Ahead of print articles
PHYSICAL FRAILTY AND FUNCTIONAL RESILIENCE AFTER HIP FRACTURE IN OLDER ADULTS: A RISK-SET MATCHED LONGITUDINAL STUDY
Haiyan Hu, Fangfang Deng, Bo Chen
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BACKGROUND: Functional trajectories after hip fracture vary widely; whether physical frailty amplifies excess decline or instead marks poorer functional prognosis remains unclear.
OBJECTIVES: To distinguish these roles of physical frailty after hip fracture.
DESIGN: Population-based cohort study with risk-set matching and a case-only prognostic analysis.
SETTING: Community-based, China.
PARTICIPANTS: Adults aged at least 60 years participating in the China Health and Retirement Longitudinal Study, 2011–2020.
MEASUREMENTS: Hip-fracture cases were matched to up to 4 same-wave fracture-free comparators. Preceding-wave physical frailty was assessed using an adapted Fried score (0–5). Matched models estimated fracture-associated excess activities of daily living (ADL) and instrumental activities of daily living (IADL) change and Fried-score interactions; case-only models estimated the probability of being alive with ADL maintained at or returned to the pre-event level at the next survey.
RESULTS: The analysis included 252 cases (mean age at the first fracture-report interview, 70.6 years; 132 [52.4%] women) and 1005 comparator records. Relative to matched comparators, hip fracture was associated with greater ADL and IADL deterioration, with average excess increases of 0.73 difficulties in ADL (95% confidence interval [CI], 0.47 to 0.99) and 0.31 difficulties in IADL (95% CI, 0.09 to 0.53). The ADL contrast did not clearly vary by Fried score (interaction per criterion, 0.03; 95% CI, −0.28 to 0.34). Among cases, the adjusted probability of being alive with ADL maintained at or returned to the pre-event level declined from 72.9% at Fried score 0 to 46.4% at score 3 (risk difference, −26.5 percentage points; 95% CI, −50.3 to −2.8).
CONCLUSIONS: Physical frailty was associated with poorer functional prognosis, whereas evidence that it modified fracture-associated excess decline was unclear. Functional assessment should span frailty levels; frailty may inform support and follow-up intensity but should not determine rehabilitation access.
CITATION:
Haiyan Hu ; Fangfang Deng ; Bo Chen: Physical frailty and functional resilience after hip fracture in older adults: a risk-set matched longitudinal study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.1016/j.tjfa.2026.100210
DIAGNOSIS OF URINARY TRACT INFECTION IN THE EMERGENCY DEPARTMENT – A REAL INFECTION OR AN ALARMING INDICATION FOR COMPREHENSIVE GERIATRIC ASSESSMENT? A RETROSPECTIVE FOLLOW-UP STUDY
Laura Soikkeli, Marika Salminen, Tero Vahlberg, Laura Viikari, Ulla Hohenthal, Matti Viitanen
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PURPOSE: To investigate whether urinary tract infection (UTI) diagnoses assigned in the emergency department (ED) were true UTI infections, characterize hospitalized UTI patients, and analyze the 12-month mortality and institutionalization rates.
METHODS: A retrospective study among older adults (75+) who were admitted to the ED in 2017 and diagnosed UTI by the ED physician. Patients were categorized into four groups based on the level of UTI diagnosis and the follow-up treatment location: discharged cystitis, hospitalized cystitis, discharged pyelonephritis, and hospitalized pyelonephritis. Group differences were analyzed using Chi-squared, Fisher´s exact, or Mann-Whitney U tests. Logistic regression adjused for confounders was used to compare symptoms. Kaplan-Meier and Cox regression analyses were applied to asses mortality and institutionalization during the 12-month follow-up.
RESULTS: Of 658 ED-diagnosed UTIs, only 354 (54%) had significant bacterial growth in urine cultures. Nevertheless, antibiotics were prescribed in 98% of cases. Institutionalization was significantly higher among hospitalized (31%) than among discharged (11%) cystitis patients (log-rank test, p < 0.001); age, Carlson Comorbidity Index and frailty adjusted HR=2.72, 95% CI 1.62–4.55, p < 0.001). Interestingly, hospitalized cystitis patients had higher institutionalization rates (31%) than hospitalized pyelonephritis patients (15%) (log-rank test, p = 0.003; age and gender adjusted HR=0.52, 95% CI 0.31–0.87, p = 0.014).
CONCLUSIONS: In ED UTIs are frequently overdiagnosed in older adults, often masking more complex underlying conditions. Because a hospitalization for cystitis serves as a major red flag for institutionalization within a year, these patients require an urgent comprehensive geriatric assessment rather than just a standard infection diagnosis.
CITATION:
Laura Soikkeli ; Marika Salminen ; Tero Vahlberg ; Laura Viikari ; Ulla Hohenthal ; Matti Viitanen ; Maarit Wuorela: Diagnosis of urinary tract infection in the emergency department – a real infection or an alarming indication for comprehensive geriatric assessment? A retrospective follow-up study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.1016/j.tjfa.2026.100208
LETTER TO THE EDITOR: RETHINK POVERTY DURING AGE: TIME FOR UMBERTO D. AGAIN
Emanuele Marzetti, Hélio Jose Coelho-Junior
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CITATION:
Emanuele Marzetti ; Hélio Jose Coelho-Junior ; ; (2026): Letter to the Editor: Rethink poverty during age: Time for Umberto D. again. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.1016/j.tjfa.2026.100197
LETTER TO THE EDITOR: SYSTEMIC BARRIERS TO GERIATRIC CARE IN SOUTH AFRICA: A QUALITATIVE STAKEHOLDER-INFORMED ANALYSIS
Linda Mayer, Tersia Ellis, Rebecca Foxton, Dhanalutchmee Govender, Wanda Serena Pettersson, Kathryn Stinson, Janette Strauss, Jeanne Uys
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CITATION:
Linda Mayer ; Tersia Ellis ; Rebecca Foxton ; Dhanalutchmee Govender ; Wanda Serena Pettersson ; Kathryn Stinson ; Janette Strauss ; Jeanne Uys ; (2026): Letter to the Editor: Systemic barriers to geriatric care in South Africa: A qualitative stakeholder-informed analysis✰. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.1016/j.tjfa.2026.100198
FAT-FREE MASS INDEX AND APIXABAN EXPOSURE IN FRAIL HOSPITALIZED OLDER ADULTS: AN EXPLORATORY STUDY
Tancrède de Jerphanion, Olivier Brière, Jennifer Gautier, Alexis Bourgeais, Cédric Annweiler, Mathieu Corvaisier
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BACKGROUND: Reduced muscle mass may influence creatinine-based renal estimates and direct oral anticoagulant exposure in frail older adults.
