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04/2014 journal articles

DESIGNING DRUG TRIALS FOR SARCOPENIA IN OLDER ADULTS WITH HIP FRACTURE – A TASK FORCE FROM THE INTERNATIONAL CONFERENCE ON FRAILTY AND SARCOPENIA RESEARCH (ICFSR)

B. Vellas, R. Fielding, R. Miller, Y. Rolland, S. Bhasin, J. Magaziner, H. Bischoff-Ferrari, on behalf of the ICFSR Task Force members

J Frailty Aging 2014;3(4):199-204

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In May 2012, a Sarcopenia Consensus Summit was convened by the Foundation of the National Institutes of Health (FNIH), National Institute of Aging (NIA), and the U.S. Food and Drug Administration (FDA); and co-sponsored by five pharmaceutical companies. At this summit, sarcopenia experts from around the world worked to develop agreement on a working definition of sarcopenia, building on the work of previous efforts to generate a consensus. With the ultimate goal of improving function and independence in individuals with sarcopenia, the Task Force focused its attention on people at greatly increased risk of muscle atrophy as a consequence of hip fracture. The rationale for looking at this population is that since hip fracture is a recognized condition, there is a clear regulatory path forward for developing interventions. Moreover, patients with hip fracture may provide an appropriate population to advance understanding of sarcopenia, for example helping to define diagnostic criteria, develop biomarkers, understand the mechanisms that underlie the age-related loss of muscle mass and strength, and identify endpoints for clinical trials that are reliable, objective, and clinically meaningful. Task Force members agreed that progress in treating sarcopenia will require strengthening of partnerships between academia, industry, and government agencies, and across continents to reach consensus on diagnostic criteria, optimization of clinical trials design, and identification of improved treatment and preventive strategies. In this report, the main results of the Task Force discussion are presented.

CITATION:
B. Vellas ; R. Fielding ; R. Miller ; Y. Rolland ; S. Bhasin ; J. Magaziner ; H. Bischoff-Ferrari, on behalf of the ICFSR Task Force members (2014): DESIGNING DRUG TRIALS FOR SARCOPENIA IN OLDER ADULTS WITH HIP FRACTURE – A TASK FORCE FROM THE INTERNATIONAL CONFERENCE ON FRAILTY AND SARCOPENIA RESEARCH (ICFSR). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.24

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FRAILTY IS ASSOCIATED WITH DISABILITY AND RECENT HOSPITALIZATION IN COMMUNITY-DWELLING ELDERLY: THE COYOACAN COHORT

J.A. Avila-Funes, R.H. Medina-Campos, O. Tamez-Rivera, A.P. Navarrete-Reyes, H. Amieva, S. Aguilar-Navarro

J Frailty Aging 2014;3(4):206-210

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Background: The phenotype of frailty proposed by Fried et al has shown to predict several adverse health-related outcomes in elderly populations worldwide; however, the description of such associations in Latin America is still scarce. Objective: To describe the association between frailty and recent hospitalization, disability for basic (ADL) and instrumental activities of daily living (IADL). Design, Setting and Participants: Cross-sectional study of 1,124 community-dwelling adults aged 70 and older participating in the Coyoacán cohort. Measurements: Frailty was defined by the presence of at least three of the following criteria: weight loss, exhaustion, low physical activity, slowness, and weakness. Multiple regression analyses were used to test the association between frailty and the outcomes of interest, adjusting for potential confounders. Results: Mean age was 78.2 (SD ±6.1) years. Prevalence of frailty was 14.1%. Adjusted multivariate models showed that frail status was associated with ADL disability (OR 3.06, 95%CI 1.52-6.17), IADL disability (OR 17.02, 95%CI 6.16-47.01), and recent hospitalization (OR 3.21, 95%CI 1.31-7.8). Conclusion: Among Mexican community-dwelling elderly, frailty is associated with ADL and IADL disability as well as with recent hospitalizations. Moreover, frailty’s prevalence in this population appears to be greater compared to what has been reported elsewhere. Social and cultural traits should be further studied as correlates of frailty in diverse populations.

