Ahead of print articles
THE FEASIBILITY OF IMPLEMENTING THE WHO INTEGRATED CARE FOR OLDER PEOPLE (ICOPE) FRAMEWORK IN SINGAPORE
C.H.K. Ma, D.Q.L. Chua, L. Tay, E.W.C. Teo, W.C. Ng, A.Y.M. Leung
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BACKGROUND: The World Health Organization (WHO) introduced the Integrated Care for Older People (ICOPE) approach to assist communities in evaluating the intrinsic capacities of older adults and proposing strategies to prevent, mitigate, or reverse declines. This study represents the inaugural attempt to assess intrinsic capacities among older adults in Singapore, aligning with the nation’s Healthier Singapore (Healthier SG) initiative aimed at enhancing quality of life.
OBJECTIVES: This study aims to investigate the feasibility of implementing Step 1 screening of the ICOPE framework, which assesses cognition, locomotion, vitality, psychological state, visual and auditory functions, within the Singapore context.
DESIGN, SETTING, AND PARTICIPANTS: Using a mixed-method approach, this cross-sectional study established a baseline understanding of the levels of intrinsic capacity in 367 community-dwelling older adults in Singapore (mean age 71.8 years), elucidated the experiences of administering the ICOPE Step 1 screening tool and the formulation of personalized care plans from the perspective of 25 assessors.
MEASUREMENTS: Participants completed ICOPE Step 1 screening, providing basic demographic and health profiles, while assessors engaged in focus group discussions.
RESULTS: Among older participants, 284 exhibited signs of decline in intrinsic capacity. The primary areas of decline were visual impairment (42.0%), hearing loss (33.5%), and cognitive deterioration (31.3%), followed by limited mobility (24.3%), malnutrition (16.1%), and depressive symptoms (16.1%). Assessors found the ICOPE screening tool user-friendly and appreciated its person-centred approach, noting its integration with care plans, which many other tools lacked. They were confident in Singapore’s capacity to adopt the ICOPE approach, citing existing practices in assessing intrinsic capacity domains and integrated care models.
CONCLUSION: Critical steps for successful implementation of the ICOPE framework include follow-up interventions like self-management strategies for declining intrinsic capacity, diagnostic assessments, and routine monitoring. Coordination between healthcare clusters and community care networks is essential for its success.
CITATION:
C.H.K. Ma ; D.Q.L. Chua ; L. Tay ; E.W.C. Teo ; W.C. Ng ; A.Y.M. Leung (2024): The Feasibility of Implementing the WHO Integrated Care for Older People (ICOPE) Framework in Singapore. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.59
SELF-REPORTED FATIGUE AND ITS CROSS-SECTIONAL ASSOCIATIONS WITH PHYSICAL FUNCTION THROUGHOUT ADULTHOOD: THE INSPIRE-T COHORT
D. Matsumoto, J. Raffin, W.-H. Lu, S. Guyonnet, F. Pillard, Y. Rolland, B. Vellas, P. de Souto Barreto, for the IHU HealthAge INSPIRE/Open Science group
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BACKGROUND: Fatigue negatively impacts health outcomes but its association with physical function across the adulthood remains unclear.
OBJECTIVES: This study described self-reported fatigue levels across age and sex categories, investigated the associations between fatigue and physical functions, and examined wheth-er age and sex moderated their associations.
DESIGN: Cross-sectional design.
SETTING: Community.
PARTICIPANTS: Nine hundred sixteen participants aged 20-100 years in the observational INSPIRE-T cohort study.
MEASUREMENTS: Participants were classified into four age categories. Fatigue was asses-sed using the Patient-Reported Outcomes Measurement Information System (Short Form v1.0 – Fatigue 8a) and physical function was assessed by handgrip strength (HGS, Kg), usual gait speed (UGS, m/s), both 5-repetition (5CR, s) and 30-sec chair rise tests (30sCR, times), isokinetic knee extension strength (IKES, N m), and maximum oxygen consumption (V̇O2 max, ml/kg/min). Multiple linear regressions were performed to examine the associations between fatigue and the physical function outcomes (all square-root-transformed). Interac-tions of fatigue with age and sex were considered.
RESULTS: Fatigue levels were the highest in people 75+ years. Women had a higher fatigue level than men. Fatigue was significantly associated with decreasing performance in UGS, HGS, 5CR, and 30sCR but not in IKES and V̇O2 max. Interaction analyses revealed that fa-tigue was associated with reduced UGS as people age (Fatigue × age: B = -0.002, 95% con-fidence interval = -0.003, -0.001). Sex did not moderate the association between fatigue and physical function.
CONCLUSIONS: Our study indicated that fatigue was negatively associated with several components of physical function. Although sex did not moderate the relationship between fatigue and physical function, the association between fatigue and low UGS was more pro-nounced with increasing age.
CITATION:
D. Matsumoto ; J. Raffin ; W.-H. Lu ; S. Guyonnet ; F. Pillard ; Y. Rolland ; B. Vellas ; P. de Souto Barreto ; for the IHU HealthAge INSPIRE/Open Science group (2024): Self-Reported Fatigue and Its Cross-Sectional Associations with Physi-cal Function throughout Adulthood: The INSPIRE-T Cohort. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.56
BLOOD PRESSURE VARIABILITY AND FRAILTY IN END-STAGE KIDNEY DISEASE
T. Zanotto, T.H. Mercer, A. Gupta, M.L. van der Linden, P. Koufaki
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BACKGROUND: High blood pressure variability (BPV) is a predictor of cardiovascular events and all-cause mortality in people with end-stage kidney disease (ESKD) and a marker of aging in geriatric populations. Nevertheless, the relationship between BPV and geriatric syndromes, such as frailty, in people with ESKD is not well understood.
OBJECTIVE: To examine the association between very short-term BPV and frailty in people with ESKD and receiving hemodialysis.
DESIGN: Cross-sectional study.
SETTING: Three dialysis units in the United Kingdom.
PARTICIPANTS: Sixty-nine people receiving hemodialysis (median age=62.0 years, interquartile range [IQR]=19.0; 52.2% male; median dialysis vintage=1.1 years, IQR=2.4).
MEASUREMENTS: Systolic and diastolic BPV were recorded using continuous, non-invasive BP monitoring (Task Force Monitor). The very low, low, and high frequency components of BPV (VLF-BPV, LF-BPV, and HF-BPV), as well as the power spectral density (PSD-BPV) and low frequency/high frequency ratio of BPV (LF/HF-BPV) were analyzed. Frailty was evaluated using the Fried frailty phenotype.
RESULTS: Twenty-six (37.7%) participants were classified as frail and 43 (62.3%) as non-frail. Frail participants had higher median systolic (2.1, IQR=5.2 mmHg2 vs. 1.1, IQR=1.6 mmHg2, p=0.002) and diastolic HF-BPV (0.9, IQR=2.3 mmHg2 vs. 0.5, IQR=1.0 mmHg2, p=0.048) compared to their non-frail counterparts. In addition, frail participants had higher median systolic VLF-BPV (3.2, IQR=12.5 mmHg2 vs. 2.0, IQR=2.4 mmHg2, p=0.012), LF-BPV (2.0, IQR=3.8 mmHg2 vs. 1.1, IQR=2.0 mmHg2, p=0.016), and PSD-BPV (6.6, IQR=27.6 mmHg2 vs. 4.5, IQR=5.9 mmHg2, p=0.005) compared to the non-frail participants. In age- and sex-adjusted logistic regression analyses, only systolic VLF-BPV (odds ratio [OR]=1.13, 95% confidence interval [CI]:1.01-1.26, p=0.035), HF-BPV (OR=1.26, 95%CI:1.01-1.57, p=0.044), and PSD-BPV (OR=1.06, 95%CI:1.01-1.12, p=0.029) were associated with increased odds of being frail.
CONCLUSION: Higher systolic BPV is associated with frailty in people receiving hemodialysis. Beat-to-beat assessments of BPV through continuous, non-invasive BP monitoring may be useful in evaluating frailty in ESKD populations.
CITATION:
T. Zanotto ; T.H. Mercer ; A. Gupta ; M.L. van der Linden ; P. Koufaki (2024): Blood Pressure Variability and Frailty in End-Stage Kidney Disease . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.61
UTILISATION AND OUTCOME OF CRANIAL CT IMAGING IN OLDER ADULTS ATTENDING ED FOLLOWING A FALL
K. Warren, T. Akinola, K. Bailey, J. Gwinnett, C. Wharton
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from the literature is lacking on the value of neuroimaging, particularly for those who have fallen but have no head injury or an unclear history. We carried out retrospective analysis of data from Emergency Department attendances at a large English hospital to assess compliance with guidelines and explore utility of CT scans for those not covered by existing guidance. Following a fall, 49% (577) of older adults received a cranial CT scan, 4.9% (28) of whom had an intracranial haemorrhage and only 2 received neurosurgical intervention. Only 59% who had a CT had a clear history of head injury, unwitnessed falls were common (71%) and there was a high prevalence of dementia (23%); those scanned without a clear history of head injury were significantly more frail, but not older. There was some indication that seizure, reduced GCS and neurological signs are predictive of intracranial haemorrhage regardless of head injury history, but further research is recommended to provide clarity on which groups stand to benefit most and how clinicians can be supported in decision making that balances diagnostic yield, patient benefit and imaging demand.
CITATION:
K. Warren ; T. Akinola ; K. Bailey ; J. Gwinnett ; C. Wharton (2024): Utilisation and Outcome of Cranial CT Imaging in Older Adults Attending ED Following a Fall . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.55
LETTER TO THE EDITOR: “KAMI-CHIGIRI” (NEWSPAPER TEAR-OFF) TEST: SIMPLE SCREENING METHOD FOR ASSESSING MUSCLE WEAKNESS AMONG COMMUNITY-DWELLING OLDER ADULTS
T. Tanaka, W. Lyu, Y. Yoshizawa, B.-K. Son, K. Iijima
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CITATION:
T. Tanaka ; W. Lyu ; Y. Yoshizawa ; B.-K. Son ; K. Iijima (2024): Letter to the Editor: “Kami-Chigiri” (Newspaper Tear-Off) Test: Simple Screening Method for Assessing Muscle Weakness among Community-Dwelling Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.62
DOES A POOR PREOPERATIVE NUTRITIONAL STATUS IMPACT OUTCOMES OF HEART VALVE SURGERY?
N. Pavone, F. Cammertoni, P. Bruno, G. Cutrone, G.A. Chiariello, M. Calabrese, M. Grandinetti, M. Nesta, E. Marzetti, R. Calvani, R. Gambardella, A.D. Conserva, E. Romagnoli, F. Burzotta, M. Massetti
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BACKGROUND: Malnutrition has been variously associated with poor postoperative outcomes. Of note, 10–25 % of cardiac surgery patients are reported to be malnourished.
OBJECTIVES: To assess the impact of nutritional status (evaluated with the Geriatric Nutritional Risk Index – GNRI) on outcomes of older patients undergoing heart valve surgery.
DESIGN: Retrospective, single-center.
SETTING: Cardiac Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy.
PARTICIPANTS: 448 patients older than 75 years who had undergone isolated, elective heart valve surgery. Patients were divided into low (GNRI≥92; 346 patients) and moderate-to-high (GNRI<92; 102 patients) risk groups of nutrition-related complications.
MEASUREMENTS: Demographic, clinical, and biological variables were retrieved from the institutional Heart Valve Database. GNRI was calculated as follows: [1.489 × serum albumin (g/dL)] + [41.7 × actual body weight (kg) / ideal body weight (kg)]. Operative and postoperative outcomes were compared between GNRI groups. Survival at 3 years follow-up was analyzed using the Kaplan-Meier method and log-rank test. Cox regression was used to identify variables associated with survival.
RESULTS: Mortality at 30 days did not differ between groups (0.98% vs 0.58% for GNRI < 92 and GNRI ≥ 92, respectively; p=0.54). Those with a GNRI < 92 required more frequently dialysis (2.9% vs 0.3%, p=0.04), inotropes (33.3% vs 22.8%, p=0.04), red blood cells transfusions (63.7% vs 19.9%, p<0.01), and longer mechanical ventilation support (12 ± 2 vs 6 ± 1.5 hours, p=0.03). Intensive care unit (4.7 ± 0.9 vs 1.6 ± 0.8 days, p=0.05) and total postoperative hospital (11.1 ± 1.9 vs 5.2 ± 1.5 days, p=0.05) stays were significantly longer in the GNRI < 92 group.
CONCLUSION: A poor nutritional status may increase morbidity and prolong hospitalization after cardiac surgery. GNRI might improve risk assessment and should be integrated into traditional surgical risk models to offer tailored care to older patients.
CITATION:
N. Pavone ; F. Cammertoni ; P. Bruno ; G. Cutrone ; G.A. Chiariello ; M. Calabrese ; M. Grandinetti ; M. Nesta ; E. Marzetti ; R. Calvani ; R. Gambardella ; A.D. Conserva ; E. Romagnoli ; F. Burzotta ; M. Massetti ; (2024): Does a Poor Preoperative Nutritional Status Impact outcomes of Heart Valve Surgery?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.54
APPLICATION OF A SOCIAL VULNERABILITY INDEX AND ITS ASSOCIATIONS WITH PHYSICAL FRAILTY AND DISABILITY IN A CROSS-SECTIONAL STUDY OF OLDER KENYAN WOMEN LIVING WITH AND WITHOUT HIV
S. Prabhu, B. Oyaro, G. Wanje, F.M. Aunon, N. Gomez Juarez, B.P. Flaherty, W. McCormick, M.K. Andrew, W. Jaoko, R.S. McClelland, S.M. Graham
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BACKGROUND: Social vulnerability reflects deficits in social resources that may disproportionally impact older women with HIV (WWH) in Africa.
OBJECTIVE: To examine the relationship between scores on an adapted Social Vulnerability Index (SVI) and measures of physical frailty and disability.
DESIGN: Cross-sectional study.
PARTICIPANTS: 293 women (156 HIV-positive, 137 HIV-negative) aged >40 years in Mombasa, Kenya who were recruited from the Mombasa Cohort of women with a history of transactional sex and the general community.
MEASUREMENTS: Assessments including an SVI adapted for the Kenyan context (SVI-Kenya), the Clinical Frailty Scale (CFS) and the World Health Organization Disability Assessment (WHODAS) were compared by HIV status. Linear regression was used to determine the relationship between SVI-Kenya score and both CFS and WHODAS, after adjustment for potential confounders. An exploratory analysis identified factors associated with SVI-Kenya score. An age-by-HIV-status interaction term was tested and retained if significant in unadjusted analyses.
RESULTS: Mean SVI-Kenya score was 34.1 (SD, 12.9) and did not differ by HIV status (p=0.49). In adjusted analyses, each increment in SVI-Kenya score was associated with a 1.10-point higher WHODAS score (95%CI:0. 21, 1.99), but not with CFS. In exploratory analysis, factors associated with higher SVI-Kenya score included WHODAS score (adjusted beta=0.20; 95%CI: 0.05,0.35) and Mombasa Cohort recruitment (adjusted beta=5.91; 95%CI: 2.07,9.75). Being married, separated/divorced, or widowed predicted lower SVI-Kenya scores (by 5.52-9.09 points) compared to being single. Age did not predict SVI-Kenya score.