OBJECTIVES: To explore the relationship between fat-free mass index (FFMI) and apixaban trough concentrations in hospitalized older adults.
METHODS: In this retrospective study, FFMI was assessed by bioelectrical impedance analysis in patients aged ≥75 years treated with apixaban. FFMI was considered a body-composition marker, not a diagnostic criterion for sarcopenia.
RESULTS: Among 305 screened patients, 43 receiving apixaban 5 mg twice daily with compliant trough sampling were included. Mean age was 83.6 ± 5.8 years. FFMI correlated inversely with apixaban concentrations in the unadjusted analysis (Spearman’s ρ = −0.34, p = 0.024). In univariable linear regression, lower FFMI was associated with higher apixaban concentrations (β = −8.64 ng/mL per kg/m², 95% CI −16.15 to −1.13; p = 0.025), but this association was not confirmed after adjustment for sex and serum creatinine (adjusted β = −6.77, 95% CI −15.20 to 1.65; p = 0.112) or in the sensitivity analysis including both dose groups (n = 82; ρ = −0.06, p = 0.575). Body weight, BMI, and creatinine-based renal estimates were not significantly associated with apixaban concentrations.
CONCLUSIONS: An inverse relationship between FFMI and apixaban trough concentrations was observed in the unadjusted primary analysis but was not confirmed after multivariable adjustment or in the sensitivity analysis. This preliminary signal should be considered hypothesis-generating and requires confirmation in larger prospective studies.
CITATION:
Tancrède de Jerphanion ; Olivier Brière ; Jennifer Gautier ; Alexis Bourgeais ; Myriam Mellou ; Léa Bourreau ; Cédric Annweiler ; Mathieu Corvaisier ; ; (2026): Fat-free mass index and apixaban exposure in frail hospitalized older adults: An exploratory study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/110.1016/j.tjfa.2026.100201
ASSOCIATION OF PLASMA GROWTH DIFFERENTIATION FACTOR-15 WITH THE FRAILTY PHENOTYPE – EVIDENCE FROM THE COGFRAIL STUDY
Federico Bellelli, Juan Luis Sanchez Sanchez, Davide Angioni, Alexandre Lucas, Yves Rolland, Marco Proietti, Bruno Vellas, Philipe De Souto Barreto, Sandrine Sourdet
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BACKGROUND: Growth differentiation factor-15 (GDF-15) has been consistently associated with physical frailty. However, it remains unclear whether GDF-15 further discriminates adverse outcomes among older adults who are already physically and cognitively impaired.
OBJECTIVES: To evaluate whether GDF-15 is associated with measures of physical frailty - incident weight loss, decline in muscle strength and gait speed, fatigue, and sedentary behaviours - over a 2-year follow-up.
DESIGN: Monocentric prospective study
SETTING: Frailty and Memory Clinics, Gérontopôle Toulouse University-Hospital.
PARTICIPANTS: 206 pre-frail and frail older adults with cognitive impairment from the COGFRAIL study with available plasma GDF-15 concentrations (median age 82.0). Secondary analyses were performed in a subgroup with repeated GDF-15 measurements during follow-up (n = 129).
MEASUREMENTS: GDF-15 concentrations were analysed as a continuous variable and by tertiles. Exploratory analyses used two thresholds: 1500pg/mL (eligibility cut-off for GDF-15 inhibitor treatment in cancer-cachexia) and 2443pg/mL (upper tertile of the 6-month distribution).
RESULTS: Higher GDF-15 levels were associated with a steeper decline in handgrip strength over time (p = 0.047), with no significant associations for weight loss, gait speed, sedentary behaviour, or fatigue. By tertiles, participants in the highest tertile had greater handgrip strength decline compared to those in the lowest (p = 0.018). Participants in the intermediate group had a higher risk of worsening frailty (p = 0.013) and incident weight loss (SHR 2.51; 95% CI: 1.04–6.04; p = 0.040) compared with the lowest tertile. Individuals with persistently high or increasing GDF-15 concentrations (≥2443pg/mL) experienced greater decline in handgrip strength than those with persistently low levels (p < 0.001).
CONCLUSIONS: Higher plasma GDF-15 concentrations consistently predicted a steeper decline in muscle strength over time. Associations with incident weight loss and worsening frailty were also observed, although they appeared weaker at higher concentrations, possibly because of greater competing mortality in participants with very high GDF-15 levels. Further research should clarify the mechanisms linking GDF-15 to physical decline and weight loss, and whether targeting this pathway could help slow frailty progression
CITATION:
Federico Bellelli ; Juan Luis Sanchez Sanchez ; Davide Angioni ; Alexandre Lucas ; Yves Rolland ; Marco Proietti ; Bruno Vellas ; Philipe De Souto Barreto ; Sandrine Sourdet ; ; (2026): Association of plasma growth differentiation factor-15 with the frailty phenotype – Evidence from the COGFRAIL study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.1016/j.tjfa.2026.100194
COMPONENTS AND CLASSIFICATION OF FRAILTY AND PALLIATIVE CARE
Tjeerd van der Ploeg, Johan Wens, Robbert J J Gobbens
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BACKGROUND: Globally, the number of people aged 65 years and older is expected to double by 2050. With increasing age, the risk of frailty and the need for palliative care also rise. A shared understanding of how to assess frailty and determine the need for palliative care could support interprofessional collaboration in clinical practice. The transition from a frail condition to palliative care is a dynamic and individualized process. Although frailty and palliative care are distinct concepts, they may overlap. The present study aimed to examine the components of frailty and palliative care in community-dwelling older people. Early recognition by healthcare professionals of the components that contribute to severe frailty can enable the timely initiation of palliative care. Our second aim was to gain insight into whether an individual should be classified as frail or in need of palliative care according to healthcare professionals.
