Ahead of print articles
THE INFLUENCE OF ETHNICITY ON FRAILTY IN A UNITED KINGDOM (UK) POPULATION
AH Heald, W Lu, R Williams, K Mccay, A Clegg, C Todd, A Maharani, MJ Cook, TW O’Neill
Show summaryHide summary
BACKGROUND: Frailty is an important and increasing clinical and public health problem. Within the United Kingdom (UK). Most data relating to the occurrence of frailty is derived from Caucasian groups. This study aimed to determine the influence of ethnicity on the occurrence of frailty in a large UK urban conurbation. We also looked at frailty-related risk of severe illness related to COVID-19 infection.
METHODS: Using data from the Greater Manchester Health Record (GMCR), we analysed primary care electronic medical records of 534,367 men and women aged 60 years and over who were alive on 1st January 2020. We assessed frailty using an electronic frailty index (eFI) and categorised subjects as fit, mild, moderate, and severe frailty. We used logistic regressions to examine the association between moderate and severe frailty (eFI ≥ 0.25) and ethnicity adjusted with age, sex and area deprivation (as measured using Townsend Index). We also looked among those with a first positive COVID test, the influence of frailty on subsequent admission to the hospital within 28 days.
RESULTS: The majority of subjects were White (84 %), with 4.7 % describing themselves as Asian or Asian British, and 1.3 % Black or Black British. The unadjusted prevalence of moderate to severe frailty (eFI ≥ 0.25) was 22.1 %. Compared to the prevalence of frailty in Whites (22.5 %), the prevalence was higher in those of Asian or Asian British ethnicity (28.1 %) and lower in those of Black/Black British descent (18.7 %). After adjustment for age, gender, and deprivation, the risk of frailty remained higher in Asians (Odds Ratio = 1.61; 95 % Confidence Intervals = 1.56–1.66) and lower in Black British (OR = 0.73; 95 % CI 0.68–0.78) compared to White British. Among those with a positive COVID-19 test, those with frailty were more likely to require admission to the hospital within 28 days (OR = 1.61; 95 % CI = 1.53, 1.69).
CONCLUSIONS: There is variation in the occurrence of frailty across Greater Manchester across ethnic groups, with higher frequency among those of Asian or Asian British descent and lower frequency among those of Black or Black British descent. This study has added to our understanding of the way that frailty prevalence maps across communities, in this case in a large European conurbation. Further research is required to understand the causes of ethnic variation in frailty and whether ethnicity influences frailty outcomes.
CITATION:
AH Heald ; W Lu ; R Williams ; K Mccay ; A Clegg ; C Todd ; A Maharani ; MJ Cook ; TW O’Neill (2025): The influence of ethnicity on frailty in a United Kingdom (UK) population. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100089
BENEFITS OF PHYSICAL ACTIVITY ON COGNITIVE FUNCTION IN PATIENTS WITH NEUROCOGNITIVE DISORDERS: A SYSTEMATIC REVIEW
Théodore Decaix, Claire Bonnin, Karl Götze, Véronique François, Camille Petit, Clémentine Rivière, Sandrine Greffard, Emmanuel Cognat, Jacques Hugon, Claire Paquet, Louise Sindzingre, Matthieu Lilamand
Show summaryHide summary
Neurocognitive disorders, particularly in older adults, significantly affect functional abilities and global health. Physical activity has emerged as a potential non-pharmacological intervention to improve cognitive performance in patients with neurodegenerative diseases. This review specifically addressed the issue of tailored physical activity interventions for individuals with various neurocognitive disorders.
This literature review analyzed studies investigating the effects of physical activity on cognitive function in patients with Alzheimer’s disease (AD), vascular cognitive impairment, Parkinson’s disease, and Lewy body dementia. The studies were evaluated for methodological rigor, participant characteristics, types of physical activities, and cognitive outcomes.
Of the 21 studies reviewed, 14 reported beneficial effects of physical exercise on cognitive function, particularly with aerobic activities. While most studies observed improvements in cognitive performance and physical functional capacity, results were inconsistent, and effect sizes were modest. Mechanisms proposed for cognitive improvement in AD included reductions in β-amyloid and tau protein burdens, improved glucose metabolism, and enhanced brain-derived neurotrophic factor levels. Specific improvements were noted in Parkinson’s disease, with evidence suggesting mediation through dopamine pathways. Despite evidence of short-term benefits, significant variability exists among studies, highlighting the need for individualized exercise programs tailored to specific neurocognitive conditions.
Physical activity stands as a cornerstone non-pharmacological intervention, essential for supporting cognitive health in individuals with neurodegenerative diseases. Further research is necessary to establish long-term effects and optimal exercise modalities, along with standardized evaluation criteria to assess the cognitive impacts of physical activity reliably.
CITATION:
Théodore Decaix ; Claire Bonnin ; Karl Götze ; Véronique François ; Camille Petit ; Clémentine Rivière ; Sandrine Greffard ; Emmanuel Cognat ; Jacques Hugon ; Claire Paquet ; Louise Sindzingre ; Matthieu Lilamand (2025): Benefits of physical activity on cognitive function in patients with neurocognitive disorders: A systematic review. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100069
THE PREVALENCE OF SARCOPENIA AND SARCOPENIC OBESITY IN A GERMAN GERIATRIC DAY CLINIC
Basel Habboub, Emmanuel Oludowole, Robert Speer, Johanna Masuch, Ursula Berger, Markus Gosch, Katrin Singler
Show summaryHide summary
PURPOSE: Sarcopenia and sarcopenic obesity are defined by the loss of muscle strength and mass. Both diseases pose a growing global challenge. Their prevalences vary between studied populations. The aim of this study is to estimate the prevalences of sarcopenia and sarcopenic obesity in sample of community-dwelling older adults attending a geriatric day clinic.
METHODS: A secondary analysis of the Paint-II Data (single-center randomized controlled trial on the effects of art therapy) was used to estimate the prevalence of sarcopenia and sarcopenic obesity. Furthermore, a machine learning model predicted factors associated with both diseases.
RESULTS: We had body composition information on 255 of the 409 Paint-II participants. Their mean age was 81 ± 5 years and 78 % were female. Depending on the appendicular skeletal muscle mass (ASM) definition, the prevalence of sarcopenia ranged between 10 % and 24 % using ASM/height2 or absolute ASM respectively. The prevalence of sarcopenic obesity was 15 %. Weight was the most influential predictor, with higher weight being linked to sarcopenic obesity and lower weight associated with sarcopenia.
CONCLUSIONS: The prevalence of sarcopenia and sarcopenic obesity among community-dwelling older adults attending geriatric day clinics is higher than among the general geriatric population. There is a significant discrepancy in sarcopenia prevalence depending on whether muscle mass is measured absolutely or adjusted for body size. Diagnosis is further complicated by varying recommended cut-offs. We support efforts to simplify and standardize the diagnostic criteria.
