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01/2013 journal articles

THE PHENOTYPE OF FRAILTY AND HEALTH-RELATED QUALITY OF LIFE

M. Moreno-Aguilar, J.M.A. García-Lara, S. Aguilar-Navarro, A.P. Navarrete-Reyes, H. Amieva, J.A. Avila-Funes

J Frailty Aging 2013;2(1):2-7

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Background: Frailty is a multidimensional problem in the elderly, but there is little information about its implications on health-related quality of life (HRQoL). Objectives: To determine the association between frailty and HRQoL as well as the association between each component of the phenotype of frailty and the physical (PCS) and mental (MCS) components summaries of QoL. Design, setting and participants: Cross-sectional study of 496 community-dwelling elderly aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty. Measurements: Frailty was defined by the presence of at least three of the following criteria: weight loss, exhaustion, low physical activity, slowness, and weakness. QoL and both of its components were assessed through the SF-36. The association of each component of frailty with the PCS and the MCS of QoL was determined through the construction of multivariate lineal regression models. Final analyses were adjusted by socio-demographic characteristics and by the remaining four components of frailty as covariates. Results: Mean age of participants was 78.0 (SD ± 6.2), 49.4% were women, and 12.7% were frail. Multivariate lineal regression analysis showed that frail and prefrail participants had lower scores for the PCS (P < .001) and the MCS (P < .001) of QoL in comparison with non-frail subjects. Weight loss (P < .001) and exhaustion (P < .001) had an independent inverse association with the MCS of QoL while gait speed (P < .001) and grip strength (P < .001) were also inversely associated with the PCS score. Conclusion: Frailty is independently associated with lower scores in the MCS and the PCS of QoL. The finding that different components of frailty were associated with both dimensions of QoL reflects the need for individualized treatment of frail elderly.

CITATION:
M. Moreno-Aguilar ; J.M.A. García-Lara ; S. Aguilar-Navarro ; A.P. Navarrete-Reyes ; H. Amieva ; J.A. Avila-Funes (2013): THE PHENOTYPE OF FRAILTY AND HEALTH-RELATED QUALITY OF LIFE. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.1

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APPROPRIATE PRESCRIBING FOR OLDER PEOPLE: A NEW TOOL FOR THE GENERAL PRACTITIONER

E. Lenaerts, F. De Knijf, B. Schoenmakers

J Frailty Aging 2013;2(1):8-14

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Background: Appropriate prescribing for older people is a challenge. General practitioners (GPs) are aware of their key position in relation to prescribing practice in the elderly. However, they often feel powerless and report a need for simple GP friendly tools to assess and support their prescribing practice. Objectives: In this study such a tool is developed: the Appropriate Medication for Older people-tool (AMO-tool). The purpose of the study is to investigate whether GPs consider the use of the AMO-tool to be practically feasible and resulting in more appropriate prescribing. Design: This pilot study with an interventional design was conducted over a period of six months. Setting: The study was conducted in nursing homes visited by GPs. Participants: The studied population consisted of nine GPs and 67 nursing home residents. Intervention: The intervention consisted of the use of the AMO-tool. Measurements: The Short Form (SF)-12 questionnaire was administered to the patients. Patients' medication lists were recorded. The GPs completed a semi-quantitative questionnaire on their experiences with the AMO-tool. A descriptive qualitative and semi-quantitative analysis was carried out on the GP questionnaire. The results of the SF-12 questionnaires and medication lists were analysed quantitatively. A multivariate analysis was carried out. Results: In the perception of GPs, applying the AMO-tool to medication lists of nursing home residents was feasible and resulted in more appropriate prescribing. A slight reduction was recorded in the number of medications prescribed. Self-reported well-being improved and rose in parallel with the number of medication changes. Conclusion: According to GPs, the AMO-tool offers GPs the support in their prescribing practice. Changes are made to medication lists and improvements occur in patients' self-reported well-being. Future research should objectify the appropriateness of prescriptions before and after using the tool. Furthermore, it should investigate the possible causal relationship between the use of the AMO-tool, an increase in appropriateness of medication lists and an improvement of general well-being.

CITATION:
E. Lenaerts ; F. De Knijf ; B. Schoenmakers (2013): Appropriate prescribing for older people: a new tool for the general practitioner. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.2

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FEASIBILITY OF USING INFORMATION DERIVED FROM A CARE PARTNER TO DEVELOP A FRAILTY INDEX BASED ON COMPREHENSIVE GERIATRIC ASSESSMENT

