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01/2017 journal articles

PUBLIC HEALTH IMPACT OF FRAILTY: ROLE OF PHYSICAL THERAPISTS

A.M. Gustavson, J.R. Falvey, C.M. Jankowski, J.E. Stevens-Lapsley

J Frailty Aging 2017;6(1):2-5

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Frailty is an emerging and immediate public health concern given the growing aging population. The condition of frailty is characterized by a reduction in physiologic reserve, which places frail older adults at considerable risk for further functional decline, hospitalization, institutionalization, and death. Recent research suggests that frailty may be reversible, which could result in significant improvement in public health. Thus, a strong impetus exists to develop strategies for frail older adults that achieve the Triple Aim through better promotion of population health, optimization of patient experiences, and delivery of high-quality care at minimal cost. Physical therapists often treat frail older adults, yet how physical therapists can contribute to preventing or reversing frailty in healthcare settings has not been described, and may potentially influence patient outcomes and healthcare spending. Therefore, the purpose of this publication is to outline the potential role of physical therapists in achieving the Triple Aim for the frail older adult population.

CITATION:
A.M. Gustavson ; J.R. Falvey ; C.M. Jankowski ; J.E. Stevens-Lapsley (2017): Public Health Impact of Frailty: Role of Physical Therapists. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.1

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CIRCULATING CD34-POSITIVE CELLS ARE ASSOCIATED WITH HANDGRIP STRENGTH IN JAPANESE OLDER MEN: THE NAGASAKI ISLANDS STUDY

H. Yamanashi, Y. Shimizu, J. Koyamatsu, M. Nagayoshi, K. Kadota, M. Tamai, T. Maeda

J Frailty Aging 2017;6(1):6-11

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Background: Handgrip strength is a simple measurement of overall muscular strength and is used to detect sarcopenia. It also predicts adverse events in later life. Many mechanisms of sarcopenia development have been reported. A hypertensive status impairs endothelial dysfunction, which might deteriorate skeletal muscle if vascular angiogenesis is not maintained. Objectives: This study investigated muscle strength and circulating CD34-positive cells as a marker of vascular angiogenesis. Design: Cross-sectional study. Participants: 262 male Japanese community dwellers aged 60 to 69 years. Measurements: The participants’ handgrip strength, medical history, and blood samples were taken. We stratified the participants by hypertensive status to investigate the association between handgrip strength and circulating CD34-positive cells according to hypertensive status. Pearson correlation and linear regression analyses were used. Results: In the Pearson correlation analysis, handgrip strength and the logarithm of circulating CD34-positive cells were significantly associated in hypertensive participants (r=0.22, p=0.021), but not in non-hypertensive participants (r=−0.01, p=0.943). This relationship was only significant in hypertensive participants (ß=1.94, p=0.021) in the simple linear regression analysis, and it remained significant after adjusting for classic cardiovascular risk factors (ß=1.92, p=0.020). The relationship was not significant in non-hypertensive participants (ß=−0.09, p=0.903). Conclusions: We found a positive association between handgrip strength and circulating CD34-positive cells in hypertensive men. Vascular maintenance attributed by circulating CD34-positive cells is thought to be a background mechanism of this association after hypertension-induced vascular injury in skeletal muscle.

CITATION:
H. Yamanashi ; Y. Shimizu ; J. Koyamatsu ; M. Nagayoshi ; K. Kadota ; M. Tamai ; T. Maeda (2016): Circulating CD34-positive cells are associated with handgrip strength in Japanese older men: the Nagasaki Islands study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.107

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PREVALENCE OF SARCOPENIA IN COMMUNITY-DWELLING CHILEAN ELDERS ACCORDING TO AN ADAPTED VERSION OF THE EUROPEAN WORKING GROUP ON SARCOPENIA IN OLDER PEOPLE (EWGSOP) CRITERIA

L. Lera, C. Albala, H. Sánchez, B. Angel, M.J. Hormazabal, C. Márquez, P. Arroyo

J Frailty Aging 2017;6(1):12-17

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Background: Sarcopenia is the progressive loss of mass and skeletal muscle strength and has serious consequences on older people’s health. The Chilean older population has a high life-expectancy, but the prevalence of functional dependence is also high. Objective: To determine the prevalence of sarcopenia in Chilean older adults and its relationship with age, gender, and body mass index (BMI). Design: Cross-sectional study. Setting: Community. Participants: 1,006 non-disabled, community-dwelling subjects aged 60 years or older living in Santiago. Measurements: Anthropometric measurements, handgrip strength, physical performance tests, and dual-energy-x-ray-absorptiometry (DXA) scan were performed. Sarcopenia was defined using the algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP). Muscle mass was measured with DXA scan; skeletal muscle mass index (SMI) and hand dynamometry were defined with cut-off points obtained for the Chilean population. For a 3m walking speed we used the cut-off point of the EWGSOP definition. Nutritional status and obesity were defined according to World Health Organization standards. Association between sarcopenia and age, gender, BMI and lean/fat mass ratio was estimated by logistic regression models. Results: The prevalence of sarcopenia was 19.1% (95%CI: 16.8%-21.8%), similar in men and women. There was an increasing trend of sarcopenia by age group and a decreasing trend with nutritional status. After logistic regression, sarcopenia was positively associated with age (OR=1.10; 95%CI:1.06-1.15) and falls (OR=1.83; 95%CI:1.07-3.15) and negatively associated with overweight (OR=0.31; 95%CI:0.16-0.59), obesity (OR=0.02; 95%CI:0.004-0.11), lean mass/fat mass ratio (OR=0.69; 95%CI:0.48-0.9997), knee height (OR=0.78; 95%CI:0.68-0.89) and calf circumference (OR=0.87; 95%CI:0.77-0.97). Conclusions: The total prevalence of sarcopenia was 19.1% increasing with age reaching 39.6% in people of 80 or more years of age. A negative association of sarcopenia with overweight, obesity and lean/fat mass ratio was observed. Although the high prevalence of obesity (35.9%), only 2% of obese people were sarcopenic.

