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03/2016 journal articles

BASELINE FRAILTY EVALUATION IN DRUG DEVELOPMENT

F. Cerreta, J. Ankri, D. Bowen, A. Cherubini, A.J. Cruz Jentoft, A. Guðmundsson, M. Haberkamp, P. Jansen, N. Marchionni, S. Morgan, E. Rönnemaa, M. Petrovic, A. Pilotto, M. Rosa, H. Wildiers

J Frailty Aging 2016;5(3):139-140

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CITATION:
F. Cerreta ; J. Ankri ; D. Bowen ; A. Cherubini ; A.J. Cruz Jentoft ; A. Guðmundsson ; M. Haberkamp ; P. Jansen ; N. Marchionni ; S. Morgan ; E. Rönnemaa ; M. Petrovic ; A. Pilotto ; M. Rosa ; H. Wildiers ; (2016): Baseline frailty evaluation in drug development. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.99

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ASSOCIATION BETWEEN NUTRITIONAL STATUS AND QUALITY OF LIFE IN (PRE)FRAIL COMMUNITY-DWELLING OLDER PERSONS

E. Luger, S. Haider, A. Kapan, K. Schindler, C. Lackinger, T.E. Dorner

J Frailty Aging 2016;5(3):141-148

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Background: For developed countries, healthy aging is one of the challenges and the number of healthy life years and especially the quality of life (QoL) are important. Objective: This study aimed to assess the association between nutritional status and different domains of QoL in (pre)frail community-dwelling elders. Design: Baseline data from persons, who participated in a 12-week nutritional and physical training intervention program, conducted from September 2013 - July 2015. Setting: (Pre)frail community-dwelling elders living in Vienna, Austria. Participants: A total of 83 older persons living at home, 12 men and 71 women (86%) aged 65 to 98 years. Measurements: Structured interviews were conducted at participants’ homes. Mini Nutritional Assessment® long-form (MNA®-LF) was used to investigate the nutritional status. The QoL domains were assessed with the World Health Organization Quality of Life questionnaires. Simple and multiple linear regression analyses were performed to evaluate the association between nutritional status and QoL domains, adjusted for possible confounders. Results: 45% of the participants were at risk of malnutrition and 3% were malnourished. Compared to normal nourished people, persons who had an impaired nutritional status, significantly differed in the QoL domain ‘autonomy’ with mean (SD) scores of 50.0 (14.9) vs. 57.3 (13.7); p=0.022 and in the QoL domain ‘social participation’ with scores of 40.1 (13.6) vs. 47.0 (11.2); p=0.014, respectively. According to linear regression analyses, the MNA®-LF score was significantly associated with ‘overall QoL’ (β=0.26; p=0.016) and the QoL domains ‘physical health’ (β=0.23; p=0.036), ‘autonomy’ (β=0.27; p=0.015), and ‘social participation’ (β=0.28; p=0.013). Conclusions: There was a significant association between nutritional status and QoL in elderly (pre)frail community-dwelling people, in particular for the QoL domains ‘autonomy’ and ‘social participation’. However, it remains unclear whether malnutrition was the cause or the consequence, or it was mediated through a third possible factor e.g. the functional status.

CITATION:
E. Luger ; S. Haider ; A. Kapan ; K. Schindler ; C. Lackinger ; T.E. Dorner (2016): Association between nutritional status and quality of life in (pre)frail community-dwelling older persons. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.88

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FACTORS ASSOCIATED WITH NUTRITIONAL RISK AMONG HOMEBOUND OLDER ADULTS WITH DEPRESSIVE SYMPTOMS