CONCLUSION: Social vulnerability as measured by the SVI-Kenya score was associated with greater disability but not physical frailty. Social vulnerability was also associated with prior sex work and never having married. Our findings suggest that social vulnerability is a distinct construct from physical frailty among older Kenyan women and not related to HIV status.
CITATION:
S. Prabhu ; B. Oyaro ; G. Wanje ; F.M. Aunon ; N. Gomez Juarez ; B.P. Flaherty ; W. McCormick ; M.K. Andrew ; W. Jaoko ; R.S. McClelland ; S.M. Graham ; (2024): Application of a Social Vulnerability Index and Its Associations with Physical Frailty and Disability in a Cross-sectional Study of Older Kenyan Women Living with and without HIV. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.71
FECAL MICROBIOTA TRANSPLANTATION MODULATES GUT MICROBIOME COMPOSITION AND GLIAL SIGNALING IN BRAIN AND COLON OF RATS WITH NEUROPATHIC PAIN: EVIDENCE FOR MICROBIOTA-GUT-BRAIN AXIS
C.-L. Shen, H. Deshmukh, J.M. Santos, M.M. Elmassry, P. Presto, Z. Driver, V. Bhakta, V. Yakhnitsa, T. Kiritoshi, G. Ji, J. Lovett, A. Hamood, V. Neugebauer
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Despite evidence linking the gut microbiome to neuropathic pain (NP), it is not known if altering gut microbiota can alleviate NP via the microbiome-gut-brain axis. This study examined if healthy gut microbiota of sham male rats (Sham+V) and dysbiotic gut microbiota of NP rats (spinal nerve ligation: NP, SNL+V) can be disrupted and restored, respectively, via fecal microbiota transplant (FMT) from the opposite group [Sham+(SNL-FMT) and SNL+(Sham-FMT), respectively]. All groups received FMT daily for two weeks, followed by three weeks without FMT. SNL rats showed higher mechanical hypersensitivity [SNL+V vs. Sham+V] throughout the study. After two weeks, the FMT of healthy gut microbiota decreased mechanical hypersensitivity in SNL rats [SNL+(Sham-FMT) vs. SNL+V]. A temporal shift in microbiome profiles after 2-week FMT treatment was observed in Sham+(SNL-FMT) and SNL+(Sham-FMT) groups, while the microbiome profile shifted back a certain extent after FMT ceased. At the end of study, the Sham+(SNL-FMT) group acquired low abundance of UCG-001, Odoribacter, and Peptococcaceae, and high abundance of UBA1819 and Victivallis. The SNL+(Sham-FMT) group maintained high abundance of Butyricimonas and Escherichia-Shigella. The SNL+(Sham-FMT) group had altered glial and macrophage activation/inflammation markers in the brain/colon than the SNL+V group. Relative to the SNL+V group, the SNL+(Sham-FMT) group had significantly lower gene expressions of GFAP (hypothalamus), IBA-1 (colon), and NF-κB (amygdala/colon), but higher gene expressions of complex I (amygdala/hypothalamus) and claudin-3 (amygdala/hypothalamus/colon). In conclusion, FMT containing healthy microbiota given to SNL rats attenuates mechanical hypersensitivity, modulates microbiota composition, and mitigates downstream glial activation/inflammation markers in a NP model.
CITATION:
C.-L. Shen ; H. Deshmukh ; J.M. Santos ; M.M. Elmassry ; P. Presto ; Z. Driver ; V. Bhakta ; V. Yakhnitsa ; T. Kiritoshi ; G. Ji ; J. Lovett ; A. Hamood ; V. Neugebauer (2024): Fecal Microbiota Transplantation Modulates Gut Microbiome Composition and Glial Signaling in Brain and Colon of Rats with Neuropathic Pain: Evidence for Microbiota-Gut-Brain Axis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.65
THE RELATIONSHIP OF FRAILTY WITH PSYCHOPATHOLOGY, CHILDHOOD TRAUMAS AND INSECURE ATTACHMENT IN YOUNG ADULTS: A CROSS-SECTIONAL INVESTIGATION
F.S. Bersani, M. Canevelli, C. Imperatori, B. Barchielli, E. Prevete, F. Sciancalepore, R. Vicinanza, A. Maraone, M. Salzillo, L. Tarsitani, S. Ferracuti, M. Pasquini, G. Bruno
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OBJECTIVE: Reciprocal connections exist between mental health and physical health, and conditions of cellular senescence/advanced biological age have been observed in association with certain psychiatric diseases. However, the construct of frailty has only preliminarily been explored in young adults and in relation to psychopathology so far. In the present study we aimed at further elucidating the relationships linking psychopathological phenomena with physical diseases in a sample of young adults.
METHODS: The sample was made of 527 Italian young adults (age range: 18-34). Participants were assessed on clinical/socio-demographic information as well as on the following measures: an ad hoc designed Frailty Index (FI), the Brief Symptroms Inventory (BSI), the Relationship Questionnaire (RQ), and the Childhood Trauma Questionnaire (CTQ).
RESULTS: Individuals with clinically-relevant psychopathological symptoms (based on established BSI cut-off scores) showed significantly higher FI values than individuals without clinically-relevant psychopathological symptoms (p<0.001). Higher levels of childhood traumatic experiences and higher levels of insecure forms of attachment were significantly associated with higher FI scores. The severity of preoccupied attachment style was significantly independently associated with higher FI scores also when multiple confounding variables were controlled for.
DISCUSSION: Our findings provide novel pieces of insight on the complex relationship of frailty, conceptualized as a measure of deficit accumulation and an indicator of functional status and biological age, with psychopathology, childhood traumas and insecure attachment, with potential implications for the clinical management of young individuals.
CITATION:
F.S. Bersani ; M. Canevelli ; C. Imperatori ; B. Barchielli ; E. Prevete ; F. Sciancalepore ; R. Vicinanza ; A. Maraone ; M. Salzillo ; L. Tarsitani ; S. Ferracuti ; M. Pasquini ; G. Bruno (2024): The Relationship of Frailty with Psychopathology, Childhood Traumas and Insecure Attachment in Young Adults: A Cross-Sectional Investigation. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.49
POLYPHENOL SUPPLEMENTATION AND SARCOPENIA: A SYSTEMATIC REVIEW AND META-ANALYSIS OF CLINICAL TRIALS
A. Medoro, G. Scapagnini, S. Davinelli
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BACKGROUND: Experimental evidence suggests that polyphenols, a large group of phytochemicals found in fruits and vegetables, may preserve muscle mass and strength by increasing the expression of anabolic factors and enhancing mitochondrial function.
OBJECTIVES: This systematic review and meta-analysis aims to summarize the evidence about the effect of polyphenol supplementation on muscle mass, muscle strength, and physical performance in individuals with sarcopenia.
Methods: A systematic search was conducted using three databases (PubMed/Medline, Scopus, and Web of Science) from the date of inception to April 2024. Interventional studies examining the effect of polyphenol supplementation on muscle measures and physical performance in middle-aged and older subjects with sarcopenia were included.
Results: Of the 344 articles screened, 7 articles were included in the systematic review. Five of the 7 included studies were meta-analyzed, involving a total of 227 patients with sarcopenia. The results showed a statistically significant effect of polyphenols on muscle mass (SMD = 1.50; 95% CI: 0.26, 2.75; Z = 2.36; P = 0.02), no effect on muscle strength (SMD = 0.03; 95% CI: −0.24, 0.30; Z = 0.20; P = 0.84), and a near-significant trend on physical performance (SMD = 0.52; 95% CI: −0.03, 1.07; P = 0.06).
Conclusions: Based on the available data, this study provides pooled evidence that treatment with polyphenols may have a beneficial effect on muscle mass in sarcopenic subjects.
However, further studies with larger sample sizes are required to substantiate this effect and draw more accurate conclusions.
CITATION:
A. Medoro ; G. Scapagnini ; S. Davinelli (2024): Polyphenol Supplementation and Sarcopenia: A Systematic Review and Meta-Analysis of Clinical Trials. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.73
EVALUATION OF HANDGRIP STRENGTH ASYMMETRY TO ASSESS SARCOPENIA IN OLDER PATIENTS WITH CHRONIC LOW BACK PAIN: A RETROSPECTIVE CROSS-SECTIONAL STUDY
H.J. Kim, S.H. Kim
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BACKGROUND: Handgrip strength (HGS) is a crucial measurement for diagnosing sarcopenia, and HGS asymmetry indicates functional impairment and correlates with adverse health outcomes. Although chronic low back pain (CLBP) often coexists with sarcopenia in older people, the association between HGS asymmetry and sarcopenia in that population has not been investigated.
OBJECTIVES: This study examines the association between HGS asymmetry and sarcopenia in older patients with CLBP and explores differences in the proportion of sarcopenia and severe sarcopenia according to the severity of HGS asymmetry.
DESIGN: A retrospective observational study.
SETTING: The study included patients who visited the outpatient department for pain management at a university hospital.
PARTICIPANTS: Ambulatory patients 65 years and older with CLBP assessed for sarcopenia per the Asian Working Group for Sarcopenia (AWGS) 2019 protocol were enrolled.
MEASUREMENTS: HGS asymmetry was categorized into three groups (< 10%, 10–20%, and > 20%) based on the difference between the hands.
RESULTS: A total of 575 CLBP patients aged 65–90 years was analyzed. In females, physical performance scores declined as HGS asymmetry severity increased (p < 0.001), alongside a proportional rise in the proportion of sarcopenia (p = 0.006) and severe sarcopenia (p = 0.002). Conversely, males showed no such association. Moreover, patients with low HGS (meeting the AWGS 2019 criteria) had a higher proportion of sarcopenia (p = 0.019) and severe sarcopenia (p = 0.017) as HGS asymmetry severity increased. The multivariable analysis identified > 20% HGS asymmetry as an independent predictor of sarcopenia (adjusted odds ratio (OR) 3.296, 95% confidence interval (CI) 1.595–6.811, p = 0.001) and severe sarcopenia (adjusted OR 3.092, 95% CI 1.467–6.517, p = 0.003) exclusively in females.
CONCLUSIONS: Severe HGS asymmetry was associated with poor physical performance and a higher proportion of sarcopenia in older female patients with CLBP.
CITATION:
H.J. Kim ; S.H. Kim ; (2024): Evaluation of Handgrip Strength Asymmetry to Assess Sarcopenia in Older Patients with Chronic Low Back Pain: A Retrospective Cross-Sectional Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.64
MUSCLE MASS, STRENGTH, POWER AND PHYSICAL PERFORMANCE AND THEIR ASSOCIATION WITH QUALITY OF LIFE IN OLDER ADULTS, THE STUDY OF MUSCLE, MOBILITY AND AGING (SOMMA)
N. Petnehazy, H.N. Barnes, A.B. Newman, S.B. Kritchevsky, S.R. Cummings, R.T. Hepple, P.M. Cawthon
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BACKGROUND: Sarcopenia negatively impacts quality of life. It is unclear whether different measures of muscle size, strength, physical performance, and fitness have similar associations with quality of life.
OBJECTIVE: To describe associations of sarcopenia metrics with quality of life outcomes.
PARTICIPANTS: Community-dwelling adults aged 70+ years participating in the SOMMA (Study of Muscle, Mobility and Aging) study, (N=875 ((women: 519, men:356)), age, years 76.3±5.0).
DESIGN AND SETTINGS: Two academic medical centers.
MEASUREMENTS: Measures included muscle size (MRI- muscle volume. D3Cr muscle mass); strength and power (grip strength, leg extension power and strength, stair climb); walking and physical performance (4m and 400m walk, SPPB (Short Physical Performance Battery), chair stand); fitness (VO2 peak); health related quality of life (EQ-5D); and anthropometrics (weight, height, and body mass index).
Results were stratified by sex. Correlations, scatterplots and linear regression models described the association between various measures of sarcopenia and fitness with overall quality of life score (EQ5D VAS) as a continuous variable. We also quantified differences between sarcopenia and fitness measures by overall QOL (Quality of Life) as a categorical variable (low, medium, high) and by QOL subcomponents (pain and discomfort, problems with usual activities, mobility, anxiety and depression, and problems with self-care) using distributionally appropriate methods.
RESULTS: Walking tests and physical performance were most consistently (but modestly) associated with overall quality of life (r~0.2, p<.001) and its subcomponents. For both men and women, several sarcopenia and fitness measures were more strongly associated with pain and usual activity than other QOL components.
CONCLUSIONS: Poor performance, lower fitness and lower strength are related to worse quality of life, particularly pain, in older adults. Future studies should quantify these relationships longitudinally.
CITATION:
N. Petnehazy ; H.N. Barnes ; A.B. Newman ; S.B. Kritchevsky ; S.R. Cummings ; R.T. Hepple ; P.M. Cawthon ; (2024): Muscle Mass, Strength, Power and Physical Performance and Their Association with Quality of Life in Older Adults, the Study of Muscle, Mobility and Aging (SOMMA). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.45
ERRATUM TO: MUSCLE STRENGTH MATTERS MOST FOR RISK OF FALLING APART FROM BODY MASS INDEX IN OLDER ADULTS: A MEDIATED-MODERATION ANALYSIS
F. Rodrigues, M. Izquierdo, D. Monteiro, M. Jacinto, R. Matos, N. Amaro, R. Antunes, D.S. Teixeira
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CITATION:
F. Rodrigues ; M. Izquierdo ; D. Monteiro ; M. Jacinto ; R. Matos ; N. Amaro ; R. Antunes ; D.S. Teixeira (2024): Erratum to: Muscle Strength Matters Most for Risk of Falling Apart from Body Mass Index in Older Adults: A Mediated-Moderation Analysis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.72
THE RELATIONSHIP BETWEEN LEISURE TIME PHYSICAL ACTIVITY AND COGNITIVE FUNCTION IN OLDER AMERICANS
J. Yang, X. Zheng, Y. Wang, H. Wang, G. Song
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OBJECTIVE: This study aims to investigate the correlation between leisure-time physical activity (LTPA) and cognitive function in older adults.
METHODS: We conducted an analysis of 2,657 participants (aged ≥60 years) from the cross-sectional National Health and Nutrition Examination Survey (NHANES) spanning 2011-2014. Multiple logistic regression and linear regression analyses were employed to explore the associations between leisure-time physical activity and cognitive function.
RESULTS: Significant correlations were observed between LTPA duration and frequency with Animal Fluency Test (AF) and Digit Symbol Substitution Test (DSST) scores. Engaging in leisure-time physical activity 1-4 times per week was associated with a 33%((OR) 0.67, (CI) 0.48-0.92) reduced risk of memory decline compared to non-active individuals. An inverted U-shaped relationship was observed between LTPA duration and AF/DSST and a U-shaped relationship between LTPA frequency and the risk of memory decline.
CONCLUSION: Encouraging older adults to participate in leisure activities 3-4 times per week may help protect cognitive function.
CITATION:
J. Yang ; X. Zheng ; Y. Wang ; H. Wang ; G. Song ; (2024): The Relationship between Leisure Time Physical Activity and Cognitive Function in Older Americans. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.70
INTRINSIC CAPACITY AND ITS ASSOCIATION WITH ADVERSE HEALTH OUTCOMES IN OLDER JAPANESE OUTPATIENTS
J. Li, K. Kinoshita, M. Yasuoka, K. Maeda, M. Takemura, Y. Matsui, H. Arai, S. Satake
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OBJECTIVES: This study aimed to provide evidence regarding the clinical significance of assessing intrinsic capacity (IC).