METHODS: We presented fifteen case studies to respondents who were selected based on their specific expertise in the Netherlands and Belgium. Each respondent was asked to identify, for each case study, the components that indicated frailty, palliative care needs, or both. Additionally, they were asked to rate their level of certainty regarding each indication. Wilcoxon tests were employed to assess differences, and regression analyses were conducted to identify the components most strongly associated with frailty and in need of palliative care.
RESULTS: In most cases, differences were observed between the identification of frailty and palliative care needs, with par-ticipants indicating that a patient could exhibit components of frailty without necessarily having palliative care needs (p-value < 0.05). In no case were palliative components recognized with greater certainty than components of frailty. The case in our study with the highest certainty score for frailty components showed a significant difference compared to the corresponding certainty score for palliative care needs. Conversely, the case with the highest certainty score for palliative care needs did not differ significantly from the certainty score for frailty components.
CONCLUSIONS: Our study showed that healthcare professionals use different components to classify individuals as frail or in need of palliative care. In addition, these professionals were more certain in identifying frailty than in identifying palliative care needs, and may be less likely to recognize palliative care needs in their patients, who may already be quite frail. Improved understanding of the progression from frailty to the need for palliative care may support patient-centered care and increase enhance the quality of life for individuals requiring support.
CITATION:
Tjeerd van der Ploeg ; Johan Wens ; Robbert J J Gobbens ; ; (2026): Components and classification of frailty and palliative care. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.1016/j.tjfa.2026.100196
HIGHER CYSTATIN C, BUT NOT CREATININE, PREDICTS FRAILTY RISK IN INDIVIDUALS WITH NORMAL KIDNEY FUNCTION
Fan Zhang, Yue Xing, Yan Bai, Liuyan Huang, Yifei Zhong
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OBJECTIVE: This study investigates the associations of creatinine and cystatin C with frailty risk in individuals with normal kidney function, using data from the Health and Retirement Study (HRS) and the China Health and Retirement Longitudinal Study (CHARLS).
METHODS: We used CKD-EPI to estimate glomerular filtration rate based on serum creatinine (eGFRscr) and cystatin C (eGFRcysc), respectively, and an eGFR ≥60 was considered "normal kidney function". Frailty was assessed using a frailty index derived from clinical and functional measures. Cox proportional hazards models were used to evaluate the associations of creatinine and cystatin C with incident frailty, adjusting for demographic, lifestyle, and clinical covariates.
RESULTS: Creatinine levels showed no significant association with frailty risk in individuals with normal kidney function across both cohorts. In contrast, cystatin C levels were consistently and significantly associated with an increased risk of frailty in individuals with normal eGFRscr. For each 1-unit increase in cystatin C, the adjusted hazard ratios (HRs) were 2.05 (95% CI: 1.30–3.22) in HRS and 2.12 (95% CI: 1.60–2.82) in CHARLS. Quartile analyses revealed a dose-response relationship, with the highest quartile of cystatin C associated with significantly higher frailty risk compared to the lowest quartile (HRS: HR = 1.34, 95% CI: 1.02–1.76; CHARLS: HR = 1.70, 95% CI: 1.40–2.07).
CONCLUSIONS: Higher cystatin C levels, but not creatinine levels, were significantly associated with an increased risk of frailty among individuals with normal kidney function, suggesting that cystatin C may be a useful biomarker for early identification of frailty risk.
CITATION:
Fan Zhang ; Yue Xing ; Yan Bai ; Liuyan Huang ; Yifei Zhong ; ; (2026): Higher cystatin C, but not creatinine, predicts frailty risk in individuals with normal kidney function. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.1016/j.tjfa.2026.100195
INTRINSIC CAPACITY AND SELF-PERCEIVED HEALTH AMONG HOME-DWELLING OLDER ADULTS: THE HUNT STUDY
Kjerstin Næss Melsæter, Turid Follestad, Gro Gujord Tangen, Beatrix Vereijken, Pernille Thingstad
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PURPOSE: To describe intrinsic capacity (IC) distribution across age and sex and investigate its subdomains’ association with self-perceived health in home-dwelling older adults.
METHODS: This cross-sectional study used population-based data from the Trøndelag Health Study (HUNT). Self-perceived health was assessed by a 4-point Likert scale and dichotomized into good or poor health. IC consists of five subdomains (vitality, locomotion, cognition, psychological, and sensory capacity), assessed in line with the WHO recommendations. Capacity in locomotion and cognition was assessed by the SPPB and MoCA, while the remaining subdomains were assessed through questionnaires. Associations between subdomains and self-perceived health were examined using simple and multiple regression models, adjusting for age and education.
RESULTS: We included 8718 home-dwelling older adults (aged 70–101 years; 52.5% women). Good health was reported by 69.8% among those < 85 years and by 48.6% among those ≥ 85 years. High capacity in ≥ 3 subdomains was observed in 79.3% and 40.9% among individuals < 85 years and ≥ 85 years, respectively. High locomotor capacity showed the strongest association with good self-perceived health. The probability of poor self-perceived health increased with lower IC, but among women, significantly less by older age and more by higher education.
CONCLUSION: We observed a strong association between IC and self-perceived health, suggesting that IC is closely linked to individuals’ self-perceived health. Our findings support IC as a relevant tool in the shift toward preventive, health-promoting care, and we believe the use of IC can help tailor interventions to optimize functional ability and well-being.
CITATION:
Kjerstin Næss Melsæter ; Turid Follestad ; Gro Gujord Tangen ; Beatrix Vereijken ; Pernille Thingstad ; ; (2026): Intrinsic capacity and self-perceived health among home-dwelling older adults: The HUNT study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.1016/j.tjfa.2026.100188
EFFECT OF SEATED AEROBIC EXERCISE ON PHYSICAL ENDURANCE IN LONG-TERM CARE RECIPIENTS: SECONDARY ANALYSIS OF A CLUSTER NON-RANDOMIZED CONTROLLED TRIAL
Makoto Asaeda, Kiyo Ueda, Takeya Araki, Noriaki Maeda, Yuki Nakashima, Kouki Fukuhara, Ken Kouda, Yukio Mikami
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BACKGROUND: Japan's long-term care insurance (LTCI) system provides rehabilitation services. This study examined whether adding seated aerobic exercises to daycare rehabilitation improves endurance and frailty.
