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01/2016 journal articles

EXERCISE: AN IMPORTANT KEY TO PREVENT PHYSICAL AND COGNITIVE FRAILTY

M.C. Dulac, M. Aubertin-Leheudre

J Frailty Aging 2016;5(1):3-5

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CITATION:
M.C. Dulac ; M. Aubertin-Leheudre (2015): Exercise: An important key to prevent physical and cognitive frailty. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.72

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GENETIC MODERATORS OF THE IMPACT OF PHYSICAL ACTIVITY ON DEPRESSIVE SYMPTOMS

V.M. Dotson, F.C. Hsu, T.Y. Langaee, C.W. McDonough, A.C. King, R.A. Cohen, A.B. Newman, S.B. Kritchevsky, V. Myers, T.M. Manini, M. Pahor, For the LIFE Study Group

J Frailty Aging 2016;5(1):6-14

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Background: Converging evidence suggests that physical activity is an effective intervention for both clinical depression and sub-threshold depressive symptoms; however, findings are not always consistent. These mixed results might reflect heterogeneity in response to physical activity, with some subgroups of individuals responding positively, but not others. Objectives: 1) To examine the impact of genetic variation and sex on changes in depressive symptoms in older adults after a physical activity (PA) intervention, and 2) to determine if PA differentially improves particular symptom dimensions of depression. Design: Randomized controlled trial. Setting: Four field centers (Cooper Institute, Stanford University, University of Pittsburgh, and Wake Forest University). Participants: 396 community-dwelling adults aged 70–89 years who participated in the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P). Intervention: 12-month PA intervention compared to an education control. Measurements: Polymorphisms in the serotonin transporter (5-HTT), brain-derived neurotrophic factor (BDNF), and apolipoprotein E (APOE) genes; 12-month change in the Center for Epidemiologic Studies Depression Scale total score, as well as scores on the depressed affect, somatic symptoms, and lack of positive affect subscales. Results: Men randomized to the PA arm showed the greatest decreases in somatic symptoms, with a preferential benefit in male carriers of the BDNF Met allele. Symptoms of lack of positive affect decreased more in men compared to women, particularly in those possessing the 5-HTT L allele, but the effect did not differ by intervention arm. APOE status did not affect change in depressive symptoms. Conclusions: Results of this study suggest that the impact of PA on depressive symptoms varies by genotype and sex, and that PA may mitigate somatic symptoms of depression more than other symptoms. The results suggest that a targeted approach to recommending PA therapy for treatment of depression is viable.

CITATION:
V.M. Dotson ; F.C. Hsu ; T.Y. Langaee ; C.W. McDonough ; A.C. King ; R.A. Cohen ; A.B. Newman ; S.B. Kritchevsky ; V. Myers ; T.M. Manini ; M. Pahor ; For the LIFE Study Group (2016): Genetic Moderators of the Impact of Physical Activity on Depressive Symptoms. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.76

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FRAILTY ACROSS AGE GROUPS

M.U. Pérez-Zepeda, J.A. Ávila-Funes, L.M. Gutiérrez-Robledo, C. García-Peña

J Frailty Aging 2016;5(1):15-19

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Background: The implementation of an aging biomarker into clinical practice is under debate. The Frailty Index is a model of deficit accumulation and has shown to accurately capture frailty in older adults, thus bridging biological with clinical practice. Objectives: To describe the association of socio-demographic characteristics and the Frailty Index in different age groups (from 20 to over one hundred years) in a representative sample of Mexican subjects. Design: Cross-sectional analysis. Setting: Nationwide and population-representative survey. Participants: Adults 20-years and older interviewed during the last Mexican National Health and Nutrition Survey (2012). Measurements: A 30-item Frailty Index following standard construction was developed. Multi-level regression models were performed to test the associations of the Frailty Index with multiple socio-demographic characteristics across age groups. Results: A total of 29,504 subjects was analyzed. The 30-item Frailty Index showed the highest scores in the older age groups, especially in women. No sociodemographic variable was associated with the Frailty Index in all the studied age groups. However, employment, economic income, and smoking status were more consistently found across age groups. Conclusions: To our knowledge, this is the first report describing the Frailty Index in a representative large sample of a Latin American country. Increasing age and gender were closely associated with a higher score.

