Kenneth Rockwood

Kenneth Rockwood
Dalhousie University | Dal · Division of Geriatric Medicine

About

1,023
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174,014
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72,874
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Additional affiliations
June 1989 - present
Dalhousie University
Position
  • Professor, Physician

Publications

Publications (1,023)
Article
Background: Physical activity (PA) interventions may reduce the burden of frailty and can prevent mobility disability for older adults. We explored whether a 2-year PA intervention would improve frailty trajectory, lead to clinically meaningful frailty changes (CMC), or impact major mobility disability (MMD) across baseline frailty levels. Method...
Article
In arts-based-research, knowledge and meaning emerge from people's experiences of being in dynamic, ambiguous, intentional, and ethical relationships with each other and the arts. This case study draws on Launer's "7 C's" (context, conversations, curiosity, complexity, challenge, caution, and care) to understand the aesthetics (shape and form) and...
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Introduction: GOAL-Hēm is a novel, haemophilia-specific, patient-centred outcome measure (PCOM) based on goal attainment scaling, allowing people with haemophilia (PwH) to set and monitor the attainment of individualized goals for treatment. Aim: To provide a thorough overview of the creation, validation, and development of GOAL-Hēm. Methods:...
Article
Background: Frailty can be operationalised using the deficit accumulation approach, which considers health deficits across multiple domains. We aimed to develop, validate and compare three different frailty indices (FI) constructed from self-reported health measures (FI-Self Report), blood-based biomarkers (FI-Blood) and examination-based assessme...
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Introduction Frailty is recognized as a clinical condition associated with increased vulnerability for developing negative health outcomes but has been little studied in patients with Parkinson's disease (PD). Here, we investigated the risk of frailty in de novo PD patients and its association with subsequent development of dementia. Methods We co...
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Evidence-based decisions on clinical and cost-effectiveness of interventions are ideally informed by meta-analyses of intervention trial data. However, when undertaken, such meta-analyses in ageing research have typically been conducted using standard methods whereby summary (aggregate) data are extracted from published trial reports. Although meta...
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Background: There is an unmet public health need to understand better the relationship between baseline cognitive function, the occurrence and severity of delirium, and subsequent cognitive decline. Our aim was to quantify the relationship between baseline cognition and delirium and follow-up cognitive impairment. Methods: We did a prospective l...
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Background: Goal Attainment Scaling for Hemophilia (GOAL-Hēm) is a novel, hemophilia-specific, validated patient engagement tool and patient-reported outcome instrument. Objective: We evaluated the degree to which the language of GOAL-Hēm was patient-centric and the content valuable and relevant for people with hemophilia (PWH) and/or their care...
Article
Missing data are ubiquitous in aging studies. Combining the National Health and Nutrition Examination Survey (NHANES) 2003/2004 and 2005/2006 cross-sectional aging studies (N = 9307), we investigated the effects of both real and simulated missing data on the Frailty Index (FI) and survival analysis, along with several mitigation strategies. We obse...
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Aims: People with atrial fibrillation (AF) frequently live with frailty, which increases the risk of mortality and stroke. This study reports the association between oral anticoagulation (OAC) and outcomes for people with frailty, and whether there is overall net benefit from treatment in people with AF. Methods and results: Retrospective open c...
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Purpose: Acute illness severity predicts mortality in intensive care unit (ICU) patients, however, its predictive value decreases over time in ICU. Typically after 10 days, pre-ICU (antecedent) characteristics become more predictive of mortality, defining the onset of persistent critical illness (PerCI). How patient frailty affects development and...
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We have built a computational model for individual aging trajectories of health and survival, which contains physical, functional, and biological variables, and is conditioned on demographic, lifestyle, and medical background information. We combine techniques of modern machine learning with an interpretable interaction network, where health variab...
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Objective: To optimise dementia prevention strategies, we must understand the complex relationships between lifestyle behaviours, frailty and genetics. Methods: We explored relationships between frailty index, healthy lifestyle and polygenic risk scores (all assessed at study entry) and incident all-cause dementia as recorded on hospital admission...
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We have built a computational model of individual aging trajectories of health and survival, that contains physical, functional, and biological variables, and is conditioned on demographic, lifestyle, and medical background information. We combine techniques of modern machine learning with an interpretable network approach, where health variables a...
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Main problem: Frailty is an established risk factor for cognitive decline and Alzheimer's disease. Few studies have examined the longitudinal relationship between frailty and cognition. Methods: Participants of Rush Memory and Aging project (n = 625, 67.5% female, 83.2 ± 5.9 years at baseline) underwent annual clinical evaluations (average follo...
