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02/2016 journal articles

THE ROLE OF NUTRITION IN FRAILTY: AN OVERVIEW

S. Goisser, S. Guyonnet, D. Volkert

J Frailty Aging 2016;5(2):74-77

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Inadequate nutritional intake is an important modifiable risk factor for frailty. Existing evidence supports the importance of adequate dietary quantity and especially quality to ensure sufficient intakes of energy, protein and micronutrients. However, to date no nutritional intervention or supplementation concept has emerged as being effective for the prevention or treatment of frailty. Further research, including specifically the group of frail older persons and those at risk of frailty, and focussing on functional benefits as an outcome, is needed to allow definite recommendations for optimal diet, i.e. food and nutrient intakes, for this population. This article aims to give a short overview on current knowledge concerning the role of nutrition for the prevention and treatment of frailty, while providing readers with references giving an overview for further reading.

CITATION:
S. Goisser ; S. Guyonnet ; D. Volkert ; (2016): The role of nutrition in frailty: an overview. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.87

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CONSTRUCT VALIDITY OF FOUR FRAILTY MEASURES IN AN OLDER AUSTRALIAN POPULATION: A RASCH ANALYSIS

I.S. Widagdo, N. Pratt, M. Russell, E.E. Roughead

J Frailty Aging 2016;5(2):78-81

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Individuals identified as frail have been shown to be at an increased risk of adverse health outcomes. However, there is no gold standard frailty measure and frailty status can vary depending on the measure used, suggesting the measures perform differently. Construct validity can be used to assess a measure’s performance. This study aimed to examine the construct validity of four frailty measures in an Australian older population using Rasch analysis. Frailty status among the 2087 participants aged 65 years and above from the Australian Longitudinal Study of Ageing (ALSA) was assessed using: frailty phenotype - FP, simplified frailty phenotype - SFP, frailty index - FI, and prognostic frailty score – PFS. Rasch analysis was used to assess the unidimensionality of the measures, which is the extent to which the underlying characteristic of frailty is assessed. The criteria for unidimensionality from principal component analysis of the residuals was when 50% or more of the raw variance was explained by the measures, and less than 5% was unexplained variance. Only FI meet the unidimensionality criteria with 74% of explained variance and 2.1% of unexplained variance. SFP did not show a unidimensional construct with 13.3% of explained variance and 47.1% of unexplained variance. FP and PFS had 39.6%, 18.1% and 46.5%, 8.7% of explained and unexplained variance, respectively. Our findings showed that FI has better construct validity than the other three measures in assessing frailty among the Australian older population.

CITATION:
I.S. Widagdo ; N. Pratt ; M. Russell ; E.E. Roughead (2016): Construct validity of four frailty measures in an older Australian population: A Rasch analysis . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.83

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DISSEMINATING A CLINICALLY EFFECTIVE PHYSICAL ACTIVITY PROGRAM TO PRESERVE MOBILITY IN A COMMUNITY SETTING FOR OLDER ADULTS

J. Laussen, C. Kowaleski, K. Martin, C. Hickey, R.A. Fielding, K.F. Reid

J Frailty Aging 2016;5(2):82-87

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Background: As the population of older adults continues to increase, the dissemination of strategies to maintain independence of older persons is of critical public health importance. Recent large-scale clinical trial evidence has definitively shown intervention of moderate-intensity physical activity (PA) reduces major mobility disability in at-risk older adults. However, it remains unknown whether structured PA interventions, with demonstrated efficacy in controlled, clinical environments, can be successfully disseminated into community settings to benefit wider populations of older adults. Objective: To assess the dissemination of an evidence-based PA program for older adults by evaluating program participation and its impact on mobility, strength and quality of life. Setting: An urban senior center. Participants: Fifty older adults (71.2 ± 8 years aged; BMI: 30.1 ± 7 kg/m2). Intervention: Average of 8.0 ± 1.8 months of participation in the Fit-4-Life Program, a community-based PA and nutrition counseling intervention. Measurements: Mobility (Short Physical Performance Battery (SPPB)), self-reported physical activity (CHAMPS questionnaire), leg strength, grip strength, and quality of life (Quality of Well-Being Self-Administered (QWB-SA) scale) were assessed at baseline and follow-up. Results: Mean attendance was 55.8%. Fourteen participants were lost to follow-up. Those who dropped-out engaged in less PA at baseline (78 ± 108 mins/wk) compared to those who completed follow-up (203 ± 177 mins/wk, P=0.01). Participants exhibited sustained increases of PA (65 ± 153 mins/wk, P= 0.08), and there were meaningful improvements in SPPB (0.5 ± 0.2, P< 0.01), knee extensor strength (2.6 ± 4.4 kg, P< 0.01) and QWB-SA (0.04 ± 0.09, P= 0.05). Conclusion: The dissemination of a clinically efficacious PA intervention into a community-based setting can improve mobility, strength and quality of life for older adults. This knowledge may be helpful for the design and implementation of larger-scale PA intervention studies designed to preserve mobility in older adults within community-based settings.