CITATION:
Basel Habboub ; Emmanuel Oludowole ; Robert Speer ; Johanna Masuch ; Ursula Berger ; Markus Gosch ; Katrin Singler (2025): The prevalence of sarcopenia and sarcopenic obesity in a German geriatric day clinic. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100072
PHASE ANGLE IS RELATED TO PHYSICAL FUNCTION IN HIGH-RISK DUTCH OLDER ADULTS: IMPLICATIONS FOR SARCOPENIA SCREENING
Pol Grootswagers, Alice Ricco, Paul Hulshof, Lisette de Groot
Show summaryHide summary
INTRODUCTION: Sarcopenia, a progressive age-related loss of skeletal muscle mass and function, poses significant health risks in older adults. Phase angle (PhA), derived from bioimpedance analysis, has been proposed as an indicator of muscle quality and physical functioning. This study investigates the association between PhA and physical function, and its potential utility in case-finding phase of sarcopenia assessment based on EWGSOP2 functional cut-offs.
METHODS: This cross-sectional observational study used baseline data from two clinical trials involving Dutch older adults (≥65 years, n=228) at risk of malnutrition or frailty. PhA was measured using multi-frequency bioimpedance vector analysis. Physical functioning was assessed through handgrip strength, knee extension strength, chair rise test, and gait speed (4m and 400-m/6-min walk tests). Associations were evaluated using linear mixed models adjusted for age, gender, height, and lean body mass. Receiver-operating characteristic (ROC) analyses identified PhA thresholds for low performance based on EWGSOP2 cut-offs.
RESULTS: PhA was significantly associated with all performance outcomes in crude models. After adjustment, each unit increase in PhA was associated with a 43.5 ± 8.4 N increase in knee extension strength (P < 0.0001), a 1.5 ± 0.4 s reduction in chair rise time (P = 0.0004), and a 0.14 ± 0.02 m/s increase in gait speed (P < 0.0001). Associations with handgrip strength became non-significant after full adjustment. A PhA threshold of 5.4° showed high sensitivity (0.96) for detecting low physical performance via the chair rise test. However, misclassification rates exceeded 25 %.
CONCLUSIONS: PhA is associated with physical function, particularly lower-body performance measures, but without muscle mass assessment, it cannot support a complete diagnosis of sarcopenia. It may be valuable as a case-finding tool in older adults at risk.
CITATION:
Pol Grootswagers ; Alice Ricco ; Paul Hulshof ; Lisette de Groot (2025): Phase angle is related to physical function in high-risk Dutch older adults: implications for sarcopenia screening. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100071
ASSOCIATION BETWEEN THE FREQUENCY OF GOING OUTDOORS BY LIFE SPACE AND INCIDENT DISABILITY AMONG OLDER ADULTS
Takehiko Doi, Sho Nakakubo, Fumio Sakimoto, Soichiro Matsuda, Hiroyuki Shimada
Show summaryHide summary
BACKGROUND: Going outdoors is crucial in promoting older adults’ health. This study examined the association between incident disability and the frequency of going outdoors in certain life spaces.
METHODS: This prospective study included 19,822 older adults (mean age ± standard deviation: 73.5 ± 5.8 years; 53.6 % women). The frequency of going outdoors within the past month was collected based on life space, categorized by distance from home (up to 1 km; 1–10 km; and >10 km). Participants were classified into three groups (called “Rarely”: less than 1 day, “Sometimes”: 1 to 3 days, and “Often”: 4 days or more) for each life space. Incident disability was defined using the Long-Term Care Insurance system data (mean follow-up: 23.3 months). A Cox proportional hazards model was used to examine the association between incident disability and the frequency of going outdoors for each life space, adjusted for covariates.
RESULTS: A total of 1038 (5.2 %) participants had an incident disability. Within the “up to 1 km” category, no frequency group was associated with disability; within “1–10 km,” two frequency groups were associated with disability (“Sometimes” group: hazard ratio [HR] 0.85, [95 % confidence interval [CI]: 0.73–0.99]; “Often” group: HR 0.68, [95 % CI: 0.57–0.81]); within “>10 km,” similar results were observed (“Sometimes” group: HR 0.84, [95 % CI: 0.72–0.98]; “Often” group: HR 0.75, [95 % CI: 0.53–1.07]).
CONCLUSIONS: The frequency of going outdoors at specific distances from home is associated with disability.
CITATION:
Takehiko Doi ; Sho Nakakubo ; Fumio Sakimoto ; Soichiro Matsuda ; Hiroyuki Shimada (2025): Association between the frequency of going outdoors by life space and incident disability among older adults. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100070
CORRELATES OF HAND GRIP STRENGTH IN A COHORT OF OLDER NIGERIAN AFRICANS: FINDINGS FROM THE POPULATION-BASED VALIANT PROJECT
Rufus O. Akinyemi, Oladotun V. Olalusi, Gabriel O. Ogunde, Tolulope O. Akinyemi, Joseph O. Yaria, Olabode Oguntiloye, Ayotomiwa Fagbemi, Eniola O. Cadmus, Femi O. Popoola, Mayowa Ogunronbi, Dorcas Olujobi, Olaoluwa Famuyiwa, Joshua O. Akinyemi, Mayowa O. Owolabi, Roman Romero-Ortuno, Adesola Ogunniyi, Raj Kalaria, Brian Lawlor
Show summaryHide summary
Previous evidence suggests there are racial, genetic, and geographic differences in hand grip strength (HGS) underlying the need to define population-specific normative values and their determinants. We determined the normative values of HGS and investigated its correlates in an urban community sample in Nigeria. We assessed 607 participants from the Vascular heAlth, fraiLty, and cognItion in Ageing Nigerians sTudy [VALIANT] – a population-based cohort of 1031 older persons in Ibadan, a city in Southwestern Nigeria. They were recruited through a multi-stage, stratified cluster random sampling method. HGS was defined as the highest recorded/maximum HGS (max. HGS) of both hands. The determinants (β coefficient, p values) of HGS were identified using linear regression model. The mean (SD) age of the participants was 64.6 (11.5) with 67.8 % females. The mean (SD) max. HGS (in kg) of the study population was 19.65±10.16 overall; 24.51(14.01) among males and 17.31(6.51) among females (p < 0.001). Overall, female sex (β=-6.38, p < 0.001), clinical frailty (β=-1.35, p < 0.001), and baseline MoCA scores (β=0.37, p 0.001) were independently associated with max. HGS. In the subgroup analysis, presence of hypertension (β=2.64, p < 0.001) and diabetes mellitus (β=-2.61, p 0.05) were independently associated with max. HGS among females, but not males. Our findings buttress the intricate link between overall physical, cardiometabolic as well as cognitive health in this unique West African population.
