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01/2012 journal articles

FRAILTY AND AGING

M. Cesari

J Frailty Aging 2012;1(1):3-6

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CITATION:
M. Cesari (2012): Frailty and Aging. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2012.1

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HOW MIGHT DEFICIT ACCUMULATION GIVE RISE TO FRAILTY?

K. Rockwood, A. Mitnitski

J Frailty Aging 2012;1(1):8-12

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Frailty is a multiply determined vulnerability state. People who are frail are at risk of many adverse health outcomes, including death. For any individual, this risk can only be expressed probabilistically. Even very fit people can suddenly die or become catastrophically disabled, but their risk of both is much lower than a very frail person, who might nevertheless suddenly succumb without worsening health. Frailty occurs with ageing, a stochastic, dynamic process of deficit accumulation. Deficits occur ubiquitously at subcellular levels, ultimately affecting tissues, organs and integrated organ action, especially under stress. Some people are disposed to accumulate deficits at higher rates, but on average, deficit accumulation varies across the life course and likely is mutable. In this way, the clinical definition of frailty is distinct from the statistical definition, which sees frailty as a fixed factor for an individual. Recent, early animal work links subcellular deficits to whole body frailty. In humans, clinically detectable health deficits combine to increase the risk of adverse health outcomes. The rate of deficit accumulation occurs with remarkable regularity around the world, as does a limit to frailty. Of note, when 20+ deficits are counted, these characteristics are indifferent to which deficits are considered. The expression of risk in relation to deficit accumulation varies systematically. For example, at any given level of deficit accumulation, men are more susceptible to adverse health outcomes than are women. Likewise, in China, the lethality of deficit accumulation appears to be higher than in Western countries. In consequence, it may be necessary to better distinguish between frailty and physiological reserve; the latter may apply chiefly in relation to microscopic deficits. The expression of frailty risk in relation to deficit accumulation depends on the environment, including both the physical and social circumstances in which people find themselves.

CITATION:
K. Rockwood ; A. Mitnitski ; (2012): How might deficit accumulation give rise to frailty?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2012.2

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HOW TO INCLUDE THE SOCIAL FACTOR FOR DETERMINING FRAILTY?

L.M. Gutierrez-Robledo, J.A. Ávila-Funes

J Frailty Aging 2012;1(1):13-17

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Traditionally, frailty has been understood as a biological syndrome associated with bad health-related outcomes. However, nowadays there are no universally accepted diagnostic criteria for this syndrome, much less studies approaching it from a non-biological framework. Some previous work has been able to highlight social factors as important features implicated in the development of this entity, and are now recognized as relevant to understand frailty. However, research in this field is still limited. It seems clear that social factors, often ignored in the medical context, might represent risk factors for the development of this geriatric syndrome. To identify these factors, as well as their role in the physiopathology of frailty, could be of great importance in order to establish potential multidimensional models to treat frailty. A life course approach to determine the correlates and trajectories of frailty seems to be necessary. The allostatic load through life and chronic inflammation in the elderly are potential mediators of this relationship. Therefore, social profile should be systematically assessed and taken into account when evaluating an elderly person. So, the present review proposes how to include social factors as another determinant of frailty.

CITATION:
L. Miguel Gutiérrez-Robledo ; J.A. Avila-Funes (2012): HOW TO INCLUDE THE SOCIAL FACTOR FOR DETERMINING FRAILTY?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2012.3