CITATION:
J.A. Avila-Funes ; R.H. Medina-Campos ; O. Tamez-Rivera ; A.P. Navarrete-Reyes ; H. Amieva ; S. Aguilar-Navarro (2014): FRAILTY IS ASSOCIATED WITH DISABILITY AND RECENT HOSPITALIZATION IN COMMUNITY-DWELLING ELDERLY: THE COYOACAN COHORT. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.25

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COMPARISON OF NEAR-INFRARED SPECTROSCOPY AND BIOELECTRICAL IMPEDANCE ANALYSIS FOR THE ASSESSMENT OF BODY COMPOSITION IN THE FRAIL ELDERLY

T. Kamo, H. Ishii, D. Takahashi, K. Iwagaya, T. Ishida, Y. Nishida

J Frailty Aging 2014;3(4):211-215

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Background: Body composition is an important component of health related fitness. Near-infrared spectroscopy (NIRS) is a non-invasive, simple and rapid method of assessing body fat percentage. However, it is unknown whether NIRS can accurately estimate FFM in community-dwelling frail elderly. Objectives: This study aimed to compare NIRS with bioelectrical impedance analysis (BIA) in FFM measurement. Design: Cross-sectional study. Setting: Shizuoka, Japan. Participants: The study population comprised 53 community-dwelling frail elderly (15 men, 38 women; mean age 84.8±6.4 years; body mass index 19.7±3.5 kg/m2). Measurement: FFM and percentage fat mass (%FM) were estimated using a NIRS device at two sites (biceps and calf) and compared to body composition measured by BIA. Simple linear regression and Bland–Altman analyses were used to determine agreement between the methods. Results: FFM determined by BIA highly correlated with that determined by NIRS at both the biceps and calf (r=0.92 for both; p<0.001). The correlation coefficients for %FM estimated by NIRS were slightly lower (r=0.70 for biceps; r=0.66 for calf). In NIRS assessments, systematic biases were found for %FM but not for FFM. Conclusion: NIRS has significant potential for body composition analysis. Further comparative and longitudinal studies need to be conducted using an agreed reference analysis method to find a simple and more suitable method that can be applied among the community-dwelling frail elderly.

CITATION:
T. Kamo ; H. Ishii ; D. Takahashi ; K. Iwagaya ; T. Ishida ; Y. Nishida (2014): COMPARISON OF NEAR-INFRARED SPECTROSCOPY AND BIOELECTRICAL IMPEDANCE ANALYSIS FOR THE ASSESSMENT OF BODY COMPOSITION IN THE FRAIL ELDERLY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.26

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FACILITATING FRAILTY IDENTIFICATION: COMPARISON OF TWO METHODS AMONG COMMUNITY-DWELLING OLDER ADULTS

A. Islam, S.W. Muir-Hunter, M. Speechley, M. Montero-Odasso

J Frailty Aging 2014;3(4):216-221

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Background: Frailty is characterized by increased vulnerability for adverse events such as falls, fractures, placement, and death. Several frailty models have been developed, including the widely accepted Frailty Phenotype. However, the Frailty Phenotype can be difficult to apply in clinical practice. Alternatively, the Clinical Frailty Scale has been proposed based on its simplicity. To date, the Clinical Frailty Scale has not been validated against the Frailty Phenotype. Objective: We aimed to test the inter-rater reliability of the Clinical Frailty Scale and its agreement with the Frailty Phenotype in frailty identification. Design: Cross-sectional study. Setting: Retirement community in London, Ontario, Canada. Participants: One hundred and four community-dwelling older adults (age ≥75 years). Measurements: Participants were first classified using the Frailty Phenotype criteria as not frail, pre-frail or frail. Subsequently, two clinicians blinded to the first assessment, determined frailty status using the Clinical Frailty Scale. Differences between assessments were resolved by consensus. Inter-rater reliability was assessed using kappa statistics. Spearman Rho correlation coefficients evaluated the concurrent validity of the Clinical Frailty Scale against Frailty Phenotype components. Results: Analysis with kappa statistic showed substantial agreement between raters in applying the Clinical Frailty Scale to the sample (κw= 0.76, 95% CI 0.68, 0.84). The Clinical Frailty Scale scores also positively correlated with an increasing number of Frailty Phenotype components (ρ=0.69, p<0.01). Conclusion: The Clinical Frailty Scale is reliable and comparable to the Frailty Phenotype in identifying frailty in community-dwelling older adults with the advantage of being easy to administer in clinical settings. Reliable tools to identify frailty in community-dwelling older adults may help provide timely interventions to ameliorate risk of adverse events.