METHODS: We performed a secondary analysis of a cluster nonrandomized trial conducted at 10 Japanese daycare facilities. Certified older adults requiring care were enrolled in September 2023. Facilities were allocated to the aerobic program or the usual rehabilitation. The aerobic program included seated stepping and arm movements at 120 bpm for two 2-minute sets during rehabilitation for 6 months. Outcomes included the 2-minute step test, Borg scale, grip strength, Timed Up and Go (TUG) test, Barthel Index, and frailty classification using Japanese Cardiovascular Health Study criteria (J-CHS). Analyses used baseline-adjusted analysis of covariance (ANCOVA) with group, frailty category, and interaction as fixed effects. Mixed-effects models with facility as a random intercept were used for sensitivity analyses.
RESULTS: Of 575 screened individuals, 308 were enrolled, and 252 completed the assessment (aerobic, n = 119; usual, n = 133). The aerobic group showed greater 2-minute step test performance (adjusted mean 103.883 vs. 84.494; mean difference 19.388, 95 % CI 7.350–31.426; p = 0.002). Borg scores were lower in the aerobic group (difference −1.093; 95 % CI −2.202 to 0.015; p = 0.053). Other measures showed no significant between-group differences. Frailty distribution differed at 6 months (p = 0.036), with reduced frailty in the aerobic group.
CONCLUSIONS: Brief seated aerobic exercise within LTCI daycare rehabilitation improved endurance and modestly improved frailty classification. These findings support aerobic exercise in LTCI rehabilitation; however, nonrandom allocation and lack of blinding limit interpretation.
CITATION:
Makoto Asaeda ; Kiyo Ueda ; Takeya Araki ; Noriaki Maeda ; Yuki Nakashima ; Kouki Fukuhara ; Ken Kouda ; Yukio Mikami ; ; (2026): Effect of seated aerobic exercise on physical endurance in long-term care recipients: secondary analysis of a cluster non-randomized controlled trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.1016/j.tjfa.2026.100184
JFA N°04 - 2026
EDITORIAL: CHALLENGES IN ASSESSING MUSCLE FUNCTION WITHIN SARCOPENIA AND INTRINSIC CAPACITY FRAMEWORKS
D Azzolino, T Lucchi
J Frailty Aging 2026;15(4)
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CITATION:
D Azzolino ; T Lucchi (2025): Editorial: Challenges in assessing muscle function within sarcopenia and intrinsic capacity frameworks. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100162
EDITORIAL: “THIS HAS NO FLAVOR”: BALANCING NUTRITION, TASTE, AND SALT RESTRICTION IN GERIATRIC CARE UNITS
Emanuele Marzetti, Riccardo Calvani, Isabel Rodriguez Sanchez, Hélio Jose Coelho-Junior
J Frailty Aging 2026;15(4)
Show summaryHide summarySalt (sodium chloride, NaCl) has played a fundamental role in human history, not only as a dietary component but also as a cultural, symbolic, and economic resource. Global salt intake remains high and heterogeneous, with marked geographical variation in both consumption levels and dietary sources. Numerous studies have shown significant associations between salt consumption and adverse health outcomes. Hospitals have implemented salt-restriction strategies that may have unintended consequences for food palatability and nutritional intake, particularly among older adults. In geriatric settings, where appetite-related disorders such as dysgeusia, dysphagia, and xerostomia are common, strict dietary sodium restriction may further compromise food consumption and increase the risk of malnutrition. Here, we discuss the potential implications of salt restriction in acute geriatric care, highlighting its possible impact on dietary intake, palatability and nutritional status.
CITATION:
Emanuele Marzetti ; Riccardo Calvani ; Isabel Rodriguez Sanchez ; Hélio Jose Coelho-Junior (2025): Editorial: “This has no flavor”: balancing nutrition, taste, and salt restriction in geriatric care units. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100183
METABOLOMIC PROFILES OF DIETARY EXPOSURE ASSOCIATED WITH FRAILTY IN OLDER ADULTS: A SYSTEMATIC REVIEW
Samar El Sherbiny, Evgeniia Puzankova, Miriam Martínez-Huélamo, Natàlia Garcia-Giralt, Jose Antonio Carnicero Carreño, Leocadio Rodriguez Mañas, Jose Antonio Serra Rexach, Francisco José García García, Xavier Nogués, Pedro Abizanda Soler, Cristina Andrés-Lacueva, Montserrat Rabassa
J Frailty Aging 2026;15(4)
Show summaryHide summaryFrailty is defined by the World Health Organization as a state of increased vulnerability in older adults, characterized by a decline in physiological functions across multiple systems and heightened sensitivity to external stressors. The global prevalence of frailty is expected to rise due to population ageing, highlighting the need for effective preventive strategies. However, while diet can play a crucial role in this context, their relationship is complex and potentially bidirectional: unhealthy dietary patterns may contribute to the onset of frailty, whereas early stages of frailty may influence food choices through limitations in meal preparation, and appetite. Hence, identifying biomarkers associated with frailty phenotypes may help clarify these mechanisms and improve prevention strategies. This systematic review aims to summarize current evidence on metabolomics-derived biomarkers potentially involved in the relationship between dietary patterns and frailty. A comprehensive literature search was conducted across three electronic databases (PubMed, Web of Science, Scopus) in accordance with the PRISMA guidelines, yielding 1661 studies, of which five met the inclusion criteria. Three dietary exposures were identified and analyzed: fruit and vegetable, plant/animal protein intake, and adherence to the Mediterranean diet. The findings suggest that specific metabolites, such as hippuric acid, different amino acids, and lipid derived compounds may represent potential candidates for establishing a metabolic signature of frailty. Nevertheless, current evidence remains limited and unclear about the direction of associations. Further research is needed, particularly in healthy populations, to validate the effectiveness of these biomarkers, and tailor guidelines specific for older adults.