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Background Most people living with dementia want to remain living in their own homes and are supported to do so by family carers. No interventions have consistently demonstrated improvements to people with dementia’s life quality, functioning, or other indices of living as well as possible with dementia. We have co-produced, with health and social...
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Background The role of ambulance services is shifting, due in part to more intermediate, non-urgent patients who do not require direct emergency department conveyance, yet who cannot be safely left at home alone. Evidence surrounding the safety, effectiveness and efficiency of alternate care routes is not well known. Methods This scoping review so...
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Background As life expectancy of people with Down syndrome (DS) increases, so does the risk of Alzheimer’s disease (AD). Identifying symptoms and tracking disease progression is especially challenging whenever levels of function vary before the onset of dementia. Goal Attainment Scaling (GAS), an individualized patient-reported outcome, can aid in...
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Alzheimer’s disease is a major cause of morbidity and mortality. Currently, there are no disease-modifying pharmacotherapies for this condition. Aducanumab, an amyloid beta-directed monoclonal antibody that targets aggregated forms of amyloid-beta in the brains of people with Alzheimer’s disease, has raised hopes that such a therapy has been discov...
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The IVS10+14 microtubule‐associated protein tau gene (MAPT) mutation causes dysregulated protein splicing of MAPT, resulting in abnormal 4‐repeat isoform tau accumulation and associated with neurodegeneration. Three families expressing the IVS10+14 MAPT mutation have been reported who express the IVS10+14 MAPT mutation displaying a high degree of i...
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Background: Indigenous populations experience high rates of age-related illness when compared to their non-Indigenous counterparts. Frailty is a challenging expression of aging and an important public health priority. The purpose of this review was to map what the existing literature reports around frailty in Indigenous populations and to highlight...
Article
Background: The IVS10+14 mutation in the microtubule-associated protein tau gene, MAPT , is a rare point mutation that dysregulates tau splicing resulting in pathological aggregation. This mutation has been identified in three families with severe neurodegenerative disease. We characterized the clinicopathological features of a fourth, Canadian fam...
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The many changes that occur in the lives of older people put them at an increased risk of being socially isolated and lonely. Intergenerational programs for older adults and young children can potentially address this shortfall, because of the perceived benefit from generations interacting. This study explores whether there is an appetite in the co...
Article
The comprehensive geriatric assessment (CGA) is the core tool used by geriatricians across diverse clinical settings to identify vulnerabilities and estimate physiologic reserve in older adults. In this paper, we demonstrate the iterative process at our institution to identify and develop a feasible, acceptable, and sustainable bedside CGA‐based fr...
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Multistate life tables are used to estimate life expected in three frailty states: frailty free, mild/moderate frailty, severe frailty. Estimates are provided for the combination of education and wealth by age, stratified by sex. Data consider 17,115 cases from the Health and Retirement Study, 2000–2014. Frailty is measured using a 59 item frailty...
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Purpose of Review Biological age is the concept of using biophysiological measures to more accurately determine an individual’s age-related risk of adverse outcomes. Grading of the degree of frailty and measuring biomarkers are distinct methods of measuring biological age. This review compares these strategies for estimating biological age for clin...
Article
measures of health quantify the aging process of individuals. They should be interpretable, associated with future adverse outcomes, and straightforward to assemble. We use the rank-ordering of risk within a population to construct a quantile frailty index (QFI) that avoids dichotomization, is convenient and interpretable, and is associated with ad...
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Purpose Study associations between frailty, illness severity and post-discharge survival in older adults admitted to medical wards with acute clinical conditions. Methods Prospective cohort study of 195 individuals (mean age 86; 63% females) admitted to two medical wards with acute illness, followed up for all-cause mortality for 20 months after d...
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Frailty is a multiply determined, age-related state of increased risk for adverse health outcomes. We review how the degree of frailty conditions the development of late-life diseases and modifies their expression. The risks for frailty range from subcellular damage to social determinants. These risks are often synergistic—circumstances that favor...
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Background Frailty is associated with hospitalization and mortality among dialysis patients. To now, few studies have considered the degree of frailty as a predictor of hospitalization. Objective We evaluated whether frailty severity was associated with hospitalization after dialysis initiation. Design Retrolective cohort study. Setting Nova Sco...
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Background Frailty is associated with poor outcomes in critical illness. However, it is unclear whether frailty screening on admission to ICU can be routinely conducted at the population level and whether it has prognostic importance. Research Question Can population-scale frailty screening with the Clinical Frailty Scale (CFS) be implemented for...
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Background The extent by which the degree of baseline frailty, as measured using standardized multidimensional health assessments before admission to hospital, predicts survival among older adults following admission to an intensive care unit (ICU) remains unclear. Research Question Is baseline frailty an independent predictor of survival among ol...