CITATION:
Rufus O. Akinyemi ; Oladotun V. Olalusi ; Gabriel O. Ogunde ; Tolulope O. Akinyemi ; Joseph O. Yaria ; Olabode Oguntiloye ; Ayotomiwa Fagbemi ; Eniola O. Cadmus ; Femi O. Popoola ; Mayowa Ogunronbi ; Dorcas Olujobi ; Olaoluwa Famuyiwa ; Joshua O. Akinyemi ; Mayowa O. Owolabi ; Roman Romero-Ortuno ; Adesola Ogunniyi ; Raj Kalaria ; Brian Lawlor (2025): Correlates of hand grip strength in a cohort of older Nigerian Africans: Findings from the population-based VALIANT project. The Journal of Prevention of Alzheimer’s Disease (JPAD). https://doi.org/10.1016/j.tjfa.2025.100068
COMPREHENSIVE MANAGEMENT OF FRAILTY. A BROADER PERSPECTIVE OF IMPLEMENTATION PROJECT “SYSTEMIC APPROACH TO FRAILTY WITH A FOCUS ON PRE-FRAILTY FOR HEALTHY AND HIGH-QUALITY AGING”
Branko Gabrovec, Nadja Cirar, Katarina Cesar, Rade Pribakovi? Brinovec, Matej Vinko, Nina Pirnat, Urška Erklavec, Hajdi Kosednar, Jernej Bevk, Ivan Eržen, Tajda Golja, Anja Jutraž
Show summaryHide summary
Managing pre-frailty and frailty is crucial for maintaining the health and independence of older adults. Through “Systemic Approach to Frailty with a Focus on Pre-Frailty for Healthy and High-Quality Aging” project, Slovenia is establishing a systematic approach to identify and address frailty, while developing solutions to support preventive measures across healthcare and community levels. Key steps include integrating health and social care systems, strengthening health literacy, adapting and co-creating healthy living environments through a community-based approach and social participation, all essential for promoting healthier and higher-quality aging in the population.
This paper outlines the innovative conceptual and methodological approach to project development and its anticipated outcomes.
CITATION:
Branko Gabrovec ; Nadja Cirar ; Katarina Cesar ; Rade Pribakovič Brinovec ; Matej Vinko ; Nina Pirnat ; Urška Erklavec ; Hajdi Kosednar ; Jernej Bevk ; Ivan Eržen ; Tajda Golja ; Anja Jutraž (2025): Comprehensive management of frailty. A broader perspective of implementation project “Systemic Approach to Frailty with a Focus on Pre-Frailty for Healthy and High-Quality Aging”. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100075
THE CONCEPTUALISATION AND MEASUREMENT OF SOCIAL FRAILTY IN OLDER PEOPLE: AN UMBRELLA REVIEW
Martin Webber, Beth Casey, Laura Tucker, Kirsty Shires, Mark Wilberforce, Barbara Hanratty, Louise Tomkow, David Sinclair, Jennifer Liddle, Dawn Sissons, Lynette Joubert
Show summaryHide summary
BaCKGROUND: The social domain of frailty is often poorly defined or missing from measures of frailty. The literature is still inconclusive on the nature and scope of social frailty, although studies indicate that it has a substantial impact on disability and mortality outcomes.
AIMS: This Umbrella Review aimed to synthesise concepts and measures of social frailty.
METHODS: A search for reviews was performed in Web of Science, CINAHL, SOCINDEX, Medline, PsychoINFO and COSMIN databases. This Umbrella Review was conducted and reported with reference to the Joanna Briggs Institute (JBI) Reviewer’s Manual. The JBI Critical Appraisal Checklist for Systematic Review was used to assess the quality of studies.
RESULTS: Sixteen reviews were included. The concept of social frailty was summarised as weakness in a person’s social infrastructure compounded by a declining ability to change their circumstances. Forty-two measures of social frailty were identified which included a total of 228 items relating to social frailty. These were grouped into nine domains, of which participation in social activities was most commonly included within measures.
CONCLUSIONS: The use of diverse indicators creates a challenge for the measurement of social frailty. Their limited use in health and social care practice undermines the practical utility of the concept. This review helps to provide conceptual clarity and a platform for the development and validation of a robust social frailty measure which will facilitate the identification of people at risk and target interventions to prevent or alleviate the impact of social frailty on older people.
CITATION:
Martin Webber ; Beth Casey ; Laura Tucker ; Kirsty Shires ; Mark Wilberforce ; Barbara Hanratty ; Louise Tomkow ; David Sinclair ; Jennifer Liddle ; Dawn Sissons ; Lynette Joubert (2025): The conceptualisation and measurement of social frailty in older people: an umbrella review. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100078
THE BIDIRECTIONAL RELATIONSHIP BETWEEN KNEE OSTEOARTHRITIS AND FRAILTY IN CHINA: A LONGITUDINAL STUDY
Ziwei Tian, Huimin Zhao, Yanping Zhai, Zhilan Yang
Show summaryHide summary
BACKGROUND: Knee osteoarthritis is a common disease that causes disability and loss of independence in middle-aged and older adults, and may interact with frailty through shared pathways. Understanding their bidirectional relationship is clinically meaningful for early intervention. This study aimed to investigate the associations between knee osteoarthritis and frailty among middle-aged and older adults in China.
METHODS: The data for this study came from three waves (baseline 2011, follow-up 2013 and 2015) of the China Health and Retirement Longitudinal Study (CHARLS). A total of 3560 participants were included. Frailty was assessed with the Frailty Index. Knee osteoarthritis was defined as physician-diagnosed arthritis with self-reported knee pain. Longitudinal bidirectional relationships were found using cross-lagged panel models and random-intercept cross-lagged panel models.
RESULTS: A longitudinal bidirectional relationship between knee osteoarthritis and frailty was observed, with a stronger effect of frailty on subsequent knee osteoarthritis (Wald χ² = 11.416, P < 0.001). At the between-person level, individuals with knee osteoarthritis also tend to have a higher risk of frailty (β= 0.454, P < 0.001). At the within-person level, the predictive effect of knee osteoarthritis on frailty was significant only in the long term (β=0.055, P < 0.05). Subgroup analyses showed that this longitudinal bidirectional relationship was particularly strong among females as well as those with low education levels.
CONCLUSIONS: This study reveals a longitudinal bidirectional relationship between knee osteoarthritis and frailty in middle-aged and older adults. In particular, the dominant role of frailty in the development of knee osteoarthritis was found, as well as the negative impact of knee osteoarthritis accumulation on frailty over time. This result suggests that targeting frailty early interventions in an ageing society may help to interrupt the vicious cycle of knee osteoarthritis and reduce the risk of disability. It provides a scientific basis for public health strategies.
CITATION:
Ziwei Tian ; Huimin Zhao ; Yanping Zhai ; Zhilan Yang (2025): The bidirectional relationship between knee osteoarthritis and frailty in China: A longitudinal study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100087
FRAILTY MODERATES THE RELATION BETWEEN MODERATE-TO-VIGOROUS PHYSICAL ACTIVITY & STATIONARY TIME WITH KNEE OSTEOARTHRITIS SYMPTOMS
Sophie E. Rayner, Selena P. Maxwell, Jocelyn Waghorn, Rebecca Moyer, Kenneth Rockwood, Olga Theou, Myles W. O’Brien
Show summaryHide summary
BACKGROUND: Physical activity is protective against osteoarthritic development and is among the best approaches to manage frailty, which can be characterized as the presence of health deficits. It is unclear whether overall health of a person influences the relation between physical activity and knee-joint health.