DESIGN: Longitudinal study.
SETTING: Frailty clinic.
PARTICIPANTS: 351 disability-free outpatients aged ≥65 years.
MEASUREMENTS: Adverse health outcomes were a composite of adverse health outcomes, including mortality, emergency hospitalization, nursing home placement, and new certification or exacerbation for long-term care. We created a composite score based on five IC domains using assessment scales from the WHO ICOPE handbook, with the weights for each domain determined through confirmatory factor analysis.
RESULTS: The composite score of IC was inversely associated with adverse health outcomes within 1-year; the multivariable-adjusted odds ratio (95% confidence interval) was 0.20 (0.09–0.41) for the highest versus lowest tertile, and 0.63 (0.48–0.83) for each 1-point increment in IC score, respectively. Similar associations were observed for specific adverse health outcome, but not for mortality.
CONCLUSION: IC was inversely associated with subsequent adverse health outcomes in older outpatients, suggesting its prognostic value in routine geriatric practices. Considering the limited sample size, our findings need to be further confirmed.
CITATION:
J. Li ; K. Kinoshita ; M. Yasuoka ; K. Maeda ; M. Takemura ; Y. Matsui ; H. Arai ; S. Satake ; (2024): Intrinsic Capacity and Its Association with Adverse Health Outcomes in Older Japanese Outpatients. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.63
HOME-BASED EXERCISE PROGRAMS FOR THE OLDEST-OLD TO ATTENUATE PHYSICAL FRAILTY: A SCOPING REVIEW
B. da Silva Capanema, F. Fank, M.C. Machado Trento, D. Lima Costa, A.R. Amaral da Rocha, G. Zarpellon Mazo
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BACKGROUND: With the significant increase in the number of long-lived elderly people living at home, the development of effective physical exercise interventions at home becomes essential to preserve their independence and delay institutionalization and hospitalizations.
OBJECTIVE: to map and describe home exercise programs for elderly people aged 80 or over with physical frailty.
METHODS: The scoping review allowed the inclusion of several methodologies and varied perspectives, maintaining rigor in accordance with the methodological steps of the Joanna Briggs Institute (JBI). The systematic search covered studies available until May 2023 in five databases and gray literature. Frailty was assessed according to the criteria of Fried et al. (2001), physical performance scale (SPPB), such as gait and mobility, and the authors’ assessment of reduced physical function were considered. The study followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines and is publicly available in the Open Science Framework (OSF) repository.
RESULTS: Twenty studies were identified that met the inclusion criteria. The total number of elderly people investigated in the study was 1,796. The most important physical interventions were muscular strength training, mainly of the lower limbs, together with flexibility, balance, aerobic and functional training. These home interventions have demonstrated potential, safety and effectiveness in preventing and alleviating physical frailty. These home interventions demonstrated potential, safety and effectiveness in preventing and alleviating physical frailty, adherence in most studies varied between 72% and 89%.
CONCLUSION: This study will allow us to design home-based exercise interventions, potentially providing practical solutions and assisting healthcare professionals in home-based interventions to reduce and mitigate physical frailty in the growing population of older adults. It will also help fill the existing knowledge gap and provide recommendations for future research.
CITATION:
B. da Silva Capanema ; F. Fank ; M.C. Machado Trento ; D. Lima Costa ; A.R. Amaral da Rocha ; G. Zarpellon Mazo (2024): Home-Based Exercise Programs for the Oldest-Old to Attenuate Physical Frailty: A Scoping Review. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.41
SEVERITY OF FALL-RELATED INJURIES AND OLDER PERSONS’ HOSPITAL ADMISSION IN KUWAIT: A CROSS-SECTIONAL STUDY
H. Alsaleh, S. AlObaidi, A. Alsaber
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BACKGROUND: Falls among the older population have attracted global attention, with a specific emphasis on the regional contexts of falls. This study reports the incidence and characteristics of falls in the State of Kuwait, where there is currently no national fall prevention strategy.
METHODOLOGY: A prospective, cross-sectional study reported on 420 individuals aged 55 years and above admitted to Alrazi Orthopaedic Hospital in Kuwait City due to falls between March 2022 and February 2023. ICD-10 codes were used to classify the fall causes. The National Database of Nursing Quality Indicators injury severity classification was used to classify the fall-related injuries. Structured interviews were used to identify 10 main fall risk factors. Annual fall-rate was calculated and fall-related injuries were reported in frequencies and percentages. Chi-square tests and multinomial logistic regression models were used to examine the cross-sectional associations between fall severity and risk factors to determine the factors that could predict more severe fall-related injuries.
RESULTS: Fall-related injuries comprised 24.1% of the total hospital admissions, with 4% mortality rate. Around 31.6% of the falls led to temporary impairment injuries, 23.5% resulted in long-term impairment injuries, and 44.8% created potentially fatal injuries. The results of this study show that being between 55 and 74 years of age, having no history of falls, suffering from at least one illness, with no polypharmacy effect, and possessing fair vision are significantly associated with the severity of fall injuries. Being male (odds ratio [OR] = 3.38), being over 65 years of age (OR = 3.46), having a history of falls (OR = 2.49), and limitations in visual acuity predict more severe fall injuries among older individuals.
CONCLUSION: The severity of fall injuries is significantly associated with more capable older people. Government officials should immediately design and implement culture-specific fall-prevention strategies tailored to the targeted population.
CITATION:
H. Alsaleh ; S. AlObaidi ; A. Alsaber ; (2024): Severity of Fall-Related Injuries and Older Persons’ Hospital Admission in Kuwait: A Cross-Sectional Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.76
LETTER TO THE EDITOR: IS IT TIME TO LET MASCULINITY GO? REFLECTION ON THE CASE OF AN 87-YEAR-OLD MAN
H.J. Coelho Júnior, A. Picca, R. Calvani, E. Marzetti
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CITATION:
H.J. Coelho Júnior ; A. Picca ; R. Calvani ; E. Marzetti (2024): Letter to the Editor: Is It Time to Let Masculinity Go? Reflection on the Case of an 87-Year-Old Man. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.69
MOST HOSPITAL-ACQUIRED COMPLICATIONS AMONG OLDER ADULTS ARE ASSOCIATED WITH FRAILTY: THE SOUTH-WESTERN SYDNEY FRAILTY AND HOSPITAL-ACQUIRED COMPLICATIONS STUDY
S.A. Frost, D. Ni Chroinin, L. Mc Evoy, N. Francis, V. Deane, M. Bonser, C. Wilson, M. Perkins, B. Shepherd, V. Vueti, R. Shekhar, M. Mayahi-Neysi, K.M. Hillman
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BACKGROUND: People live longer, and frailty has become an important problem in the acute hospital setting. Increasingly the association between frailty and hospital-acquired complications has been reported. However, the overall burden of frailty in this setting has not been described. Therefore, we undertook this study to describe the association between frailty and the risk of hospital-acquired complications among older adults across our five acute hospitals and to estimate the overall burden of frailty attributable to these complications.
METHODS: Consecutive admissions among women and men aged ≥ 65 years across our local health district’s five acute hospitals, between January 2010 and December 2020, were included to investigate the association between the number of cumulative frailty deficit items and hospital-acquired complications and infections. The numbers of cumulative frailty deficits are presented in four groups (0-1 item, 2 items, 3 items, and 4-13 items). Individual events such as falls, delirium, pressure injuries, thromboembolism, malnutrition, and multiple types of infections are also presented. The overall burden of frailty was estimated using a population-attributable-risk approach.
RESULTS: During the study period there were 4,428 hospital-acquired complications, among 120,567 older adults (52% women). The risk of any hospital-acquired complication (HAC) or any hospital-acquired infection (HAI) increased as the cumulative number of frailty deficits increased. For the 0-1 deficit item group versus the 4-13 items group, the risk of any HAC increased from 5.5/1000 admissions to 80.0/1000 admissions, and for any HAI these rates were 6.2/1000 versus 58.2/1000, respectively (both p-values < 0.001). The 22% (27,144/120,567) of patients with 3 or more frailty deficit items accounted for 63% (2,774/4,428) of the combined hospital-acquired complications and infections. We estimated that the population-attributable risks of any hospital-acquired complication or infection were 0.54 and 0.47, respectively.
CONCLUSION: We found that an increasing number of cumulative frailty deficit items among older patients are associated with a higher risk of hospital-acquired complications or infections. Importantly, frail older adults account for most of these adverse events.
CITATION:
S.A. Frost ; D. Ni Chroinin ; L. Mc Evoy ; N. Francis ; V. Deane ; M. Bonser ; C. Wilson ; M. Perkins ; B. Shepherd ; V. Vueti ; R. Shekhar ; M. Mayahi-Neysi ; K.M. Hillman ; (2024): Most Hospital-Acquired Complications among Older Adults Are Associated with Frailty: The South-Western Sydney Frailty and Hospital-Acquired Complications Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.60
TEMPORAL MUSCLE THICKNESS PREDICTS MORTALITY AND DISABILITY IN OLDER ADULTS DIAGNOSED WITH MILD DEMENTIA
M.G. Borda, J. Patricio Baldera, D. Patino-Hernandez, E. Westman, M.U. Pérez-Zepeda, F.J. Tarazona-Santabalbina, H. Wakabayashi, H. Arai, M. Kivipelto, D. Aarsland, in behalf of NJ FINGER
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BACKGROUND: Sarcopenia contributes to increased hospitalizations, cognitive impairment, falls, and all-cause mortality. Current diagnostic methods, like body Magnetic Resonance Imaging and dual-energy X-ray absorptiometry, are costly and impractical. Notably, there is no standardized approach for assessing sarcopenia in dementia clinics. We studied the association of temporal muscle thickness (TMT) with key prognostic factors in people with Alzheimer’s disease (AD) and Lewy body dementia (DLB).
METHODS: We utilized data from the DemVest, a longitudinal cohort study, and included participants clinically diagnosed with mild AD or DLB. TMT was measured using baseline MRI scans. The main outcome measures were cognition, functional performance, malnutrition, and mortality. Various demographic and clinical factors were considered as potential confounders.
RESULTS: The AD sample was mainly composed by females(76.9%), age 75.5(SD 6.95). The DLB sample was mostly composed by men(63.6%), age 75.8(SD 6.85). At baseline TMT showed significant association with cognitive performance in the DLB group (Est.=0.593, p-value=0.049). The longitudinal analysis revealed significant associations between TMT and functional decline in DLB (Est.=-0.123, p-value 0.007) and increased mortality in the whole sample(HR=0.815, p-value 0.002), the AD group (HR=0.834 p-value=0.031), and the DLB group (HR=0.767 p-value=0.019) respectively. These associations remained significant after adjusting for confounders.
CONCLUSIONS: The TMT measurement was associated with mortality in both dementia groups as well as with cognition and function in DLB. TMT emerges as a cost-efficient measure of muscle mass indicating clinical relevance and utility in healthcare settings. Implementing TMT assessment could improve patient care and aid in identifying individuals at risk of adverse outcomes in mild dementia.
CITATION:
M.G. Borda ; J. Patricio Baldera ; D. Patino-Hernandez ; E. Westman ; M.U. Pérez-Zepeda ; F.J. Tarazona-Santabalbina ; H. Wakabayashi ; H. Arai ; M. Kivipelto ; D. Aarsland ; in behalf of NJ FINGER ; (2024): Temporal Muscle Thickness Predicts Mortality and Disability in Older Adults Diagnosed with Mild Dementia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.39
DEPRESSION AND FUNCTIONAL RECOVERY AFTER HIP FRACTURE IN COMMUNITY-DWELLING OLDER ADULTS
F. Remelli, M.C. Ferrara, F. Triolo, M. Belvederi Murri, G. Caruso, G. Bellelli, S. Volpato, C. Trevisan, on behalf of the GIOG Study Group
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The impact of depression on functional recovery in older adults following hip fracture is unclear. We aimed to examine the association between depression and 4-month functional recovery of older inpatients with hip fracture. We conducted a longitudinal cohort study on older hip fracture patients admitted to an Orthogeriatric Unit between January 2021 and February 2022 within the multicenter “Gruppo Italiano di Ortogeriatria” network. Depression was assessed retrospectively from patient medical history. Poor functional status was a Cumulated Ambulation Score <4 after 4 months. The sample included 154 patients (72.1% females, mean age 81.9). A history of depression was reported in 25.3% of participants. Depression was independently associated with higher odds of poor functional outcome (OR = 2.94, 95%CI: 1.15 - 7.85). Depression predicts a poorer functional recovery after hip fracture. The identification and treatment of depression might promote better physical recovery in orthogeriatric patients.
CITATION:
F. Remelli ; M.C. Ferrara ; F. Triolo ; M. Belvederi Murri ; G. Caruso ; G. Bellelli ; S. Volpato ; C. Trevisan ; on behalf of the GIOG Study Group ; (2024): Depression and Functional Recovery after Hip Fracture in Community-Dwelling Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.67
ADMISSION OF OLDER PATIENTS TO GERIATRIC INPATIENT CARE FROM THE EMERGENCY DEPARTMENT COMPARED WITH ADMISSION THROUGH ACUTE MEDICAL UNIT: COST AND LENGTH OF STAY OUTCOMES
R.A. Merchant, Y.H. Chan, N.M.W. Ling, M.Z.X. Chen, V.W.T. Ho, B.L.L. Wong, Z. Lim, S.E. Ng, V. Anantharaman
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OBJECTIVE: To investigate whether direct admission to geriatric inpatient care from the emergency department (EMD) was associated with lower length of stay (LOS) and cost compared to patients admitted through an acute medical unit (AMU).
METHODS: Retrospective single-centre cohort study conducted using hospital database on older patients ≥ 75 years discharged from geriatric inpatient service in a tertiary academic centre from March 2021 to September 2021 who were admitted through AMU or direct from EMD.
INTERVENTION: Traditional AMU run by internists followed by geriatrician led-care compared with geriatrician led-care.
MEASURE: We evaluated the difference in median length of stay (LOS), and cost using quantile regression adjusted for primary discharge diagnoses, hospital frailty risk score (HFRS) and Age-adjusted Charlson Comorbidity Index (ACCI).
RESULTS: Among 574 older patients, 140 (24.4%) were admitted from AMU. Mean age was 84.0 ± 6.3 years and 83.8% were categorized as high or intermediate frailty risk based on HFRS. 46% of patients admitted through EMD were discharged within three days. After adjusting for primary diagnoses, HFRS, and ACCI, patients admitted through AMU had a longer median LOS of 1.6 days (95% confidence interval (CI): 0.86-2.4, p<0.001), higher total cost $1386.0 (95% CI 733-2038, p<0.001), laboratory cost $226.0 (95% CI 131-322, p<0.001), medication cost $65.0 (95% CI 15-115, p<0.010), physiotherapy cost $45.0 (95% CI 16-75, p=0.002) and occupational therapy cost $35.0 (95% CI 12-58, p=0.003).
CONCLUSION: Older adults admitted through AMU had significantly longer median LOS, higher total cost, physiotherapy and occupational therapy costs, medication, and laboratory costs.
