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02/2014 journal articles

THE COMPLEX CONSTRUCT OF MILD COGNITIVE IMPAIRMENT: BE AWARE OF COGNITIVE FRAILTY

M. Canevelli, E. Kelaiditi

J Frailty Aging 2014;3(2):87-88

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CITATION:
M. Canevelli ; E. Kelaiditi (2014): THE COMPLEX CONSTRUCT OF MILD COGNITIVE IMPAIRMENT: BE AWARE OF COGNITIVE FRAILTY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.6

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MOLECULAR CROSSROADS OF FRAILTY AND HIV

O. Tamez-Rivera, P. Martinez-Ayala, A.P. Navarrete-Reyes, H. Amieva, J.A. Avila-Funes

J Frailty Aging 2014;3(2):89-96

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An epidemiological transition is occurring regarding Human Immunodeficiency Virus (HIV) infection. This phenomenon, explained by several mechanisms (e.g.: physiologic changes, pharmacologic advances, sexual behaviors), is demonstrated by a significant increase in the number of patients aged 50 years and older diagnosed with this infection. The immunological changes observed in HIV-infected patients may prompt the appearance of an accelerated aging process as well as that of comorbidities and other pathological entities commonly diagnosed in older adults. Frailty is a biologic syndrome characterized by a multi-systemic decrease of the individual’s physiologic and homeostatic reserves, leading to diminished resistance against stressors and increased vulnerability. The purpose of this review is to describe the common molecular changes seen in both frailty and HIV-1 infection, offering an in-depth analysis of their pathophysiology and specifying common processes where their pathways meet.

CITATION:
O. Tamez-Rivera ; P. Martinez-Ayala ; A.P. Navarrete-Reyes ; H. Amieva ; J.A. Avila-Funes (2014): MOLECULAR CROSSROADS OF FRAILTY AND HIV. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.7

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PRESBYPHAGIA AND SARCOPENIC DYSPHAGIA: ASSOCIATION BETWEEN AGING, SARCOPENIA, AND DEGLUTITION DISORDERS

H. Wakabayashi

J Frailty Aging 2014;3(2):97-103

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Presbyphagia refers to age-related changes in the swallowing mechanism in the elderly associated with a frailty in swallowing. Presbyphagia is different from dysphagia. Sarcopenic dysphagia is difficulty swallowing due to sarcopenia of generalized skeletal muscles and swallowing muscles. Age-related loss of swallowing muscle mass becomes evident in the geniohyoid muscle and tongue. Elderly subjects with both sarcopenia and dysphagia may have not only disease-related dysphagia but also sarcopenic dysphagia. In cases of aspiration pneumonia, deterioration in activity-, disease-, and nutrition-related sarcopenia of generalized skeletal muscles and swallowing muscles may develop into sarcopenic dysphagia. Assessment of sarcopenic dysphagia includes evaluation of both dysphagia and sarcopenia. The 10-item Eating Assessment Tool (EAT-10) and a water test combined with pulse oximetry are useful for dysphagia screening. Assessment of the multi-factorial causes of sarcopenia including nutritional review is important, because rehabilitation of sarcopenic dysphagia differs depending on its etiology. Consensus diagnostic criteria for sarcopenic dysphagia were proposed at the 19th Annual Meeting of the Japanese Society of Dysphagia Rehabilitation. Rehabilitation for sarcopenic dysphagia includes treatment of both dysphagia and sarcopenia. The core components of dysphagia rehabilitation are oral health care, rehabilitative techniques, and food modification. The causes of adult malnutrition may also contribute to the etiology of secondary sarcopenia and sarcopenic dysphagia. Therefore, nutrition management is indispensable for sarcopenic dysphagia rehabilitation. In cases of sarcopenia with numerous complicating causes, treatment should include pharmaceutical therapies for age-related sarcopenia and comorbid chronic diseases, resistance training, early ambulation, nutrition management, protein and amino acid supplementation, and non-smoking.