J. Goldstein, R.E. Hubbard, P. Moorhouse, M.K. Andrew

J Frailty Aging 2013;2(1):15-21

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Background: Frailty is a state of increasing vulnerability that places an individual at high risk for adverse health outcomes. The best approach for frailty measurement in clinical practice has not been resolved. Frailty can be measured by deficit accumulation and be derived from a comprehensive geriatric assessment (CGA). In busy clinical practice, it may not be feasible to gather this information entirely from patients, particularly from those with cognitive decline. Objective: We describe the feasibility of a frailty index based upon a care partner derived CGA (CP-CGA). In addition, we sought to establish the acceptability of the questionnaire and explore whether care partners felt that the provided information contribute to patient assessment. Design and Setting: A cross-sectional data analysis of 99 community dwelling older adults attending geriatric ambulatory care clinics at a single tertiary care center. Measurements: Care partners completed the CP-CGA and a Clinical Frailty Scale (CFS; Range 1 -Very fit- to 9 -Terminally ill). We evaluated the time to complete and item completeness. Results: The mean age of patients was 81.3±5.7 years. Most were women (n=54), widowed, lived in their own home, with a median CFS of 5 (Mildly Frail). The care partner respondent was usually an offspring. Item completeness was 95% with a mean time to complete of 15.5±8.6 minutes. Conclusion: The CP-CGA seems feasible for gathering information that would be integral towards determining frailty by deficit accumulation. Future inquiries will evaluate its feasibility in other settings and validity as a form of frailty assessment.

CITATION:
J. Goldstein ; R.E. Hubbard ; P. Moorhouse ; M.K. Andrew (2013): FEASIBILITY OF USING INFORMATION DERIVED FROM A CARE PARTNER TO DEVELOP A FRAILTY INDEX BASED ON COMPREHENSIVE GERIATRIC ASSESSMENT . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.3

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WALKING ACTIVITY OF OLDER PATIENTS IN REHABILITATION: A PROSPECTIVE STUDY

N.M. Peel, S.S. Kuys

J Frailty Aging 2013;2(1):22-26

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Objectives: To quantify, using accelerometry, walking activity of older rehabilitation inpatients and to examine the relationship between walking activity and functional outcomes. Design: Prospective cohort study. Setting: Inpatient geriatric rehabilitation unit. Participants: Of 74 consecutive eligible patients, aged 60 years or older and able to walk independently or with assistance, 60 participants (32 males, 28 females) with a mean (SD) length of stay of 37 (26) days completed the study. Intervention Measures: An accelerometer was worn in daytime hours from study recruitment until discharge to monitor daily walking minutes. Results: On study entry, patients spent a median (IQR) of 33 (20 to 48) minutes (7%) of the daily monitored eight hour period walking. By discharge, this had increased to 43 (30 to 56) minutes (9%) (p< 0.001). Average daily walking activity over the week prior to discharge correlated with change in gait speed from admission to discharge (p<0.05). Walking activity prior to discharge was significantly different (p<0.05) between the slowest gait speed group (≤0.4 m/s) and the fastest gait speed group (≥0.8 m/s). Those with discharge gait speeds ≥0.8 m/s (associated with ability to be ambulant in the community) had median (IQR) daily walking times at discharge of 51 (33 to 78) minutes. Conclusion: Activity monitoring has the potential to assist clinicians and patients set goals around activity levels to achieve better outcomes.

CITATION:
N.M. Peel ; S.S. Kuys (2013): Walking activity of older patients in rehabilitation: a prospective study . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.4

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IMPACT OF BODY COMPOSITION ON PHYSICAL PERFORMANCE TASKS IN OLDER OBESE WOMEN UNDERGOING A MODERATE WEIGHT LOSS PROGRAM

G.D. Miller, S.L. Robinson

J Frailty Aging 2013;2(1):27-32

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Background: Although obesity is a recognized risk factor for impaired physical function in older adults, there is still debate on whether older obese adults should undergo intentional weight loss due to concern of loss in lean body mass, including appendicular lean soft tissue mass. This may put them at risk for worsening muscle strength and mobility. Objectives: Therefore, the purpose of this study was to examine the effect of a weight loss intervention on body composition and physical function in obese older women. Design: Women were randomized into either a weight stable (WS) (n=20) or an intensive weight loss (WL) (n=26) group. Setting: The study setting was at a university research facility. Participants: Women (age, 67.8±1.3 yrs; BMI, 34.9 (0.7) kg/m2; mean±standard error of the mean) were recruited. Intervention: The WL intervention was for 6 months and included moderate dietary energy restriction and aerobic and strength exercise training. Measurements: Variables were obtained at baseline and 6-months and included body weight, dual energy x-ray absorptiometry (DXA), 6-minute walk distance, stair climb time, and concentric knee extension muscular strength. Results: Estimated marginal means (SEM) for weight loss at 6-months was -8.5 (0.9)% for WL and +0.7 (1.0)% for WS. There was a significant loss of body fat mass, lean body mass, appendicular lean soft tissue mass, relative muscle mass, and skeletal muscle index for WL vs. WS at 6-months. However, improvements for WL vs. WS were seen in 6-minute walk distance and stair climb time, and trends for improved relative strength and leg muscle quality. Change in body fat mass was positively related to improved physical function and muscle strength and quality. Conclusion: These results further support the use of a sound intentional weight loss program incorporating moderate dietary energy restriction and exercise training in older obese women to improve physical function. Although lean soft tissue mass was lost, over the 6-month program there was no deleterious effect on muscle strength or muscle quality.