CITATION:
J. Laussen ; C. Kowaleski ; K. Martin ; C. Hickey ; R.A. Fielding ; K.F. Reid (2016): Disseminating a Clinically Effective Physical Activity Program to Preserve Mobility in a Community Setting for Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.94

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SYSTEMATIC LITERATURE REVIEW ON THE RELATIONSHIP BETWEEN BIOMARKERS OF SARCOPENIA AND QUALITY OF LIFE IN OLDER PEOPLE

T. Woo, S. Yu, R. Visvanathan

J Frailty Aging 2016;5(2):88-99

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Sarcopenia is a multi-faceted geriatric syndrome that is prevalent in the older population. It is an independent risk factor for a variety of devastating health outcomes that threaten the independence of older people. Quality of life is also very important to older people. The objective of this systematic review therefore was to determine the relationship between the biomarkers of sarcopenia (or sarcopenia) and health related quality of life in older people. Systematic searches were done using the electronic databases from MEDLINE and EMBASE. Search terms included sarcopenia, biomarkers of sarcopenia (e.g. muscle mass, grip strength, muscle performance), and health related quality of life. A total of 20 studies were finally included in this review. Only four studies were deemed of good quality. Sarcopenia was associated with poor health related quality of life in both genders from the one cross sectional study defining sarcopenia as per consensus definition. One high quality longitudinal study demonstrated that better physical performance and muscle strength was associated with a slower rate of decline in health related quality of life over six years. Muscle performance and strength were associated with health related quality of life but muscle mass was not in cross-sectional studies. Good quality and longitudinal studies where sarcopenia is defined as per consensus guidelines are required if the impact of the disease on quality of life is to be clarified.

CITATION:
T. Woo ; S. Yu ; R. Visvanathan (2016): Systematic Literature Review on the Relationship Between Biomarkers of Sarcopenia and Quality of Life in Older People. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.93

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FRAILTY AND DRUG USE

K. Palmer, A. Marengoni, P. Russo, F. Mammarella, G. Onder

J Frailty Aging 2016;5(2):100-103

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CITATION:
K. Palmer ; A. Marengoni ; P. Russo ; F. Mammarella ; G. Onder (2016): Frailty and drug use. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.84

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MEASURING THE EFFECT OF CARERS ON PATIENTS’ RISK OF ADVERSE HEALTHCARE OUTCOMES USING THE CAREGIVER NETWORK SCORE

R. O’Caoimh, N. Cornally, A. Svendrovski, E. Weathers, C. FitzGerald, E. Healy, E. O’Connell, G. O’Keeffe, E. O’Herlihy, Y. Gao, R. O’Donnell, R. O’Sullivan, P. Leahy-Warren, F. Orfila, C. Paúl, R. Clarnette, D.W. Molloy

J Frailty Aging 2016;5(2):104-110

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Background: Although caregivers are important in the management of frail, community-dwelling older adults, the influence of different caregiver network types on the risk of adverse healthcare outcomes is unknown. Objective: To examine the association between caregiver type and the caregiver network subtest of The Risk Instrument for Screening in the Community (RISC), a five point Likert scale scored from one (“can manage”) to five (“absent/liability”). To measure the association between caregiver network scores and the one-year incidence of institutionalisation, hospitalisation and death. Design: Observational cohort study. Setting and Participants: Community-dwelling adults, aged >65,attending health centres in Ireland,(n=779). Procedure and Measurements: The caregiver network subtest of the RISC was scored by public health nurses. Caregivers were grouped dichotomously into low-risk (score of one) or high-risk (scores two-five). Results: The majority of patients had a primary caregiver (582/779;75%), most often their child (200/582;34%). Caregiver network scores were highest, indicating greatest risk, when patients had no recognised primary caregiver and lowest when only a spouse or child was available. Despite this, patients with a caregiver were significantly more likely to be institutionalised than those where none was required or identified (11.5% versus 6.5%,p=0.047). The highest one-year incidence of adverse outcomes occurred when state provided care was the sole support; the lowest when private care was the sole support. Significantly more patients whose caregiver networks were scored high-risk required institutionalisation than low-risk networks; this association was strongest for perceived difficulty managing medical domain issues, odds ratio (OR) 3.87:(2.22-6.76). Only perceived difficulty managing ADL was significantly associated with death, OR 1.72:(1.06-2.79). There was no association between caregiver network scores and risk of hospitalisation. Conclusion: This study operationalizes a simple method to evaluate caregiver networks. Networks consisting of close family (spouse/children) and those reflecting greater socioeconomic privilege (private supports) were associated with lower incidence of adverse outcomes. Caregiver network scores better predicted institutionalisation than hospitalisation or death.