CITATION:
Samar El Sherbiny ; Evgeniia Puzankova ; Miriam Martínez-Huélamo ; Natàlia Garcia-Giralt ; Jose Antonio Carnicero Carreño ; Leocadio Rodriguez Mañas ; Jose Antonio Serra Rexach ; Francisco José García García ; Xavier Nogués ; Pedro Abizanda Soler ; Cristina Andrés-Lacueva ; Montserrat Rabassa (2025): Metabolomic profiles of dietary exposure associated with frailty in older adults: A systematic review. https://doi.org/10.1016/j.tjfa.2026.100163
PHENOTYPES OF FRAILTY AND THEIR MORTALITY AND DISABILITY IMPLICATIONS
Lorena Suárez Portugués, José A. Carnicero, Alonso Sepúlveda Martínez, Fabio A. Quiñónez Bareiro, Ana Alfaro Acha, Ignacio Ara, Leocadio Rodriguez Mañas, Francisco J. García García
J Frailty Aging 2026;15(4)
Show summaryHide summaryBACKGROUND: Frailty is a geriatric syndrome defined as increased vulnerability to stressors due to dysfunction in multiple physiological systems, measured by different tools.
OBJECTIVES: To assess whether participants characterized as frail by multiple scales simultaneously have differentiated risks.
DESIGN: Prospective population-based cohort study.
SETTING AND PARTICIPANTS: Community-dwelling adults from the first wave of The Toledo Study for Healthy Aging (TSHA), including a total of 1.563 participants with a mean age of 74.51 years. Frailty was assessed using three tools: the Frailty Index (FI), the Fried Phenotype, and the Frailty Trait Scale (FTS-5). Eight groups were defined based on the presence or absence of frailty according to these scales. Associations between frailty categories and outcomes were evaluated using multivariate Cox proportional hazards models for mortality and logistic regression models for incident and worsening disability.
RESULTS: The FTS-5 scale identified the highest number of frail participants, suggesting it may be the most sensitive tool for detecting early physiological changes related to aging. Risk of adverse events varied depending on the specific combination of frailty criteria met. Individuals classified as frail by both FTS-5 and FI exhibited the highest mortality risk, exceeding that of participants frail on all three scales. Regarding worsening health or disability, the highest risk was among those frails on all three scales, followed closely by the FTS-5-FI group.
CONCLUSION: Our findings highlight variability in frailty assessment, showing that different instruments capture complementary aspects of frailty and that their combined use may improve risk stratification.
CITATION:
Lorena Suárez Portugués ; José A. Carnicero ; Alonso Sepúlveda Martínez ; Fabio A. Quiñónez Bareiro ; Ana Alfaro Acha ; Ignacio Ara ; Leocadio Rodriguez Mañas ; Francisco J. García García (2025): Phenotypes of frailty and their mortality and disability implications. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100164
COMPARING TWO METHODS TO QUANTIFY PHYSICAL RESILIENCE
Heather E. Whitson, Marissa Ashner, Virginia B. Kraus, Sarah Peskoe, Janet L. Huebner, Corey B. Simon, Katherine Hall, Cathleen Colon-Emeric
J Frailty Aging 2026;15(4)
Show summaryHide summaryPhysical resilience, conceptualized as the extent of observed recovery after a health stressor, is an important construct in research on aging and frailty. Various methods have been proposed to quantify physical resilience using repeated measures of health or function following a stressor. The purpose of this analysis is to directly compare two alternative approaches to quantifying physical resilience – the recovery trajectory (RT) and the expected recovery differential (ERD) – using data from 170 older adults in an observational study of elective knee replacement surgery. Each participant’s resilience, based on repeated measures of pain interference over 6 months after surgery, was determined using both the RT and the ERD method. The 10 individuals classified as high resilience based on RT also had better-than-expected recovery based on ERD. However, ERD scores were more variable among individuals classified by RT as moderate resilience (n = 82). Of those classified as low resilience (n = 78) by RT, most (85.9%) also had worse-than-expected recovery based on ERD. In this head-to-head comparison of two conceptually distinct approaches for quantifying resilience after a health stressor, the results were most comparable in individuals at extremes of high or low recovery patterns. Each approach has merit for quantifying physical resilience after a health stressor, and factors that may influence the choice of method and interpretation of results are discussed.
CITATION:
Heather E. Whitson ; Marissa Ashner ; Virginia B. Kraus ; Sarah Peskoe ; Janet L. Huebner ; Corey B. Simon ; Katherine Hall ; Cathleen Colon-Emeric (2025): Comparing two methods to quantify physical resilience. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100179
EXERCISE TO PREVENT FALLS IN OLDER ADULTS WITH PHYSICAL FRAILTY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Poonam Mehta, Eduardo Caldas Costa, Leony Morgana Galliano, Lara Vlietstra, Bruno T Saragiotto, Eduardo Lusa Cadore, Mikel Izquierdo, Debra L. Waters
J Frailty Aging 2026;15(4)
Show summaryHide summaryINTRODUCTION: Physical frailty is associated with increased risk of falls. Although exercise mitigates age-related declines, evidence regarding its effects on falls in older adults with frailty is limited. This systematic review examined the effects of exercise on fall-related outcomes in older adults with frailty.
METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and CINAHL for randomised controlled trials published from 2001 (when the Fried frailty phenotype was introduced) to January 2024. Eligible studies included older adults with frailty and reported at least one of the following outcomes: i) physical function (gait speed, strength, balance), ii) fear of falling, or iii) falls incidence. Meta-analyses were conducted using random-effects models, with results presented as weighted/standardized mean differences with 95% confidence intervals.
RESULTS: Fourteen studies (n = 2719; mean age range 73–86 years) were included, most of which used the Fried frailty phenotype (n = 12) and were conducted in Europe (n = 6). Most interventions included multicomponent (n = 10) and resistance (n = 4) training. Exercise improved gait speed (MD 0.09 m/s, 0.02/0.15; I2=94%; n = 5), TUG (MD -3.73 s, -5.92/-1.55; I2=95%; n = 6), and 5-times sit-to-stand (MD -2.66 s, -4.19/-1.14; I2=77%; n = 4) over short-term period (≤12 weeks), with low-to-very low certainty evidence. A trend toward improved balance was also noted (SMD 2.80, -0.17/5.76; p = 0.06; I²=99%; n = 5), with very low certainty evidence. Limited data was observed for fear of falling (n = 1) and falls incidence (n = 2).
CONCLUSIONS: Exercise training enhances physical function in older adults with physical frailty. However, its impact on fear of falling and fall incidence remains uncertain.