CITATION:
A. Islam ; S.W. Muir-Hunter ; M. Speechley ; M. Montero-Odasso (2014): FACILITATING FRAILTY IDENTIFICATION: COMPARISON OF TWO METHODS AMONG COMMUNITY-DWELLING OLDER ADULTS. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.27

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IMPACT OF DIFFERENT DIAGNOSTIC CRITERIA ON THE PREVALENCE OF SARCOPENIA IN AN ACUTE CARE GERIATRIC WARD

W.M.W.H. Sipers, J.M.M. Meijers, R.B. van Dijk, R.J.G. Halfens, J.M.G.A. Schols

J Frailty Aging 2014;3(4):222-229

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Background: Sarcopenia is probably an important causal factor for functional decline in acutely ill hospitalized geriatric patients. Low skeletal muscle mass, low gait speed and low grip strength are hallmarks of diagnosing sarcopenia. However there are many different diagnostic criteria to assess sarcopenia. Objectives: In this study the influence of different criteria for sarcopenia was studied on sarcopenia prevalence in geriatric patients admitted to an acute care hospital. Design: Cross sectional study design. Setting: A geriatric ward of a large Dutch hospital. Participants: Geriatric patients. Measurements: Skeletal muscle mass measured using bio impedance analysis (BIA), gait speed using the 4 meter walking test and grip strength. The sarcopenia prevalence was investigated according to criteria of: muscle mass, grip strength, the European Working Group on Sarcopenia in Elderly People, the International Working Group on Sarcopenia and the Special Interest Group of Society of Sarcopenia, Cachexia and Wasting Disorders. Results: 85 geriatric patients were included (61 women). Applying the 17 different criteria, the sarcopenia prevalence varied from 26-75% for women and from 42-100% for men. Comparing the Janssen calculation with the Maltron calculation sarcopenia prevalence ranged from respectively 26-67% and 67-70% for women and from 42-71% and 75-100% for men. Almost all patients (96%) had a low gait speed. Conclusions: Sarcopenia is highly prevalent in an acute hospitalized geriatric population, although the prevalence varies widely depending on the diagnostic criteria applied. A prospective study is needed to discover which criteria of sarcopenia can predict best adverse outcomes.

CITATION:
W.M.W.H. Sipers ; J.M.M. Meijers ; R.B. van Dijk ; R.J.G. Halfens ; J.M.G.A. Schols (2014): IMPACT OF DIFFERENT DIAGNOSTIC CRITERIA ON THE PREVALENCE OF SARCOPENIA IN AN ACUTE CARE GERIATRIC WARD. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.28

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CONSIDERATIONS FOR THE PERIOPERATIVE CARE OF ELDERLY AND FRAIL PATIENTS

M.M. Kurrek, S. Barnett, V. Minville

J Frailty Aging 2014;3(4):230-233

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The number of elderly patients undergoing anesthesia is increasing. At the same time aging is associated with decreased functional reserve of all major organ systems and an increase in comorbid conditions, requiring a comprehensive perioperative evaluation to minimize morbidity and mortality. The preoperative assessment should focus on the risk/benefit analysis vis-à-vis the proposed intervention, allowing the practitioner to adapt surgical and anesthetic care, as well optimize health and functional status. In addition to the usual evaluation for cardiac and pulmonary risk, the preoperative assessment in the older patient should also address the risk of postoperative cognitive dysfunction and delirium. ‘Do-not-resuscitate’ orders must be clarified with the patients or substitute decision maker. Studies have not been able to clearly show the superiority of one anesthetic approach for the geriatric patient, although there are probably advantages to using regional anesthetic techniques. Overall the patient’s preoperative functional status along with the proposed intervention is the primary determinants of the patient’s long term functional outcome and wellbeing. The elderly patient may be at his most vulnerable during the postoperative phase, and a relatively high frequency of adverse events in the elderly, including respiratory insufficiency, myocardial and cerebrovascular ischemia, renal failure, infectious complications as well as delirium and postoperative cognitive dysfunction have been observed. Perioperative interventions should target modifiable risk factors and the avoidance of even minor complications with an ultimate goal of improving long-term outcome.

