frailty status was evaluated according to a multidimensional frailty score (MFS) using a comprehensive geriatric assessment, and participants were classified into 5 categories. UGS was evaluated by having participants walk through the clinic using an automated laser‐gated chronometer. MAC was recorded using a tape measure on a blood pressure cuff. Correlations between these two physical measurements and MFS were assessed. Results The mean age of the 93 participants who successfully underwent UGS evaluation was 75.8 ± 4.7; 35 were male. In this population, the mean Charlson Comorbidity Index was 2.2 ± 1.4, mean MFS was 4.1 ± 2.0, and 20 participants were considered to be at high risk of experiencing adverse outcomes. Mean UGS was 0.75 ± 0.16 m/s, and mean MAC was 31.2 ± 1.9 cm); both physical parameters were correlated with MFS (UGS: standardized beta = −0.420, P < .001; MAC: standardized beta = −0.457, P < .001). Using UGS and MFS, the area under curve of receiver operating curve for determining which participants were at high risk of experiencing adverse outcomes was 0.809 (P < .001). Conclusion UGS and MAC are viable methods of clinically screening for frailty.

Background Gait speed measurements are widely used in clinical practice, as slow gait is a major predictor of frailty and a diagnostic criterion for sarcopenia. With the development of wearable devices, it is possible to estimate the gait speed in daily life by simply wearing the device. Objective This study aims to accurately determine the characteristics of daily life gait speed and analyze their association with sarcopenia. Methods We invited community-dwelling men aged >50 years who had visited the outpatient clinic at a tertiary university hospital to participate in the study. Daily life gait speed was assessed using a wearable smart belt (WELT) for a period of 4 weeks. Data from participants who wore the smart belt for at least 10 days during this period were included. After 4 weeks, data from a survey about medical and social history, usual gait speed measurements, handgrip strength measurements, and dual-energy x-ray absorptiometry were analyzed. Results A total of 217,578 daily life gait speed measurements from 106 participants (mean age 71.1, SD 7.6 years) were analyzed. The mean daily life gait speed was 1.23 (SD 0.26) m/s. The daily life gait speed of the participants varied according to the time of the day and day of the week. Daily life gait speed significantly slowed down with age (P Conclusions More diverse and accurate information about gait speed can be obtained by measuring daily life gait speed using a wearable device over an appropriate period, compared with one-time measurements performed in a laboratory setting. Importantly, in addition to age, daily life gait speed is significantly associated with skeletal muscle mass of the lower limbs.

Background Caregivers of patients who wear conventional diapers are required to check for voiding every hour because prolonged wearing of wet diapers causes health problems including diaper dermatitis and urinary tract infections. However, frequent checking is labor intensive and disturbs patients’ and caregivers’ sleep. Furthermore, assessing patients’ urine output with diapers in an acute care setting is difficult. Recently, a smart diaper system with wetness detection technology was developed to solve these issues. Objective We aimed to evaluate the applicability of the smart diaper system for urinary detection, its accuracy in measuring voiding volume, and its effect on incontinence-associated dermatitis (IAD) occurrence in an acute care hospital. Methods This prospective, observational, single-arm pilot study was conducted at a single tertiary hospital. We recruited 35 participants aged ≥50 years who were wearing diapers due to incontinence between August and November 2020. When the smart diaper becomes wet, the smart diaper system notifies the caregiver to change the diaper and measures voiding volume automatically. Caregivers were instructed to record the weight of wet diapers on frequency volume charts (FVCs). We determined the voiding detection rate of the smart diaper system and compared the urine volume as automatically calculated by the smart diaper system with the volume recorded on FVCs. Agreement between the two measurements was estimated using a Bland-Altman plot. We also checked for the occurrence or aggravation of IAD and bed sores. Results A total of 30 participants completed the protocol and 390 episodes of urination were recorded. There were 108 records (27.7%) on both the FVCs and the smart diaper system, 258 (66.2%) on the FVCs alone, 18 (4.6%) on the smart diaper system alone, and 6 (1.5%) on the FVCs with sensing device lost. The detection rate of the smart diaper system was 32.8% (126/384). When analyzing records concurrently listed in both the FVCs and the smart diaper system, linear regression showed a strong correlation between the two measurements (R2=0.88, P Conclusions The smart diaper system showed acceptable accuracy for measuring urine volume and it could replace conventional FVCs in acute setting hospitals. Furthermore, the smart diaper system has the potential advantage of preventing IAD development and bed sore worsening. However, the detection rate of the smart diaper system was lower than expected. Detection rate polarization among participants was observed, and improvements in the user interface and convenience are needed for older individuals who are unfamiliar with the smart diaper system.

