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02/2015 journal articles

TRANSITION PATTERNS OF FRAILTY SYNDROME IN COMMUNITY-DWELLING ELDERLY INDIVIDUALS: A LONGITUDINAL STUDY

S. Lanziotti Azevedo da Silva , Á. Campos Cavalcanti Maciel, L. de Sousa Máximo Pereira, J.M. Domingues Dias, M. Guimarães de Assis, R. Corrêa Dias

J Frailty Aging 2015;4(2):50-55

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Background: Little information is available about transitional patterns related to frailty syndrome in elderly individuals living in the community. Objective: To assess transitional patterns and determine which frailty phenotype variables are more involved in this process. Design: Longitudinal study. Population: Community-dwelling elderly individuals in Belo Horizonte, Minas Gerais, Brazil. Participants: Two hundred individuals over 65 years old. Measurements: The frailty phenotype was assessed at two different times, with a mean interval of 13 months. Comparison of the frequency distributions between the baseline and second assessment was conducted through Pearson’s chi-squared test, and a binary logistic regression was conducted to assess the most important items in this transition. Results: Sixty-eight percent of the elderly were women, with an average age of 73.7 (± 6.1) years. The pre-frail group transitioned the most between evaluations. Eighty-five individuals transitioned among frailty levels: 46 showed improvement while 39 worsened. Individuals who did scored low on the handgrip strength test in the first evaluation were more likely to have their frailty level worsen. Among individuals who showed improvements, those who were positive for weight loss and poor physical activity level in the first evaluation were less likely to improve. In this study, a greater number of individuals showed improved frailty levels over 13 months than worsened levels. Conclusion: Poor handgrip strength, weight loss, and poor physical activity are the most influential variables in frailty transitioning, leading to worsening levels of frailty or difficulty in making improvements.

CITATION:
S. Lanziotti Azevedo da Silva ; Á. Campos Cavalcanti Maciel ; L. de Sousa Máximo Pereira ; J.M. Domingues Dias ; M. Guimarães de Assis ; R. Corrêa Dias (2015): TRANSITION PATTERNS OF FRAILTY SYNDROME IN COMMUNITY-DWELLING ELDERLY INDIVIDUALS: A LONGITUDINAL STUDY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.43

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INTERSECTING SELF-REPORTED MOBILITY AND GAIT SPEED TO CREATE A MULTI-DIMENSIONAL MEASURE OF AMBULATION: THE “AMBULATION SPEED-ENDURANCE” (ASE) TYPOLOGY

C. Siordia

J Frailty Aging 2015;4(2):56-63

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Background: Assessing mobility through readily available and affordable protocols may help advance public health by providing early detection and implementing intervention therapies aimed at mitigating the progression from physiological vitality to disability at older ages. Until now, little attention has been given to how self-reported mobility (SRM) and gait speed can be combined in a categorization scheme. Objectives: The specific aim of this report is to introduce the Ambulation Speed-Endurance (ASE) Typology to the literature—a classification system that intersects SRM and gait speed to create a multi-dimensional measure of ambulation. Design: Cross-sectional. Setting: Community-dwelling older adults in the United States. Participants: Evidence is provided from the National Health and Aging Trends Study (NHATS) that community-dwelling older adults (n=5,403) may be found in each of the ASE Typologies. The discussion is complimented by investigating the cross-sectional predictors of a “Discrepancy Score” (measure of gap between speed and endurance) amongst those with gait speeds < 0.99 m/sec (n=4,521). Results: Multivariable linear regression results indicate level of severity in speed-endurance discrepancy is higher amongst: non-Latino-Blacks (β=0.48); Latinos (β=0.42); older ages; and lower educated. Models also show that severity in speed-endurance discrepancy is lower amongst: females (β=-0.38); those with higher body mass index; with more chronic health conditions; and poorer self-rated health. Conclusion: Research should continue to investigate how to optimize SRM.