CITATION:
R. O’Caoimh ; N. Cornally ; A. Svendrovski ; E. Weathers ; C. FitzGerald ; E. Healy ; E. O’Connell ; G. O’Keeffe ; E. O’Herlihy ; Y. Gao ; R. O’Donnell ; R. O’Sullivan ; P. Leahy-Warren ; F. Orfila ; C. Paúl ; R. Clarnette ; D.W. Molloy (2016): Measuring the effect of carers on patients’ risk of adverse healthcare outcomes using the caregiver network score. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.86

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ASSOCIATION BETWEEN PERCEIVED ETHNIC DISCRIMINATION AND HEALTH: EVIDENCE FROM THE NATIONAL LATINO & ASIAN AMERICAN STUDY (NLAAS)

C. Siordia, Y.D. Covington-Ward

J Frailty Aging 2016;5(2):111-117

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Background: The field of aging studies continues to better understand between-racial-group health disparities. Previous work provides empirical evidence for a statistical relationship between perceived discrimination and adverse health across all age groups. Specific Aim: We contribute to the literature by investigating the quantitative relationship between Perceived Ethnic Discrimination (PED), Self-Rated Physical Health (SR-PH), Self-Rated Mental Health (SR-MH), and their combined score (SR-PH-MH). Setting & Design: The cross-sectional observational study used data collected between 2002 and 2004 from the National Latino and Asian American Study (n=4,559; average age=41; 54% female; 18% Mexican; 36% Non-Mexican Latinos; 12% Chinese; 31% Non-Chinese Asians). We provide descriptive statistics for those below and at or above age 65. Results: Multivariable linear models adjusting for age, sex, ethnicity, education, body mass index, and neighborhood perception provide evidence that although a small effect, PED explains between-people variance in SR-PH (β=-0.01; α=0.001), SR-MH (β=-0.03; α=0.001), and SR-PH-MH (β=-0.04; α=0.001). Conclusions: The analysis supports arguments that PED has a non-random association with health. As we continue to explore novel measures of frailty, markers of social stress should be considered.

CITATION:
C. Siordia ; Y.D. Covington-Ward (2016): Association between Perceived Ethnic Discrimination and Health: Evidence from the National Latino & Asian American Study (NLAAS). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.90

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SOCIAL DETERMINANTS OF DISCHARGE OUTCOMES IN OLDER PEOPLE ADMITTED TO A GERIATRIC MEDICINE WARD

M. Hawker, R. Romero-Ortuno

J Frailty Aging 2016;5(2):118-120

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The factors determining hospital discharge outcomes in older people are complex. This retrospective study was carried out in an in-patient geriatric ward over a month in 2015 and aimed to explore if self-reported feeling of loneliness and clinical frailty contribute to longer hospital stays or higher rates of readmission to hospital after discharge in the older population. Twenty-two men and twenty-five women (mean age 85.1 years) were assessed. There was a significant multivariate association between both self-reported loneliness (p=0.021) and the Clinical Frailty Scale (p=0.010) with length of stay, after adjusting for age, dementia and living alone. In multivariate analysis, patients who lived alone were more likely to be readmitted to hospital within 30 days (p=0.036). Loneliness, living alone and clinical frailty were associated with adverse discharge outcomes. Lower thresholds for referral to voluntary organisations and for psychosocial interventions in patients who report loneliness or live alone may be beneficial.