CITATION:
R.A. Merchant ; Y.H. Chan ; N.M.W. Ling ; M.Z.X. Chen ; V.W.T. Ho ; B.L.L. Wong ; Z. Lim ; S.E. Ng ; V. Anantharaman (2024): Admission of Older Patients to Geriatric Inpatient Care from the Emergency Department Compared with Admission through Acute Medical Unit: Cost and Length of Stay Outcomes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.58
DIABETES MICROVASCULAR COMPLICATIONS ARE ASSOCIATED WITH A REDUCTION IN GAIT SPEED IN HIGH-FUNCTIONING OLDER ADULTS FOR OUTPATIENT CLINICS
J. Ars, A. Ribera, C. Udina, G. Maltese, Á. Ortiz-Zúñiga, M. Mota-Foix, E. Sarró, C. Castellano-Tejedor, M. Inzitari, on behalf of the DIALCAT project team
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Although the association of type 2 diabetes (T2D) with an increased risk of poor physical function and frailty in older adults is widely documented, the underlying pathophysiological pathways linking these two entities are not fully understood. Accordingly, we conducted a cross-sectional observational study aiming to investigate the association of T2D and its microvascular complications retinopathy, nephropathy, and neuropathy, with gait speed (GS), a common surrogate marker of functional decline, adjusting for age, sex, and cognitive function, in the cohort of older adults of the DIALCAT project (Catalonia, Spain). From the initial 335 participants, 84 were excluded because of missing or incorrect GS assessment. The remaining 251 individuals showed a mean (SD) age of 76.5 (5.8) years, of which 50.4% were women, and 69.4% had T2D. Participants were functionally independent (Barthel Index = 95.9 ± 7.3) but showed low physical performance (GS = 0.7 ± 0.3 m/s). Univariate analysis revealed a significant association between GS and sex, body mass index, Barthel index, Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS) scores, retinopathy, and nephropathy, and a non-significant association between GS and presence/absence of T2D. In multivariate analysis, T2D complications was independently associated with slower GS (β=-0.12 (-0.23, -0.01), p=0.029, with absence of T2D as reference group; and -0.13; (-0.23, -0.04); p=0.007, with T2D without complications as reference group). Further adjustment for MMSE and GDS, which remained significantly associated with GS, attenuated the association of GS with T2D complications. In conclusion, the presence of diabetes complications, encompassing renal, visual, peripheral, and potentially central nervous system levels, was associated with a reduction in gait speed, a relevant marker of physical function and frailty.
CITATION:
J. Ars ; A. Ribera ; C. Udina ; G. Maltese ; Á. Ortiz-Zúñiga ; M. Mota-Foix ; E. Sarró ; C. Castellano-Tejedor ; M. Inzitari ; on behalf of the DIALCAT project team ; (2024): Diabetes Microvascular Complications Are Associated with a Reduction in Gait Speed in High-Functioning Older Adults for Outpatient Clinic. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.33
INFLAMMATION, FRAILTY, AND ASPIRIN USE IN THE PHYSICIANS’ HEALTH STUDY: A PILOT STUDY
D. Gewurz, G. Zhou, Y. Endo, I. Sinha, J.M. Gaziano, H.D. Sesso, A.R. Orkaby
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Whether anti-inflammatory medications such as aspirin can lower the risk of frailty is an active area of investigation. In previous studies, we reported that regular aspirin use started in midlife was associated with a lower risk of frailty at older age. We therefore sought to further examine the relationship between inflammatory biomarkers, frailty and aspirin use in a pilot nested case-control study of 300 participants aged ≥60 years with available data to calculate a frailty index from the Physicians’ Health Study, a completed randomized trial of aspirin that began in 1982. We selected 150 individuals who were frail (frailty index >0.2) and 150 who were not frail (frailty index <0.1). We then matched 29 low users of aspirin (≤60 days/year) 3:1 to 87 regular users of aspirin (>60 days/year). After matching on age, smoking status, history of diabetes and CVD, there was no significant association between aspirin use and level of frailty among those with elevated inflammatory biomarkers (all p>0.05). In this pilot study we did not find evidence of a mediation effect of CRP, TNFR-2 or IL-6 on the association between aspirin and frailty. Additional work is needed to elucidate the potential mechanistic pathways through which medications such as aspirin may be linked with frailty.
CITATION:
D. Gewurz ; G. Zhou ; Y. Endo ; I. Sinha ; J.M. Gaziano ; H.D. Sesso ; A.R. Orkaby (2024): Inflammation, Frailty, and Aspirin Use in the Physicians’ Health Study: A Pilot Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.37
EXPLORING THE ROLE OF ANTIBIOTICS IN HOSPICE CARE
G. Ghidini, M. Fabrizi, M. Froldi, R.E. Moroni Grandini, M. Proietti, M. Cesari
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BACKGROUND: The decision regarding the use of antibiotics in hospice care, whether to initiate, defer, or discontinue therapy, presents challenges. This study aims to explore the characteristics of terminally ill patients associated with antimicrobial use in hospice.
METHODS: Data are from a registry study enrolling patients admitted to hospice after discharge from a hospital. Three-hundred-sixty-six persons aged 18 and older were considered for the present analysis. Collected data encompassed demographic information, medical history, and outcomes assessed through a comprehensive geriatric assessment.
RESULTS: Among the patients admitted to the hospice, 242 individuals did not receive antibiotics (Group A), and 91 (24.6%) were already undergoing antibiotic therapy at admission. Of these, 59 (65.6%) patients (Group B) continued the treatment, while 32 (35.6%; Group C) discontinued it. Additionally, 33 patients (Group D) initiated an antibiotic treatment during their hospice stay. Patients undergoing antibiotic therapy (Group D) presented higher residual functions than the other groups, especially compared to Group C (p<0.001). The four groups also differed in mortality risk. In particular, Cox proportional hazard models indicated that Group D presented a lower risk of death than Group A, even after adjustment for age, sex, estimated poor prognosis and two different performance status (PS ECOG, Karnofsky PS).
CONCLUSION: A relatively high number of persons admitted to the hospice receive antibiotic therapy without apparent benefit. The decision to prescribe antibiotics in hospice care appears to be based on the patient’s functional performance and estimated prognosis.
CITATION:
G. Ghidini ; M. Fabrizi ; M. Froldi ; R.E. Moroni Grandini ; M. Proietti ; M. Cesari (2024): Exploring the Role of Antibiotics in Hospice Care. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.74
MUSCLE STRENGTH MATTERS MOST FOR RISK OF FALLING APART FROM BODY MASS INDEX IN OLDER ADULTS: A MEDIATEDMODERATION ANALYSIS
F. Rodrigues, M. Izquierdo, D. Monteiro, M. Jacinto, R. Matos, N. Amaro, R. Antunes, D.S. Teixeira
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The primary objective of this study was to analyze the moderating effect of body mass index (BMI) on the association between lower body strength, agility, and dynamic balance, considering the mediating influence of lower body flexibility and aerobic endurance in community-dwelling older adults. This study included a sample of 607 community-dwelling older adults (female = 443; male = 164) aged between 60 and 79 years (M = 69.24; SD = 5.12). Participants had a mean body mass index of 28.33kg/m2 (SD = 4.45). In the mediation-moderation model, positive associations were found between lower body strength and lower body flexibility, aerobic endurance, and agility and dynamic balance (p < 0.05). As for the moderation effects and interactions, BMI was found to have a significant interaction with lower body strength on agility and dynamic balance (β = -.04, [-.06, -.03]), representing an R2-change of 0.04 (p < .001). Conditional direct effects were estimated at BMI scores of 23.9 (β = -.09, [-.15, -.03]), 27.7 (β = -.19, [-.24, -.14]), and 32.7 (β = -.33, [-.40, -.26]) kg/m2. Older adults with high levels of muscular strength tended to have shorter timed up-and-go test times, regardless of BMI. Also, individuals with lower levels of lower body strength were found to have longer timed up-and-go test times, and this relationship became more pronounced with increasing BMI.
CITATION:
F. Rodrigues ; M. Izquierdo ; D. Monteiro ; M. Jacinto ; R. Matos ; N. Amaro ; R. Antunes ; D.S. Teixeira (2024): Muscle Strength Matters Most for Risk of Falling Apart from Body Mass Index in Older Adults: A Mediated-Moderation Analysis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.68
FIVE-TIME SIT-TO-STAND LOWER LIMB MUSCLE POWER IN OLDER WOMEN: AN EXPLORATIVE, DESCRIPTIVE AND COMPARATIVE ANALYSIS
H.J. Coelho-Júnior, A. Álvarez-Bustos, L. Rodríguez-Mañas, I. de Oliveira Gonçalves, R. Calvani, A. Picca, M.C. Uchida, S. da Silva Aguiar, E. Marzetti
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BACKGROUND: Muscle power assessment entails the use of complex equipment which impacts its clinical applicability. Recently, equations to estimate lower-limb muscle power measures based on 5-repetition sit-to-stand (5STS) performance and anthropometric parameters were validated. However, their ability to discriminate physical performance status in older adults is still unknown. Moreover, the analysis of the biomechanical aspects of 5STS might represent a valid instrument to identify people with different physical statuses.
OBJECTIVES: Explore and examine the biomechanical aspects of 5STS performance, and compare the capacity of this measure and 5STS muscle power equations to discriminate older women with different physical function levels.
DESIGN: Cross-sectional study. Setting: Community. Participants: Older women. Measurements: 5STS using a linear encoder, Timed “Up-andGo” (TUG), isometric handgrip strength (IHG) and walking speed (WS).
RESULTS: Results from ANOVA analysis indicated that peak concentric muscle power was reached in the first 5STS repetition and then declined significantly (P= 0.006). When participants were divided in high and low physical performance groups according to median results of TUG, IHG and WS tests, significant differences in 5STS biomechanical aspects were observed, according to independent t-test results (P< 0.05). However, no differences were found for 5STS muscle power equations. Pearson’s correlation analysis indicated that 5STS biomechanical aspects (P< 0.05), but not 5STS muscle power equations, were significantly associated with physical performance.
CONCLUSION: Findings of the present study suggest that 5STS biomechanical aspects might contribute to discriminating older women with high and low physical performance.
CITATION:
H.J. Coelho-Júnior ; A. Álvarez-Bustos ; L. Rodríguez-Mañas ; I. de Oliveira Gonçalves ; R. Calvani ; A. Picca ; M.C. Uchida ; S. da Silva Aguiar ; E. Marzetti (2024): Five-Time Sit-To-Stand Lower Limb Muscle Power in Older Women: An Explorative, Descriptive and Comparative Analysis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.50
THE SALIVA AND MUSCLE STUDY (SAMU): RATIONALE AND PROTOCOL FOR ASSOCIATIONS BETWEEN SALIVARY MICROBIOME AND ACCELERATED MUSCLE AGEING
L. Crombez, A. Descamps, H. Hirmz, M. Lambert, J. Calewaert, D. Siluk, M. Markuszewski, M. Biesemans, G. Petrella, D. Cicero, S. Cesaroni, T. Stokowy, G.K. Gerber, C. Tataru, P. Naumovski, D. Elewaut, C. Van De Looverbosch, P. Calders, N. Van Den Noortgate, B. De Spiegeleer, E. Wynendaele, A. De Spiegeleer
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BACKGROUND: The gut microbiome is recognized as a pivotal factor in the pathophysiology of sarcopenia—a condition marked by the accelerated loss of muscle strength, mass and function with ageing. Despite this well-known gut-muscle axis, the potential links between other microbial ecosystems and sarcopenia remain largely unexplored. The oral microbiome has been linked to various age-related health conditions such as rheumatoid arthritis and colorectal cancer. However, its potential association with sarcopenia is unknown. The Saliva and Muscle (SaMu) study seeks to address this knowledge gap.
METHODS: The SaMu study comprises three sequential phases. In phase 1, a cross-sectional analysis will be conducted on a cohort of 200 individuals aged 70 years or older to examine the relationship between salivary microbiome and sarcopenia status. Participants will be recruited in the three main places of living: general community, assisted living facilities and nursing homes. The salivary microbiome composition will be evaluated utilizing shotgun metagenomics sequencing, while sarcopenia status will be determined through muscle mass (determined by whole-body bioelectrical impedance analysis and calf circumference), muscle strength (grip strength and the 5-times-sit-to-stand test) and physical performance (usual walking speed). In addition to investigating the microbiome composition, the study aims to elucidate microbiome functions by exploring potential omic associations with sarcopenia. To achieve this, salivary proteomics, metabolomics and quorum sensing peptidomics will be performed. Covariates that will be measured include clinical variables (sociodemographic factors, health status, health-related behaviours, oral health and quality of life) as well as blood variables (immune profiling, hormones, kidney and liver function, electrolytes and haematocrit). In phase 2, an in-depth mechanistic analysis will be performed on an envisaged subcohort of 50 participants. This analysis will explore pathways in muscle tissue using histology, genomics and transcriptomics, focusing on (maximal) 25 healthy older adults and (maximal) 25 with severe sarcopenia. Phase 3 involves a two-year clinical follow-up of the initial participants from the cross-sectional analysis, along with a resampling of blood and saliva. Additionally, secondary outcomes like falls, hospitalization and mortality will be examined.
DISCUSSION: Using a salivary multi-omics approach, SaMu primarily aims to clarify the associations between the oral microbiome and sarcopenia. SaMu is expected to contribute to the discovery of predictive biomarkers of sarcopenia as well as to the identification of potential novel targets to prevent/tackle sarcopenia. This study-protocol is submitted for registration at the ISRCTN registry.
CITATION:
L. Crombez ; A. Descamps ; H. Hirmz ; M. Lambert ; J. Calewaert ; D. Siluk ; M. Markuszewski ; M. Biesemans ; G. Petrella ; D. Cicero ; S. Cesaroni ; T. Stokowy ; G.K. Gerber ; C. Tataru ; P. Naumovski ; D. Elewaut ; C. Van De Looverbosch ; P. Calders ; N. Van Den Noortgate ; B. De Spiegeleer ; E. Wynendaele ; A. De Spiegeleer (2024): The Saliva and Muscle Study (SaMu): Rationale and Protocol for Associations between Salivary Microbiome and Accelerated Muscle Ageing. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.75
INTRINSIC CAPACITY IMPAIRMENTS (ICOPE STEP 1 AND STEP 2), CARDIOMETABOLIC RISK AND IMMUNE RESILIENCE: AN EXPLORATORY ANALYSIS FROM THE GAN-DAU HEALTHY LONGEVITY PLAN
Z.-J. Chen, W.-H. Lu, L.-C. Meng, W.-F. Chao, H.-H. Tung, F.-Y. Hsiao, L.-K. Chen
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IMPORTANCE: Intrinsic capacity (IC), defined by the World Health Organization’s Integrated Care for Older People (ICOPE) framework, is crucial for promoting healthy aging. Understanding the associations between IC impairments and age-related biomarkers can provide insights into the underlying pathophysiological mechanisms and potential interventions.