CITATION:
C. Siordia (2015): INTERSECTING SELF-REPORTED MOBILITY AND GAIT SPEED TO CREATE A MULTI-DIMENSIONAL MEASURE OF AMBULATION: THE “AMBULATION SPEED-ENDURANCE” (ASE) TYPOLOGY . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.42

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GAIT SPEED AS A PREDICTOR OF RESPIRATORY MUSCLE FUNCTION, STRENGTH, AND FRAILTY SYNDROME IN COMMUNITY-DWELLING ELDERLY PEOPLE

A.N. Parentoni, V.A. Mendonça , K.D. Dos Santos , L.F. Sa, F.O. Ferreira, , D.A. Gomes Pereira, L.P. Lustosa

J Frailty Aging 2015;4(2):64-68

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Background: Gait speed is considered a predictor of adverse health outcomes and functional decline in the elderly. This decline is also identified in respiratory muscles. Objective: To assess the impact of gait speed in maximal inspiratory pressure, maximal expiratory pressure, handgrip strength, and the different types of frailty syndrome in community-dwelling elderly people. Design: Cross-sectional study. Participants: Women (aged ≥ 65 years) were classified into different frailty phenotypes (n = 106). Measurements: Gait speed (10 m), handgrip strength (Jamar dynamometer), and maximum inspiratory and expiratory pressures (GerAr manovacuometer, MV-150/300 model) were measured. Linear regression analyses were conducted to determine the influence of gait speed and age on handgrip strength, maximal inspiratory pressure, and maximal expiratory pressure. Logistic regression was performed to assess the influence of gait speed and frailty age (α = 0.05). Results: A total of 106 elderly women participated in the study (73.96 ± 6.91 years). Thirty-two subjects were not frail, 42 were pre-frail, and 32 were frail. Gait speed and age significantly predicted handgrip strength and frailty (p < 0.05). In the multivariate model, gait speed had the greatest contribution, while age lost statistical significance. Regarding maximal inspiratory and maximal expiratory pressures, gait speed and age were significant explanatory variables (p < 0.05). In the multivariate model, gait speed lost statistical significance to predict maximal inspiratory pressure. Conclusion: Gait speed was confirmed to be a predictor of some health outcomes, including respiratory muscle function. The results suggest that interventions to increase gait speed may contribute to improve respiratory function and muscle strength, and decrease the risk of frailty among elderly people.

CITATION:
A.N. PARENTONI ; V.A. MENDONÇA ; K.D. DOS SANTOS ; L.F. SÁ ; F.O. FERREIRA ; D.A. GOMES PEREIRA ; L.P. LUSTOSA ; (2015): GAIT SPEED AS A PREDICTOR OF RESPIRATORY MUSCLE FUNCTION, STRENGTH, AND FRAILTY SYNDROME IN COMMUNITY-DWELLING ELDERLY PEOPLE. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.41

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FROM HOSPITAL TO HOME: LIMITED NUTRITIONAL AND FUNCTIONAL RECOVERY FOR OLDER ADULTS

A.M. Young, A.M. Mudge, M.D. Banks, L. Rogers, J. Allen, B. Vogler, E. Isenring

J Frailty Aging 2015;4(2):69-73

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Background: The post-hospital period may be a vulnerable time for elders recovering from acute illness. Few studies have examined nutrition outcomes of older people at nutrition risk after acute hospitalisation. Objectives: This study aims to describe a) standard nutrition care received by recently discharged older medical patients, b) change in nutritional and functional status at six weeks post-discharge and c) clinical outcomes at twelve weeks post discharge. Design: Prospective cohort study. Setting: Two metropolitan teaching hospitals in Brisbane, Australia. Participants: Medical patients aged ≥65 years at risk of malnutrition (Malnutrition Screening Score ≥2) and discharged to independent living in the community. Measurement: Nutritional status (Mini Nutritional Assessment (MNA), weight, lean body mass), functional status (grip strength, walk speed, activities of daily living) and health-related quality of life assessed on discharge and six weeks post-discharge. Inpatient and post-discharge nutrition intervention was recorded. Death and unplanned admissions were measured at 12 weeks. Results: Of the 42 consented participants, only 14% (n=6) received post-discharge dietitian review and 19% (n=8) received practical nutrition supports at home (meal delivery, shopping assistance) as part of standard care. While there was a small improvement in MNA (18.4±4.0 to 20.1±4.2, p=0.004) and walk speed (0.7±0.3 m/s to 0.9±0.3, p=0.004) at six weeks, there was no difference in mean weight, lean body mass, grip strength or activities of daily living. Five (15%) participants lost ≥5% body weight. By twelve weeks, 17 participants (46%) had at least one unplanned hospital admission and four (10%) had died. Conclusions: Few patients at nutrition risk received nutrition-focussed care in the post-hospital period, and most did not improve nutritional or functional status at 6 weeks.