CITATION:
L. Lera ; C. Albala ; H. Sánchez ; B. Angel ; M.J. Hormazabal ; C. Márquez ; P. Arroyo (2016): Prevalence of sarcopenia in community-dwelling Chilean elders according to an adapted version of the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.117

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PREVALENCE OF CONCOMITANT BONE AND MUSCLE WASTING IN ELDERLY WOMEN FROM THE SARCOPHAGE COHORT: PRELIMINARY RESULTS

M. Locquet, C. Beaudart, J.-Y. Reginster, J. Petermans, S. Gillain, A. Quabron, J. Slomian, F. Buckinx, O. Bruyère

J Frailty Aging 2017;6(1):18-23

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Background: Recent studies suggest that bone and muscle wasting are closely interconnected. Objective: The aim was of this study is to assess the prevalence of osteoporosis in a population of women diagnosed with sarcopenia. Participants, setting and design: We analyzed cross-sectional data of women, aged 65 years and above, for whom bone mineral density was available at the time of inclusion in the SarcoPhAge (Sarcopenia and Physical impairment with advancing Age) cohort, an ongoing prospective study with the aim to assess consequences of sarcopenia. Measurements: Muscle strength was evaluated with a hydraulic hand-dynamometer, appendicular lean mass and bone mineral density by Dual-Energy X-Ray Absorptiometry and physical performance by the Short Physical Performance Battery test (SPPB). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People definition, i.e. a low muscle mass plus either low muscle strength or low physical performance. A bone mineral density T-score equal to or below -2.5SD at the lumbar spine, at the total hip or at the femoral neck was used to define osteoporosis (World Health Organization definition). Results: A total of 126 women aged 74.38±6.32 years were included. Among them, 26 were assessed with sarcopenia (20.6%) and 34 (27.0%) with osteoporosis. There were more osteoporotic women among sarcopenic subjects (46.1%) than among non-sarcopenic subjects (22.0%) (p-value=0.011). A significant lower appendicular lean mass index was observed in osteoporotic women (p-value=0.025). We also observed, in osteoporotic subjects, a lower muscle strength (p-value=0.023). Numerical values of bone mineral density were lower in the sarcopenic population but the differences did not reach the level of statistical significance. Conclusion: Our study demonstrated that muscle mass and strength are lower in patients with osteoporosis. Prospective changes in bone and muscle mass will be investigated during the follow-up of our cohort.

CITATION:
M. Locquet ; C. Beaudart ; J.-Y. Reginster ; J. Petermans ; S. Gillain ; A. Quabron ; J. Slomian ; F. Buckinx ; O. Bruyère (2016): Prevalence of concomitant bone and muscle wasting in elderly women from the SarcoPhAge cohort: preliminary results. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.111

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BODY MASS INDEX AND ITS RELATIONSHIP WITH DISABILITY, CHRONIC DISEASES AND FRAILTY IN OLDER PEOPLE: A COMPARISON OF THE LIPSCHITZ AND WHO CLASSIFICATIONS

F.P.A.S. Pessanha, L.P. Lustosa, J.A.O. Carneiro, K. Pfrimer, P.G. Fassini, N.M.C. Alves, T.L. Pontes, J.C. Moriguti, N.K.C. Lima, E. Ferriolli