OBJECTIVE: To investigate the associations between IC impairments (ICOPE step 1 and step 2, respectively) and aging-related biomarkers, including inflammatory and cardiometabolic markers, in community-dwelling middle-aged and older adults.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of data from 755 participants (aged 50-64 years, n=212; 65-74 years, n=357; ≥75 years, n=186) enrolled in the Gan-Dau Healthy Longevity Plan, a community-based survey in Taipei City, Taiwan, from 2022.
EXPOSURES: IC impairments assessed by ICOPE Step 1 (screening) and Step 2 (in-depth assessment) across six domains: locomotion, vitality, vision, hearing, cognition, and psychological well-being.
MAIN OUTCOMES AND MEASURES: Levels of inflammatory biomarkers (albumin, white blood cell count, neutrophils, lymphocytes, monocytes, neutrophil-to-lymphocyte ratio [NLR], lymphocyte-to-monocyte ratio [LMR], platelet-to-lymphocyte ratio [PLR]) and cardiometabolic biomarkers (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], total cholesterol, fasting glucose, triglycerides, triglyceride-glucose [TyG] index).
RESULTS: Of the 755 participants, the mean age was 68.5 years, and 68.2% were women. The proportion of participants with any IC impairment increased with age: 63.2% for those aged 50-64, 65.8% for those aged 65-74, and 74.7% for those aged ≥75 years based on ICOPE Step 1. For ICOPE Step 2, the proportions were 59.9%, 56.9%, and 64.0%, respectively. Impairments in locomotion and cognition were significantly higher in the oldest age group (≥75 years). Adjusted for covariates, IC impairment (ICOPE Step 2) was associated with higher levels of neutrophil count (β = 3.17, p = 0.015) and NLR (β = 0.34, p = 0.021) in those aged 50-64 years, and higher levels of monocyte count in those aged 65-74 years (β = 0.65, p = 0.001) and ≥75 years (β = 0.68, p = 0.037).
CONCLUSIONS AND RELEVANCE: In conclusion, IC impairments were associated with alterations in specific inflammatory biomarkers, suggesting potential interactions between IC, age, and inflammatory processes. Longitudinal studies are warranted to establish causal relationships and elucidate the underlying mechanisms linking IC impairments, immune dysregulation, and the aging process.
CITATION:
Z.-J. Chen ; W.-H. Lu ; L.-C. Meng ; W.-F. Chao ; H.-H. Tung ; F.-Y. Hsiao ; L.-K. Chen ; (2024): Intrinsic Capacity Impairments (ICOPE Step 1 and Step 2), Cardiometabolic Risk and Immune Resilience: An Exploratory Analysis from the Gan-Dau Healthy Longevity Plan. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.66
OBJECTIVE MEASURES OF PHYSICAL ACTIVITY AND FRAILTY IN AMBULATORY ADULTS AGED 85–89 YEARS IN KAWASAKI, JAPAN: A CROSS-SECTIONAL STUDY
T. Tajima, Y. Oguma, Y. Saito, Y. Abe, I.M. Lee, Y. Arai
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BACKGROUND: While physical activity (PA) can reduce physical frailty, the specific intensity and duration of PA required to prevent frailty are yet to be defined.
OBJECTIVES: This study aimed to investigate the relationship between objectively measured PA or sedentary behavior (SB) and physical frailty and to explore the theoretical effect of replacing SB with different intensities of PA on the risk of frailty.
DESIGN: Cross-sectional study.
SETTING: Community-based assessments.
PARTICIPANTS: Independently living adults aged 85–89 years participating in the Kawasaki Aging and Wellbeing Project.
MEASUREMENTS: PA was measured using a triaxial accelerometer for a minimum of 10 h per day over a minimum of 3 days. Physical frailty was measured using the revised Japanese version of the Cardiovascular Health Study criteria. Physical frailty was classified as non-frail, pre-frail, and frail. The relationship between PA and frailty was assessed using analysis of covariance. The effect of replacing SB with light-intensity PA (LPA) or moderate-to-vigorous-intensity PA (MVPA) on the risk of frailty was estimated using multinomial logistic regression and an isotemporal substitution model.
RESULTS: The analysis included 1004 participants (503 men and 501 women) of whom 242 were classified as frail. The mean step count, MVPA, and LPA were lower, and SB was higher in the frail group than in the non-frail group. SB replacement with MVPA for 10 min/day was associated with a significantly lower odds of frailty (odds ratio [95% confidence interval]: pre-frail men, 0.86 [0.77, 0.96]; frail men, 0.70 [0.60, 0.83]; pre-frail women, 0.77 [0.66, 0.90], frail women, 0.59 [0.47, 0.75]). SB replacement with LPA was not significantly associated with frailty odds in men or women.
CONCLUSIONS: Replacing 10 min of SB with MVPA was associated with lower risk of frailty in adults aged 85–89 years. These findings require confirmation in longitudinal and intervention studies.
CITATION:
T. Tajima ; Y. Oguma ; Y. Saito ; Y. Abe ; I.M. Lee ; Y. Arai ; (2024): Objective Measures of Physical Activity and Frailty in Ambulatory Adults Aged 85–89 Years in Kawasaki, Japan: A Cross-sectional Study . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.57
ASSOCIATION BETWEEN DIETARY FLAVONOID INTAKE AND THE LIKELIHOOD OF FRAILTY IN MIDDLE-AGED AND OLDER ADULTS: A POPULATION-BASED ANALYSIS FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES)
H.-J. Guo, Y.-L. Ye, R. Cao, T.-H. Yu, Q. He
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OBJECTIVES: Flavonoids are of particular interest for their antioxidant property and anti-inflammatory, and a therapeutic potential for age-related diseases has been suggested. Frailty is becoming a global public health concern due to an increasingly aging population. We aimed to evaluate the association between dietary flavonoid intake and the likelihood of frailty in middle-aged and older adults.
DESIGN: A US nationally representative cross-sectional study.
SETTING: National Health and Nutrition Examination Surveys database.
PARTICIPANTS: Of the 8159 adults aged 50 years and older.
MEASUREMENTS: This study used data from NHANES (2007-2010 and 2017-2018). Dietary flavonoid intake data were obtained from a 24-h recall interview. Frailty was measured using a 53-item frailty index (FI) and diagnosed as FI > 0.21. We used survey-weighted logistic regression models to assess the association between flavonoid intake and odds of having frailty. The dose-response association between flavonoid intake and frailty was estimated using a survey-weighted restricted cubic spline (RCS) model.
RESULTS: Among the 8159 adults (63.42 ± 0.20 years), 2551 (31.3%) had frailty. The RCS depicted a U-shaped association between total flavonoid intake and frailty. Compared with those in the lowest quintile (≤14.55 mg/day), participants in the fourth total flavonoid intake quintile (84.13–313.51 mg/day) had the lowest likelihood of frailty with an OR (95% CI) of 0.65 (0.51–0.84). The likelihood of frailty decreased until 220 mg/day, with 2% (0.8%-4.1%) lower odds of frailty per 10 mg higher total flavonoid intake, which increased thereafter. Similarly, the U-shaped relation with frailty was observed for five flavonoid subclasses (flavan-3-ols, flavanones, flavones, flavonols, isoflavones), while a roughly negative linear relation was observed for the other flavonoid subclass (anthocyanidins).
CONCLUSION: U-shaped associations with frailty for dietary intake of total flavonoids and flavonoid subclasses (flavan-3-ols, flavanones, flavones, flavonols, and isoflavones) were observed in middle-aged and older US adults.
CITATION:
H.-J. Guo ; Y.-L. Ye ; R. Cao ; T.-H. Yu ; Q. He ; (2024): Association between Dietary Flavonoid Intake and the Likelihood of Frailty in Middle-Aged and Older Adults: A Population-Based Analysis from the National Health and Nutrition Examination Survey (NHANES). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.40
COMPARATIVE ANALYSIS OF GAIT SPEED MEASUREMENT PROTOCOLS: STATIC START VERSUS DYNAMIC START IN A CROSSSECTIONAL STUDY USING LIGHT DETECTION AND RANGING
S. Ji, H.-W. Jung, S. Yoon, H. Roh, M. Kim, H. Jung, R. Jang, H. Ha, J.Y. Baek, I.-Y. Jang, E. Lee
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BACKGROUND: There is currently no standardized protocol for the measurement of gait speed in older adults, particularly regarding the choice between static versus dynamic start.
OBJECTIVES: This study aimed to assess the impact of removing the initial phase on gait speed measurement and compare the correlation of different measurement methods with other physical performance metrics.
DESIGN: A cross-sectional study.
SETTING: A geriatric clinic in a tertiary hospital in Seoul, Korea.
PARTICIPANTS: Adults aged 65 years or older who underwent physical performance examinations during comprehensive geriatric assessments (n = 511).
MEASUREMENTS: A one-dimensional light detection and ranging device was used to obtain real-time gait signal data and measure the participants’ gait speed. Descriptive statistics were obtained for the acceleration phase. Various lengths of the initial phase were removed to determine the point at which gait speed plateaued. Correlations between four-meter gait speeds, with different initial phase lengths, and chair stand and balance test results were examined.
RESULTS: The mean ± standard deviation of the acceleration phase (m) was 0.92 ± 0.51. The removal of various initial phase lengths showed that 2 m gait speed based on dynamic start (0.5 m) significantly differed from static start (0.7 m/s versus 1.05 m/s, p<0.001). Gait speed showed an increase with the removal of longer initial phases but plateaued after removing 1 meter. This change lacked clinical significance after removing 0.5 meters. Dynamic start gait speed exhibited superior discriminative ability in chair stand and balance tests compared to static start gait speed.
CONCLUSION: Static start underestimates gait speed, while dynamic start aligns better with other physical performance results. An acceleration phase of 0.5 to 1 meter appears sufficient, but further studies are needed to optimize gait measurement methods.
CITATION:
S. Ji ; H.-W. Jung ; S. Yoon ; H. Roh ; M. Kim ; H. Jung ; R. Jang ; H. Ha ; J.Y. Baek ; I.-Y. Jang ; E. Lee (2024): Comparative Analysis of Gait Speed Measurement Protocols: Static Start Versus Dynamic Start in a Cross-Sectional Study Using Light Detection and Ranging. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.48
THE EFFICACY OF 12-WEEK PROGRESSIVE HOME-BASED STRENGTH AND TAI-CHI EXERCISE SNACKING IN OLDER ADULTS: A MIXED-METHOD EXPLORATORY RANDOMISED CONTROL TRIAL
I.J. Liang, O.J. Perkin, S. Williams, P.M. McGuigan, D. Thompson, M.J. Western
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CITATION:
I.J. Liang ; O.J. Perkin ; S. Williams ; P.M. McGuigan ; D. Thompson ; M.J. Western ; (2024): The Efficacy of 12-Week Progressive Home-Based Strength and Tai-Chi Exercise Snacking in Older Adults: A Mixed-Method Exploratory Randomised Control Trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.32
FEASIBILITY OF A MULTICOMPONENT DIGITAL FALL PREVENTION EXERCISE INTERVENTION FOR AT-RISK OLDER ADULTS
N. Bajdek, N.K. Latham, M. Dishaw, S. Farrell, Y.V. Shang, K.M. Pencina, R. Valderrábano, M. McAlevey, R. Dixon, A. Williams, N. Hachen, K.F. Reid
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BACKGROUND: Falls are a leading cause of disability, institutionalization and mortality for older adults. More effective strategies to prevent falls are essential and may help at-risk older adults continue to live independently. While exercise programs with in-person supervision reduce fall risk, there are numerous barriers associated with older adults’ participation in such programs. Digitally delivered exercise interventions utilizing wearable technology may be an alternative fall prevention strategy for many vulnerable older adults. OBJECTIVES: To evaluate the feasibility of a scalable, multicomponent, remotely delivered, digital fall prevention exercise intervention for community-dwelling older adults with elevated fall risk. DESIGN: This single arm intervention trial enrolled older adults who reported ≥ 2 falls, or ≥ 1 injurious fall in the past year, or fear of falling.
STUDY SETTING AND PARTICIPANTS: Community-dwelling adults aged ≥ 65 years were recruited from the greater Boston region, MA, USA.
INTERVENTION: The 12-week multicomponent intervention was delivered via tablet and wearable sensors and consisted of a program of progressive moderate-intensity strength, power and balance training, adaptive aerobic walking exercise, regular coaching calls and digital motivational messaging.
MEASUREMENTS: Intervention adherence and measures of intervention feasibility, acceptability, and appropriateness were evaluated. Intervention effects on measures of fall risk, physical and cognitive performance, and other measures of well-being were also examined.
RESULTS: Twenty-three participants enrolled in the study and 20 completed the intervention (mean age: 76.3±5.5 yrs; BMI: 26.9±4.6 kg/m2; short physical performance battery score: 8.8 ± 2.2; 70% female). Overall adherence rates were 84.4±14.6% with no serious adverse events. Significant reductions in fear of falling and improvements in cognition and technology readiness were elicited (p≤0.04).
CONCLUSION: This study has demonstrated the feasibility of a multicomponent digital fall prevention exercise intervention for at-risk older adults. Additional studies are warranted to establish the efficacy of this highly scalable fall prevention strategy.
CITATION:
N. Bajdek ; N.K. Latham ; M. Dishaw ; S. Farrell ; Y.V. Shang ; K.M. Pencina ; R. Valderrábano ; M. McAlevey ; R. Dixon ; A. Williams ; N. Hachen ; K.F. Reid (2024): Feasibility of a Multicomponent Digital Fall Prevention Exercise Intervention for At-Risk Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.35
EXERCISE MODALITIES IN MULTI-COMPONENT INTERVENTIONS FOR OLDER ADULTS WITH MULTI-MORBIDITY: A SYSTEMATIC REVIEW AND NARRATIVE SYNTHESIS
F. Forsyth, C.L. Soh, N. Elks, H. Lin, K. Bailey, S. Rowbotham, J. Mant, P. Hartley, C. Deaton
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BACKGROUND: Exercise is efficacious in older adults, including those with multi-morbidity. However, the optimum mode is not known and there are conflicting findings as regards the types of exercises to recommend. It is postulated that multi-component exercise interventions better meet the needs of older adults who experience multi-morbidity as they more holistically address the range of functional problems they may experience. To date, no review has explored and described in detail what multi-component exercise interventions have been tested in older adults with multi-morbidity.
OBJECTIVES: To explore the number and types of exercises included within multi-component exercise interventions that have been tested in older adults with multi-morbidity. Secondary objectives were to explore the rationale for selecting particular exercise components within the intervention design and to describe the characteristics of the exercise program.
DESIGN: Systematic review and narrative synthesis.
RESULTS: Database searches yielded 51,001 articles; following screening 138 unique interventions were retained for analysis. Across studies, 22 different multi-component combinations were identified, and there was marked variation in frequency, intensity and duration. Few studies describe characteristics that are in line with the preferences or needs of older adults with multi-morbidity. Exercise design decisions were most frequently judged to be based on practitioner intuition/local practice.
CONCLUSION: There is substantial heterogeneity within multi-component exercise interventions; which has significant implications for meta-analysis of effects. Interventions do not frequently appear to consider the abilities or needs of those with multi-morbidity, nor do they seem to be attuned to the participation barriers they experience.