CITATION:
Poonam Mehta ; Eduardo Caldas Costa ; Leony Morgana Galliano ; Lara Vlietstra ; Bruno T Saragiotto ; Eduardo Lusa Cadore ; Mikel Izquierdo ; Debra L. Waters (2026): Exercise to prevent falls in older adults with physical frailty: A systematic review and meta-analysis. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100187
FRAILTY DIMENSIONS AND COGNITIVE FUNCTION IN RELATION TO DUAL-TASK COST: A MULTIDOMAIN ANALYSIS IN COMMUNITY-DWELLING OLDER ADULTS
Louise Heyzer, Kristabella Low, Cai Ning Tan, Audrey Yeo, Jia Qian Chia, Justin Chew, Joanne Kua, Wee Shiong Lim
J Frailty Aging 2026;15(4)
Show summaryHide summaryBACKGROUND: Dual-task cost (DTC) is the performance decline observed during simultaneous motor and cognitive tasks. It is associated with cognitive and physiological vulnerability. However, it remains unclear how specific frailty dimensions and cognitive domains contribute to DTC during arithmetic and verbal fluency tasks.
OBJECTIVES: We aim to investigate the independent associations between physical, social and oral frailty dimensions versus cognition function with DTC in community-dwelling older adults.
METHODS: We studied 281 participants from the GeriLABS-2 study. Physical frailty was assessed using Fried’s Frailty Phenotype, social frailty using the 8-item Social Frailty Scale (SF8) and oral frailty using the Oral Frailty Index-8 (OFI-8). Cognitive function was assessed with Chinese Mini Mental State Examination (CMMSE) and Chinese Frontal Assessment Battery (CFAB). DTC on gait was assessed with arithmetic (counting backwards from 100) and verbal fluency (animal naming) cognitive tasks. Association of DTC with frailty dimensions and cognition were evaluated via hierarchical linear regression, adjusted for demographics.
RESULTS: Higher CFAB score was significantly associated with lower DTC in both arithmetic (B=-2.067, p < 0.001) and verbal fluency (B=-1.489, p = 0.020) tasks, suggesting individuals with better executive function showed lower DTC. Social frailty (Factor 2 – social activity and financial resources) and oral frailty (Factor 3 – dietary and social habits) were significantly associated with DTC for arithmetic task (B = 2.664, p = 0.030; B = 3.718, p = 0.007). No significant association was observed for physical frailty. The final composite model showed that CFAB has a significant associated with DTC arithmetic (B=-2.012, p < 0.001) and DTC verbal fluency (B=-1.537, p = 0.016) tasks.
CONCLUSION: Cognitive frailty, particularly executive dysfunction, is a key factor contributing to difficulties with dual tasking. Social and oral frailty factors may influence DTC during arithmetic tasks, however their effects were attenuated after adjusting for cognition. Interventions addressing cognitive frailty may be a promising target for mitigating DTC in older adults.
CITATION:
Louise Heyzer ; Kristabella Low ; Cai Ning Tan ; Audrey Yeo ; Jia Qian Chia ; Justin Chew ; Joanne Kua ; Wee Shiong Lim (2025): Frailty dimensions and cognitive function in relation to dual-task cost: A multidomain analysis in community-dwelling older adults. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100166
INCIDENT DEMENTIA RISK BY FRAILTY STATUS AND LIVING ARRANGEMENTS IN OLDER ADULTS
Kate McEwen, Suraj Samtani, Rory Chen, John D. Crawford, Perminder S. Sachdev, Katya Numbers
J Frailty Aging 2026;15(4)
Show summaryHide summaryBACKGROUND: Frailty and social isolation are independently associated with dementia risk. This study examined whether frailty predicts dementia differently for older adults living alone versus with others.
METHODS: Participants were 967 community-dwelling, dementia-free older adults from the Sydney Memory and Ageing Study (2005–2020). Frailty was assessed using an adapted Fried Frailty Phenotype (robust, pre-frail, frail). Dementia was diagnosed via biennial neuropsychological testing and clinical consensus. Cox regressions analysed associations between baseline frailty, living arrangements (alone vs. with others), and incident dementia over 12 years.
RESULT: Frail individuals had 1.74 times higher dementia risk than robust individuals (HR = 1.74, 95% CI: 1.16–2.60, p = .007). Living alone was not independently associated with dementia (HR = 1.03, p = .825). The interaction between frailty and living arrangements was non-significant (HR = 1.23, p = 0.600). Exploratory stratified analyses showed frailty predicted dementia among those living alone (HR = 1.92, 95% CI: 1.06–3.51, p = .033) but not those living with others (HR = 1.42, p = 0.224).
CONCLUSION: Frailty is a significant predictor of dementia risk in older adults. While the formal interaction test was non-significant, exploratory findings suggest frail individuals living alone may be particularly vulnerable, warranting further investigation and potential targeting for combined physical and social interventions, pending replication.
CITATION:
Kate McEwen ; Suraj Samtani ; Rory Chen ; John D. Crawford ; Perminder S. Sachdev ; Henry Brodaty ; Katya Numbers (2026): Incident dementia risk by frailty status and living arrangements in older adults. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100185
COMPARING TWO COMMON FRAILTY MEASURES IN THE RESIDENT ASSESSMENT INSTRUMENT IN HOME CARE (RAI-HC): A CROSS-SECTIONAL COHORT STUDY IN ALBERTA
Jananee Rasiah, Andrea Gruneir, Jeffrey Poss, Jayna Holroyd-Leduc, Greta.G. Cummings
J Frailty Aging 2026;15(4)
Show summaryHide summaryBACKGROUND: Many older adults living with frailty rely on publicly funded home care services; however, the health profile of home care clients in Alberta is not well characterized, particularly regarding how different frailty measures embedded within the Resident Assessment Instrument in Home Care (RAI-HC) classify frailty. We aimed to compare the Changes in Health, End-stage disease and Signs Scale (CHESS) and the 72-item Frailty Index (Full FI) in this study.
METHODS: A cross-sectional study was conducted using Alberta population-based administrative data linked to RAI-HC assessments for long-stay home care clients aged 65–104 years (N = 19,916) between 2015 and 2016. Various health and functional characteristics were summarized across robust, pre-frail, and frail groups as defined by CHESS and Full FI. Group differences were examined using chi-square tests, and agreement between measures was assessed using a weighted kappa statistic.