OBJECTIVE: Test the hypothesis that physical activity is associated with knee osteoarthritis symptoms and investigate frailty as a moderator.
DESIGN: This cohort observational study included participants (n = 1351; 728 females) from the Osteoarthritis Initiative, aged 45–79 (60±9) years. Hip-worn accelerometers were used to quantify free-living stationary time, light (LPA) and moderate-to-vigorous-physical-activity (MVPA). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) defined symptom progression. Baseline frailty was determined via a 31-item Frailty Index and participants grouped into Non-Frail (0–0.09), Very-Mild Frailty (0.1–0.19), and Mild Frailty+ (>0.2). Accelerometry and WOMAC were determined at 72-month follow-up.
RESULTS: MVPA (18±19mins/day) was negatively related to WOMAC outcomes (β<-0.0155, p < 0.0022), while LPA (274±79mins/day) was not (β<0.0005, p > 0.3061). Stationary time (606±88mins/day) was positively associated with WOMAC stiffness (β=0.0009, p = 0.0147). Frailty (0.134±0.077) did not moderate LPA and WOMAC relations (p > 0.308). A stronger negative relation between MVPA and WOMAC pain (β=-0.0092, p = 0.041) was observed in the Mild Frailty+ group compared to the Very-Mild Frailty and Non-Frail groups. A stronger positive relation between Stationary time and WOMAC stiffness (β=0.0013, p = 0.012) was observed in the Mild Frailty+ groups compared to the Very-Mild Frailty and Non-Frail groups.
CONCLUSION: Engaging in MVPA and limiting stationary time may be more beneficial on knee osteoarthritis pain and stiffness among frailer older adults.
CITATION:
Sophie E. Rayner ; Selena P. Maxwell ; Jocelyn Waghorn ; Rebecca Moyer ; Kenneth Rockwood ; Olga Theou ; Myles W. O’Brien (2025): Frailty moderates the relation between moderate-to-vigorous physical activity & stationary time with knee osteoarthritis symptoms. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100077
FRAILTY NEXUS: COMMUNITY OF PRACTICE FOR FRAILTY RESEARCHERS AND HEALTHCARE PROFESSIONALS
Benignus Logan, Adrienne Young, Kristiana Ludlow, David Ward, Leila Shafiee Hanjani, Natasha Reid, Ruth E Hubbard
Show summaryHide summary
BACKGROUND: There has been success in implementing frailty education for healthcare professionals, but there remains a need to improve the knowledge and skills of researchers and healthcare professionals to develop, implement and evaluate frailty-focused research.
OBJECTIVES: This paper describes how the Australian Frailty Network developed and evaluated a virtual community of practice (VCOP), a proven model for fostering knowledge mobilisation, to support researchers and healthcare professionals in advancing frailty research and practice in Australia.
DESIGN: Mixed methods.
SETTING: Australian research and healthcare workplaces.
PARTICIPANTS: Researchers and healthcare professionals.
MEASUREMENTS: A survey of prospective members sought to define the VCOP’s purpose, membership and structure. An evaluation was undertaken 18 months post-commencement, guided by the RE-AIM framework to assess reach, effectiveness, adoption, implementation and maintenance.
RESULTS: Fifty-five prospective members completed the initial survey. There was wide agreement from respondents to be inclusive in defining membership. The preferred purposes of the group included networking, opportunities to gain feedback, review frailty research, and knowledge and skill acquisition. In response, Frailty Nexus was launched, with three core components (‘Learning Link-Up’, online learning events; ‘Nexus News’, newsletter sharing learning and research opportunities; ‘Nexus Nook’, a library of shared resources). Membership totalled 618 from 81 organisations. Ninety-six percent of surveyed members expressed satisfaction with Frailty Nexus.
CONCLUSIONS: Frailty Nexus is contributing to capacity building in multidisciplinary and translational frailty research. This VCOP could serve as a model that can be adapted by others to improve research outcomes and policy implementation.
CITATION:
Benignus Logan ; Adrienne Young ; Kristiana Ludlow ; David Ward ; Leila Shafiee Hanjani ; Natasha Reid ; Ruth E Hubbard (2025): Frailty Nexus: Community of practice for frailty researchers and healthcare professionals. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100074
JFA N°04 - 2025
EDITORIAL: ENVIRONMENTAL, INFRASTRUCTURAL, AND SOCIAL DRIVERS OF PHYSICAL ACTIVITY IN AGING CITIES
Emanuele Marzetti, Riccardo Calvani, Hélio Jose Coelho-Junior
J Frailty Aging 2025;14(4)
Show summaryHide summary
CITATION:
Emanuele Marzetti ; Riccardo Calvani ; Hélio Jose Coelho-Junior (2025): Editorial: Environmental, infrastructural, and social drivers of physical activity in aging cities. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100066
THE VITALITY DOMAIN OF INTRINSIC CAPACITY: A SCOPING REVIEW OF CONCEPTUAL FRAMEWORKS AND MEASUREMENTS
J. Chew, J. Lee, H.H.C. Hernandez, Y.L. Munro, C.L. Lim, W.S. Lim
J Frailty Aging 2025;14(4)
Show summaryHide summaryBACKGROUND: Intrinsic capacity (IC) is a composite indicator of physical and mental capacities that are critical for healthy aging. IC comprises five domains, with “vitality” gaining most attention due to its potential impact on functional and physiological reserves with increasing age. The World Health Organization 2022 framework redefined vitality as an underlying physiological determinant of IC. However, the concept and measurement of vitality and its empirical validation are not well defined.
OBJECTIVES: This scoping review aims to: (1) map the conceptual frameworks underpinning vitality within the IC domain and (2) identify existing measures used to assess vitality.
METHODS: A systematic search of MEDLINE, PubMed, Embase, Web of Science, and WHO databases (2003–2023) using Arksey and O’Malley’s framework and PRISMA-ScR guidelines. Studies involving adults ≥50 years old that addressed vitality in IC were included. We extracted data on conceptual frameworks, measurement tools, and construct validity.
RESULTS: Eighty-one studies met the inclusion criteria. Initial frameworks of vitality focused on nutritional indicators, while recent concepts include neuromuscular function, metabolism, and immune-stress responses. However, operationalization of these concepts remains inconsistent, with most studies relying on anthropometry, appetite, weight loss, and handgrip strength, while immune and stress response-related biomarkers were rarely assessed. Only 10.5 % of studies evaluated construct validity of vitality, and limited studies validated the potential roles of vitality underpinning the other expressed capacities.
CONCLUSIONS: Currently, vitality within IC varies in definitions and measurement approaches, with a predominant focus on nutrition and muscle strength. Empirical validation of vitality’s role as a foundational IC domain remains limited. Expanding the scope of vitality to include metabolic and immune markers, and deeper examination of the interactions between vitality with other IC domains may enhance understanding and improve assessment frameworks for healthy aging.