A.P. Greenfield, S. Banerjee, A. DePasquale, N. Weiss, J. Sirey

J Frailty Aging 2016;5(3):149-157

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Objectives: This study used the Evans model of public health determinants to identify factors associated with nutritional risk in older adults. Design: The Evans model domains (physical and mental well-being, social/environmental statuses, individual choice, and economic security) were measured in a sample of homebound older adults. Regularized logistic regression analysis with LASSO penalty function was used to determine the strongest domain of the Evans model. Using traditional logistic regression, individual variables across all domains were compared to identify the significant predictors. Setting: Older adults receiving home meal services were referred to the study by community program staff. Participants: Participants included 164 homebound older adults (age > 60) who endorsed at least one gateway symptom of depression. Measurements: Nutritional risk was determined using the Mini Nutritional Assessment. Domains of the Evans model were measured using the MAI Medical Condition Checklist, items from the IADL scale, the Structured Clinical Interview for DSM-IV Axis I Disorders, the Duke Social Support Index, living arrangements, marital status, the Alcohol Use Disorders Identification Test, items from the SCID Screening Module, and a self-report of perceived financial security. Results: Poor mental well-being, defined by a diagnosis of major depressive disorder, was identified as the strongest Evans model domain in the prediction of nutritional risk. When each variable was independently evaluated across domains, instrumental support (Wald’s Z=-2.24, p=0.03) and a history of drug use (Wald’s Z=-2.40, p=0.02) were significant predictors. Conclusions: The Evans model is a useful conceptual framework for understanding nutritional health, with the mental domain found to be the strongest domain predictor of nutritional risk. Among individual variables across domains, having someone to help with shopping and food preparation and a history of drug use were associated with lower nutritional risk. These analyses highlight potential targets of intervention for nutritional risk among older adults.

CITATION:
A.P. Greenfield ; S. Banerjee ; A. DePasquale ; N. Weiss ; J. Sirey ; (2016): Factors Associated with Nutritional Risk Among Homebound Older Adults with Depressive Symptoms. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.91

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MEASURING ACTIVITY PERFORMANCE OF CONTINUING CARE RESIDENTS USING THE ACTIVPAL: AN EXPLORATORY STUDY

C.S. Chan, S.E. Slaughter, C.A. Jones, A.S. Wagg

J Frailty Aging 2016;5(3):158-161

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Few studies have measured the activity patterns of continuing care residents using objective, uniaxial, accelerometers such as the activPAL. This exploratory study described the activity performance of continuing care residents and explored the correlation of activity performance with grip strength, falls and mobility. Data were gathered from 24 continuing care residents. Participants (82.3 ± 5.8 years of age), wore the activPAL an average of 12.60 hours per day (SD = 0.96) and were stepping for a median of 0.47 hours (25th and 75th percentiles = 0.31, 0.81) with a median step count of 1906 steps (25th and 75th percentiles = 1216, 3420). Participants were inactive (sitting/lying/standing) for a mean 11.99 hours (SD = 1.03). No statistically significant correlations were identified between activity performance (active time, inactive time or step count) and grip strength, falls or mobility. Ambulatory older adults in continuing care centres were more sedentary compared to community-dwelling older adults or older adults with cancer.

CITATION:
C.S. Chan ; S.E. Slaughter ; C.A. Jones ; A.S. Wagg (2016): Measuring activity performance of continuing care residents using the activPAL: an exploratory study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.97

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THE EMERGENCE OF FRAILTY MAY LEAD TO A STATE OF BURNT OUT TYPE 2 DIABETES

A.H. Abdelhafiz, L. Koay, A.J. Sinclair

J Frailty Aging 2016;5(3):162-167

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Ageing is associated with hyperglycaemic tendency due to the change in body composition leading to accumulation of visceral fat and increased insulin resistance on the one hand and reduced insulin secretion due to decreased number and function of the β-cells of the pancreas on the other. However, with the emergence of frailty there may be a tendency towards normoglycaemia or even hypoglycaemia due to malnutrition, weight loss and reduced physiologic reserve. This shift in glucose metabolism induced by frailty may change the natural history of type 2 diabetes from a progressive to a regressive course. Studies which showed increased risk of mortality with low HbA1c included frail patients in the lower HbA1c categories and healthier patients in the higher HbA1c categories suggesting that frailty is a possible confounding factor. Therefore, hypoglycemia may be a prognostic tool to identify vulnerable patients who may be at increased risk of mortality. The metabolic changes of insulin/glucose dynamics associated with frailty need further research.