RESULTS: Frailty prevalence differed markedly by measure: 27% were classified as frail using CHESS compared with 11% using the Full FI. Agreement between measures was fair (k = 0.31), reflecting their measurement of different constructs; acute health instability (CHESS) versus multidimensional deficit accumulation (Full FI).
CONCLUSIONS: Differences in frailty classification underscore the conceptual distinctions between CHESS and the Full FI. The Full FI is feasible to derive from RAI-HC data and may better identify modifiable deficits relevant to care planning, while CHESS is more sensitive to acute deterioration. Using both measures together may enhance frailty identification, support tailored home care interventions, and improve resource allocation for older adults aging in place.
CITATION:
Jananee Rasiah ; Andrea Gruneir ; Jeffrey Poss ; Jayna Holroyd-Leduc ; Greta.G. Cummings (2026): Comparing two common frailty measures in the resident assessment instrument in home care (RAI-HC): a cross-sectional cohort study in Alberta. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100165
EXPLORING SEX DIFFERENCES IN FRAILTY AND HOSPITALIZATION AMONG OLDER ADULTS WITH DIABETES IN VIETNAM
Tan Van Nguyen, Dung Ngoc Truong, Wei Jin Wong, Mark Woodward
J Frailty Aging 2026;15(4)
Show summaryHide summaryBACKGROUND: Older adults with diabetes often face multiple health challenges such as frailty. Sex-related differences in frailty may influence health outcomes in this population. This study sought to examine the prevalence of frailty in older adults with type 2 diabetes in an older cohort in Vietnam, and the association between frailty and hospitalizations, with a focus on sex disparities.
RESEARCH DESIGN AND METHODS: An observational cohort study was conducted at two tertiary hospitals in Vietnam from November 2022 to June 2023. Patients aged 60 years or above with type 2 diabetes that visited the cardio-metabolic clinics during the study period were recruited. Frailty was measured using Fried’s frailty criteria. Logistic regression models were applied to examine the association between frailty and all-cause hospitalization over 6 months. Ratios of odds ratios (ORs) were computed to quantify the sex difference.
RESULTS: There were 644 participants, with a mean age of 71.8 years (SD 7.6), and 30.0% were classified as frail. The prevalence of frailty in women was higher compared to men (31.3%vs 28.8%, p < 0.001). The adjusted ORs of frailty on 6-month all-cause hospitalization were 3.30 (95% CI 1.37–7.98) in women, and 2.01 (95% CI 0.88–4.59) in men.
CONCLUSIONS: In this study, frailty was more prevalent in women and was associated with an increased risk of hospitalizations in women than in men. This study adds to the understanding of how frailty and sex influence health outcomes in older adults with diabetes, implying the need for sex-specific approaches in managing diabetes in older adults.
CITATION:
Tan Van Nguyen ; Dung Ngoc Truong ; Wei Jin Wong ; Mark Woodward ; Tu Nguyen (2025): Exploring sex differences in frailty and hospitalization among older adults with diabetes in Vietnam. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100168
SCREENING OF INTRINSIC CAPACITY IMPAIRMENT IN COMMUNITY-DWELLING OLDER ADULTS IN CAMEROON: A NATIONAL CROSS-SECTIONAL STUDY
Thierry Roland Njille Ehawa, Gustave Mabiama, Marie-Josiane Ntsama Essomba, Christine Fernande Nyangono Biyegue, Maturin Tabue-Teguo, Isabelle Bourdel-Marchasson
J Frailty Aging 2026;15(4)
Show summaryHide summaryOBJECTIVE: This study aimed to determine the prevalence of intrinsic capacity (IC) impairment among community-dwelling older adults in Cameroon, and to assess the applicability of ICOPE Step 1 cutoffs for nutrition and locomotion.
METHODS: A national cross-sectional study was conducted from January to June 2024 across the ten regions of Cameroon. A two-stage sampling method was used to include 597 older adults (≥ 60 years). IC was assessed using step 1 of the Integrated Care to Older People (ICOPE) screening tool. For validation, Step 1 vitality was compared against the Mini Nutritional Assessment Short-Form (MNA-SF), and Step 1 locomotion against the Rosow-Breslau disability score. Any impairment reported for one of the IC domains was considered as positive screening. A p-value < 0.05 was used to define statistical significance.
RESULTS: A total of 597 participants were included with a majority of women (54.9 %). The median age was 68 (interquartile range 63–73) years. Furthermore, validation analyses showed that impaired vitality at Step 1 had a sensitivity of 62.7 % and a specificity of 77.3 %. The PPV was 84.3 % and a significant agreement was found (K = 0.357; p < 0.001). Regarding locomotion, a highly significant difference (p < 0.001) in Rosow-Breslau mean scores was observed between participants with and without an alert (1.23 vs 2.19, respectively), validating the tool for physical disability screening in this context. Overall, 96.8 % had at least one impaired domain. Nineteen participants (3.2 %) had no impaired domain, while 61 (10.2 %) had impairment in one domain. A total of 134 participants (22.4 %) presented impairment in two domains and 162 (27.1 %) in three domains. Impairment in four domains was observed in 114 participants (19.1 %), whereas 80 participants (13.4 %) had five affected domains. The highest level of impairment, involving all six domains was found in 27 participants (4.5 %). The most frequently affected domains were locomotion (81.4 %), psychological well-being (73.4 %) and vision (60 %).
CONCLUSION: Intrinsic capacity impairment is highly prevalent among older adults in Cameroon. Our findings support the validity and applicability of the ICOPE Step 1 tool for community-based screening, particularly for the vitality and locomotion domains. Integrating this tool into primary care could facilitate early identification of geriatric syndromes.