CITATION:
M.U. Pérez-Zepeda ; J.A. Ávila-Funes ; L.M. Gutiérrez-Robledo ; C. García-Peña (2016): Frailty Across Age Groups. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.77

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ASSOCIATION BETWEEN BERG BALANCE, PHYSIOLOGICAL PROFILE ASSESSMENT AND PHYSICAL ACTIVITY, PHYSICAL FUNCTION AND BODY COMPOSITION: A CROSS-SECTIONAL STUDY

D.J. Smee, H.L. Berry, G. Waddington, J. Anson

J Frailty Aging 2016;5(1):20-26

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Background: Falls are of great concern to older adults and costly to the health system. In addition the relationship between falls risk and falls risk predictor characteristics is complex. Objective: This study aimed to explore the relationship between two objective fall-risk measures tools, the Physiological Profile Assessment and the Berg Balance Scale and to determine how an individual’s sex, level of physical function, health-related and body composition characteristics impact these objective falls risk measures. Design: A cross-sectional, observational study. Participants: 245 community-dwelling older adults (M age=68.12 years, SD=6.21; 69.8% female). Measurements: Participants were assessed for falls-risk (Physiological Profile Assessment and the Berg Balance Scale), physical activity, physical functional and body composition characteristics. Pearson product-moment correlation coefficients were calculated to examine bivariate relationships and hierarchical multiple linear regression modelling was used to estimate the contribution of each predictor in explaining variance in falls-risk. Results: In females, there was a weak association between the two objective falls-risk measures (r =-0.17 p <0.05). The number of falls in the previous 12 months explained 6% of variance in Physiological Profile Assessment scores, with bone density of the lumbar spine contributing a further 1%. In males and females, variance in the Berg Balance Scale showed that age (25%) and physical function (16% for females, 28% for males) contributed significantly to the explaining variance in the falls-risk measure. Conclusion: Sex differences are apparent and as such males and females should be assessed (and potentially treated) differently with regards to falls risk. Results indicate that both falls risk assessment tools measure aspects of balance but are not interchangeable. The Berg Balance Scale may be more discriminative in older, less functioning adults and the Physiological Profile Assessment is more useful in assessing falls risk in females.

CITATION:
D.J. Smee ; H.L. Berry ; G. Waddington ; J. Anson (2015): Association Between Berg Balance, Physiological Profile Assessment and Physical Activity, Physical Function and Body Composition: A Cross-Sectional Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.57

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VALIDITY AND RELIABILITY OF THE POLISH VERSION OF THE TILBURG FRAILTY INDICATOR (TFI)

I. Uchmanowicz, B. Jankowska-Pola?ska, B. Uchmanowicz, K. Kowalczuk, R.J.J. Gobbens

J Frailty Aging 2016;5(1):27-32

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Background: In the last decade, studies on frailty have become increasingly frequent in the literature on aging, and also the number of available questionnaires regarding frailty has increased over the years. Therefore, the choice of which questionnaire to use is becoming more difficult. Objective: The aim of this study was to assess the psychometric properties of the Polish version of the Tilburg Frailty Indicator (TFI), an instrument that identifies frailty in the elderly population. Design: Setting, and Participants. The study was carried out in a community-based setting in Wrocław, Poland. Nurses and doctors (general practitioners) administered the TFI in primary care facilities. Participants included a sample of 212 community dwelling elderly aged 60 or older (mean age:70.6 SD≥7.16). Measurements: The validation (assessment of face validity, content validity) was carried out in accordance with the literature. The Tilburg Frailty Indicator (TFI) consists of two different parts. One part addresses the potential determinants of frailty and the other specifically addresses the components of frailty, covering its physical, psychological and social domains. Scale reliability was estimated using two methods: Cronbach’s alpha, measuring the scale’s internal consistency, and the test-retest method, determining the scale’s absolute stability. To assess test-retest reliability, the same group was re-interviewed by the same observer within 10-14 days of the first interview. Results: The test-retest reliability showed a high level of agreement for all items of the instrument, with values ranging from 96 to 100%. The Cronbach’s Alpha internal consistency was 0.74. Conclusion: The Polish version of the TFI proved to be a valid and reproducible tool for assessment of Frailty Syndrome for the Polish population. We would recommend to be used as the screening tool to assess frailty.

CITATION:
I. Uchmanowicz ; B. Jankowska-Polańska ; B. Uchmanowicz ; K. Kowalczuk ; R.J.J. Gobbens (2015): VALIDITY AND RELIABILITY OF THE POLISH VERSION OF THE TILBURG FRAILTY INDICATOR (TFI). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.66

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MUSCLE DISUSE AS A PIVOTAL PROBLEM IN SARCOPENIA-RELATED MUSCLE LOSS AND DYSFUNCTION