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GENDER SPECIFIC ASSOCIATIONS BETWEEN FRAILTY AND BODY COMPOSITION

D. Walters, G. Abellan Van Kan, M. Cesari, K. Vidal, Y. Rolland, B. Vellas

J Frailty Aging 2012;1(1):18-23

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Frailty is a widespread geriatric syndrome, but its relationship with body composition is largely unknown. Objectives: Assess the relationship between body composition and frailty in older persons. Design, participants and setting: Cross-sectional data analyses in 120 community-dwelling older persons (50 men, 70 women, mean age 78.5 ± 6 yr). Measurements: Frailty was measured according to Fried’s criteria and calculated as a score, and also a binary variable. Anthropometric measures were obtained (height, weight), and body composition (total lean body mass, appendicular skeletal muscle mass (ASM), total fat mass, and percentage fat), assessed by dual energy x-ray absorptiometry. Multiple regression and logistic regression analyses stratified by gender were conducted. Results: Frailty, as a binary measure, was more prevalent in women than men (67.1% vs 46% p=0.04). Prevalence of low muscle mass (ASM/ht2) was higher in men than in women (40.0% vs 32.9%, p=0.04). Using gender-specific percentage fat cut-scores (27% men, 38% women, respectively) obesity was more prevalent in women than men (58.6% vs 34%, respectively, p=0.01). Multiple regression models showed age as an independent associated factor of frailty in men (β 0.310, p=0.009) and women (β .581 p<0.001). ASM/ht2 was a significant associated factor in men (β -0.517, p<0.001) and trended towards significance in women (β -0.188, p=0.06). Percentage fat was a significant associated factor in women only (β 0.234, p=0.02). Logistic regression with frailty as a binary dependent variable yielded similar results. Conclusion: In this sample of older adults, the significant associated factor of frailty in men was ASM/ht2, whereas it was percentage fat in women. These associations were independent of age. With increasing longevity and the high prevalence of sarcopenia and obesity in older populations, these findings have public health implications. Larger sample and specifically designed studies are needed in order to confirm and extend these findings.

CITATION:
D.L. Waters ; G. Abellan van Kan ; M. Cesari ; K. Vidal ; Y. Rolland ; B.Vellas (2012): Gender specific associations between frailty and body composition. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2012.4

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THE TREVISO DEMENTIA (TREDEM) STUDY: A BIOMEDICAL, NEURORADIOLOGICAL, NEUROPSYChOLOGICAL AND SOCIAL INVESTIGATION OF DEMENTIA IN NORTH-EASTERN ITALY

M. Gallucci, E. Mariotti, D. Saraggi, T. Stecca, M.G. Oddo, C. Bergamelli, P. Boldrini, S. Mazzuco, F. Ongaro, P. Mecocci, F. Di Paola, M. Bendini, G.L. Forloni, D. Albani, P. Antuono, L. Caberlotto, A. Zanardo, M. Siculi, G.B. Gajo, E. Durante, G. Buscato

J Frailty Aging 2012;1(1):24-31

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The incidence of dementia increases exponentially with age but knowledge of real disease-modifying interventions is still limited. Objectives: To describe the study design and methods of a large prospective cohort study aimed at exploring the complex underlying relationships existing among cognition, frailty, and health-related events in older persons with cognitive impairment. Design: Prospective cohort study of a representative population of outpatients attending the Treviso Cognitive Impairment Center between 2000 and 2010. Setting: The TREVISO DEMENTIA (TREDEM) Study conducted in Treviso, Italy. Participants: 490 men and 874 women, mean age 79.1 ± 7.8 years (range 40.2–100 years). Measurements: Physiological data, biochemical parameters, clinical conditions, neuroradiological parameters (e.g., brain atrophy and cerebral vascular lesions identified by computerized tomography scans), neuropsychological assessment, and physical function markers were measured at baseline. Patients were followed-up to 10 years. Results: The final sample included in the study was predominantly composed of women and characterized by an initial physical function impairment and increased vascular risk profile. Cognitive function of the sample population showed moderate cognitive impairment (Mini Mental State Examination 20.2 ± 6.3; Clinical Dementia Rating 1.2 ± 0.7), and a prevalence of vascular dementia of 26.9%. Cortical, subcortical and hippocampus atrophy were all significantly correlated with age and cognitive function. Conclusion: Results obtained from the preliminary analyses conducted in the TREDEM study suggest that the database will support the accomplishment of important goals in understanding the nature of cognitive frailty and neurodegenerative diseases.

CITATION:
M. Gallucci ; E. Mariotti ; D. Saraggi ; T. Stecca ; M.G. Oddo ; C. Bergamelli ; P. Boldrini ; S. Mazzuco ; F. Ongaro ; P. Mecocci ; F. Di Paola ; M. Bendini ; G.L. Forloni ; D. Albani ; P. Antuono ; L. Caberlotto ; A. Zanardo ; M. Siculi ; G.B. Gajo ; E. Durante ; G. Buscato (2012): THE TREVISO DEMENTIA (TREDEM) STUDY: A BIOMEDICAL, NEURORADIOLOGICAL, NEUROPSYChOLOGICAL AND SOCIAL INVESTIGATION OF DEMENTIA IN NORTH-EASTERN ITALY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2012.5