CITATION:
Thierry Roland Njille Ehawa ; Gustave Mabiama ; Marie-Josiane Ntsama Essomba ; Christine Fernande Nyangono Biyegue ; Maturin Tabue-Teguo ; Isabelle Bourdel-Marchasson (2025): Screening of intrinsic capacity impairment in community-dwelling older adults in Cameroon: A national cross-sectional study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100167
EFFECTIVENESS OF INTERVENTIONS USING ACTIVITY TRACKERS AND SMARTPHONE APPLICATIONS FOR INCREASING PHYSICAL ACTIVITY IN OLDER ADULTS WITH HEALTH CONDITIONS: A SYSTEMATIC REVIEW WITH META-ANALYSIS
Nusrat Hamdani, Bruno T Saragiotto, Peter Stubbs, Juliana Oliveira, Anne Tiedemann, Paloma Santana, Gabriel Ferretti, Arianne Verhagen, Poonam Mehta
J Frailty Aging 2026;15(4)
Show summaryHide summaryBACKGROUND: Evidence suggests that physical activity is fundamental to healthy ageing and is associated with prevention of chronic diseases, reduced frailty risk, and premature mortality in older adults.
OBJECTIVE: To evaluate the effectiveness of interventions using activity trackers and smartphone applications for increasing physical activity (steps per day) in people aged ≥60 years with an underlying health condition.
METHODS: Six databases were searched from inception to January 2025. We included randomised controlled trials of interventions that used activity trackers or smartphone applications, to promote physical activity among people aged ≥60 years with an underlying health condition, compared to minimal interventions or other active interventions.
RESULTS: We identified 44 trials (n = 4148). Compared with minimal intervention, the evidence is very uncertain about the effect of activity trackers on physical activity in the short term (near to intervention completion) (MD 1671 steps, 95% CI 1113 to 2229; I² = 90%, 37 trials). At 12 months, activity trackers probably increase physical activity compared with no or minimal intervention (MD 1838 steps, 95% CI 980 to 2696; I² = 64%, 6 trials; moderate certainty). At 6 months and 24 months, the effect of activity trackers on steps was uncertain. Subgroup analyses suggest activity trackers may improve physical activity across metabolic, neurological, and pulmonary conditions based on moderate to low certainty evidence.
CONCLUSION: Interventions using activity trackers may increase physical activity in the short term, although the evidence is very uncertain, and probably increase physical activity at approximately 12 months. Effects at intermediate-term and 24-month follow-up remain uncertain. Effects on mobility, quality of life and mental health were unclear or small.
CITATION:
Nusrat Hamdani ; Bruno T Saragiotto ; Peter Stubbs ; Juliana Oliveira ; Anne Tiedemann ; Catherine Sherrington ; Paloma Santana ; Gabriel Ferretti ; Arianne Verhagen ; Poonam Mehta ; ; (2026): Effectiveness of interventions using activity trackers and smartphone applications for increasing physical activity in older adults with health conditions: a systematic review with meta-analysis. The Journal of Prevention of Alzheimer’s Disease (JPAD). https://dx.doi.org/110.1016/j.tjfa.2026.100180
RESEARCH ON THE MODERATING ROLE OF AGE-FRIENDLY COMMUNITIES IN THE RELATIONSHIP BETWEEN INTRINSIC CAPACITY AND FUNCTIONAL ABILITY
Hongsai Zhang, Shuqin Xiao, Luqi Dong, Xian Ma, Weiyao Li
J Frailty Aging 2026;15(4)
Show summaryHide summaryBACKGROUND AND AIMS: Maintaining functional ability (FA) is the core goal of healthy aging. The World Health Organization (WHO) emphasizes that FA is shaped by intrinsic capacity (IC) , the environment, and their interaction. However, this interaction remains underexplored. This study investigated the moderating role of age-friendly community environments in the IC–functional performance relationship among older adults to inform targeted environmental interventions for disability prevention and healthy aging.
METHODS: A cross-sectional survey was conducted between May and October 2024 using convenience sampling to recruit 256 older adults from three distinct community contexts in Beijing. Data were collected via structured questionnaires, including demographic and health-related variables, the WHO Intrinsic Capacity Instrument, and the Instrumental Activities of Daily Living Scale. Hierarchical regression and moderation analyses were performed to examine the interactions between IC and age-friendly environments.
RESULTS: Of 256 participants, 20.3% (n = 52) had IADL impairment. Age-friendly environments significantly mitigated the negative impact of declining IC on IADL (B = -0.284, P = 0.002), with housing showing the strongest overall effect (B = -0.281, P < 0.001). The buffering effect was most notable in individuals with low IC (B = -3.034, P = 0.010). Stratified results: (1) Low IC: housing (B = -1.913, P = 0.015) and social participation (B = -1.281, P = 0.024) were key; (2) Moderate IC: transportation (B=-0.191, P = 0.003) and social participation (B = -0.267, P = 0.013); (3) High IC: only social inclusion/health services worked (B = -0.576, P = 0.029).
CONCLUSION: Age-friendly community environments are crucial for maintaining functional performance, with varying effects depending on IC level, highlighting the importance of developing tailored and personalized supportive environments to promote healthy aging.
CITATION:
Hongsai Zhang ; Shuqin Xiao ; Luqi Dong ; Xian Ma ; Weiyao Li (2026): Research on the moderating role of age-friendly communities in the relationship between intrinsic capacity and functional ability. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2026.8
LETTER TO THE EDITOR: AN OLD DOG TEACHING US NEW TRICKS IN AGEING BIOLOGY
Olga Maria de Silvério Carvalho, Aya Abukwaik, Ola Sultan, Louis J Koizia, Benjamin H L Harris
J Frailty Aging 2026;15(4)
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CITATION:
Olga Maria de Silvério Carvalho ; Aya Abukwaik ; Ola Sultan ; Louis J Koizia ; Benjamin H L Harris (2025): Letter to the Editor: An OLD DOG teaching us new tricks in ageing biology. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100181
LETTER TO THE EDITOR: FROM HEALTH LITERACY TO CAPACITY PRESERVATION: ADVANCING THE NEXT STEP IN MIDLIFE FRAILTY PREVENTION
Sitti Johri Nasela, Zulfikar Peluw, Muhammad Taufan Umasugi
J Frailty Aging 2026;15(4)
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CITATION:
Sitti Johri Nasela ; Zulfikar Peluw ; Muhammad Taufan Umasugi (2025): Letter to the Editor: From health literacy to capacity preservation: advancing the next step in midlife frailty prevention. The Journal of Frailty and Aging (JFA).https://doi.org/10.1016/j.tjfa.2026.100182