CITATION:
J. Chew ; J. Lee ; H.H.C. Hernandez ; Y.L. Munro ; C.L. Lim ; W.S. Lim (2025): The vitality domain of intrinsic capacity: A scoping review of conceptual frameworks and measurements. The Journal of Prevention of Alzheimer’s Disease (JPAD). https://doi.org/10.1016/j.tjfa.2025.100058
LETTER TO THE EDITOR: A SIMPLE TEST OF “KAMI-TSUMAMI” (PAPER TUG) FOR PINCH STRENGTH SCREENING AMONG COMMUNITY-DWELLING OLDER ADULTS
Weida Lyu, Tomoki Tanaka, Katsuya Iijima
J Frailty Aging 2025;14(4)
Show summaryHide summary
CITATION:
Weida Lyu ; Tomoki Tanaka ; Katsuya Iijima (2025): Letter to the Editor: A simple test of “Kami-Tsumami” (Paper Tug) for pinch strength screening among community-dwelling older adults. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100060
CHRONIC PAIN AS A MEDIATOR IN THE FALLS-FRAILTY ASSOCIATION: EVIDENCE FROM MIDDLE-AGED AND OLDER ETHNIC MINORITIES IN YUNNAN, CHINA
Xuan Wen, Rui Deng, Xinping Wang, Chunyan Deng, Xiaoju Li, Yafang Zhang, Ying Chen, Yuan Huang
J Frailty Aging 2025;14(4)
Show summaryHide summaryBACKGROUND: Falls are associated with an increased risk of frailty in middle-aged and older adults; however, the mediating role between falls and frailty remains underexplored, particularly among ethnic minority groups with distinct sociocultural and environmental exposures. Ethnic minority populations exhibit significant disparities in the prevalence of falls, frailty, and chronic pain compared to the majority. The primary objective of this study is to examine the relationship between falls and frailty in middle-aged and elderly individuals residing in Yunnan Province, China, with a specific emphasis on exploring the potential mediating effect of chronic pain across different ethnic groups.
METHODS: Employing a cross-sectional design, data were collected from July to December 2022 from adults aged ≥45 years in five ethnically diverse counties of Yunnan Province, China. Structured face-to-face interviews and stratified multistage cluster sampling were used for data collection. Baron and Kenny’s causal steps method was used to explore the mediating effect of chronic pain on the relationship between falls and frailty. Spearman correlation analysis, multiple linear regression models, and bootstrap method were used for data analysis.
RESULTS: A total of 2710 respondents participated in this study. The age distribution was as follows: 1161 (42.84 %) aged 45–59 years, 863 (31.85 %) aged 60–69 years, and 686 (25.31 %) aged 70 years or older. The sample comprised 1218 males (44.94 %) and 1492 females (55.06 %). The prevalence of falls among middle-aged and older individuals was 12.77 %, while the prevalence of frailty in the same population was observed to be 21.62 %. Spearman correlation analysis revealed significant positive association between chronic pain and both falls (r = 0.135, P < 0.05) as well as frailty (r = 0.383, P < 0.05). Frailty also exhibited a significant positive correlation with falls (r = 0.162, P < 0.05). After adjusting for all covariates, the total effect of falls on frailty was estimated to be 1.065 (95 % bootstrap CI: 0.804∼1.326), with a direct effect estimate of 0.797 (95 % bootstrap CI: 0.511∼1.083). The indirect effect of chronic pain on this association was found to be approximately one-quarter at 0.268 (95 % bootstrap CI: 0.170∼0.366). The subgroup analysis discovered differences in the mediating effects across different ethnic groups; specifically, the proportions mediated by chronic pain were found to be 28.2 %, 18.4 %, and 21.5 % for Han majority group, Zhiguo ethnic minorities, and other ethnic minority groups, respectively.
CONCLUSION: This study provides valuable insights into the intricate association between frailty, falls, and chronic pain among middle-aged and older adults from diverse ethnic backgrounds in a western province of China. Effective management strategies targeting chronic pain and falls prevention could serve as crucial interventions to address frailty.
CITATION:
Xuan Wen ; Rui Deng ; Xinping Wang ; Chunyan Deng ; Xiaoju Li ; Yafang Zhang ; Ying Chen ; Yuan Huang (2025): Chronic pain as a mediator in the falls-frailty association: Evidence from middle-aged and older ethnic minorities in Yunnan, China. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100050
ASSOCIATIONS BETWEEN SARCOPENIA OPERATIONALIZED USING MUSCLE STRENGTH OR POWER AND HEALTH-RELATED PARAMETERS
Hélio José Coelho Júnior, Alejandro Álvarez-Bustos, Riccardo Calvani, Stefano Cacciatore, Anna Picca, Matteo Tosato, Francesco Landi, Emanuele Marzetti, Lookup Study Group
J Frailty Aging 2025;14(4)
Show summaryHide summaryBACKGROUND AND OBJECTIVES: The present study examined the associations between sarcopenia, operationalized through muscle strength or muscle power, and health parameters in Italian community-dwelling older adults. DESIGN: Cross-sectional study. SETTING: Unconventional settings across Italy. PARTICIPANTS: Italian older adults (65+ years) who provided a written informed consent. MEASUREMENTS: Physical function was evaluated according to isometric handgrip strength (IHG) and 5-time sit-to-stand (5STS) performances. Muscle power parameters were estimated based on 5STS values. Sarcopenia was operationalized according to the presence of low physical function (i.e., IHG or 5STS), or low muscle power, plus low appendicular skeletal muscle mass. Health parameters included the capacity to perform the 400 m test, adherence to the Mediterranean (MED) diet, practice of physical activity (PA), blood pressure (BP) values, blood concentration of total cholesterol and glucose, verbal fluency, sleep quality, and self-reported health status. RESULTS: Results indicated that sarcopenic indexes had a poor-to-moderate level of agreement. Moreover, results indicated that operationalizing sarcopenia using muscle power measures provided exclusive or stronger associations with health parameters. Specifically, older adults classified as sarcopenic based on muscle power values were less likely to complete the 400-meter walk test, more likely to engage in PA, reported poorer self-rated health, and showed lower adherence to the MED diet. CONCLUSIONS: Findings of the present study indicated that sarcopenia indexes based on muscle strength or muscle power capture different aspects of older adults’ health. Specifically, operationalizing sarcopenia using muscle power measures provided exclusive or stronger associations with health parameters.
CITATION:
Hélio José Coelho Júnior ; Alejandro Álvarez-Bustos ; Riccardo Calvani ; Stefano Cacciatore ; Anna Picca ; Matteo Tosato ; Francesco Landi ; Emanuele Marzetti ; Lookup Study Group (2025): Associations between sarcopenia operationalized using muscle strength or power and health-related parameters. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100062
ASSOCIATIONS BETWEEN INTRINSIC CAPACITY, PLASMA P-TAU181 AND COGNITIVE FUNCTION OVER A 5-YEAR FOLLOW-UP AMONG COMMUNITY-DWELLING OLDER ADULTS: A SECONDARY ANALYSIS OF THE MAPT STUDY
Kelly Virecoulon Giudici, Philipe de Souto Barreto, Christelle Cantet, Henrik Zetterberg, Kaj Blennow, Bruno Vellas, or the MAPT/DSA group
J Frailty Aging 2025;14(4)
Show summaryHide summaryBACKGROUND: Intrinsic capacity (IC) is a recent key concept proposed by the World Health Organization (WHO) based on aspects of functional ability (both physical and mental) rather than the presence or absence of diseases, with a potential to predict several health outcomes.