Background We aimed to show the frailty status in older AF patients, and to find the association between frailty and the scores of CHA 2 DS 2 -VASc and HAS-BLED. Ultimately, we sought to investigate the impact of frailty on cardiovascular and all-cause mortality in older AF patients. Methods We retrospectively evaluated 365 patients (≥65 years old) with AF, who underwent comprehensive geriatric assessment (CGA) between 2007 and 2014 in a single tertiary hospital. The CHA 2 DS 2 -VASc and HAS-BLED scores were calculated based on the electronic medical records and the frailty index was computed from the CGA data. The primary outcomes were cardiovascular and all-cause mortality. Results Frailty status was positively associated with the CHA 2 DS 2 -VASc score ( P P = 0.01). Patients with high CHA 2 DS 2 -VASc and HAS-BLED scores were more likely to be treated with anticoagulants rather than antiplatelet agents. However, frailty status was not associated with antithrombotic therapy. During the follow-up period (median [interquartile range], 22.9 [8.4–42.2] months), 141 patients (38.6%) died, of which 48 were due to cardiovascular events. CHA 2 DS 2 -VASc score could predict cardiovascular mortality, but not all-cause mortality. In contrast, frailty status was the independent predictor for both cardiovascular and all-cause mortality after adjusting for possible confounders (hazard ratio for all-cause mortality, 4.549; 95% CI, 2.756–7.509; P Conclusion Frailty assessment can be used to predict mortality in older AF patients, and provides additional prognostic value, along with the CHA 2 DS 2 -VASc and HAS-BLED scores.

BackgroundPostoperative delirium (POD) is a common clinical syndrome with significant negative outcomes. Thus, we aimed to evaluate the feasibility and effectiveness of a delirium screening tool and multidisciplinary delirium prevention project.MethodsA retrospective cohort study was conducted at a single teaching center in Korea. A cohort of patients who underwent a delirium prevention program using a simple delirium screening tool from December 2018 to February 2019 (intervention group,N = 275) was compared with the cohort from the year before implementation of the delirium prevention program (December 2017 to February 2018) (control group,N = 274). Patients aged ≥65 years who were admitted to orthopedic wards and underwent surgery were included. The incidence rates of delirium before and after implementation of the delirium prevention program, effectiveness of the delirium screening tool, change in the knowledge score of nurses, and length of hospital stay were assessed.ResultsThe sensitivity and specificity of the screening tool for the incidence of POD were 94.1 and 72.7%, respectively. The incidence rates of POD were 10.2% (control group) and 6.2% (intervention group). The odds ratio for the risk reduction effect of the project related to the incidence of POD was 0.316 (95% confidence interval: 0.125–0.800,p = 0.015) after adjustment for possible confounders. The delirium knowledge test score increased from 40.52 to 43.24 out of 49 total points (p p = 0.062).ConclusionThe screening tool successfully identified patients at a high risk of POD at admission. The POD prevention project was feasible to implement, effective in preventing delirium, and improved knowledge regarding delirium among the medical staff.Trial registrationNone.

Background/Aims: The fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale is a screening tool for frailty status using a simple 5-item questionnaire. The aim of this study was to evaluate the clinical feasibility and validity of the Korean version of the FRAIL (K-FRAIL) scale. Methods: Questionnaire items were translated and administered to 103 patients aged ≥ 65 years who underwent a comprehensive geriatric assessment at the Seoul National University Bundang Hospital. In this cross-sectional study, the K-FRAIL scale was compared with the domains and the multidimensional frailty index of the comprehensive geriatric assessment. We also assessed the time required to complete the scale. Results: The participants’ mean age was 76.8 years (standard deviation [SD], 6.1), and 55 (53.4%) were males. The mean overall frailty index was 0.19 (SD, 0.17). For K-FRAIL-robust, prefrail, and frail patients, the mean frailty indices were 0.09, 0.18, and 0.34, respectively (p for trend < 0.001). A higher degree of impairment in the K-FRAIL scale was associated with worse nutritional status, poor physical performance, functional dependence, and polypharmacy. The number of items with impairment in the K-FRAIL scale was positively associated with the frailty index (B = 3.73, p < 0.001). The K-FRAIL scale could differentiate vulnerability from robustness with a sensitivity of 0.90 and a specificity of 0.33. Of all patients, 75 (72.8%) completed the K-FRAIL scale within < 3 minutes. Conclusions: The K-FRAIL scale is correlated with the frailty index and is a simple tool to screen for frailty in a clinical setting.