CITATION:
M. Hawker ; R. Romero-Ortuno ; (2016): Social determinants of discharge outcomes in older people admitted to a geriatric medicine ward . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.89

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HIGHER PHYSIOTHERAPY FREQUENCY IS ASSOCIATED WITH SHORTER LENGTH OF STAY AND GREATER FUNCTIONAL RECOVERY IN HOSPITALIZED FRAIL OLDER ADULTS: A RETROSPECTIVE OBSERVATIONAL STUDY

P. Hartley, J. Adamson, C. Cunningham, G. Embleton, R. Romero-Ortuno

J Frailty Aging 2016;5(2):121-125

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Extra physiotherapy has been associated with better outcomes in hospitalized patients, but this remains an under-researched area in geriatric medicine wards. We retrospectively studied the association between average physiotherapy frequency and outcomes in hospitalized geriatric patients. High frequency physiotherapy (HFP) was defined as ≥0.5 contacts/day. Of 358 eligible patients, 131 (36.6%) received low, and 227 (63.4%) HFP. Functional improvement (discharge versus admission) in the modified Rankin scale was greater in the HFP group (1.1 versus 0.7 points, P<0.001). The mean length of stay (LOS) of the HFP group was 6 days shorter (7 versus 13 days, P<0.001). After adjusting for age, gender, comorbidity (Charlson index), frailty (Clinical Frailty Scale), dementia and acute illness severity, HFP was an independent predictor of functional improvement, shorter LOS and likelihood of being discharged without a formal care package. Prospective research is needed to examine the effect of physiotherapy frequency and intensity in geriatric wards.

CITATION:
P. Hartley ; J. Adamson ; C. Cunningham ; G. Embleton ; R. Romero-Ortuno (2016): Higher physiotherapy frequency is associated with shorter length of stay and greater functional recovery in hospitalized frail older adults: a retrospective observational study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.95

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RESISTANCE TRAINING AND CO-SUPPLEMENTATION WITH CREATINE AND PROTEIN IN OLDER SUBJECTS WITH FRAILTY

J. Collins, G. Longhurst, H. Roschel, B. Gualano

J Frailty Aging 2016;5(2):126-134

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Background: Studies assessing the effects co-supplementation with creatine and protein, along with resistance training, in older individuals with frailty are lacking. Objectives: This is an exploratory trial from the Pro-Elderly study (“Protein Intake and Resistance Training in Aging”) aimed at gathering knowledge on the feasibility, safety, and efficacy of co-supplementation with creatine and protein supplementation, combined with resistance training, in older individuals with frailty. Design: A 14-week, double-blind, randomized, parallel-group, placebo controlled exploratory trial. Setting, participants: The subjects were randomly assigned to whey protein and creatine co-supplementation (WHEY+CR) or whey protein supplementation (WHEY) group. All subjects undertook a supervised exercise training program and were assessed at baseline and after 14 weeks. Measurements: Muscle function, body composition, blood parameters, and self-reported adverse events were assessed. Results: No interaction effects (between-group differences) were observed for any dependent variables (p > 0.05 for all). However, there were main time-effects in handgrip (WHEY+CR = 26.65 ± 31.29; WHEY = 13.84 ± 14.93 Kg; p = 0.0005), timed-up-and-go (WHEY+CR = -11.20 ± 9.37; WHEY = -17.76 ± 21.74 sec; p = 0.006), and timed-stands test (WHEY+CR = 47.50 ± 35.54; WHEY = 46.87 ± 24.23 reps; p = 0.0001), suggesting that WHEY+CR and WHEY were similarly effective in improving muscle function. All of the subjects showed improvements in at least two of the three functional tests, regardless of their treatments. Body composition and blood parameters were not changed (p > 0.05). No severe adverse effects were observed. Conclusions: Co-supplementation with creatine and whey protein was well-tolerable and free of adverse events in older subjects with frailty undertaking resistance training. Creatine supplementation did not augment the adaptive effects of resistance training along with whey protein on body composition or muscle function in this population. Clinicaltrials.gov: NCT01890382.

CITATION:
J. Collins ; G. Longhurst ; H. Roschel ; B. Gualano (2016): Resistance training and co-supplementation with creatine and protein in older subjects with frailty. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.85

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ICFSR 2016: INTERNATIONAL CONFERENCE ON FRAILTY & SARCOPENIA RESEARCH THURSDAY - FRIDAY, APRIL 28-29, 2016 PHILADELPHIA, PA, USA

Abstract

J Frailty Aging 2016;5(S1):15-128

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