OBJECTIVE: To explore associations between IC and cognitive function (prospectively), and between IC and plasma p-tau181 (cross-sectionally and prospectively) among community-dwelling older adults.
METHODS: Observational study with 491 subjects ≥70 years (67.4 % female, mean 75.3 years, SD=4.4), participants from the Multidomain Alzheimer Preventive Trial (MAPT). IC domains (locomotion, cognition, psychological, vitality) were combined into a 0–100 score. Alternative classification was based on the number of domains’ abnormalities. Plasma p-tau181 was measured at baseline and 36 months of follow-up. A composite cognitive score (CCS) based on four tests was determined at baseline, 6, 12, 24, 36, 48 and 60 months.
RESULTS: Inverse cross-sectional associations were observed between baseline IC score and p-tau181 (unadjusted model: β=-0.08, 95 %CI -0.13 to -0.03; p = 0.0025). A significant mean difference in p-tau181 3-year changes was observed between participants with low and normal IC (based on IC score) (adjusted model: 1.71, 95 %CI 0.01 to 3.40; p = 0.0483). Prospective 5-year associations between IC and CCS were only observed in unadjusted analysis according to the alternative IC classification (-0.21, 95 %CI -0.38 to -0.04; p = 0.0156).
CONCLUSION: IC was associated with plasma p-tau181 and cognitive function, but findings varied according to the method of IC classification. Further research may help settle the role of IC as a predictor of neurodegenerative diseases such as AD. In this regard, multidomain interventions have potential to protect IC over the aging process and prevent cognitive impairment, and should also be encouraged.
CITATION:
Kelly Virecoulon Giudici ; Philipe de Souto Barreto ; Christelle Cantet ; Henrik Zetterberg ; Kaj Blennow ; Bruno Vellas ; for the MAPT/DSA group (2025): Associations between intrinsic capacity, plasma p-tau181 and cognitive function over a 5-year follow-up among community-dwelling older adults: a secondary analysis of the MAPT Study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100064
INTRINSIC CAPACITY IN LEWY BODY DEMENTIA: A REVIEW
Federica Sanapo, Marie Signoret, Mihaela Nodit, Antoine Garnier-Crussard
J Frailty Aging 2025;14(4)
Show summaryHide summaryFrailty is a clinical syndrome characterized by diminished physiological reserves and increased vulnerability to stressors. While frailty has been largely studied in Alzheimer’s disease, few study focused on Lewy body dementia (LBD). Beyond frailty, the World Health Organization recently highlights the concept of intrinsic capacity (IC), offering a promising framework for the early identification and intervention to mitigate the risk of frailty and disability in older adults. IC refers to an individual's physical and mental abilities (including five dimensions: sensory, psychology, locomotion, vitality and cognition), which support the maintenance of functional capacity and promote healthy aging. In this review, we aimed to describe the prevalence of IC decline in LBD and its potential consequences. While few studies focused specifically on this question, we found evidence in the literature of a higher prevalence of IC decline in LBD, compared to cognitively unimpaired older adults and to Alzheimer’s disease patients. If future studies are needed to confirm these results, we assume that IC assessment and monitoring in LBD may be a further step towards a better integrated and personalized care for patients. This may open the avenue to develop specific tailored interventions, to decrease disability and increase quality of life and “healthy ageing” of patients despite the presence of LBD.
CITATION:
Federica Sanapo ; Marie Signoret ; Mihaela Nodit ; Antoine Garnier-Crussard (2025): Intrinsic capacity in Lewy body dementia: a review. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100076
PATIENT-OUTCOMES OF A FRAILTY MANAGEMENT PROGRAM FOR COMMUNITY-DWELLING OLDER ADULTS IN SINGAPORE: A COHORT EVALUATION
Ze Ling Nai, Robin Choo, Grace Sum, Siew Fong Goh, Yew Yoong Ding, Wee Shiong Lim, Woan Shin Tan, Geriatric Service Hub Programme Group
J Frailty Aging 2025;14(4)
Show summaryHide summaryBACKGROUND: There is urgency to manage frailty due to its increasing prevalence. The Geriatric Service Hub (GSH) is a novel programme in Singapore, which aims to manage frailty amongst community-dwelling older adults.
OBJECTIVES: We aimed to (1) assess the effectiveness of the GSH through patient-outcomes including patient activation, functional status, and quality-of-life (QoL), and (2) assess impact on patient-outcomes through different levels of frailty using the Clinical Frailty Scale (CFS) scores.
DESIGN: Single-arm pre-post design.
SETTING: Community-based health and social care provider.
PARTICIPANTS: 218 GSH patients, aged≥65, with CFS4 to CFS7.
INTERVENTION: Patients received comprehensive geriatric assessments in community-based settings and had individualised care plans formed by a multi-disciplinary care team. Patients were then referred to health and social services located in the community based on identified needs.
MEASUREMENTS: Functional status (Barthel Index), Patient activation (Patient Activation Measure), health-related QoL (EuroQoL 5-dimension 5-level tool) and the emotional-related QoL (Control, Autonomy, Self-realisation, and Pleasure tool). Measurements administered at baseline, 3- and 6-months post-enrolment. Analysis included unadjusted t-tests and multi-level mixed-effects linear regression.
RESULTS: We studied 191 (87.6 %) participants who completed all 3-timepoints. Compared to baseline, functional status was maintained at 3-months (Mdiff=-0.2, 95 % CI [-1.8;1.3]) and 6-months (Mdiff=-0.5, 95 % CI[-2.2;1.2]). Patient activation increased slightly at 3-months (Mdiff=3.0, 95 % CI [0.1;5.9]) but not at 6-months (Mdiff=1.5, 95 % CI [-1.2;4.1]). There were significant increases for health-related QoL a t 3-months (Mdiff=0.068, 95 %CI [0.041;0.095]) and 6-months (Mdiff=0.045, 95 % CI [0.016;0.074]), and for emotional-related QoL at 3-months (Mdiff=2.3, 95 % CI [1.2;3.3]) and 6-months (Mdiff=1.5, 95 % CI [0.4;2.7]). For sub-group analyses, there were significant increases for patient activation and both QoL measurements for patients categorised as CFS4 and CFS5, and no significant changes for patient-outcomes for CFS6–7.
CONCLUSIONS: Overall, results suggest maintenance in patient activation and functional status, with improvements in QoL. Sub-group analyses suggest that GSH is beneficial for patients categorised as CFS4 and CFS5, but the programme played a largely maintenance role for patients with CFS6–7.