CITATION:
F. Forsyth ; C.L. Soh ; N. Elks ; H. Lin ; K. Bailey ; S. Rowbotham ; J. Mant ; P. Hartley ; C. Deaton (2024): Exercise Modalities in Multi-Component Interventions for Older adults with Multi-Morbidity: A Systematic Review and Narrative Synthesis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.28
FRAILTY INDEX, NOT AGE, PREDICTS TREATMENT OUTCOMES AND ADVERSE EVENTS FOR OLDER ADULTS WITH CANCER
J. Fletcher, N. Reid, R.E. Hubbard, R. Berry, M. Weston, E. Walpole, R. Kimberley, D.A. Thaker, R. Ladwa
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BACKGROUND: Frailty is an indicator of individual vulnerability and differentiates health status among people of the same chronological age.
OBJECTIVES: This study aimed to determine whether baseline frailty index (FI) was associated with systemic anticancer therapy treatment outcomes in older adults with solid cancers.
DESIGN: Retrospective cohort study.
SETTING: Major metropolitan outpatient oncology service.
PARTICIPANTS: Adults aged over 65 years with a solid malignancy who had been referred for consideration of systemic therapy, and had completed a baseline frailty assessment between January 2019 and July 2021.
MEASUREMENTS: Frailty had been prospectively assessed with a 58-item FI derived from a geriatric oncology nurse assessment prior to initial oncologist appointments. Primary outcome was treatment completion, and secondary outcomes included incidence of high-grade treatment-related toxicity or unplanned hospital admissions, and survival outcomes. Univariate and multivariable regression analyses were conducted to test the association between treatment outcomes and baseline FI. Co-variates included age, sex, performance status, treatment intent, and stage. Kaplan-Meier and cox proportional hazard analysis were conducted for survival analysis.
RESULTS: The median FI (IQR) was 0.24 (0.15-0.31) and 43% were frail (FI>0.25). FI was positively correlated with ECOG, however 28% of ECOG 0-1 were frail. In multivariable regression analyses, each 0.10 increase in FI was associated with an increased likelihood of not completing or not receiving treatment (OR 1.37, 95% CI 1.02-1.84; p=.04), treatment-related toxicity (OR 1.60, 95% CI 1.14-2.23; p<.01) and unplanned hospital admissions (OR 1.61; 95% CI 1.16-2.25; p<.01). Frail patients had increased mortality (adjusted HR 2.81, 95% CI 1.42-5.56; p<.01). Age did not predict treatment completion, toxicities, or survival.
CONCLUSION: Baseline FI is a granular measure that can help to identify frailer older patients who are more likely to require tailored therapy and support, and less frail older patients who are more likely to tolerate treatment.
CITATION:
J. Fletcher ; N. Reid ; R.E. Hubbard ; R. Berry ; M. Weston ; E. Walpole ; R. Kimberley ; D.A. Thaker ; R. Ladwa (2024): Frailty Index, Not Age, Predicts Treatment Outcomes and Adverse Events for Older Adults with Cancer. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.22
THE INTERPLAY AMONG RESPIRATORY FAILURE, DELIRIUM, FRAILTY AND SEVERITY OF ILLNESS IN HOSPITALIZED OLDER MEDICAL PATIENTS: A NATIONWIDE MULTICENTER OBSERVATIONAL STUDY
F.L. Fimognari, E. Tassistro, E. Rossi, V. Bambara, M.G. Valsecchi, A. Cherubini, A. Marengoni, E. Mossello, M. Inzitari, A. Morandi, G. Bellelli, on behalf of the Italo-Catalan Study Group on Delirium (ICSGoD)
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BACKGROUND: Prevalence, correlates and outcomes of respiratory failure (RF) were never studied in large populations of older patients hospitalized in acute care medical settings. Little is known about the possible association between RF and delirium, and whether these two syndromes, alone or in combination, may affect short-term mortality.
OBJECTIVES: To investigate prevalence and features of RF, the association between delirium and RF, and their effect on short-term mortality.
DESIGN:Prospective cross-sectional study with data collection on an index day and 30-day follow up.
SETTING AND PARTICIPANTS: 1493 patients aged ≥ 65 years hospitalized in Italian acute medical wards from the 2017 Delirium Day database.
METHODS: RF was identified according to the detection of peripheral oxygen saturation ≤ 91% on the index day, or to ongoing oxygen therapy or non-invasive ventilation on the index day or the day before. A modified National Early Warning Score (NEWS), obtained removing the “Oxygen Saturations” and “Any Supplemental Oxygen” items, measured non-hypoxemic severity of acute illness.
RESULTS: 300 patients (20.1%) had RF. Mortality was 16.6% in the RF group and 8.2% in the non-RF group (p<0.001). Delirium prevalence was 31.3% in RF (94 patients, 72 of whom with hypoactive or mixed delirium) and 22% in non-RF patients (p<0.001). Age, frailty, modified NEWS, steroids use, presence of urinary catheters or other major devices, but not delirium, were independent RF correlates. RF alone (OR [odds ratio]: 1.83; 95% CI [confidence interval]: 1.02-3.29) predicted 30-day mortality after adjustment for confounders, including modified NEWS. Without adjustment for modified NEWS, the combination of delirium and RF also significantly predicted 30-day mortality (OR: 2.26; 95% CI 1.08-4.72).
CONCLUSIONS: In hospitalized older medical patients, RF was a prevalent syndrome which was frequently complicated by delirium. RF was featured by older age, frailty and severe illness, and independently predicted short-term mortality.
CITATION:
F.L. Fimognari ; E. Tassistro ; E. Rossi ; V. Bambara ; M.G. Valsecchi ; A. Cherubini ; A. Marengoni ; E. Mossello ; M. Inzitari ; A. Morandi ; G. Bellelli ; on behalf of the Italo-Catalan Study Group on Delirium (ICSGoD) ; (2024): The Interplay among Respiratory Failure, Delirium, Frailty and Severity of Illness in Hospitalized Older Medical Patients: A Nationwide Multicenter Observational Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.12
THE PREDICTION OF HEALTHCARE UTILIZATION BY FRAILTY AND DISABILITY AMONG DUTCH COMMUNITY-DWELLING PEOPLE AGED 75 YEARS OR OLDER
T. van der Ploeg, R.J.J. Gobbens
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BACKGROUND: Population aging is occurring worldwide. As a result, frailty and disability are in the full interest of practice, policy, and science. An increase in healthcare utilization is an adverse outcome of frailty and disability.
OBJECTIVE: The aim of the present study was the prediction of six indicators of healthcare utilization by frailty and disability measures. The six indicators of healthcare utilization of interest were: use of informal care, number of visits to a general practitioner, hospital admission, receiving nursing care, receiving personal care, and contacts with (health)care professionals.
METHODS: We used a sample of 484 people that was randomly drawn from the municipality of Roosendaal (the Netherlands), a municipality with 78,000 inhabitants. A subset of people who completed the Tilburg Frailty Indicator (TFI) at baseline and the Groningen Activity Restriction Scale (GARS) questionnaires was used with a nine-year followup. We used generalized estimation equations (GEE) to predict the six indicators with the frailty measures (physical, psychological, and social scores) and disability measures (ADL and IADL scores). We also performed GEE analyses adjusted for age, gender, and multimorbidity from part A of the TFI at baseline.
RESULTS: The significant predictors were different for each indicator. However, the physical frailty score, the ADL score, and the IADL score often emerged as significant predictors. These three variables predicted several indicators of healthcare utilization: use of informal care, number of visits to a general practitioner, hospital admission, receiving nursing care, receiving personal care, and contacts with (health)care professionals. The social score was found to be significant for the indicator use of disciplines.
CONCLUSIONS: In conclusion, our study showed that in particular physical frailty, and ADL and IADL disability predicted healthcare utilization in community-dwelling people aged 75 years or older. It is important that care and welfare professionals pay attention to physical frailty and both ADL and IADL disability aiming to diminish frailty and disability and preventing intensive healthcare utilization and related costs. Future research will have to focus on more representative Dutch municipalities in order to get a more reliable and accurate picture of the disciplines used by people with frailty and disability.
CITATION:
T. van der Ploeg ; R.J.J. Gobbens (2024): The Prediction of Healthcare Utilization by Frailty and Disability among Dutch Community-Dwelling People Aged 75 Years or Older. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.14
JFA N°03 - 2024
INTRINSIC CAPACITY AND ITS BIOLOGICAL BASIS: A SCOPING REVIEW
M.B. Beyene, R. Visvanathan, A.T. Amare
J Frailty Aging 2024;13(3)193-202
Show summaryHide summaryBACKGROUND: In 2015, the World Health Organization (WHO) introduced the concept of intrinsic capacity (IC) to define healthy aging based on functional capacity. In this scoping review, we summarized available evidence on the development and validation of IC index scores, the association of IC with health-related factors, and its biological basis. The review specifically focused on identifying current research gaps, proposed strategies to leverage biobank datasets, and opportunities to study the genetic mechanisms and gene-environment interactions underlying IC.
METHODS: The literature search was conducted across six databases, including PubMed, CINAHL, Web of Science, Scopus, AgeLine, and PsycINFO, using keywords related to IC.
RESULTS: This review included 84 articles, and most of them (n=38) adopted the 5-domains approach to operationalize IC, utilizing correlated five factors or bifactor structures. Intrinsic capacity has consistently shown significant associations with socio-demographic and health-related outcomes, including age, sex, wealth index, nutrition, exercise, smoking, alcohol use, ADL, IADL, frailty, multimorbidity, and mortality. While studies on the biological basis of the composite IC are limited, with only one study finding a significant association with the ApoE gene variants, studies on specific IC domains — locomotor, vitality, cognitive, psychological, and sensory suggest a heritability of 20-85% of IC and several genetic variants associated with these subdomains have been identified. However, evidence on how genetic and environmental factors influence IC is still lacking, with no available study to date.
CONCLUSION: Our review found that there was inconsistency in the use of standardized IC measurement tools and indicators, but the IC indices had shown good construct and predictive validity. Research into the genetic and gene-to-environment interactions underlying IC is still lacking, which calls for the use of resources from large biobank datasets in the future.
CITATION:
M.B. Beyene ; R. Visvanathan ; A.T. Amare (2024): Intrinsic Capacity and Its Biological Basis: A Scoping Review. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.30
CIRCULATING ANGIOGENIC AND SENESCENT T LYMPHOCYTES IN AGEING AND FRAILTY
T. Byrne, J. Cooke, E. McNeela, P. Bambrick, R.P. Murphy, M. Harrison
J Frailty Aging 2024;13(3)203-212
Show summaryHide summaryBACKGROUND: There is a need to identify vascular and geroscience-relevant markers and mediators that can physiologically link ageing to vascular disease. There is evidence of specific T cell subsets, all influenced by age, that exert positive and negative effects on vascular health. CD31+, termed angiogenic T cells, have been linked to vascular repair whereas CD28null, termed senescent T cells, display pro-inflammatory and cytotoxic effector functions.
OBJECTIVE: This study sought to determine the combined influence of increasing age and frailty status on these circulating CD31+ and CD28null T cell subsets.
METHODS: This cross-sectional study recruited four different cohorts of men and women; young (20-30 years, n=22), older (65-75 years, n=17), robust non-frail (76+ years, n=17), and frail (76+ years, n=15) adults. Frailty was determined using the Fried Frailty method. T cell subsets were determined by whole blood flow cytometry based on the expression of CD3, CD4, CD8, CD31 and CD28. Cognitive impairment (CI) was measured via the Montreal Cognitive Assessment test.
RESULTS: Whether expressed as circulating counts or as a % of total T cells, there was a progressive decrease (p<0.05) in CD31+ T cells with increasing age but paradoxically higher values (p<0.05) in the frail compared to the robust non-frail group. These changes were similar in the CD4+ and CD8+ fractions. CD28null T cells were considerably higher (p<0.05) in the frail compared to the robust non-frail group, including in the CD8+ (47% vs 29%, p<0.05) and CD4+ (4% vs 1%, p<0.05) fractions. CD28null T cell percentage was also higher (p<0.05) in those with moderate CI compared to mild CI and normal function.
CONCLUSION: CD8+CD28null T cells are considerably elevated in frailty and with cognitive impairment and may serve as a useful target for intervention. Currently, the utility of CD31+ T cells as an ageing biomarker may be confined to healthy ageing cohorts.
CITATION:
T. Byrne ; J. Cooke ; E. McNeela ; P. Bambrick ; R.P. Murphy ; M. Harrison ; (2024): Circulating Angiogenic and Senescent T Lymphocytes in Ageing and Frailty. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.38
PROGNOSTIC VALUE OF A LABORATORY INDEX OF FRAILTY IN OLDER PATIENTS HOSPITALIZED FOR COVID-19: THE COMEPA STUDY
N. Veronese, V. Briganò, S. Ciriminna, A. Ganci, F. Bifara, F. Pollicino, M.C. Garlisi, F. Tantillo, S. Amodeo, G. Rizzo, L. Vernuccio, P. Mansueto, A. Licata, L. Giannitrapani, L.J. Dominguez, M. Barbagallo, the COMEPA group
J Frailty Aging 2024;13(3)213-217
Show summaryHide summaryBACKGROUND: Several indexes based on clinical and laboratory tests to identify frailty and to predict mortality have been produced. Only two studies, mixing clinical and laboratory parameters were made about a frailty index made of laboratory tests (FI-Lab) and mortality in older patients hospitalized for COVID-19. The aim of this study was to explore the accuracy and precision of an FI-Lab constructed with some common bio-humoral tests and mortality in a cohort of patients hospitalized for COVID-19.
METHODS: The FI-Lab was constructed using 40 different bio-humoral tests during the first four days of hospitalization, with a score from 0 to 1. The association between FI-Lab and mortality was assessed using a multivariate Cox’s regression analysis, reported as hazard ratios (HRs) and 95% confidence intervals (CIs). The accuracy of the FI-Lab was reported as area under the curve (AUC) and the precision with the C-Index.
RESULTS: 376 patients (mean age: 65 years; 53.7% males) were initially included. During the follow-up period, 41 deceased. After adjusting for five different factors, an FI-Lab value >0.54, the median value of our cohort, was associated with a relative risk about five times greater than lower values. Modeling FI-LAB as a continous variable, each increase in 0.01 points was associated with an increased risk in mortality of 8.4% (HR=1.084; 95%CI: 1.039-2.044). The FI-Lab was highly accurate (AUC=0.91; 95%CI: 0.87-0.95) and precise (C-Index=0.81) in predicting death.
CONCLUSIONS: A simple index based on common laboratory tests can be used to predict mortality among older people hospitalized for COVID-19.
CITATION:
N. Veronese ; V. Briganò ; S. Ciriminna ; A. Ganci ; F. Bifara ; F. Pollicino ; M.C. Garlisi ; F. Tantillo ; S. Amodeo ; G. Rizzo ; L. Vernuccio ; P. Mansueto ; A. Licata ; L. Giannitrapani ; L.J. Dominguez ; M. Barbagallo ; the COMEPA group ; (2024): Prognostic Value of a Laboratory Index of Frailty in Older Patients Hospitalized for COVID-19: The COMEPA Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.29
ASSOCIATION OF FINGER TAPPING MOVEMENTS WITH FRAILTY STATUS IN OLDER JAPANESE ADULTS: A CROSS-SECTIONAL STUDY
R. Shi, W. Hao, W. Zhao, T. Kimura, T. Mizuguchi, S. Ukawa, K. Kondo, A. Tamakoshi
J Frailty Aging 2024;13(3)218-223
Show summaryHide summaryBACKGROUND: Finger tapping impairment and frailty share overlapping pathophysiology and symptoms in older adults, however, the relationship between each other has not been previously studied.
