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Assuming a persona might help to arrest Covid

‘The Art of Doctoring’ available from Amazon books

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Frailty begins in the forties

Background: There is little known about pre-frailty attributes or when changes which contribute to frailty might be detectable and amenable to change. This study explores pre-frailty and frailty in independent community-dwelling adults aged 40–75 years.

Methods: Participants were recruited through local council networks, a national bank and one university in Adelaide, Australia. Fried frailty phenotype scores were calculated from measures of unintentional weight loss, exhaustion, low physical activity levels, poor hand grip strength and slow walking speed. Participants were identified as not frail (no phenotypes), pre- frail (one or two phenotypes) or frail (three or more phenotypes). Factor analysis was applied to binary forms of 25 published frailty measures Differences were tested in mean factor scores between the three Fried frailty phenotypes and ROC curves estimated predictive capacity of factors.

Results: Of 656 participants (67% female; mean age 59.9 years, SD 10.6) 59.2% were classified as not frail, 39.0% pre-frail and 1.8% frail. There were no gender or age differences. Seven frailty factors were identified, incorporating all 25 frailty measures. Factors 1 and 7 significantly predicted progression from not-frail to pre-frail (Factor 1 AUC 0.64 (95%CI 0.60–0.68, combined dynamic trunk stability and lower limb functional strength, balance, foot sensation, hearing, lean muscle mass and low BMI; Factor 7 AUC 0.55 (95%CI 0.52–0.59) comprising continence and nutrition. Factors 3 and 4 significantly predicted progression from pre-frail to frail (Factor 3 AUC 0.65 (95% CI 0.59–0.70)), combining living alone, sleep quality, depression and anxiety, and lung function; Factor 4 AUC 0.60 (95%CI 0.54–0.66) comprising perceived exertion on exercise, and falls history.

Conclusions: This research identified pre-frailty and frailty states in people aged in their 40s and 50s. Pre-frailty in body systems performance can be detected by a range of mutable measures, and interventions to prevent progression to frailty could be commenced from the fourth decade of life.

Gordon et al BMC Geriatrics.

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Covid will impact all of our health

Homebound status is associated with poorer physical and mental health, as well as disability in the elderly. We aimed to examine the prevalence and the role of homebound status on mortality in a representative sample of the French non-institutionalized population. This study included 7497 people aged 65 and over who were interviewed in 1999 and 2001 about the consequences of health problems on activities of daily living. Homebound status was defined as staying permanently inside the home, excluding an accident or a temporary illness. The influence of the homebound status on two-year mortality was assessed in a logistic regression model adjusted for the main confounders (age, sex, living as a couple, physical and mental impairments). The prevalence of homebound status was 4.7% (95% CI: 3.9–5.4) in this study. The number of homebound elderly was estimated at 421 000 in France. The prevalence of homebound status increases with age and reaches 33.9% in people aged 95–99 years (95% CI: 13.1–54.6). Compared to non-homebound subjects, homebound elderly were more likely to be female, widower, to live alone and to have had a former low level job. Homebound status was associated with a number of physical and mental impairments. It increased the risk of dying within two years with an adjusted OR 3.45 (95% CI: 2.66–4.46). Homebound status should be considered as an indicator of frailty and used in the identification of old people likely to benefit from preventive interventions.

Herr et al. Homebound status increases death risk within two years in the elderly: Results from a national longitudinal survey

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A global and urgent need to change our behaviour

Public engagement in ethically laden pandemic planning decisions may be important for transparency, creating public trust, improving compliance with public health orders, and ultimately, contributing to just outcomes. We conducted focus groups with members of the public to characterize public perceptions about social distancing measures likely to be implemented during a pandemic. Participants expressed concerns about job security and economic strain on families if businesses or school closures are prolonged. They shared opposition to closure of religious organizations, citing the need for shared support and worship during times of crises. Group discussions elicited evidence of community-mindedness (e.g., recognition of an extant duty not to infect others), while some also acknowledged strong self-interest. Participants conveyed desire for opportunities for public input and education, and articulated distrust of government. Social distancing measures may be challenging to implement and sustain due to strains on family resources and lack of trust in government.

“Listen to the People”: Public Deliberation About Social Distancing Measures in a Pandemic
Nancy M. Baum , Peter D. Jacobson  & Susan D. Goold

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COVID-19 will impact more than those with the virus

The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.

Brookes et al The Lancet Volume 395, Issue 10227, 14–20 March 2020, Pages 912-920

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Is normal too thin?

Try this experiment. If you are tending to overweight ( Body Mass Index (BMI) 25 or over) then try to get to BMI 18.5 -24.9.  If you succeed people will decide you have lost ‘too much weight’  even when your BMI is in the middle of the normal range. If normal was defined as ‘what is most common’ then to have a ‘normal’ BMI is unusual and we may have become blind to normal so that what we perceive as ‘normal’ is not ideal. Rates of overweight and obesity are now at 60-70%.

In an Australian study on the public perception of body size the authors report that:

Overweight participants were also most likely to incorrectly identify themselves as a healthy weight (67 per cent, p<0.001), compared to 12 per cent of obese participants . The majority (89 per cent) of normal weight participants accurately identified themselves as being a healthy weight. Flanagan et al

Therefore it is not surprising that when people are challenged about their weight in healthcare they are reluctant to identify the issue as a problem.

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