Jung-Yeon Choi,1 Sun-wook Kim,1 Sol-Ji Yoon,2 Min-gu Kang,1 Kwang-il Kim,1 Cheol-Ho Kim1 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea; 2Department of Internal Medicine, Kangwon National University Hospital Gangwon-Do 200-722, Republic of Korea Purpose: Pneumonia poses a significant health risk in aging societies. We aimed to elucidate the determinative value of frailty for do-not-resuscitate (DNR) orders in pneumonia patients. Patients and methods: This was a retrospective cohort study conducted at the Seoul National University Bundang Hospital (SNUBH) in Korea. Medical records of 431 pneumonia patients, aged 65 years and older, who were admitted between June 2014 and May 2015 were analyzed. Patients were categorized into DNR and no-DNR groups. Results: Among the 65 patients (15.1% of pneumonia patients) who completed DNR documents, 24 patients were survived, and 21 patients decided imminent to death (

Frailty is a common geriatric syndrome characterized by increased risk of disability, hospitalization, and mortality. Hypertension (HTN) is one of the most common chronic medical conditions in the elderly. However, there have been few studies regarding the association between frailty and HTN prevalence, treatment, and control rates. We analyzed data of 4,352 older adults (age ≥ 65 years) from the fifth Korea National Health and Nutrition Examination Survey. We constructed a frailty index based on 42 items and classified participants as robust, pre-frail, or frail. Of the subjects, 2,697 (62.0%) had HTN and 926 (21.3%) had pre-HTN. Regarding frailty status, 721 (16.6%), 1,707 (39.2%), and 1,924 (44.2%) individuals were classified as robust, pre-frail and frail, respectively. HTN prevalence was higher in frail elderly (67.8%) than pre-frail (60.8%) or robust elderly (49.2%) (P P P = 0.005). Considering the adverse cardiovascular outcomes associated with frailty, more attention should be paid to the blood pressure control of the frail elderly.

High mortality and dependent living after hip fracture pose a significant public health concern. Retrospective study was conducted with 481 hip fracture patients (≥65 years of age) undergoing surgery from March 2009 to May 2014. The Hip-MFS was calculated by Comprehensive Geriatric Assessment (CGA). The primary outcome was the 6-month all-cause mortality rate. The secondary outcomes were 1-year all-cause mortality, postoperative complications and prolonged hospital stay, and institutionalization. Thirty-five patients (7.3%) died within 6 months after surgery (median [interquartile range], 2.9 [1.4–3.9] months). The fully adjusted hazard ratio per 1 point increase in Hip-MFS was 1.458 (95% confidence interval [CI]: 1.210–1.758) for 6-months mortality and odds ratio were 1.239 (95% CI: 1.115–1.377), 1.156 (95% CI: 1.031–1.296) for postoperative complications and prolonged total hospital stay, respectively. High-risk patients (Hip-MFS > 8) showed higher risk of 6-month mortality (hazard ratio: 3.545, 95% CI: 1.466–8.572) than low-risk patients after adjustment. Hip-MFS successfully predict 6-month mortality, postoperative complications and prolonged hospital stay in elderly hip fracture patients after surgery. Hip-MFS more precisely predict 6-month mortality than age or existing tools (P values of comparison of ROC curve: 0.002, 0.004, and 0.044 for the ASA classification, age and NHFS, respectively).