K.E. Bell, M.T. von Allmen, M.C. Devries, S.M. Phillips

J Frailty Aging 2016;5(1):33-41

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An age-associated loss of muscle mass and strength – sarcopenia – begins at around the fifth decade of life, with mass being lost at ~0.5-1.2% per year and strength at ~3% per year. Sarcopenia can contribute to a variety of negative health outcomes, including an increased risk for falls and fractures, the development of metabolic diseases like type 2 diabetes mellitus, and increase the chance of requiring assisted living. Linear sarcopenic declines in muscle mass and strength are, however, punctuated by transient periods of muscle disuse that can accelerate losses of muscle and strength, which could result in increased risk for the aforementioned conditions. Muscle disuse is recognizable with bed rest or immobilization (for example, due to surgery or acute illness requiring hospitalization); however, recent work has shown that even a relative reduction in ambulation (reduced daily steps) results in significant reductions in muscle mass, strength and possibly an increase in disease risk. Although reduced ambulation is a seemingly “benign” form of disuse, compared to bed rest and immobilization, reports have documented that 2-3 weeks of reduced daily steps may induce: negative changes in body composition, reductions in muscle strength and quality, anabolic resistance, and decrements in glycemic control in older adults. Importantly, periods of reduced ambulation likely occur fairly frequently and appear more difficult to fully recover from, in older adults. Here we explore the consequences of muscle disuse due to reduced ambulatory activity in older adults, with frequent comparisons to established models of disuse: bed rest and immobilization.

CITATION:
K.E. Bell ; M.T. von Allmen ; M.C. Devries ; S.M. Phillips (2016): Muscle disuse as a pivotal problem in sarcopenia-related muscle loss and dysfunction. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.78

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FRAILTY AND CONSTELLATIONS OF FACTORS IN AGING HIV-INFECTED AND UNINFECTED WOMEN - THE WOMEN’S INTERAGENCY HIV STUDY

D.R. Gustafson, Q. Shi, M. Thurn, S.A. Holman, H. Minkoff, M. Cohen, M.W. Plankey, R. Havlik, A. Sharma, S.Gange, M. Gandhi, J. Milam, D. Hoover

J Frailty Aging 2016;5(1):43-48

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Background: Biological similarities are noted between aging and HIV infection. Middle-aged adults with HIV infection may present as elderly due to accelerated aging or having more severe aging phenotypes occurring at younger ages. Objectives: We explored age-adjusted prevalence of frailty, a geriatric condition, among HIV+ and at risk HIV- women. Design: Cross-sectional. Setting: The Women’s Interagency HIV Study (WIHS). Participants: 2028 middle-aged (average age 39 years) female participants (1449 HIV+; 579 HIV-).Measurements: The Fried Frailty Index (FFI), HIV status variables, and constellations of variables representing Demographic/health behaviors and Aging-related chronic diseases. Associations between the FFI and other variables were estimated, followed by stepwise regression models. Results: Overall frailty prevalence was 15.2% (HIV+, 17%; HIV-, 10%). A multivariable model suggested that HIV infection with CD4 count<200; age>40 years; current or former smoking; income ≤$12,000; moderate vs low fibrinogen-4 (FIB-4) levels; and moderate vs high estimated glomerular filtration rate (eGFR) were positively associated with frailty. Low or moderate drinking was protective. Conclusions: Frailty is a multidimensional aging phenotype observed in mid-life among women with HIV infection. Prevalence of frailty in this sample of HIV-infected women exceeds that for usual elderly populations. This highlights the need for geriatricians and gerontologists to interact with younger ‘at risk’ populations, and assists in the formulation of best recommendations for frailty interventions to prevent early aging, excess morbidities and early death.

CITATION:
D.R. Gustafson ; Q. Shi ; M. Thurn ; S.A. Holman ; H. Minkoff ; M. Cohen ; M.W. Plankey ; R. Havlik ; A. Sharma ; S.Gange ; M. Gandhi ; J. Milam ; D. Hoover (2016): Frailty and constellations of factors in aging HIV-infected and uninfected women - The Women’s Interagency HIV Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.79

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DIETARY PROTEIN TO MAINTAIN MUSCLE MASS IN AGING: A CASE FOR PER-MEAL PROTEIN RECOMMENDATIONS

C.H. Murphy, S.Y. Oikawa, S.M. Phillips

J Frailty Aging 2016;5(1):49-58

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It is well accepted that daily protein intake is an important dietary consideration to limit and treat age-related declines in muscle mass, strength, and function. Furthermore, we propose that there is a growing appreciation for the need to consider protein intake on a per-meal basis rather than simply focusing on the total daily protein intake. The existence of a saturable dose-response relationship between muscle protein synthesis (MPS) and the quantity of protein consumed in a single meal/bolus provides the rationale for promoting an even/balanced pattern of daily protein intake. We hypothesize that a balanced/even protein intake pattern with the ingestion a quantity of protein shown to optimally stimulate MPS at each meal may be an effective strategy to alleviate sarcopenic muscle loss. In this review we examine the available evidence supporting the influence of dietary protein intake pattern on muscle protein turnover, muscle mass, and muscle function. We present several practical considerations that, it is proposed, should be taken into account when translating a per-meal protein recommendation into dietary advice for older adults.