CITATION: H. WAKABAYASHI (2014): PRESBYPHAGIA AND SARCOPENIC DYSPHAGIA: ASSOCIATION BETWEEN AGING, SARCOPENIA, AND DEGLUTITION DISORDERS. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.8

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ASSOCIATION BETWEEN SELF–REPORTED HEALTH STATUS AND FRAILTY IN COMMUNITY–DWELLING ELDERLY

A.M. González-Pichardo, A.P. Navarrete-Reyes, H. Adame-Encarnación, S. Aguilar-Navarro, J.M.A. García-Lara, H. Amieva, J.A. Avila-Funes

J Frailty Aging 2014;3(2):104-108

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Background: The phenotype of frailty proposed by Fried et al. has been related with increased vulnerability for the development of adverse health-related outcomes. However, this phenotype is not often used in daily clinical practice. On the other hand, poor self-reported health status (SRHS) has been associated with similar adverse health-related outcomes. Objectives: To determine the association between poor SRHS and frailty. Design, setting and participants: Cross-sectional study of 927 community-dwelling elderly aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty. Measurements: SRHS was established by the question “How do you rate your health status in general?” Frailty was defined according to the phenotype proposed by Fried et al. The association between SRHS and frailty was determined through the construction of multinomial logistic regression models. Final analyses were adjusted by socio-demographic and health covariates, including depressive symptoms. Also, agreement between SRHS and the phenotype of frailty was explored. Results: Prevalence of frailty was 14.1%, and 4.4% of participants rated their health status as “poor”. The unadjusted regression analyses demonstrated that fair and poor SRHS were significantly associated with prefrail and frail status. After adjustment for multiple covariates, the association remained statistically significant. However, in the final adjustment for depressive symptoms, only the association between poor SRHS and frail status continued to be statistically significant. Fair agreement between poor SRHS and frail status was also found. Conclusion: Poor SRHS shares common correlates as well as health-related adverse outcomes with frailty syndrome, and remains associated with it even when possible confounders are taken into account. Therefore, poor SRHS could be further explored as an option for frailty syndrome screening.

CITATION: A.M. González-Pichardo ; A.P. Navarrete-Reyes ; H. Adame-Encarnación ; S. Aguilar-Navarro ; J.M.A. García-Lara ; H. Amieva ; J.A. Avila-Funes (2014): ASSOCIATION BETWEEN SELF–REPORTED HEALTH STATUS AND FRAILTY IN COMMUNITY–DWELLING ELDERLY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.9

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GAIT SPEED AND HANDGRIP STRENGTH AS PREDICTORS OF INCIDENT DISABILITY IN MEXICAN OLDER ADULTS

T. López-Teros, L.M. Gutiérrez-Robledo, M.U. Pérez-Zepeda

J Frailty Aging 2014;3(2):109-112

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Physical performance tests are associated with different adverse outcomes in older people. The objective of this study was to test the association between handgrip strength and gait speed with incident disability in community-dwelling, well-functioning, Mexican older adults (age ≥70 years). Incident disability was defined as the onset of any difficulty in basic or instrumental activities of daily living. Of a total of 133 participants, 52.6% (n=70) experienced incident disability during one year of follow-up. Significant associations of handgrip strength (odds ratio [OR] 0.96, 95% confidence interval [95%CI] 0.93-0.99) and gait speed (OR 0.27, 95%CI 0.07-0.99) with incident disability were reported. The inclusion of covariates in the models reduced the statistical significance of the associations without substantially modifying the magnitude of them. Handgrip strength and gait speed are independently associated with incident disability in Mexican older adults.

CITATION: T. López-Teros ; L.M. Gutiérrez-Robledo ; M.U. Pérez-Zepeda (2014): GAIT SPEED AND HANDGRIP STRENGTH AS PREDICTORS OF INCIDENT DISABILITY IN MEXICAN OLDER ADULTS. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.10

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STAGE-SPECIFIC RELATIONSHIP BETWEEN FRAILTY AND COGNITIVE IMPAIRMENT IN A SPECIALIST MEMORY CLINIC SETTING

M.S. Chong, L. Tay, M. Chan, W.S. Lim, R. Ye, W.C. Wong, J.P. Lim, E.K. Tan, Y.Y. Ding