CITATION:
Ze Ling Nai ; Robin Choo ; Grace Sum ; Siew Fong Goh ; Yew Yoong Ding ; Wee Shiong Lim ; Woan Shin Tan ; Geriatric Service Hub Programme Group (2025): Patient-outcomes of a frailty management program for community-dwelling older adults in Singapore: A cohort evaluation. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100048
HEALTHCARE UTILIZATION, PHARMACOTHERAPY PRESCRIPTIONS, AND CLINICAL OUTCOMES ACROSS A 5-YEAR DURATION PRECEDING AND SUCCEEDING THE INITIATION OF HOME HEALTH CARE IN A NATIONWIDE POPULATION-BASED COHORT OF 187,547 OLDER ADULTS WITH DISABILITIES
Shih-Tsung Huang, Fei-Yuan Hsiao, Wei-Ju Lee, Ming-Yueh Chou, Chih-Kuang Liang, Chu-Sheng Lin, Ching-Hui Loh, Liang-Kung Chen
J Frailty Aging 2025;14(4)
Show summaryHide summaryBACKGROUND: Longitudinal trajectories of healthcare utilization, medication prescription, and clinical outcomes among older adults with disabilities receiving home healthcare (HHC) holds significance but remains elusive.
METHODS: People aged≥65 years who newly received Taiwan’s National Health Insurance funded HHC program from January 2005 to December 2013 were identified. Healthcare utilization, life-sustaining treatment, medication prescriptions (polypharmacy, psychotropics, anticholinergic burden and antibiotics), health status (Charlson’s comorbidity index, CCI), and mortality were assessed over a 10-year period spanning 5 years before and after initiating HHC.
RESULTS: Overall, 187,547 patients (80.6 ± 7.7 years, 51.2 % females, CCI 3+: 51.2 %) with a high prevalence of dementia (34.0 %), stroke (38.7 %), and pneumonia (49.5 %), and usage of life-sustaining treatment (urinary catheters: 82.8 % and nasogastric feeding: 78.7 %) were obtained. A sudden peak of admission rate at 1 year (91.7 %) before HHC, followed by the 70 % and 60 % admission rate in the first and second year after receiving HHC were found. Quarterly changes of using life-sustaining treatment showed significant increases from as early as 1 year prior to HHC. Gradual increases of polypharmacy, use of psychotropics, and antibiotic (4.5-fold and 3-fold) after HHC further demonstrated the complex needs (both p < 0.01). The 5-year cumulative mortality rate was 81 % (40 % in the first year with an annual rate of 25 %).
INTERPRETATION: HHC recipients embody a confluence of complex care needs and high mortality risk, whereby various interventions aim to alleviate symptoms and sustain life. Engaging in proactive advanced care planning and end-of-life care should be prioritized when home healthcare is being contemplated.
CITATION:
Shih-Tsung Huang ; Fei-Yuan Hsiao ; Wei-Ju Lee ; Ming-Yueh Chou ; Chih-Kuang Liang ; Chu-Sheng Lin ; Ching-Hui Loh ; Liang-Kung Chen (2025): Healthcare utilization, pharmacotherapy prescriptions, and clinical outcomes across a 5-year duration preceding and succeeding the initiation of home health care in a nationwide population-based cohort of 187,547 older adults with disabilities. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100063
ASSOCIATION OF LIFESTYLE MODIFICATIONS WITH FRAILTY IN OLDER ADULTS: A CROSS-SECTIONAL STUDY USING NHANES
Yuanyuan Wu, Hongyan Peng, Rui Xu, Yingxue Hua, Yanan Zhang
J Frailty Aging 2025;14(4)
Show summaryHide summaryBACKGROUND: Frailty significantly impacts healthy aging, yet lifestyle interventions may reduce its prevalence. This study investigated the association between a comprehensive lifestyle score, comprising eight modifiable factors (diet, physical activity, smoking, sleep, body mass index [BMI], non-HDL cholesterol, blood glucose, and blood pressure), and frailty risk in older adults, identifying key components for targeted interventions.
METHODS: Using data from the National Health and Nutrition Examination Survey (NHANES, 2005–2018), we analyzed 10,065 adults aged ≥60 years (mean age: 69.61, 54.97 % female). Each lifestyle factor was scored from 0 to 100, and frailty was defined using a 49-item index (>0.21). Weighted logistic regression assessed individual associations, restricted cubic spline (RCS) analysis explored dose-response relationships, and quantile g-computation evaluated joint effects.
RESULTS: Higher scores for dietary score (OR=0.69, 95 % CI: 0.52–0.90, score 100 vs. 0), non-smoking (OR=0.62, 95 % CI: 0.51–0.75), sleep (OR=0.29, 95 % CI: 0.17–0.49), blood glucose (OR=0.27, 95 % CI: 0.17–0.44), and blood pressure (OR=0.43, 95 % CI: 0.30–0.61, score 25 vs. 0) were associated with lower frailty risk (all P < .05). Diet and non-HDL cholesterol showed no linear association; smoking, BMI, blood glucose, and blood pressure exhibited non-linear patterns (P<.05). A simultaneous one-level increase in all lifestyle factors reduced frailty risk by 94 % (95 % CI: 92–95 %), with physical activity, blood glucose, and sleep as primary contributors.
CONCLUSION: These findings highlighted the association between specific lifestyle factors and reduced frailty risk, underscoring the need for prospective studies to prioritize interventions for frailty prevention.
CITATION:
Yuanyuan Wu ; Hongyan Peng ; Rui Xu ; Yingxue Hua ; Yanan Zhang (2025): Association of lifestyle modifications with frailty in older adults: A cross-sectional study using NHANES. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100061
BUILT-IN HEALTHCARE APPLICATIONS REVEAL STEP CHANGES ASSOCIATED WITH TEMPERATURE, TRANSPORTATION, AND MARITAL STATUS AMONG URBAN CITIES IN JAPAN
Nobuhiko Wakai, Taiga Yamada, Hiroyuki Tomoyama, Shigehiro Iida
J Frailty Aging 2025;14(4)
Show summaryHide summaryBACKGROUND: Walking is a fundamental daily activity representing health status and physical condition. The number of steps taken in a given time period is widely used in research areas such as aging, geriatrics, gerontology, public health, and preventive medicine. However, the underlying mechanisms of step counts are not well understood.
OBJECTIVES: To investigate daily step counts associated with temperature, transportation, and marital status.
DESIGN: Time series analysis of daily steps using built-in healthcare applications on smartphones.
SETTING: Government-designated, well-developed urban cities in Japan: Fukuoka, Kawasaki, Kobe, Kyoto, and Saitama.
PARTICIPANTS: Respondents totaled 622 40- to 79-year-olds, comprising 370 males and 252 females.
MEASUREMENTS: The mean period of our retrospective data was 2,344 days.