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Background: The SARS-CoV-2 (Severe Acute Respiratory Syndrome coronavirus 2) has led to more than 165 million COVID-19 cases and >3.4 million deaths worldwide. Epidemiological analysis has revealed that the risk of developing severe COVID-19 increases with age. Despite a disproportionate number of older individuals and long-term care facilities be...
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Background Comparisons between frailty assessment tools for waitlist candidates are a recognized priority area for kidney transplantation. We compared the prevalence of frailty using three established tools in a cohort of waitlist candidates. Methods Waitlist candidates were prospectively enrolled from 2016 to 2020 across five centers. Frailty was...
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Introduction: Older Canadians living with frailty are high users of healthcare services; however, the healthcare system is not well designed to meet the complex needs of many older adults. Older persons look to their primary care practitioners to assess their needs and coordinate their care. They may need care from a variety of providers and servi...
Preprint
Full-text available
We have built a computational model for individual aging trajectories of health and survival, which contains physical, functional, and biological variables, and is conditioned on demographic, lifestyle, and medical background information. We combine techniques of modern machine learning with an interpretable interaction network, where health variab...
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Older persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/D...
Preprint
BACKGROUND Individuals who live with dementia or mild cognitive impairment (MCI) experience a variety of symptoms and challenges that trouble them and/or their carers. The usual remedy for this heterogeneity is to employ several standardized tests to cover the variety of problems in cognition, behaviour and function. These tests are used for diagno...
Article
Background: Individuals with dementia and mild cognitive impairment (MCI) experience a wide variety of symptoms and challenges that trouble them. To address this heterogeneity, numerous standardized tests are used for diagnosis and prognosis. myGoalNav Dementia is a web-based tool that allows individuals with impairments and their caregivers to id...
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The COVID-19 pandemic has disproportionately impacted frail older adults, especially residents of long-term care (LTC) facilities. This has appropriately led to prioritization of frail older adults and LTC residents, and those who care for them, in the vaccination effort against COVID-19. Older adults have distinct immunological, clinical, and prac...
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Introduction: The Clinician's Interview-Based Impression of Change Plus caregiver input (CIBIC-Plus) has been widely used in dementia drug trials to evaluate cognition, behavior, and function. New trials of symptomatic drugs forecast renewed interest in this measure. Methods: To test its clinical meaningfulness, we examined how CIBIC-Plus perfor...
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Background Growing evidence supports clinical importance of evaluating frailty in older adults, with its strong outcome relevance. We aimed to assess whether the Short Physical Performance Battery (SPPB) correlates with frailty status according to phenotype and deficit accumulation models and can be used as a link between these models. Methods We...
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Background Beyond intakes of total energy and individual nutrient, eating patterns may influence health, and thereby the risk of adverse outcomes. How different diet measures relate to frailty—a general measure of increased vulnerability to unfavorable health outcomes—and mortality risk, and how this might vary across the life course, is not known....
Article
Risk factors for developing dementia from mild cognitive impairment (MCI) likely differ between MCI subtypes. We investigated how frailty relates to dementia risk in amnestic MCI (a‐MCI; N = 2799) and non‐amnestic MCI (na‐MCI; N = 629) in the National Alzheimer's Coordinating Center database. Even though higher frailty increased dementia risk for p...
Preprint
Full-text available
Background The SARS-CoV-2 (Severe Acute Respiratory Syndrome coronavirus 2) has led to more than 114 million COVID-19 cases and over 2.5 million deaths worldwide. Epidemiological analysis has revealed that the risk of developing severe COVID-19 increases with age. Despite a disproportionate number of older individuals and long-term care facilities...
Article
In sporadic Alzheimer's disease (SpAD), acetylcholinesterase and butyrylcholinesterase, co-regulators of acetylcholine, are associated with β-amyloid plaques and tau neurofibrillary tangles in patterns suggesting a contribution to neurotoxicity. This association has not been explored in early-onset familial Alzheimer's disease (FAD). We investigate...
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Background Older adults want to live at home as long as possible, even in the face of circumstances that limit their autonomy. Home care services reflect this emergent preference, allowing older adults to ‘age in place’ in familiar settings rather than receiving care for chronic health conditions or ageing needs in an institutionalized setting. Num...
Article
Despite comprehensive multidisciplinary candidacy assessments to determine appropriateness for solid organ transplantation, limitations persist in identifying candidates at risk of adverse outcomes. Frailty measures may help inform candidacy evaluation. Our main objective was to create a solid organ transplant frailty index (FI), using the cumulati...
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Background: the Clinical Frailty Scale (CFS) was originally developed to summarise a Comprehensive Geriatric Assessment and yield a care plan. Especially since COVID-19, the CFS is being used widely by health care professionals without training in frailty care as a resource allocation tool and for care rationing. CFS scoring by inexperienced rater...