CITATION:
A.M. Young ; A.M. Mudge ; M.D. Banks ; L. Rogers ; J. Allen ; B. Vogler ; E. Isenring (2015): From Hospital to Home: limited nutritional and functional recovery for older adults . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.51

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25-OH-VITAMIN D IS NOT ASSOCIATED WITH COGNITIVE PERFORMANCE AMONG MEXICAN COMMUNITY-DWELLING OLDER PERSONS

A.P. Navarrete-Reyes, I. García-Muñoz , J.M.A. García-Lara, N.M. Torres-Carrillo , H. Amieva , J.A. Avila-Funes

J Frailty Aging 2015;4(2):74-79

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Background: Low cognitive performance has been associated with a wide array of adverse health-related outcomes in elderly populations. Recently, the effect of vitamin D on cognition has been studied; however, its benefits are still controversial. Moreover, most studies have been carried out on North-American and European populations where vitamin D deficiency could represent a greater public-health issue when compared to Latin American ones. Objective: To investigate the association between 25-OH-vitamin D and cognitive performance in Mexican community-dwelling elderly. Design, Setting and Participants: Cross-sectional study sample of 331 community-dwelling elderly aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty. Measurements: Serum 25-OH-vitamin D, cognitive performance as per the Mini-Mental State Examination (MMSE) and the IST (Isaacs Set Test), as well as several elements from the comprehensive geriatric assessment. Results: Mean age of participants was 79.3 years (SD 5.9), 54.1% were women. The mean serum 25-OH-vitamin D level was 59.0 (SD 23.3) nmol/L while mean MMSE score was 22.3 (SD 3.4) and mean IST score was 37.1 (SD 9.1). Although 25-OH-vitamin D levels were lower across all the definitions of low cognitive perfomance, the difference between groups was not statistically significant in any of them. Conclusion: No association between 25-OH-vitamin D level and cognitive performance was found in this population of Mexican community-dwelling elderly. Further investigation is required in order to clarify its existence and if so, to delineate its characteristics.

CITATION:
A.P. NAVARRETE-REYES ; I. GARCÍA-MUÑOZ ; J.M.A. GARCÍA-LARA ; N.M. TORRES-CARRILLO ; H. AMIEVA ; J.A. AVILA-FUNES (2015): 25-OH-VITAMIN D IS NOT ASSOCIATED WITH COGNITIVE PERFORMANCE AMONG MEXICAN COMMUNITY-DWELLING OLDER PERSONS. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.44

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THE COMMUNITY ASSESSMENT OF RISK INSTRUMENT: INVESTIGATION OF INTER-RATER RELIABILITY OF AN INSTRUMENT MEASURING RISK OF ADVERSE OUTCOMES

R.M. Clarnette, J.P. Ryan, E. O\' Herlihy, A. Svendrovski, N. Cornally, R. O’Caoimh, P. Leahy-Warren, C. Paul, D.W. Molloy

J Frailty Aging 2015;4(2):80-89

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Background: Frailty is increasingly common in community dwelling older adults and increases their risk of adverse outcomes. Risk assessment is implicit in the Aged Care Assessment Teams process, but few studies have considered the factors that influence the assessor’s decision making or explored the factors that may contribute to their interpretation of risk. Objective: to examine the inter-rater reliability of the Community Assessment of Risk Instrument (CARI), which is a new risk assessment instrument. Design: A cohort study was used. Setting and participants: A sample of 50 community dwelling older adults underwent comprehensive geriatric assessment by two raters: a geriatrician and a registered nurse. Procedure and measurements: Each participant was scored for risk by the two raters using the CARI. This instrument ranks risk of three adverse outcomes, namely i) institutionalisation, ii) hospitalisation and iii) death within the next year from a score of 1, which is minimal risk to 5, which is extreme risk. Inter-rater reliability was assessed with Gamma, Spearman correlation and Kappa statistics. Internal consistency was assessed with Cronbach’s alpha. Results: There were 30 female (mean age 82.23 years) and 20 male (mean age 81.75 years) participants. Items within domains showed good-excellent agreement. The gamma statistic was >0.77 on 6/7 Mental State items, 14/15 items in the Activities of Daily Living domain. In the Medical domain, 6/9 items had Gamma scores >0.80. The global domain scores correlated well, 0.88, 0.72 and 0.87. Caregiver network scores were 0.71, 0.73 and 0.51 for the three domains. Inter-rater reliability scores for global risk scales were 0.86 (institutionalisation) and 0.78 (death). The gamma statistic for hospitalisation was 0.29, indicative of lower inter-rater reliability. Cronbach’s alpha was 0.86 and 0.83 for the Activities of Daily Living domain, 0.51 and 0.42 for the Mental state domain and 0.23 and 0.10 for the Medical state domain. Conclusions: Overall, the instrument shows good inter- rater reliability. Poor correlations on some items relate to poor communication of clinical data and variable interpretation based on professional background. Lack of internal consistency in the medical condition domain confirms the discrete nature of these variables.