J Frailty Aging 2014;3(2):113-119

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Background: It is unclear if the complex relationship between physical frailty and cognition varies across the severity of cognitive impairment. Objectives: We therefore aimed to explore if there are stage-specific differences in the relationship between frailty and cognitive impairment. Design: Cross-sectional study. Setting: A specialist Memory Clinic setting. Participants: Mild cognitive impairment (MCI) and mild-moderate Alzheimer’s disease (AD) community-dwelling subjects. Measurements: We obtained data on demographics, multimorbidity, cognition-related measures, nutrition, neuroimaging measures, muscle mass, Vitamin D level, apolipoprotein – e (APOE) status and physical performance measures. Frailty measures of gait speed, hand grip strength, question on exhausation and weight loss, classified subjects according to the Buchmann criteria into non-frail and frail categories. Results: Forty-five MCI, 64 mild AD and 13 moderate AD subjects (total n=122) were studied. The prevalence of frailty for MCI, mild AD and moderate AD was 35.6%, 21.9% and 46.2% respectively, indicating a u-shaped trend. Significant differences were noted in fatigue, grip strength and gait speed frailty sub-items. Significant correlation of frailty with cognition were noted in mild-moderate AD (Spearman’s coefficient 0.26, p<0.05) but not in MCI (0.01, p=0.6). No other differences in multimorbidity, Vitamin D, APOE, nutritional measures, white matter lesions were observed. Sarcopenia interestingly had an inverse stage-specific relationship unlike frailty. Conclusions: Our results suggest a U-shaped relationship between frailty and cognition, characterized by initial dissociation with cognitive impairment and subsequent convergence at later stages. Future studies incorporating immune markers and endocrine pathways with longitudinal follow-up could potentially elucidate intermediary mechanisms in the frailty cascade.

CITATION: M.S. Chong ; L. Tay ; M. Chan, ; W.S. Lim ; R. Ye, ; W.C. Wong ; J.P. Lim ; E.K. Tan ; Y.Y. Ding (2014): STAGE-SPECIFIC RELATIONSHIP BETWEEN FRAILTY AND COGNITIVE IMPAIRMENT IN A SPECIALIST MEMORY CLINIC SETTING. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.11

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EDUCATIONAL INEQUALITIES AND FRAILTY IN SPAIN: WHAT IS THE ROLE OF OBESITY?

S. Rodríguez López, P. Montero, M. Carmenate

J Frailty Aging 2014;3(2):120-125

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Background: Evaluate how obesity is associated with the development of frailty among older adults is important. However, few studies have examined the relation between obesity and frailty within different educational backgrounds. Objectives: This study aims to investigate the association between educational level and frailty and to evaluate whether obesity explains any possible associations among Spanish adults. Design, participants and settings: This is a cross-sectional study including 2,319 50-years-old and older community-dwelling Spanish adults, who participated in the first wave (2004/05) of the Survey of Health, Ageing and Retirement in Europe (SHARE). Measurements: Educational differences in frailty phenotypes –defined by the SHARE’s operationalized criterion– and their association with obesity –estimated through self-reports of weight and height– were evaluated using multinomial logistic regression analyses. Results: Women experienced frailty in a larger proportion than men (22.3% vs. 13.3%). After adjusting for all confounders, we found a marked educational gradient in frailty, where individuals with non-formal education showed increased odds of a frailty phenotype than individuals with higher education. Moreover, obesity was significantly related to frailty and the effect of obesity is similar at all levels of education after testing for interaction effects. Although there is a mediation effect of obesity, the educational gradient in frailty is robust to controls for obesity. Conclusions: Our findings suggest a somehow independent effect of both educational background and obesity on frailty among Spanish individuals. This adds to the evidence of the frailty-obesity association among different educational backgrounds, and has implications for future interventions leading to reduce health disparities in elders.

