Medicine (RMH) - Theses
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ItemBiological assessment of geriatric rehabilitation inpatients( 2022)Chronological age is a major risk factor for the development of chronic diseases and frailty. The growing ageing population has imposed a heavy burden on healthcare systems which are being inundated with geriatric patients. In clinical practice, older adults are assessed and managed by the Comprehensive Geriatric Assessment (CGA), a multidimensional and interdisciplinary clinical tool that evaluates medical conditions and functional capacity in multiple domains. While the CGA contains several detailed clinical tools, it currently does not involve any biological assessment. A biological assessment could identify individuals with an accelerated ageing process, provide additional information about their health status and ultimately help early diagnosis, prevention and recovery of age-related diseases. This PhD project investigated the biological determinants of adverse health outcomes in geriatric rehabilitation inpatients using clinical pathology data. The unresolved inflammation characterized by high C-reactive protein and low albumin, vitamin D deficiency and higher biological age determined by combined blood biochemistry markers were associated with frailty, institutionalization and mortality. In addition, a literature review that encompasses cell cycle regulators as cellular senescence markers in human peripheral blood cells was conducted, showing the potential as a biological assessment clinically. This thesis highlighted the predictive value of pathology parameters for adverse health outcomes and the importance of ensuring the resolution of inflammation and adequate levels of vitamin D during geriatric rehabilitation. Future studies are required to investigate the association of senescence burden in blood samples with clinical phenotype and rehabilitation outcomes, and evaluate the utility of CGA integrated with biological assessments in care planning.