CITATION:
R.M. Clarnette ; J.P. Ryan ; E. O’ Herlihy ; A. Svendrovski ; N. Cornally ; R. O’Caoimh ; P. Leahy-Warren ; C. Paul ; D.W. Molloy (2015): THE COMMUNITY ASSESSMENT OF RISK INSTRUMENT: INVESTIGATION OF INTER-RATER RELIABILITY OF AN INSTRUMENT MEASURING RISK OF ADVERSE OUTCOMES. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.40

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FRAILTY AND NOVEL TECHNOLOGIES – A STEP AHEAD

E. Kelaiditi

J Frailty Aging 2015;4(2):90-92

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Dependence and disability are almost inevitable consequences of population aging. As these conditions are considered irreversible, a growing interest has been directed towards the identification of related conditions that are still amenable to preventive interventions. In this context, frailty has attracted an increasing scientific interest. Frailty is characterized by decreased homeostatic reserves and diminished resistance to stressors. The frail elderly constitutes a complex population in terms of assessment, monitoring, adherence to recommendations, and follow-up. The use of novel technologies may be considerably helpful for both clinical and research purposes. In particular, technologies may support interventions preventing disability, improving the quality of life, and enhancing the wellbeing of frail people. Traditional assessment instruments can be complemented or replaced by mobile devices measuring and monitoring frailty domains (e.g., physical performance, cognitive function, physical activity, nutritional status). Novel technologies have indeed the potential to benefit, assess, monitor, and support frail older people to live independently and improve their quality of life.

CITATION:
E. Kelaiditi (2015): Frailty and novel technologies – a step ahead. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.52

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UNALTERED IMAGE OF HEALTH MAINTENANCE: AN OBSERVATION OF NON-PARTICIPANTS IN A SWEDISH COHORT STUDY OF 85 TO 86 YEAR OLDS

H.-J. Dong, E. Wressle, J. Marcusson

J Frailty Aging 2015;4(2):93-99

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Background: Selection bias is often inevitable in epidemiologic studies. It is not surprising that study conclusions based on participants’ health status are frequently questioned. Objective: This study aimed to assess whether the non-participants affected the characteristics of a general population of the very old people. Design, Setting and Participants: Prospective, cross-sectional (N=650, aged 85 years old) analysis and 1-year follow-up (n=273), in Linköping, Sweden. Measurements: We analysed data on health-related factors from a postal questionnaire, a home visit and a clinic visit at baseline and at the 1-year follow-up. We calculated the effect size to evaluate the degree of differences between the groups. Results: A greater proportion of non-participants resided in sheltered accommodation or nursing homes (participants vs non-response vs refusal, 11% vs 22% vs 40, P<0.001, φ=0.24). During the home visit or clinic visit, a higher proportion of dropouts reported mid-severe problems in EQ-5D domains (mobility and self-care) and limitations in personal activities of daily living, but the differences between participants and dropouts were very small (φ<0.2). No significant difference was found between the groups with regard to emergency room visits or hospital admissions, despite the fact that more participants than dropouts (φ=0.23) had multimorbidities (≥2 chronic diseases). Living in sheltered accommodation or a nursing home (odds ratio (OR), 2.8; 95% confidence interval (CI), 1.5-5), female gender (OR, 1.8; 95% CI, 1.1-3.1) and receiving more home visits in primary care (OR, 1.03; 95% CI, 1-1.06) contributed positively to drop out in the data collection stages over the study period. Conclusion: Non-participants were not considered to be a group with worse health. Mobility problems may influence very old people when considering further participation, which threatens attrition.