CITATION: S. Rodríguez López ; P. Montero ; M. Carmenate (2014): EDUCATIONAL INEQUALITIES AND FRAILTY IN SPAIN: WHAT IS THE ROLE OF OBESITY?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.12

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PREDICTING THE EFFICACY OF PROTEIN-ENERGY SUPPLEMENTATION IN FRAIL OLDER ADULTS LIVING IN COMMUNITY

C.O. Kim

J Frailty Aging 2014;3(2):126-131

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Background: Protein-energy malnutrition is a major cause of functional decline in the elderly and is clearly an important component of frailty. However, limited evidence is available about how to select frail individuals most benefiting from protein-energy supplementation. Objectives: 1) To investigate factors associated with stronger benefits from protein-energy supplementation, and 2) to test the hypothesis that the severity of frailty is associated with the efficacy of protein-energy supplementation. Design: Secondary analysis of data from a pre-post-intervention study and a clinical trial. Setting: National Home Healthcare Services in Gangbuk-gu, Seoul, South Korea. Participants: 123 community-dwelling frail older adults [usual gait speed (UGS) <0.6m/sec and Mini Nutritional Assessment (MNA) <24]. Intervention: Each participant was received with two 200 mL per day of commercial liquid formula (providing additional 400 kcal of energy and 25 g of protein per day) for 12 weeks. Measurements: Relative change in the Physical Functioning (PF) and Short Physical Performance Battery (SPPB) score between the baseline and 12-week follow-up assessments were measured. Results: Multilevel mixed-effect linear regression analysis showed that a lower level of baseline UGS was associated with a greater improvement in PF and SPPB score after adjustment for age, gender, education, living status, beneficiary of public assistance, number of chronic diseases, compliance, and type of dataset (p<0.001). A lower level of baseline MNA score was associated with greater change in PF and SPPB score after adjustment for multiple covariates (p<0.045). Participants with severe frailty (UGS <0.3 m/sec + MNA <17) showed 52.4% and 44.6% more relevant improvements in PF and SPPB score, respectively, than those with mild frailty (UGS 0.3-0.6 m/sec + MNA 17-24) (p<0.001). Conclusion: Slower UGS and lower MNA score are independently associated with the greater efficacy of protein-energy supplementation on functional status.

CITATION:
C.O. Kim (2014): PREDICTING THE EFFICACY OF PROTEIN-ENERGY SUPPLEMENTATION IN FRAIL OLDER ADULTS LIVING IN COMMUNITY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.13

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THE ACUTE EFFECTS OF ECCENTRICALLY-BIASED VERSUS CONVENTIONAL WEIGHT TRAINING IN OLDER ADULTS: A RANDOMISED CONTROLLED CROSS-OVER STUDY

I. Selva Raj, B.A. Westfold, A.J. Shield, M.D. Linden, S.R. Bird

J Frailty Aging 2014;3(2):132-138

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Background: Whilst resistance training has been proven to convey considerable benefits to older people; immediately post-exercise there may be elevated transient risks for cardiac events and falls. Objectives and Measurements: We assessed the acute effects of eccentrically-biased (EB) and conventional (CONV) resistance exercise on: platelet number, activation and granule exocytsosis; and mean velocity of centre of pressure displacement (Vm). Design, Setting, Participants and Intervention: Ten older adults (7 males, 3 females; 69 ± 4 years) participated in this randomised controlled cross-over study in which they performed EB and CONV training sessions that were matched for total work and a control condition. Results: Immediately post-exercise there was a statistically significant difference in platelet count between the control condition, in which it had declined (pre 224 ± 35 109/L; post 211 ± 30 109/L: P < 0.05) and CONV in which it had increased (pre 236 ± 55 109/L; post 242 ± 51 109/L: P > 0.05). There was no change in platelet activation and granule exocytsosis or Vm following EB and CONV. Conclusions: Overall, while minor differences between regimens were observed, no major adverse effect on parameters of platelet function or centre of pressure displacement were observed acutely following either regimen. Eccentrically-biased and conventional resistance exercise training regimens do not appear to present an elevated acute risk in the context of changes to platelet function contributing to a cardiac event or postural stability increasing falls risk for apparently healthy older adults.

CITATION:
I. Selva Raj ; B.A. Westfold ; A.J. Shield ; M.D. Linden ; S.R. Bird (2014): THE ACUTE EFFECTS OF ECCENTRICALLY-BIASED VERSUS CONVENTIONAL WEIGHT TRAINING IN OLDER ADULTS: A RANDOMISED CONTROLLED CROSS-OVER STUDY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.14

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