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POTENTIAL PROGNOSTIC VALUE OF HANDGRIP STRENGTH IN OLDER HOSPITALIZED PATIENTS

E. Savino, F. Sioulis, G. Guerra, M. Cavalieri, G. Zuliani, J.M. Guralnik, S. Volpato

J Frailty Aging 2012;1(1):32-38

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Objective measures of physical function are useful prognostic tools also for hospitalized elders. Low handgrip strength is predictive of poor outcomes and it can be assessed also in a sitting position, representing a potential alternative measure in bedridden patients. We evaluated grip strength prognostic value in hospitalized older patients. Design: Prospective cohort study. Setting: Geriatric, medical ward of an academic medical center in Ferrara, Italy. Participants: Patients aged 65 and older (N = 88) admitted to the hospital for an acute medical condition. Measurements: Patients were evaluated for grip strength at hospital admission and were re-evaluated at discharge. After discharge, they were followed every 3 months for 1 year by telephone interviews to assess new hospitalizations and vital status. Results: The mean age of the sample was 77.3 years, 47% were women. At admission, mean height standardized handgrip strength was 15.7±5 kg/m; men had greater strength (p<0.001). There was a direct relationship of admission grip strength with BMI (p<0.05), serum albumin (p=0.07), and Short Physical Performance Battery score (p<0.05), and an inverse relationship with age (gender-adjusted p value <0.01). In multiple regression analysis, after adjustment for possible confounders, patients in third tertile of grip strength had a shorter hospital stay compared to those in the first tertile (β -2.8; p<0.05). Patients with higher grip strength at discharge also had a lower risk of rehospitalization or death over the follow-up, although the result was not statistically significant (OR: 0.68; 95% CI: 0.30-1.52). Conclusion: In older hospitalized medical patients, grip strength assessment might provide useful prognostic information.

CITATION:
E. Savino ; F. Sioulis ; G. Guerra ; M. Cavalieri ; G. Zuliani ; J.M. Guralnik ; S. Volpato (2012): Potential prognostic value of handgrip strength in older hospitalized patients. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2012.6

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PEDOMETER-BASED BEHAVIORAL CHANGE PROGRAM CAN IMPROVE DEPENDENCY IN SEDENTARY OLDER ADULTS: A RANDOMIZED CONTROLLED TRIAL

M. Yamada, S. Mori, S. Nishiguchi, Y. Kajiwara, K. Yoshimura, T. Sonoda, K. Nagai, H. Arai, H. Arai

J Frailty Aging 2012;1(1):39-44

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Recent studies suggested that pedometer-based walking programs are applicable to older adults. Objectives: The purpose of this study was to evaluate the use of pedometer in sedentary older adults to improve physical activity, fear of falling, physical performance, and leg muscle mass. Design: This was a pilot randomized controlled trial (RCT). Setting and participants: Eighty-seven community dwelling sedentary older adults living in Japan. Intervention: The intervention group (n=43) received a pedometer-based behavioural change program for 6 months, while the control group (n=44) did not. The participants in the intervention group were instructed to increase their mean daily steps by 10% each month. Thus, at the end of 6 months, participants in the intervention group were expected to have 77 % more daily steps than their baseline step counts. Written activity logs were monthly averaged to determine whether the participants were achieving their goal. Measurements: Outcome measures were physical activity, fear of falling, physical performances, and leg muscle mass. Results: In this 6-month trial 40 older adults (93%) completed the pedometer protocol with good adherence. In the intervention group, average daily steps were increased by 83.4% (from 20311323 to 3726 1607) during the study period, but not in the control group (from 20471698 to 22671837). The pedometer-based behavioral change program was more effective to improve their physical activity, fear of falling, locomotive function, and leg muscle mass than control (P<0.05). Conclusion: These results suggested that the pedometer-based behavioral change program can effectively improve the physical activity, fear of falling, physical performance, and leg muscle mass in sedentary older adults.

CITATION:
M. Yamada ; S. Mori ; S. Nishiguchi ; Y. Kajiwara ; K. Yoshimura ; T. Sonoda ; K. Nagai ; H. Arai ; H. Arai (2012): Pedometer-based behavioral change program can improve dependency in sedentary older adults: A randomized controlled trial . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2012.7

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