CITATION:
H.-J. Dong ; E. Wressle ; J. Marcusson ; (2015): UNALTERED IMAGE OF HEALTH MAINTENANCE: AN OBSERVATION OF NON-PARTICIPANTS IN A SWEDISH COHORT STUDY OF 85 TO 86 YEAR OLDS. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.47

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NUTRITION AND FRAILTY: A REVIEW OF CLINICAL INTERVENTION STUDIES

B. Manal, S Suzana, D.K.A. Singh

J Frailty Aging 2015;4(2):100-106

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Frailty is one of the major health concerns in aging. It is considered a geriatric syndrome characterized by muscle weakness, sarcopenia and fatigue. It is also associated with several adverse health outcomes, including disability. Literature shows that there are a number of studies conducted to define the relationship between frailty and nutrition. The majority is from cross sectional, longitudinal, and cohort studies. Few intervention studies using micronutrients, macronutrients, nutritional supplement, or food regimens have been found. This review examines the nutrition intervention studies targeted towards older adults with frailty, and evaluates the effectiveness of nutrition interventions on frailty indicators. Twenty-four intervention studies from six electronic databases met the inclusion criteria. Sixteen were randomized controlled clinical trials; one was a quasi-experimental design, whilst the rest were controlled trials. Participants included in the studies differed in terms of age and frailty status. The studies were inconsistent in intervention type, duration, and targeted outcomes. Most of the studies indicated that modification of nutrition quality, either by giving supplements or by improving diet intake, could improve strength, walking speed, and nutritional status in majority of frail or pre-frail older adults. However, there was limited evidence on the effectiveness of intervention on inflammatory status and other biomarkers related to frailty due to limited number of studies targeting frailty biomarkers as a major outcome.

CITATION:
B. Manal ; S Suzana ; D.K.A. Singh (2015): NUTRITION AND FRAILTY: A REVIEW OF CLINICAL INTERVENTION STUDIES. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.49

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EFFECT OF SELENIUM SUPPLEMENTATION ON PROTEOMIC SERUM BIOMARKERS IN ELDERLY MEN

A.M. Algotar, R. Behnejad, P. Singh, P.A. Thompson, C.H. Hsu, S.P. Stratton

J Frailty Aging 2015;4(2):107-110

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Objectives: To determine the effect of selenium supplementation on the human proteomic profile. Design: Serum samples were collected in this pilot study from a randomized placebo controlled Phase 2 Watchful Waiting (WW) clinical trial. Setting: Subjects were followed every three months for up to five years at the University of Arizona Prostate Cancer Prevention Program Clinic. Participants: One hundred and forty men (age < 85 years) had biopsy-proven prostate cancer, a Gleason sum score less than eight, no metastatic cancer, and no prior treatment for prostate cancer. Intervention: As part of the WW trial, men were randomized to placebo, selenium 200 µg/day or selenium 800 µg/day. For the purpose of the current study, 40 subjects enrolled in the WW study (20 from the placebo group and 20 from Se 800 µg/day group) were selected. Measurements: Baseline serum samples were collected at each follow-up visit and stored at -80 degrees Celsius. A multiplexed proteomic panel investigated changes in 120 proteins markers simultaneously. Results: Thirteen proteins (Apolipoprotein J, IL-10, IL-1 alpha, MMP-3, IL-12p70, IL-2 receptor alpha, cathepsin B, eotaxin, EGFR, FGF-basic, myeloperoxidase, RANTES, TGF-beta) were determined to be either statistically (p-value < 0.05) or marginally significantly (0.05 < p-value <0.1) changed in the selenium supplemented group as compared to placebo. Conclusion: Although independent validation of these results is needed, this study is the first of its kind to utilize high throughput fluorescence based protein multiplex panel in analyzing changes in the proteomic profile due to selenium supplementation. Results from this study provide insight into the ability of selenium to modulate numerous protein markers and thus impact various biological processes in humans.

CITATION:
A.M. ALGOTAR ; R. BEHNEJAD ; P. SINGH ; P.A. THOMPSON ; C.H. HSU ; S.P. STRATTON (2015): EFFECT OF SELENIUM SUPPLEMENTATION ON PROTEOMIC SERUM BIOMARKERS IN ELDERLY MEN. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.48

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