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Objective To examine the relative contributions of frailty and neuropathology to dementia expression in a population-based cohort study. Design Cross-sectional analysis of observational data. Setting Population-representative clinicopathological cohort study. Participants Adults aged 75+ recruited from general practice registries in Cambridge, U...
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Background With an ageing population, the number of people with frailty is increasing. Despite this trend, the extent to which the severity and lethality of frailty have changed over time is not well understood. We aimed to investigate how frailty severity and lethality have changed over an 18-year period in the USA. Methods In this population-bas...
Article
Background Social isolation is associated with an increased risk of adverse health outcomes, including functional decline, cognitive decline, and dementia. Intergenerational engagement, i.e. structured or semi structured interactions between non-familial older adults and younger generations is emerging as tool to reduce social isolation in older ad...
Article
Mutations in the microtubule-associated protein tau (MAPT) gene are known to cause progressive neurodegenerative disorders with variable clinical and neuropathological phenotypes, including the intronic 10 +14 (IVS10+14) splice site mutation. Three families have been reported with the IVS10+14 MAPT mutation. Here, we describe the clinical and neuro...
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Full-text available
Objectives People with neurogenic bladder and/or bowel dysfunction experience diverse challenges that can be difficult to evaluate with standardized outcome measures. Goal attainment scaling (GAS) is an individualized, patient-centric outcome measure that enables patients/caregivers to identify and track their own treatment goals. Because creating...
Article
The gradual accumulation of damage and dysregulation during the aging of living organisms can be quantified. Even so, the aging process is complex and has multiple interacting physiological scales – from the molecular to cellular to whole tissues. In the face of this complexity, we can significantly advance our understanding of aging with the use o...
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Background Atrial fibrillation (AF) is common in older people with frailty and is associated with an increased risk of stroke and systemic embolism. Whilst oral anticoagulation is associated with a reduction in this risk, there is a lack of data on the safety and efficacy of direct oral anticoagulants (DOACs) in people with frailty. This study aims...
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We develop a frailty index (FI) from continuous valued biomarker measurements that does not use thresholds to binarize deficits. In this work we construct a quantile frailty index (FI-Q) directly from risk quantiles, without binarizing the deficits. FI-Q is the average risk quantile for an individual in the population with respect to the set of mea...
Article
Full-text available
We have built a computational model of individual aging trajectories of health and survival, containing physical, functional, and biological variables, conditioned on demographic, lifestyle, and medical background information. We combine techniques of modern machine learning with a network approach, where the health variables are coupled by an inte...
Article
Full-text available
We have developed computational models of human aging that are based on complex networks of interactions between health attributes of individuals. Our “generic network model” (GNM) captures the population level exponential increase of mortality with age in Gompertz’s law together with the exponential decrease of health as measured by the frailty in...
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Background Atrial fibrillation (AF) is common in older people and is associated with increased stroke risk that may be reduced by oral anticoagulation (OAC). Frailty also increases with increasing age, yet the extent of OAC prescription in older people according to extent of frailty in people with AF is insufficiently described. Methods An electro...
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Background: Goal Attainment Scaling (GAS) is an individualized outcome measure that allows the setting of personalized treatment goals. We compared the responsiveness of GAS when individuals set only one goal instead of the recommended three or more goals. Methods: We conducted exploratory analyses on data from two randomized controlled trials:...
Article
People with Down syndrome are at an increased risk of developing Alzheimer’s Disease. As many more individuals with Down syndrome are now living into older adulthood, the prevalence of Alzheimer’s disease has risen significantly in this group. Identifying dementia symptoms in this setting can be daunting due to heterogeneous baseline function, cogn...
Article
Frailty is an established risk factor for cognitive decline and Alzheimer’s disease. Changes in frailty have been associated with adverse health outcomes including mortality, health service use, institutionalization, and disability. Few studies have examined the longitudinal relationship between frailty and cognition. Here, we use data from a longi...
Article
Predictions about future dementia prevalence vary but usually suggest large increases in numbers of people with dementia as the population ages. However, in some countries, for example, the US, UK and Netherlands, while overall numbers of people with dementia are growing as predicted, the age‐specific incidence rates of dementia have decreased subs...
Article
Within the National Alzheimer’s Coordinating Center (NACC) dataset, we quantified the associations of frailty and global neuropathological burden with clinical dementia severity, and explored whether frailty influences the expression of dementia at a given level of neuropathology. The sample included 2,621 individuals who had available clinical dat...
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Objectives To examine the feasibility and acceptability of NIDUS-Family, a 6–8 session manualised, individually tailored, modular intervention supporting independence at home for people with dementia; and explore participants’ and facilitators’ experiences of the intervention. Method In this single group multi-site feasibility study, trained, supe...