CITATION:
G.D. Miller ; S.L. Robinson (2013): Impact of Body Composition on Physical Performance Tasks in Older Obese Women Undergoing a Moderate Weight Loss Program . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.5

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NUTRITIONAL INTERVENTION VIA VIDEOCONFERENCING FOR OLDER ADULTS RECEIVING HOME CARE - A PILOT STUDY

T. Puranen, H. Finne-Soveri, K. Auranne, M. Lehtinen-Fraser, M.H. Suominen

J Frailty Aging 2013;2(1):33-37

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Background: Malnutrition is common in aged home care clients and that affects negatively the health of aged people. Nutritional screening is recommended for early detection of malnutrition. Objectives: The aim was to assess the nutritional status and food intake of home care receivers and improve their nutrient intake with tailored nutritional advice administered via videoconferencing. Design: Intervention with follow-up. Setting: Home care in the city of Helsinki. Participants: 25 older (>65 years) adults receiving home care. Intervention: After an initial assessment determining their needs, participants received tailored nutritional advice via videoconferencing over a six-month follow-up period. Measurements: Participants nutritional status was assessed with a Mini Nutritional Assessment –test (MNA). Nutrient intake was calculated based on a detailed three-day food diary compiled twice during the six-month follow-up period. Results: Altogether 25 persons participated in the study (mean age 78.5 years, 88 % females). According to the MNA test 80 % were at risk of malnutrition at the outset. Energy (1329 kcal) and mean nutrient intakes of protein (54 g) and folic acid (210 μg), for example, were inadequate. After six months of intervention, the mean energy intake had increased to 1450 (SD 319) kcal, protein to 65 (SD 20) g, and folic acid to 231 (SD 105) μg per day.. Conclusions: The energy, protein and other nutrient intake of the study participants increased during the six-month intervention. Videoconferencing seemed to be a well-accepted and feasible method for providing nutritional advice to older home care clients.

CITATION:
T. Puranen ; H. Finne-Soveri ; K. Auranne ; M. Lehtinen-Fraser ; M.H. Suominen (2013): Nutritional intervention via videoconferencing for older adults receiving home care - a pilot study . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.6

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CURRENT NUTRITIONAL RECOMMENDATIONS AND NOVEL DIETARY STRATEGIES TO MANAGE SARCOPENIA

R. Calvani, A. Miccheli, F. Landi, M. Bossola, M. Cesari, C. Leeuwenburgh, C.C. Sieber, R. Bernabei, E. Marzetti

J Frailty Aging 2013;2(1):38-53

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Sarcopenia, the loss of skeletal muscle mass and function that occurs with aging, is associated with increased risk for several adverse health outcomes, including frailty, disability, falls, loss of independent living, and mortality. At present, no pharmacological treatment exists that is able to definitely halt the progression of sarcopenia. Likewise, no pharmacological remedies are yet available to prevent the onset of age-related muscle wasting. The combination of nutritional interventions and physical exercise appears to be the most effective strategy presently available for the management of sarcopenia. The purposes of this review are to summarize the current knowledge on the role of nutrition as a countermeasure for sarcopenia, illustrate the mechanisms of action of relevant dietary agents on the aging muscle, and introduce novel nutritional strategies that may help preserve muscle mass and function into old age. Issues related to the identification of the optimal timing of nutritional interventions in the context of primary and secondary prevention are also discussed. Finally, the prospect of elaborating personalized dietary and physical exercise recommendations through the implementation of integrated, high-throughput analytic approaches is illustrated.

CITATION:
R. Calvani ; A. Miccheli ; F. Landi ; M. Bossola ; M. Cesari ; C. Leeuwenburgh ; C.C. Sieber ; R. Bernabei ; E. Marzetti (2013): Current nutritional recommendations and novel dietary strategies to manage sarcopenia . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.7

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SARCOPENIA: THE TARGET POPULATION

T.K. Malmstrom, J.E. Morley

J Frailty Aging 2013;2(1):55-56

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CITATION:
T.K. Malmstrom ; J.E. Morley ; (2013): Sarcopenia: The Target Population . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.8

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WHAT WE HAVE LEARNED FROM EXERCISE AND LIFESTYLE TRIALS TO ALLEVIATE MOBILITY IMPAIRMENT IN OLDER ADULTS

T.M. Manini, B.C. Clark

J Frailty Aging 2013;2(1):57-59

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Enhancement of cardiovascular and muscular fitness through exercise and lifestyle interventions is critical to in alleviating mobility impairment in older adults. In this review article, we discuss the current knowledge-base surrounding mobility improvements in seniors following behavioral interventions that use lifestyle modifications involving physical activity and dietary interventions.

CITATION:
T.M. Manini ; B.C. Clark (2013): What we have learned from exercise and lifestyle trials to alleviate mobility impairment in older adults . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2013.9

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