Mel-18 is a mammalian homolog of Polycomb group (PcG) genes. Microarray analysis revealed that Mel-18 expression was induced during endothelial progenitor cell (EPC) differentiation and correlates with the expression of EC-specific protein markers. Overexpression of Mel-18 promoted EPC differentiation and angiogenic activity of ECs. Accordingly, silencing Mel-18 inhibited EC migration and tube formation in vitro. Gene expression profiling showed that Mel-18 regulates angiogenic genes including kinase insert domain receptor (KDR), claudin 5, and angiopoietin-like 2. Our findings demonstrate, for the first time, that Mel-18 plays a significant role in the angiogenic function of ECs by regulating endothelial gene expression.

Background Even low-risk, elderly patients are at increased risk for postoperative morbidity compared with their younger counterparts. We sought to evaluate the role of a scoring model in predicting adverse surgical outcomes in low-risk, older, female cancer patients. Study Design From October 2011 to May 2014, two hundred and eighty-one low-risk female patients (aged 65 years and older, American Society of Anesthesiologists class 1 or 2) undergoing curative cancer surgery were included. The Multidimensional Frailty Score (MFS) was calculated by comprehensive geriatric assessment. The primary end point was postoperative complication (eg, pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned ICU admission). Secondary outcomes were length of hospital stay and institutionalization. Results Twenty patients experienced postoperative complications and 15 patients were discharged to nursing facilities. The fully adjusted odds ratio (OR) per 1-point increase in MFS was 1.412 (95% CI, 1.012–1.969; p = 0.042) for postoperative complications, 1.377 (95% CI, 0.935–2.026; p = 0.105) for institutionalization, and 1.411 (95% CI, 1.110–1.793; p = 0.005) for prolonged hospital stay. The high-risk group (MFS ≥7) showed an increased risk for postoperative complications (OR = 8.513; 95% CI, 2.210–32.785; p = 0.002), institutionalization (OR = 1.291; 95% CI, 0.324–5.152; p = 0.717), and prolonged hospital stay (OR = 2.336; 95% CI, 1.090–5.006; p = 0.029) compared with the low-risk group (MFS Conclusions Multidimensional Frailty Score based on a preoperative comprehensive geriatric assessment is useful for predicting postoperative complications and prolonged hospital stay, even in low-risk elderly women who are undergoing cancer surgery.

To understand the molecular basis of observed regional shifts in the genome types of adenovirus type 7 (Ad7) isolated in Korea during nationwide outbreaks from 1995 to 2000, the genetic variabilities of Ad7d and Ad7l were studied by sequence analysis of hexon, fiber, E3, and E4 open reading frame (ORF) 6/7 peptides. One amino acid change in the receptor-binding domain of fiber and 6 amino acid variations in E4 ORF 6/7 were identified between 2 genome types, while no variations were found in hexon and E3. Phylogenetic trees based on hexon, fiber, and E4 suggested that the Ad7 epidemic was probably caused by the introduction of the Japanese Ad7d strains. Our data also provide evidence that the rapid divergence of Ad7d to a novel genome type Ad7l could have been due to viral strategies involving multiple sequence changes in E4. This result suggests fiber and E4 ORF 6/7 peptides participate in the evolution of Ad7.

Background: Hyperopic undercorrection is a common clinical practice. However, less is known of its effect on the change in refractive errors and emmetropization throughout the later years of childhood. Objectives: To evaluate the effect of spectacle correction on the change in refractive errors in hyperopic children less than 12 years of age with or without strabismus. Data Extraction: A retrospective cohort study was performed by a computer based search of the hospital database of patients with hyperopia, accommodative esotropia or exotropia. A total of 150 hyperopic children under 12 years of age were included. Patients were classified into four groups: 1) accommodative esotropia with full correction of hyperopia, 2) exotropia with undercorrection of hyperopia, 3) orthotropia with full correction of hyperopia, 4) orthotropia with undercorrection of hyperopia. The 4 groups were matched by initial age on examination and spherical equivalent refractive errors (SER). The main outcome measure was the change in SER (Diopter/year) in both eyes after two years of follow-up. Results: An overall negative shift in SER was noted during the follow-up period in all groups, except for the group with esotropia and full correction. The mean negative shift of hyperopia was more rapid in groups receiving undercorrection of hyperopia with or without strabismus. The amount of undercorrection of hyperopia was positively correlated to the magnitude of decrease in hyperopia in all patients (r = 0.289, P