CITATION:
M.M. Kurrek ; S. Barnett ; V. Minville (2014): CONSIDERATIONS FOR THE PERIOPERATIVE CARE OF ELDERLY AND FRAIL PATIENTS. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.29

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THE IMPACT OF FRAILTY ON POST-ACUTE REHABILITATION OUTCOMES IN OLDER ADULTS

R. Romero-Ortuno, C. Tiernan, L. Cogan

J Frailty Aging 2014;3(4):234-237

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Objectives, Design, Measurements: We assessed the correlations of the Frailty Instrument for primary care of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI on admission: non-frail, pre-frail, frail) with the outcomes of a Short-term Post-Acute Rehabilitative Care programme (N=172 admissions over one-year period, 95 of which were frail). REsults: SHARE-FI correlated with age (non-frail: mean 79.2 years; frail: 83.6; P<0.001). Adjusting for age, SHARE-FI correlated with longer length of stay (non-frail: median 30 days; frail: 42; P=0.047), higher rate of emergency transfer to acute hospital (non-frail: 2.4%; frail: 21.1%; P=0.004), and lower home discharge rate (non-frail: 97.6%; frail: 81.9%; P=0.009). While frailty correlated with more disability on admission and discharge, there was no statistically significant difference in Barthel Index (BI) improvement across frailty categories (all groups had median BI improvement of ≥2 points, P=0.247). Conclusion: The post-acute rehabilitation of the frail is worthwhile but requires more time and access to acute hospital facilities.

CITATION:
R. Romero-Ortuno ; C. Tiernan ; L. Cogan (2014): THE IMPACT OF FRAILTY ON POST-ACUTE REHABILITATION OUTCOMES IN OLDER ADULTS. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.30

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PROXY-REPORTS IN THE ASCERTAINMENT OF DISABILITY PREVALENCE WITH AMERICAN COMMUNITY SURVEY DATA

C. Siordia

J Frailty Aging 2014;3(4):238-246

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Background: Population estimates on disability prevalence inform policy makers and public health professionals. Understanding how factors capable of affecting measurement (e.g., proxy-report) vary in the population is important for establishing level of confidence in sample-derived population estimates. Objectives: To establish how use of proxy-reports varies by six disability types stratified by sex, race-ethnicity, and age group. Specific aim is achieved by investigating the number of proxy-reports used amongst the disable population. Design: Cross-sectional study using American Community Survey (ACS) Public Use Microdata Sample (PUMS) 3-year file collected during 2009-2011 survey period. Setting: Community-dwelling population in continental United States (US). Participants: The unweighted count of 6,003,183 individuals in the microdata are said to represent about 193,277,485 individuals in the continental US population. Measurements: Stratified disability period estimates are computed. Amongst the disable: the number of proxy-reports; allocations; and Person Inflation Ratios (PRIs) are presented by disability type. Results: Half of all the reported disabilities are derived through the use of proxy-report. In addition, high rates of item-allocation and PRIs are generally found in race-ethnic minorities. Proxy-report use and PRIs are lower for those aged > 65—but not allocation rates. Conclusions: Although use of proxy report in the ascertainment of disability varies in complex ways, data suggest prevalence of proxy reports is lowest amongst Non-Latino-Black females ages 21 to 64. Efforts toward providing clinicians with high quality descriptive epidemiology should continue as a reliable thermometer for measuring disability in the population is needed.

CITATION:
C. Siordia (2014): PROXY-REPORTS IN THE ASCERTAINMENT OF DISABILITY PREVALENCE WITH AMERICAN COMMUNITY SURVEY DATA. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.31

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HOW DO COMMUNITY PHYSICAL AND OCCUPATIONAL THERAPISTS CLASSIFY FRAILTY? A PILOT STUDY

K.P. Roland, O. Theou, J.M. Jakobi, L. Swan, G.R. Jones

J Frailty Aging 2014;3(4):247-250

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Background: Frailty is a complex geriatric syndrome that is often difficult to diagnose, especially by healthcare professionals working in the community. Objectives, Measurements: This study examined how physical and occupational therapists classified community-dwelling clients using categories of ‘nonfrail’, ‘prefrail’ or ‘frail’ as compared to measurements of established frailty criteria from the Cardiovascular Health Study frailty index (CHSfi). Results: Results indicate that community therapists underestimate frailty in comparison to the CHSfi. Therapists’ classification of frailty suggested their perceptions of frailty may not only relate to client’s functional capacity, but the context in which the client receives care. Conclusion: A multi-dimensional approach is required to capture all aspects of frailty across the healthcare continuum that accounts for how the client thrives within their personal environment.

CITATION:
K.P. Roland ; O. Theou ; J.M. Jakobi ; L. Swan ; G.R. Jones (2014): HOW DO COMMUNITY PHYSICAL AND OCCUPATIONAL THERAPISTS CLASSIFY FRAILTY? A PILOT STUDY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.32

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