CITATION:
A.H. Abdelhafiz ; L. Koay ; A.J. Sinclair (2016): The emergence of frailty may lead to a state of burnt out type 2 diabetes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.98

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ASSESSMENT OF HEALTH INEQUALITIES AMONG OLDER PEOPLE USING THE EPICES SCORE: A COMPOSITE INDEX OF SOCIAL DEPRIVATION

B. Bongue, A. Colvez, E. Amsallem, L. Gerbaud, C. Sass

J Frailty Aging 2016;5(3):168-173

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Background: Most of the indicators commonly used to assess social deprivation are poorly suited to study health inequalities in older people. The EPICES (Evaluation of Deprivation and Inequalities in Health Examination Centres) score is a new composite index commonly used to measure individual deprivation. Objective: To assess the relationships between health indicators and the EPICES score in older people. Design, Setting, and participants: We performed a cross-sectional study using the data from the 2008 ESPS Survey (Health, HealthCare and Insurance Survey). Of the 4235 survey respondents aged 60 and over in 2008, 2754 completed the 11 items of the EPICES score and were included in the study. Main outcomes and measures: Deprivation was measured using the EPICES score. Health indicators were: Disability, physical performance, cognitive decline, self-perceived health status, and health-care use and participation in prevention programs (missing teeth not replaced, healthcare renunciation, no hemoccult test [60-75 years] and no mammography [60-75 years]). Results: Of the 4235 survey respondents aged 60 and over in 2008, 2754 completed the 11 items of the EPICES score and were included in the study. The mean age was 70.5± 8.2 years. 52.8% were women. 25.8% were living in poor households. According to the EPICES score, 35.1% were deprived. The EPICES score is linked to all the health indicators assessed in this study: Physical disability, cognitive decline; lifestyle and health care accessibility. These relationships increase steadily with the level of social deprivation. For example, the risk of having difficulties in walking 500m without help or an assistive device is multiplied by 13 (RR=13.5 [7.9-20.8]) in the elderly of quintile 5 (maximum precariousness). Limitations: The observational nature limits inferences about causality. Conclusion: The EPICES score is linked to health indicators. It could be a useful instrument to assess health inequalities in older people living in the community.

CITATION:
B. Bongue ; A. Colvez ; E. Amsallem ; L. Gerbaud ; C. Sass (2016): Assessment of health inequalities among older people using the EPICES score: a composite index of social deprivation. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.96

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FRAILTY AND HEALTH-RELATED QUALITY OF LIFE IN END STAGE RENAL DISEASE PATIENTS OF ALL AGES

M.A. McAdams-DeMarco, H. Ying, I. Olorundare, E.A. King, N. Desai, N. Dagher, B. Lonze, R. Montgomery, J. Walston, D.L. Segev

J Frailty Aging 2016;5(3):174-179

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Background: Frailty is associated with worse health-related quality of life (HRQOL) in older adults and worse clinical outcomes in adults of all ages with end stage renal disease (ESRD). It is unclear whether frail adults of all ages with ESRD are more likely to experience worse HRQOL. Objective: The goal of this study was to identify factors associated with worsening HRQOL in this population. Design, setting and measurements: We studied 233 adults of all ages with ESRD enrolled (11/2009-11/2013) in a longitudinal cohort study. Frailty status was measured at enrollment and HRQOL was reported (Excellent, Very Good, Good, Fair or Poor) at the initial assessment and follow-up (median follow-up 9.4 months). We studied factors associated with Fair/Poor HRQOL at follow-up using logistic regression and factors associated with HRQOL change using multinomial regression. All models were adjusted for age, sex, race, education, BMI, diabetes status, history of a previous transplant, type of dialysis and time between assessments. Results: Fair/Poor HRQOL was reported by 28% at initial assessment and 33% at follow-up. 47.2% of participants had stable HRQOL, 22.8% better HRQOL, and 30.0% worse HRQOL at follow-up (P<0.001). In adjusted models, only frailty was associated with Fair/Poor HRQOL at follow-up (OR: 2.79, 95% CI: 1.32-5.90) and worsening HRQOL at follow-up (RR: 2.91, 95%CI: 1.08-7.80). Conclusions: Frail adults of all ages with ESRD are more likely to experience fair/poor HRQOL and worsening HRQOL over time. Frailty represents a state of decreased physiologic reserve that impacts not only clinical outcomes but also the patient-centered outcome of HRQOL.