OBJECTIVES: To investigate how finger tapping movements correlate with frail status in older Japanese adults.
DESIGN, SETTING, AND PARTICIPANTS: Data were from a cross-sectional study called the Cognition and Activity in Rural Environment of Hokkaido Senior Survey 2018. A total of 244 community-dwelling older adults (mean age 75.3 years) were included.
MEASUREMENTS: Participants underwent physical examinations, gait and finger tapping tests, and completed self-administered questionnaires. Frailty was assessed using Fried’s frailty phenotype, and factor analysis was conducted to extract relevant finger tapping factors. Multinomial logistic regression was employed to analyze associations, generating adjusted odds ratios.
RESULTS: Of the participants, 18 were frail, and 145 pre-frail. Analysis identified three distinct finger tapping patterns: “Range of Motion - Nondominant Hand,” “Variability - Dominant Hand - Anti,” and “Variability - Nondominant Hand - Anti.” These patterns showed significant associations with aspects of Fried’s frailty phenotype, particularly low physical activity (P = 0.002), weakness (P = 0.003), and slowness (P = 0.004). A larger range of motion in the nondominant hand correlated with a lower frailty risk (Odds Ratio: 0.09, 95% CI: 0.02-0.46), while higher variability in the same hand increased the risk of pre-frailty (Odds Ratio: 2.19, 95% CI: 1.09-4.39).
CONCLUSION: Finger tapping movements are significantly associated with frailty status as determined by Fried’s phenotype. The findings underscore the importance of further longitudinal studies to understand the relationship between motor function and frailty.
CITATION:
R. Shi ; W. Hao ; W. Zhao ; T. Kimura ; T. Mizuguchi ; S. Ukawa ; K. Kondo ; A. Tamakoshi (2024): Association of Finger Tapping Movements with Frailty Status in older Japanese Adults: A Cross-Sectional Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.34
IMPACT OF INTERVENTIONS ON SARCOPENIA FROM THE PERSPECTIVE OF OLDER PERSONS: A SYSTEMATIC LITERATURE REVIEW
G.L. Doza, S. van Heden, F. Oliveira Felix, V. Singh, C. Beaudart
J Frailty Aging 2024;13(3)224-232
Show summaryHide summaryCurrent interventions targeting sarcopenia are diverse, incorporating a blend of nutritional, exercise, and pharmacological strategies. Although muscle mass, muscle strength, or functional performance typically serve as the primary endpoints, regulatory agencies have recently emphasized integrating Patient-Reported Outcome Measures (PROMs) as primary or secondary outcomes in interventional studies. This shift acknowledges the importance of PROMs and Patient-Reported Experience Measures (PREMs) in assessing intervention effectiveness and aligns with patient-centered healthcare models. The aims of this systematic review are 1) to identify all sarcopenia-designed interventional studies that used PROMs/PREMs as the primary or secondary outcome, 2) to identify the different PROMs/PREMs used within those studies, and 3) to summarize the effects of sarcopenia-designed interventions on PROMs/PREMs of sarcopenic participants. For that, a systematic search of databases (Medline, EMBASE, Review- Cochrane Central of Register of Controlled Trials, and PsychINFO (Via Ovid)) was conducted in September 2023. The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement, and the protocol was registered on Open Science Framework (https://osf.io/zxgwm/). The systematic review identified 17 RCTs as sarcopenia-designed interventional studies reporting PROMs. PROMs covered the assessment of various aspects, including quality of life, depressive symptoms, loneliness/social isolation, daytime sleepiness, insomnia impact, and sleep quality/disturbance. Only one sarcopenia-specific PROM, namely the SarQoL, was reported. The effect of sarcopenia-designed interventions on PROMs showed considerable heterogeneity, underscoring the need for standardization in sarcopenia research by developing a Core Outcome Set (COS). COS in sarcopenia studies would ensure consistent and comparable findings, ultimately enhancing the reliability and effectiveness of interventions.
CITATION:
G.L. Doza ; S. van Heden ; F. Oliveira Felix ; V. Singh ; C. Beaudart ; (2024): Impact of Interventions on Sarcopenia from the Perspective of Older Persons: A Systematic Literature Review. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.47
FRAILTY TRAJECTORIES AND ITS ASSOCIATED FACTORS IN JAPANESE OLDER ADULTS
Y. Taniguchi, A. Kitamura, T. Hata, K. Fujita, T. Abe, Y. Nofuji, S. Seino, Y. Yokoyama, S. Shinkai, Y. Fujiwara
J Frailty Aging 2024;13(3)233-239
Show summaryHide summaryBACKGROUND: Associated factors for frailty development according to age group remain unclear.
OBJECTIVES: To identify frailty score trajectories among community-dwelling older Japanese individuals and examine their associated factors.
DESIGN: 13-year longitudinal study.
SETTING: Kusatsu Town in Gunma Prefecture, Japan.
PARTICIPANTS: 1706 older adults aged ≥ 65 years who completed an annual frailty assessment at least once between 2007 and 2019.
MEASUREMENTS: Frailty status was determined using an index based on the Fried frailty phenotype criteria. Potential associated factors for frailty trajectory included physical, biological, lifestyle-related, and psychological factors, as well as comorbidities.
RESULTS: We identified five trajectory patterns in the frailty score from age of 65 to 90 years —individuals who were robust (Group 1, 10.5%) as well as individuals with late-onset frailty (Group 2, 16.1%), middle-onset frailty (Group 3, 25.6% and Group 4, 35.2%), and early-onset frailty (Group 5, 12.7%). Compared with the other groups, the early-onset group showed a higher prevalence of cerebrovascular diseases, bone and joint diseases, poor nutrition, sarcopenia, hospitalization, low cognitive function, and smoking at the end of follow-up. Associated factors in the middle-onset group largely overlapped with those of the early-onset group. The late-onset frailty group tended to have a higher association with heart disease and bone and joint diseases compared with the robust group.
CONCLUSION: Our findings from a 13-year longitudinal study identified five frailty trajectory patterns and seven associated factors for frailty trajectory. Proposed effective population-based frailty prevention strategies in each age group may contribute to effective strategies to extend healthy life expectancy in aging, aged, and super-aged communities.
CITATION:
Y. Taniguchi ; A. Kitamura ; T. Hata ; K. Fujita ; T. Abe ; Y. Nofuji ; S. Seino ; Y. Yokoyama ; S. Shinkai ; Y. Fujiwara ; (2024): Frailty Trajectories and Its Associated Factors in Japanese Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.51
CORRELATION BETWEEN MUSCLE MASS AND PHYSICAL ACTIVITY LEVEL IN OLDER ADULTS AT RISK OF FALLING: THE FITNESS STUDY
J.-B. Gauvain, S. Mandigout, M. Pambet, M. Monseu, P. Gillain, J. Gautier, C. Annweiler, F. Puisieux
J Frailty Aging 2024;13(3)240-247
Show summaryHide summaryBACKGROUND: The study investigates the correlation between muscle mass and physical activity level measured objectively and subjectively in older adults who fall or are at high risk of falling.
METHODS: FITNESS (Fall Interest to Target Newly Sarcopenic Society) is a multi-center (French university hospitals of Angers, Lille, Limoges and Orléans), cross-sectional, observational study of routine care within a French multidisciplinary hospital consultation. Inclusion criteria were ≥ 75 years old, living at home and consulting for fall or gait disorder. A standardized geriatric assessment, muscle mass evaluation by impedancemetry, physical activity by continuous actimetry (5 days) and Incidental and Planned Exercise Questionnaire (IPEQ) were performed at patient inclusion.
RESULTS: 170 people aged 75 and over were included in the FITNESS study (mean age 82.9 ± 4.7 years, women 72.9%). Muscle mass (whole body and lower limbs) correlated with active energy expenditure (AEE, ρ whole body = 0.32, p-value < 0.001; ρ lower limbs = 0.25, p-value = 0.003), but not with number of daily steps, nor with IPEQ score. Multivariate analysis of whole-body muscle mass showed a positive and significant association with AEE and albumin levels and for lower limb muscle mass, a positive association with AEE and Charlson.
CONCLUSION: This study suggests that in the particular population of older adults who fall and/or are at high risk of falling, loss of muscle mass correlates with reduced physical activity. So subjects who fall or at high risk of falling constitute a special group for whom the fight against sedentary lifestyles and the maintenance of physical activity should be a dual priority.
CITATION:
J.-B. Gauvain ; S. Mandigout ; M. Pambet ; M. Monseu ; P. Gillain ; J. Gautier ; C. Annweiler ; F. Puisieux (2024): Correlation between Muscle Mass and Physical Activity Level in Older Adults at Risk of Falling: The FITNESS Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.53
ANALYSIS OF THE CORRESPONDENCE OF THE DEGREE OF FRAGILITY WITH THE WAY TO EXERCISE THE FORCE OF THE HAND
E.P. Guindal, X. Parra, M. Musté, C. Pérez, O. Macho, A. Català
J Frailty Aging 2024;13(3)248-253
Show summaryHide summaryBACKGROUND: Frailty is a geriatric syndrome characterized by increased individual vulnerability with an increase in both dependence and mortality when exposed to external stressors. The use of Frailty Indices in routine clinical practice is limited by several factors, such as the cognitive status of the patient, times of consultation, or lack of prior information from the patient.
OBJECTIVES: In this study, we propose the generation of an objective measure of frailty, based on the signal from hand grip strength (HGS).
DESIGN AND MEASUREMENTS: This signal was recorded with a modified Deyard dynamometer and processed using machine learning strategies based on supervised learning methods to train classifiers. A database was generated from a cohort of 138 older adults in a transverse pilot study that combined classical geriatric questionnaires with physiological data.
PARTICIPANTS: Participants were patients selected by geriatricians of medical services provided by collaborating entities.
SETTING AND RESULTS: To process the generated information 20 selected significant features of the HGS dataset were filtered, cleaned, and extracted. A technique based on a combination of the Synthetic Minority Oversampling Technique (SMOTE) to generate new samples from the smallest group and ENN (technique based on K-nearest neighbors) to remove noisy samples provided the best results as a well-balanced distribution of data.
CONCLUSION: A Random Forest Classifier was trained to predict the frailty label with 92.9% of accuracy, achieving sensitivities higher than 90%.
CITATION:
E.P. Guindal ; X. Parra ; M. Musté ; C. Pérez ; O. Macho ; A. Català ; (2024): Analysis of the Correspondence of the Degree of Fragility with the Way to Exercise the Force of the Hand. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.46
IMPACT OF FRAILTY ON GAIT SPEED IMPROVEMENTS IN HOME HEALTH AFTER HOSPITAL DISCHARGE: SECONDARY ANALYSIS OF TWO RANDOMIZED CONTROLLED TRIALS
M. Tran, A. Garbin, R.E. Burke, E. Cumbler, J.E. Forster, J. Stevens-Lapsley, K.K. Mangione
J Frailty Aging 2024;13(3)254-258
Show summaryHide summaryMore than half of older adults are frail or prefrail in the United States, and hospital-associated deconditioning likely increases this risk. However, the impact of frailty on potential functional improvements after hospital discharge is poorly understood. We sought to identify the influence of baseline frailty on gait speed change in older adults receiving home health physical therapy (PT) after hospital discharge. The severity of frailty was assessed using Cardiovascular Health Study frailty criteria (weakness, slowness, weight loss, physical inactivity, and exhaustion). Gait speed was measured at baseline and 60-days post-hospital discharge. Upon admission to home health rehabilitation services, half of older adults (total N=250) were considered frail, with slowness (90%) and weakness (75%) being the most common characteristics. Older adults, whether pre-frail or frail, demonstrated similar and clinically meaningful improvements in gait speed after receiving home health rehabilitation for 60 days following hospital discharge. These results suggest that clinicians caring for older adults in the hospital can counsel both pre-frail and frail patients that, with home health rehabilitation, clinically significant improvements in function can be expected over the 2 months following discharge. Furthermore, we observed encouraging gait speed improvement with physical therapy following hospitalization in older adults. Results can inform anticipatory guidance on hospital discharge.
CITATION:
M. Tran ; A. Garbin ; R.E. Burke ; E. Cumbler ; J.E. Forster ; J. Stevens-Lapsley ; K.K. Mangione (2024): Impact of Frailty on Gait Speed Improvements in Home Health after Hospital Discharge: Secondary Analysis of Two Randomized Controlled Trials. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.52
SELF-REPORTED ORAL DISEASES AND THEIR ASSOCIATION WITH THE FRAILTY INDEX AMONG OLDER JAPANESE PEOPLE: FOURYEAR FOLLOW-UP
R.C. Castrejón-Pérez, S.A. Borges-Yáñez, R. Ramírez-Aldana, I. Nasu, Y. Saito
J Frailty Aging 2024;13(3)259-266
Show summaryHide summaryBACKGROUND: Oral health is a relevant component for overall health. Oral disease onset at an early age and may harm several health dimensions, especially among older people, and has been associated with frailty.
OBJECTIVE: To evaluate associations between the Frailty Index (FI) and self-reported oral diseases among older, community-dwelling Japanese people.
DESIGN: Cross-sectional and prospective analyses were performed.
SETTING AND PARTICIPANTS: We analyzed data from 2,529 participants at the baseline and four-year follow-up of the Nihon University Japanese Longitudinal Study of Aging, which had a four-year follow-up.
MEASUREMENTS: We used the self-reported number of teeth, self-reported satisfaction with dentures, and self-reported ability to chew hard food as independent variables. We computed an FI that included 40 deficits as the dependent variable. The FI score ranged from 0 to 1, with a higher score associated with adverse health outcomes and mortality. Considering a gamma distribution and controlling for age, gender, marital status, education, working status, and residence area, we fitted generalized linear models.
RESULTS: We found that dissatisfied denture users had a 2.1% (95% CI 1.006–3.279) higher frailty score than non-denture users at the baseline and a 2.1% (95% CI 0.629–3.690) higher frailty score than non-denture users at the four-year follow-up. In the cross-sectional analysis, with each additional reported tooth at the baseline, the FI score was lower by 1.5% (95% CI -2.878 to -0.208) at the four-year follow-up. In both the cross-sectional and the prospective analyses, the FI scores increased as the ability to chew hard food decreased.
CONCLUSIONS: Self-reported oral diseases are associated with the FI score cross-sectionally and prospectively. Identifying factors prospectively associated with frailty may improve strategies for the next generation of older people. Considering oral diseases may help clinicians personalize treatment plans for older people.