RESULTS: Seasonal-trend decomposition using loess was applied to time series steps. With the high coefficient of determination R2: 0.798, an absolute value function was fitted between temperature and the mean daily steps of the seasonal component. Furthermore, ordinary train usage in Saitama, Kawasaki, and Fukuoka was significantly greater than that in Kobe and Kyoto by 14.1 points (p=0.001). Moreover, married and divorced or bereaved males’ mean daily step counts were significantly larger than those of females’ by 1,832 (p=0.001) and 2,480 (p=0.001), respectively. By contrast, the difference in the mean daily step counts for unmarried males and females was only 100.
CONCLUSIONS: This study presents significant associations between mean daily steps and the factors of temperature, transportation, and marital status. These associations can alleviate biases in step research by area and season to facilitate better step count comparisons in many research fields.
CITATION:
Nobuhiko Wakai ; Taiga Yamada ; Hiroyuki Tomoyama ; Shigehiro Iida (2025): Built-in healthcare applications reveal step changes associated with temperature, transportation, and marital status among urban cities in Japan. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100059
THE RELATIONSHIP BETWEEN GLAUCOMA AND AN ELECTRONIC FRAILTY INDEX WITH THE CUMULATIVE INCIDENCE OF HEALTHCARE ENCOUNTERS FOR FALLS AND FRACTURES IN OLDER ADULTS
Walter D. Duy, Nicholas M. Pajewski, Jeff D. Williamson, Atalie C. Thompson
J Frailty Aging 2025;14(4)
Show summaryHide summaryOBJECTIVE: To compare the association of glaucoma and glaucoma suspect diagnoses with frailty, quantified via an electronic frailty index (eFI), and to evaluate whether a glaucoma diagnosis moderates the association between frailty and the cumulative risk of acute healthcare encounters for incident falls or fractures.
DESIGN: Retrospective study of electronic health record (EHR) data.
SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Adults ≥65 years old with an ICD-10 diagnosis code for glaucoma or glaucoma suspect who had a calculable eFI score as of 10/1/2017.
METHODS: Ordinal logistic regression was used to examine the cross-sectional association between glaucoma (predictor) and frailty status (outcome) based on the eFI. The relationship of glaucoma and frailty with the cumulative incidence of hospital or emergency room visits for injurious falls or fractures over time was modeled using cause-specific recurrent event survival models that account for censoring and the competing risk of death.
MAIN OUTCOME MEASURES: Frailty status based on the eFI and cumulative incidence of falls or fractures. RESULTS: Glaucoma patients were significantly more likely to be frail compared to glaucoma suspects (adjusted odds ratio=1.36, 95 % CI(1.16, 1.60)). Both pre-frailty and frailty were associated with an increased risk of incident falls/fractures in older adults: prefrail (hazard ratio=2.07, 95 % CI (1.40, 3.06)), frail (hazard ratio=3.35, 95 % CI (2.24, 5.03)), but there was no interaction of frailty with glaucoma status on falls/fractures risk. Also, the risk of incident falls/fractures did not significantly differ between glaucoma versus glaucoma suspects.
CONCLUSIONS: Glaucoma patients were more likely to be frail or pre-frail based on an EHR-derived index than glaucoma suspects. Both pre-frailty and frailty were associated with increased cumulative risk of injurious falls or fractures but there was no interaction of frailty with glaucoma. Frailty based on the eFI was better at discriminating who is at risk of acute healthcare utilization for falls/fractures than a glaucoma diagnosis.
CITATION:
Walter D. Duy ; Nicholas M. Pajewski ; Jeff D. Williamson ; Atalie C. Thompson (2025): The relationship between glaucoma and an electronic frailty index with the cumulative incidence of healthcare encounters for falls and fractures in older adults. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100051
A RETROSPECTIVE COHORT STUDY ON THE RELATIONSHIP BETWEEN FRAILTY AND HEALTHCARE OUTCOMES
Jinmyoung Cho, Joanne Salas, Jeffery F. Scherrer, George Grossberg
J Frailty Aging 2025;14(4)
Show summaryHide summaryBACKGROUND: Frailty increases vulnerability for adverse outcomes in older adults. Characterizing the prevalence and distribution of frailty can help guide healthcare service decision-making and policy.
OBJECTIVES: This study evaluated the association between frailty and healthcare utilization and interactions by demographic characteristics.
DESIGN: Using electronic health records (2018–2022), we conducted a retrospective cohort study with 355,266 patients ≥65 years of age who had ≥2 ambulatory office visits in separate years in the 4-year baseline period (2018–2021). The Gilbert Frailty Index (GFI) was calculated (low vs. intermediate vs. high) using ICD-10 codes. One-year utilization outcomes in 2022 included high outpatient clinic utilizations (OCU), inpatient (IP), emergency department (ED), and nursing home (NH) admissions. Fully adjusted log-binomial regression models were calculated overall and by race (White vs. Black), age groups, and gender.
RESULTS: The sample was 74.5(±7.5) years of age, 57.7 % female, 89.2 % White, and 13.5 % categorized as GFI high. After adjustment for covariates, GFI high had the highest risk for all outcomes (RR=3.31 for IP; 2.77 for ED; 4.26 for NH; 1.60 for high OCU). We observed significant interactions by race, gender, and age for some outcomes. Effects of GFI high vs. low were larger for White (IP, ED, & high OCU), female patients (ED & high OCU), and younger patients (IP). Conversely, the effects of GFI high vs. low were strongest in older patients for ED, IP and high OCU.
CONCLUSIONS: Monitoring frailty and paying attention to patient’s demographic characteristics is needed to best estimate associations between frailty and healthcare utilization.
CITATION:
Jinmyoung Cho ; Joanne Salas ; Jeffery F. Scherrer ; George Grossberg (2025): A retrospective cohort study on the relationship between frailty and healthcare outcomes. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100053
LETTER TO THE EDITOR: ENHANCING PREHABILITATION PROTOCOLS IN FRAIL OLDER ADULTS UNDERGOING JOINT REPLACEMENT - METHODOLOGICAL INSIGHTS FROM A PILOT RANDOMIZED CONTROLLED TRIAL
Xinrui Sun, Fei Gao
J Frailty Aging 2025;14(4)
Show summaryHide summary
CITATION:
Xinrui Sun ; Fei Gao (2025): Letter to the editor: Enhancing prehabilitation protocols in frail older adults undergoing joint replacement - methodological insights from a pilot randomized controlled trial. The Journal of Frailty and Aging (JFA).https://doi.org/10.1016/j.tjfa.2025.100065
REPLY TO THE LETTER TO THE EDITOR: ENHANCING PREHABILITATION PROTOCOLS IN FRAIL OLDER ADULTS UNDERGOING JOINT REPLACEMENT - METHODOLOGICAL INSIGHTS FROM A PILOT RANDOMIZED CONTROLLED TRIAL
Alexandra Papaioannou, Ashlee Azizudin, George Ioannidis, Fit-Joints study investigators
J Frailty Aging 2025;14(4)
Show summaryHide summary
CITATION:
Alexandra Papaioannou ; Ashlee Azizudin ; George Ioannidis ; Fit-Joints study investigators (2025): Reply to the Letter to the editor: Enhancing prehabilitation protocols in frail older adults undergoing joint replacement - methodological insights from a pilot randomized controlled trial. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100067