CITATION:
M.A. McAdams-DeMarco ; H. Ying ; I. Olorundare ; E.A. King ; N. Desai ; N. Dagher ; B. Lonze ; R. Montgomery ; J. Walston ; D.L. Segev (2016): Frailty and Health-Related Quality of Life in END STAGE RENAL DISEASE Patients of All Ages. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.106

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BASELINE VULNERABILITY AND INPATIENT FRAILTY STATUS IN RELATION TO ADVERSE OUTCOMES IN A SURGICAL COHORT

H.-S. Lin, N.M. Peel, R.E. Hubbard

J Frailty Aging 2016;5(3):180-182

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This study aimed to derive measures of baseline vulnerability and inpatient frailty in elderly surgical patients and to study their association with adverse post-operative outcomes. Data from comprehensive geriatric assessment of 208 general surgical and orthopaedic patients aged 70 and over admitted to four acute hospitals in Queensland, Australia, were analysed to derive a baseline and inpatient Frailty Index (FI). The association of these indices with adverse outcomes was examined in logistic regression. The mean (SD) baseline FI was 0.19 (0.09) compared to 0.26 (0.12) on admission, with a predominant increase in domains related to functional status. Both baseline and inpatient FI were significant predictors of one year mortality, inpatient delirium, and a composite adverse outcome, after adjusting for age, sex and acuity of surgery. In summary, detecting baseline frailty pre-hospitalisation may be useful to trigger the implementation of supportive and preventative measures in hospital.

CITATION:
H.-S. Lin ; N.M. Peel ; R.E. Hubbard (2016): Baseline vulnerability and inpatient frailty status in relation to adverse outcomes in a surgical cohort . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.101

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FRAILTY IN GENERAL PRACTICE

L. Letrilliart, S. Oustric

J Frailty Aging 2016;5(3):183-185

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CITATION:
L. Letrilliart ; S. Oustric (2016): Frailty in General Practice. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.82

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COCOA (Theobroma cacao) POLYPHENOL-RICH EXTRACT INCREASES THE CHRONOLOGICAL LIFESPAN OF Saccharomyces cerevisiae

I. Baiges, L. Arola

J Frailty Aging 2016;5(3):186-190

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Background: Saccharomyces cerevisiae is a model organism with conserved aging pathways. Yeast chronological lifespan experiments mimic the processes involved in human non-dividing tissues, such as the nervous system or skeletal muscle, and can speed up the search for biomolecules with potential anti-aging effects before proceeding to animal studies. Objective: To test the effectiveness of a cocoa polyphenol-rich extract (CPE) in expanding the S. cerevisiae chronological lifespan in two conditions: in the stationary phase reached after glucose depletion and under severe caloric restriction. Measurements: Using a high-throughput method, wild-type S. cerevisiae and its mitochondrial manganese-dependent superoxide dismutase null mutant (sod2Δ) were cultured in synthetic complete dextrose medium. After 2 days, 0, 5 and 20 mg/ml of CPE were added, and viability was measured throughout the stationary phase. The effects of the major components of CPE were also evaluated. To determine yeast lifespan under severe caloric restriction conditions, cultures were washed with water 24 h after the addition of 0 and 20 mg/ml of CPE, and viability was followed over time. Results: CPE increased the chronological lifespan of S. cerevisiae during the stationary phase in a dose-dependent manner. A similar increase was also observed in (sod2Δ). None of the major CPE components (theobromine, caffeine, maltodextrin, (-)-epicatechin, (+)-catechin and procyanidin B2) was able to increase the yeast lifespan. CPE further increased the yeast lifespan under severe caloric restriction. Conclusion: CPE increases the chronological lifespan of S. cerevisiae through a SOD2-independent mechanism. The extract also extends yeast lifespan under severe caloric restriction conditions. The high-throughput assay used makes it possible to simply and rapidly test the efficacy of a large number of compounds on yeast aging, requiring only small amounts, and is thus a convenient screening assay to accelerate the search for biomolecules with potential anti-aging effects.

CITATION:
I. Baiges ; L. Arola (2016): Cocoa (Theobroma cacao) polyphenol-rich extract increases the chronological lifespan of Saccharomyces cerevisiae. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.100

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