CITATION:
R.C. Castrejón-Pérez ; S.A. Borges-Yáñez ; R. Ramírez-Aldana ; I. Nasu ; Y. Saito (2024): Self-Reported Oral Diseases and Their Association with the Frailty index among Older Japanese People: Four-Year Follow-Up. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.10
INTERACTION BETWEEN HABITUAL GREEN TEA AND COFFEE CONSUMPTION AND ACTN3 GENOTYPE IN ASSOCIATION WITH SKELETAL MUSCLE MASS AND STRENGTH IN MIDDLE-AGED AND OLDER ADULTS
C. Iwasaka, H. Nanri, M. Hara, Y. Nishida, C. Shimanoe, Y. Yamada, T. Furukawa, Y. Higaki, Y. Momozawa, M. Nakatochi, K. Wakai, K. Matsuo, K. Tanaka
J Frailty Aging 2024;13(3)267-275
Show summaryHide summaryBACKGROUND: Recent studies have suggested the potential benefits of habitual coffee and green tea consumption on skeletal muscle health. However, it remains unclear whether these benefits are modified by genetic factors, particularly the alpha-actinin-3 (ACTN3) genotype, which is associated with the skeletal muscle phenotype. This study aimed to investigate the interaction between habitual coffee or green tea consumption and the ACTN3 genotype in association with skeletal muscle mass (SMM) and strength.
METHODS: This cross-sectional study was conducted on 1,023 Japanese middle-aged and older adults (619 females, aged 45–74 years) living in the community. SMM was gauged using a bioelectrical impedance spectroscopy device, and handgrip strength (HGS) was used to measure muscle strength. The ACTN3 genotype (RR, RX, and XX) was determined from blood samples. Sex-specific linear regression models were used to analyze the interactions between coffee or green tea consumption and the ACTN3 genotype in association with SMM and HGS.
RESULTS: In females, a significant interaction was observed between green tea consumption and the ACTN3 genotype in association with HGS (P interaction < 0.05). Furthermore, stratified analysis revealed a positive association between green tea consumption and HGS, specifically in females with the ACTN3 XX genotype (P trend < 0.05). In males, no significant interactions were observed between coffee or green tea consumption and the ACTN3 genotype in association with SMM or HGS (P interaction > 0.05).
CONCLUSION: Our findings suggest that the skeletal muscle strength benefits associated with habitual green tea consumption may be contingent upon sex and the ACTN3 genotype.
CITATION:
C. Iwasaka ; H. Nanri ; M. Hara ; Y. Nishida ; C. Shimanoe ; Y. Yamada ; T. Furukawa ; Y. Higaki ; Y. Momozawa ; M. Nakatochi ; K. Wakai ; K. Matsuo1 ; K. Tanaka (2024): Interaction between Habitual Green Tea and Coffee Consumption and ACTN3 Genotype in Association with Skeletal Muscle Mass and Strength in Middle-Aged and Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.3
THE PREVALENCE OF FRAILTY AND ASSOCIATED FACTORS, INCLUDING FOOD SECURITY IN COMMUNITY DWELLING OLDER ADULTS WITH MULTIMORBIDITY: A CROSS-SECTIONAL ANALYSIS FROM THE LONGITUDINAL AGING STUDY IN INDIA
V. Maheshwari, P. Samanta, S. Basu
J Frailty Aging 2024;13(3)276-284
Show summaryHide summaryBACKGROUND: The global increase in multimorbidity among older adults is a result of ongoing epidemiological and demographic transitions. This study focuses on the prevalence and determinants of frailty in this demographic in India, accounting for the potential mediating role of food insecurity.
OBJECTIVES: To determine the prevalence and determinants of frailty among older Indian adults with multimorbidity, and to ascertain the mediating effect of food insecurity on frailty.
DESIGN: Cross-sectional analysis of cohort study data.
SETTING: Analysis of data from the Longitudinal Aging Study in India (LASI) Wave 1 (2017-2018).
PARTICIPANTS: 31,902 individuals aged 60 and above of whom 7900 were categorized as having multimorbidity.
MEASUREMENTS: Frailty was assessed using a modified Fried scale. Details on sociodemographic factors, lifestyle choices, and health-related variables were collected through face-to-face participant interviews. Multimorbidity was defined as the presence of two or more chronic conditions such as hypertension, diabetes, cancer, chronic lung disease, chronic heart disease, stroke, bone disease, neurological or psychiatric problems, and high cholesterol. Statistical analysis was conducted using Stata 15.1.
RESULTS: The weighted prevalence of frailty in individuals with multimorbidity was 30.31% (95% CI: 28.17, 32.54), significantly higher than those without multimorbidity (23.81%, 95% CI: 22.90, 24.74) (P<0.001). Frailty prevalence was higher in women (33.27%) than in men (26.56%) among those with multimorbidity. In the group with multimorbidity, age ≥75 (years), middle MPCE quintile, lower educational attainment, unemployment, and low body mass index was associated with higher odds of frailty. Mediation analysis showed that 3.47% of the association between multimorbidity and frailty was mediated by food insecurity.
CONCLUSION: Frailty is prevalent among older adults with multimorbidity in India, with significant disparities based on gender, age, socioeconomic status, and body mass index. Food insecurity partially mediates the relationship between multimorbidity and frailty, highlighting the need for targeted interventions addressing both health and nutritional insecurities in this population.
CITATION:
V. Maheshwari ; P. Samanta ; S. Basu ; (2024): The Prevalence of Frailty and Associated Factors, Including Food Security in Community Dwelling Older Adults with Multimorbidity: A Cross-Sectional Analysis from the Longitudinal Aging Study in India. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.36
FOOD INSECURITY, VISION IMPAIRMENT, AND LONGITUDINAL RISK OF FRAILTY AND FALLS IN THE NATIONAL HEALTH AND AGING TRENDS STUDY
A.M. Wennberg, S. Ek, M. Na
J Frailty Aging 2024;13(3)285-292
Show summaryHide summaryBACKGROUND: Both food insecurity (FI) and vision impairment (VI), which are linked, have been independently associated with frailty and falls.
OBJECTIVES: Understand how FI and VI may together contribute to frailty and fall risk could improve insight into these growing public health challenges.
DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS: This study included 5,963 participants aged 65 and older enrolled in the National Health and Aging Trends Study. Participants were divided into four exposure groups (“No FI or VI,” “FI, no VI,” “VI, no FI,” and “Both”) based on self-report. The Fried Frailty Index and self-reported falls were assessed annually. We used adjusted logistic and Poisson regression models to examine cross-sectional associations and generalized estimating equations to examine longitudinal associations between FI/VI status and falls and frailty outcomes.
RESULTS: Most study participants reported neither FI nor VI (n=5169, 86.7%); however, having both FI and VI (n=57, 1%) was cross-sectionally associated with higher frailty score and higher odds of falling multiple times in the last year. FI and/or VI were longitudinally associated with higher frailty score and increased frailty risk, with the strongest association for Both (RRR=1.29, 95% CI 1.23, 1.58; OR=3.18, 95% CI 1.78, 5.69), and with falling, again highest among those with Both, for one (OR=2.47, 95% CI 1.41, 3.96) and multiple (OR=2.46, 95% CI 1.50, 4.06) falls in the last year.
CONCLUSION: Clinical and public health interventions could address the intersection of FI and VI with the aim of ameliorating the impact of these risk factors and health outcomes.
CITATION:
A.M. Wennberg ; S. Ek ; M. Na (2024): Food Insecurity, Vision Impairment, and Longitudinal Risk of Frailty and Falls in The National Health and Aging Trends Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.21
BODY COMPOSITION, FALLS, AND FREEZING OF GAIT IN PARKINSON’S DISEASE: GENDER-SPECIFIC EFFECTS
C. Pongmala, C. Stonsaovapak, M. van Emde Boas, H. Bhanderi, A. Luker, F. Michalakis, P. Kanel, R.L. Albin, J.M. Haus, N.I. Bohnen
J Frailty Aging 2024;13(3)293-299
Show summaryHide summaryBACKGROUND: Postural instability and gait difficulties (PIGD) are a significant cause of mobility loss and lower quality of life in Parkinson’s disease (PD). When PD progresses, patients may experience falls and freezing of gait (FoG) resulting in fear of falling and increasing sedentariness. Sedentary behavior results in sarcopenia associated with other changes in body composition, especially in older patients becoming frail. Previous studies have shown gender-specific changes in body composition with aging as well as gender disparities in symptoms and progression of PD, yet the association between gender-specific body composition and PIGD symptoms such as FoG along with falls, remains unexplored.
OBECTIVE: This study aimed to investigate the association between gender-specific changes in body composition, FoG and falls assessment.
Methods: 136 PD subjects underwent detailed clinical test batteries and had whole-body composition assessed using dual-energy X-ray absorptiometry (DXA). Multivariate logistic forward stepwise regression was performed to define body composition associations for FoG and falls.
RESULTS: Multivariate regression analysis revealed that in males with PD, lower leg lean mass was significantly associated with the presence of FoG (OR, 0.429; 95% CI, 0.219-0.839; p=0.013) but not with falls. In females with PD, higher leg adipose mass was significantly associated with falls (OR, 4.780; 95% CI, 1.506-15.174; p=0.008) but not with FoG.
CONCLUSION: These observations suggest gender specific associations between body composition and FoG vs. falls in PD. Future research should explore the impact of interventions on body composition in individuals with PD by paying specific attention to gender differences.
CITATION:
C. Pongmala ; C. Stonsaovapak ; M. van Emde Boas ; H. Bhanderi ; A. Luker ; F. Michalakis ; P. Kanel ; R.L. Albin ; J.M. Haus ; N.I. Bohnen (2024): Body Composition, Falls, and Freezing of Gait in Parkinson’s Disease: Gender-Specific Effects. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.31
CHARACTERIZING DEFICIT ACCUMULATION AMONG GULF WAR ERA VETERANS
S.E. Petry, A.D. Thompson, Jr., E.R. Hauser, S.M. Lynch, S.H. Boyle, J. Upchurch, A. Press, K.J. Sims, C.D. Williams, E.J. Gifford
J Frailty Aging 2024;13(3)300-306
Show summaryHide summaryBACKGROUND: Veterans of the first Gulf War (1990-1991) are reaching middle and older adulthood in differing degrees of health and biological age. Many Gulf War veterans report myriad negative symptoms classified as Gulf War illness (GWI), a chronic multi-symptom illness.
OBJECTIVES: To describe and analyze deficit accumulation, among veterans with Severe GWI (SGWI+) and those without Severe GWI (SGWI-), to assess the association between a medically unexplained illness and aging.
DESIGN: This study uses a retrospective cohort design with quasi-longitudinal data.
SETTING: The recruitment sample included 10,042 Gulf War era veterans across all four US Census regions.
PARTICIPANTS: The analytic sample included 1,054 participants of the GWECB for whom SGWI case status could be determined and who had valid responses for at least 90% of the deficits included in the deficit accumulation index.
MEASUREMENTS: Chronic health conditions were retroactively reported, including year of diagnosis, enabling us to create a longitudinal measure of deficit accumulation. This deficit accumulation index (DAI) ranged from 0-1 for each respondent in each year between 1991-2013. We compare veterans with SGWI+ to those with SGWI- using the CDC case definition.
RESULTS: Most veterans in our sample could expect to spend more years with moderate or substantial deficits than without deficits. SGWI+ was associated with spending more years with substantial deficits than those with SGWI-. Veterans in middle age (age 35-65) experienced more years with substantial deficits than younger veterans. Individuals with SGWI+ had 13 times the hazard of accumulating substantial deficits than those without.
CONCLUSIONS: This study demonstrated that veterans with SGWI+, even those in midlife, experienced aging as measured by accumulating deficits. Practitioners should consider patients with multi-symptom illnesses as at risk of accelerated aging, tailoring treatments to address patients’ holistic needs.
CITATION:
S.E. Petry ; A.D. Thompson, Jr. ; E.R. Hauser ; S.M. Lynch ; S.H. Boyle ; J. Upchurch ; A. Press ; K.J. Sims ; C.D. Williams ; E.J. Gifford (2024): Characterizing Deficit Accumulation Among Gulf War Era Veterans. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.44
IMPLEMENTING OCCUPATIONAL THERAPY INTO AN ACUTE GERIATRIC WARD: EFFECTS ON PATIENTS’ FUNCTIONAL STATUS AT DISCHARGE
C. Sidoli, C. Okoye, A. Staglianò, A. Zambon, C. Pozzi, M.C. Ferrara, G. Bellelli
J Frailty Aging 2024;13(3)307-312
Show summaryHide summaryhospitalization. This retrospective cohort study aimed to evaluate the effect of an Occupational Therapy (OT) program on mobility at discharge in older patients admitted to an Acute Geriatric Unit (AGU). All patients aged >65 years consecutively admitted to the AGU in an 18-month period were included in the study if scoring <4 or ≥ 8 at the Clinical Frailty Scale. Overall, 807 patients (median age 85 years, 50.2% females) were included: 665 (82%) received OT, while 142 who did not receive OT were used as controls. The Cumulated Ambulation Scale (CAS) was used to assess mobility at discharge. By multivariable logistic regression, OT was independently associated with higher odds of achieving higher CAS score at discharge. These findings emphasize the potential benefits of OT in acute geriatric settings, providing valuable insights for preserving mobility of frail older individuals during hospitalization.
CITATION:
C. Sidoli ; C. Okoye ; A. Staglianò ; A. Zambon ; C. Pozzi ; M.C. Ferrara ; G. Bellelli ; (2024): Implementing Occupational Therapy into an Acute Geriatric Ward: Effects on Patients’ Functional Status at Discharge. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.43
INTEGRATED SERVICE DELIVERY MODEL IN PRIMARY CARE TO IMPROVE FRAILTY IN OLDER MALAYSIANS: GEKO INTEGRATED SERVICE DELIVERY
S.S. Ahip, C.Y. Ting, M.A.B. Abdillah, Y.J. Tan, S.A.B. Sabri, O. Theou, S. Shariff-Ghazali, R. Visvanathan
J Frailty Aging 2024;13(3)313-318
Show summaryHide summaryBACKGROUND: This study aimed to evaluate the implementation stage of Malaysia’s GeKo-Integrated Service Delivery (ISD) model for frailty management in primary care and explore its effectiveness in improving frailty scores.
METHODS: The implementation stage of Malaysia’s first three GeKo- ISD clinics was assessed using the WHO-ICOPE (Integrated Care of the Older Persons) scorecard. This involved evaluating documents related to the GeKo services and conducting in-depth interviews with key informants identified from those documents. The efficacy of GeKo-ISD was assessed by documenting the change in mean frailty scores between baseline and 3 months post intervention, measured by the Pictorial Fit Frail Scale Malay Version (PFFS-M), in patients who received GeKo-ISD care from October 2022 to April 2023.
RESULTS: All three GeKo clinics achieved the sustaining implementation level, scoring a total of 50 out of 52. The paired t-test reported a significant reduction (p= 0.001) in the PFFS-M scores from baseline to 3 months after the GeKo-ISD intervention. The mean (SD) scores were 8.6 (4.6) at baseline and 7.0 (4.1) at 3 months post-intervention.
CONCLUSION: GeKo-ISD is a comprehensive approach of integrated care for older people, leveraging existing public funded primary care infrastructure. It shows promise, was impacted by the pandemic but now, with support from the government, exists in 32 centers across one state in Malaysia.
CITATION:
S.S. Ahip ; C.Y. Ting ; M.A.B. Abdillah ; Y.J. Tan ; S.A.B. Sabri ; O. Theou ; S. Shariff-Ghazali ; R. Visvanathan (2024): Integrated Service Delivery Model in Primary Care to Improve Frailty in Older Malaysians: GeKo Integrated Service Delivery. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.42