CITATION:
C.H. Murphy ; S.Y. Oikawa ; S.M. Phillips (2016): Dietary protein to maintain muscle mass in aging: a case for per-meal protein recommendations. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.80

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ASSOCIATION BETWEEN CHRONIC PAIN AND FRAILTY IN MEXICAN ELDERS

V.M. Castañeda Morales, A.M. Jiménez Garduño, M. V. Escárcega, L.D. Sánchez Velázquez, I. Becerra Laparra

J Frailty Aging 2016;5(1):59-61

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Chronic pain is defined as pain lasting longer than six weeks and is one of the main complaints in elderly subjects. Frailty is a pathological condition that increases an individual’s vulnerability by diminishing their homeostatic reserve, and it is considered a mortality risk factor. We examined the association between chronic pain and frailty in subjects who were recruited from a check-up clinic in Mexico City. Chronic pain and frailty were evaluated in 131 subjects through validated questionnaires. Descriptive and analytical statistics were performed. Of the participants, 41.9% presented with chronic pain, and 12.2% were frail. The unadjusted OR for the presence of frailty in subjects with chronic pain was 14.3 (95%CI 3.0-67.8), and the phi coefficient showed a weak positive correlation between the variables (φ=0.352, p<0.001). In conclusion, chronic pain is associated with a higher risk of frailty. Well-timed diagnosis and treatment of chronic pain can help prevent dependency in these individuals.

CITATION:
V.M. Castañeda Morales ; A.M. Jiménez Garduño ; M. V. Escárcega ; L.D. Sánchez Velázquez ; I. Becerra Laparra (2015): Association between chronic pain and frailty in Mexican elders. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.71

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A PHASE 2 RANDOMIZED STUDY INVESTIGATING THE EFFICACY AND SAFETY OF MYOSTATIN ANTIBODY LY2495655 VERSUS PLACEBO IN PATIENTS UNDERGOING ELECTIVE TOTAL HIP ARTHROPLASTY

L. Woodhouse, R. Gandhi, S.J. Warden, S. Poiraudeau, S.L. Myers, C.T. Benson, L. Hu, Q.I. Ahmad, P. Linnemeier, E.V. Gomez, O. Benichou, on behalf of the study investigators

J Frailty Aging 2016;5(1):62-70

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Background: Total hip arthroplasty relieves joint pain in patients with end stage osteoarthritis. However, postoperative muscle atrophy often results in suboptimal lower limb function. There is a need to improve functional recovery after total hip arthroplasty. Objectives: To assess safety and efficacy of LY2495655, a humanized monoclonal antibody targeting myostatin, in patients undergoing elective total hip arthroplasty. Design: Phase 2, randomized, parallel, double-blind, 12-week clinical trial with a 12-week follow-up period. Setting: Forty-two sites in 11 countries. Participants: Individuals (N=400) aged ≥50 years scheduled for elective total hip arthroplasty for osteoarthritis within 10 ± 6 days after randomization. Intervention: Placebo or LY2495655 (35 mg, 105 mg, or 315 mg) subcutaneous injections at weeks 0 (randomization date), 4, 8, and 12 with follow up until week 24. Measurements: Primary endpoint: probability that LY2495655 increases appendicular lean mass (operated limb excluded) by at least 2.5% more than placebo at week 12, using dual-energy x-ray absorptiometry. Exploratory endpoints: muscle strength, performance based and self-reported measures of physical function, and whole body composition over time. Results: Participants: 59% women, aged 69 ± 8 years, BMI 29 ± 5 kg/m2. Groups were comparable at baseline. The primary objective was not reached as LY2495655 changes in lean mass did not meet the superiority threshold at week 12. However, LY2495655 105 and LY2495655 315 experienced progressive increases in appendicular lean mass that were statistically significant versus placebo at weeks 8 and 16. Whole body fat mass decreased in LY2495655 315 versus placebo at weeks 8 and 16. No meaningful differences were detected between groups in other exploratory endpoints. Injection site reactions occurred more often in LY2495655 patients than in placebo patients. No other safety signals were detected. Conclusion: Dose-dependent increases in appendicular lean body mass and decreases in fat mass were observed, although this study did not achieve the threshold of its primary objective.

CITATION:
L. Woodhouse ; R. Gandhi ; S.J. Warden ; S. Poiraudeau ; S.L. Myers ; C.T. Benson ; L. Hu ; Q.I. Ahmad ; P. Linnemeier ; E.V. Gomez ; O. Benichou ; on behalf of the study investigators (2016): A Phase 2 Randomized Study Investigating the Efficacy and Safety of Myostatin Antibody LY2495655 versus Placebo in Patients Undergoing Elective Total Hip Arthroplasty. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.81

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