J Frailty Aging 2017;6(1):24-28

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Background: Anthropometric parameters are closely associated with the pathophysiology of frailty and with clinic and functional parameters assessed for its diagnosis. Objective: to evaluate the possible association of the nutritional status of older people as assessed by Body Mass Index (BMI) and functional disability, self-reported chronic diseases and frailty, comparing the use of two different classifications of BMI. Design: Cross-sectional study. Setting: The sample was selected among community-dwelling older people from the city of Ribeirão Preto/ Brazil. Participants: 326 independent older people (mean age 73.8±6.4 years) who participated in the FIBRA (Frailty in Brazilian Older People) study. Measurements: Weight and height were collected for BMI analysis and frailty criteria were applied according to Fried et al. Participants were also evaluated for self-reported activities of daily living (Katz Index and Lawton & Brody Scale), and the presence of chronic diseases. Results: The prevalence of frailty was 12.3%. Regardless of the classification of BMI applied, most of the sample was classified as overweight (50.9% and 39.3% in the Lipschitz and WHO classifications, respectively). For both classifications, low weight was the only BMI classification associated with frailty status (OR Lipschitz: 4.12(1.53-11.14); OR WHO: 6.21 (1.26-30.58). Comorbidities and dependence in activities of daily living (ADLs) were associated with BMI ≥ 30kg.m2. Conclusion: Regardless of the classification adopted, low weight is associated with frailty. However, when the WHO stratification is employed, high BMI is also associated to increased functional disability and the presence of comorbidities, coexisting factors of frailty.

CITATION:
F.P.A.S. Pessanha ; L.P. Lustosa ; J.A.O. Carneiro ; K. Pfrimer ; P.G. Fassini ; N.M.C. Alves ; T.L. Pontes ; J.C. Moriguti ; N.K.C. Lima ; E. Ferriolli (2016): BODY MASS INDEX AND ITS RELATIONSHIP WITH DISABILITY, CHRONIC DISEASES AND FRAILTY IN OLDER PEOPLE: A COMPARISON OF THE LIPSCHITZ AND WHO CLASSIFICATIONS. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.113

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IDENTIFYING FRAILTY LEVELS AND ASSOCIATED FACTORS IN A POPULATION LIVING IN THE CONTEXT OF POVERTY AND SOCIAL VULNERABILITY

M.S. Zazzetta, G.A.O. Gomes, F.S. Orlandi, A.C. M. Gratão, F.A. Vasilceac, K. Gramani-Say, M.A. Ponti, P.C. Castro, S.C.I. Pavarini, A.L. C. Menezes, C.M.C. Nascimento, M.R. Cominetti

J Frailty Aging 2017;6(1):29-32

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This study aimed to investigate a vulnerable population living in the context of poverty in a Brazilian municipality, in order to identify the factors that are associated with frailty syndrome in elderly people. From the total population living in the area, a random sample of 363 community-dwelling people, 60 years and older, age and gender-stratified, was selected to participate in the research. After losses, a sample of 304 older adults was classified as non-frail, pre-frail and frail. According to the Fried frailty criteria, the prevalence was 12.2% for non-frail individuals, 60.5% pre-frail and 27.3% frail. The main factors associated with frailty in the studied sample were low level of physical activity (OR: 5.2, 95%CI: 2.5–11.0), the occurrence of two or more falls within 12 months (OR: 3.1, 95%CI: 1.4–7.1), mobility deficits (OR: 3.0, 95%CI: 1.5–5.8), and depressive symptoms (OR: 1.9, 95%CI: 1.1–3.7). This study identified the most important factors that must be evaluated to identify frailty syndrome in a socially vulnerable population in the context of poverty. The data should help to encourage effective strategies concerning public health policies for this population.

CITATION:
M.S. Zazzetta ; G.A.O. Gomes ; F.S. Orlandi ; A.C. M. Gratão ; F.A. Vasilceac ; K. Gramani-Say ; M.A. Ponti ; P.C. Castro ; S.C.I. Pavarini ; A.L. C. Menezes ; C.M.C. Nascimento ; M.R. Cominetti (2016): Identifying frailty levels and associated factors in a population living in the context of poverty and social vulnerability. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.116

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RELATIONSHIP BETWEEN FEAR OF FALLING AND PERCEIVED DIFFICULTY WITH GROCERY SHOPPING

C.S. Johnson, K.M. Mcleod

J Frailty Aging 2017;6(1):33-36

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Fear of falling is associated with self-imposed restrictions of basic and instrumental activities of daily living (ADL/IADL), leading greater risk for functional decline and falls. The inability to independently grocery shop, a food-related IADL, negatively affects nutritional status and survival among seniors. Thus, this study examined the relationship between the fear of falling and difficulty with grocery shopping among seniors (n=98, mean age=82, 83% female), taking into account their functional capacity. Demographic profile, eating problems, physical fitness (mobility, balance, endurance, leg strength), and fear of falling (balance confidence, falls efficacy) were measured. Fifty-six percent of participants reported difficulty with grocery shopping. Those who reported difficulty had significantly lower scores for dynamic balance, balance confidence and fall efficacy compared to those who did not. This study revealed a relationship between the fear of falling and perceived difficulty with grocery shopping. Interventions should address fear of falling among the frail seniors.

CITATION:
C.S. JOHNSON ; K.M. MCLEOD (2016): RELATIONSHIP BETWEEN FEAR OF FALLING AND PERCEIVED DIFFICULTY WITH GROCERY SHOPPING. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.115

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GOAL-SETTING INSTRUMENTS IN GERIATRIC REHABILITATION: A SYSTEMATIC REVIEW

R. van Seben, L. Reichardt, S. Smorenburg, B. Buurman

J Frailty Aging 2017;6(1):37-45

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This systematic review summarizes the psychometric properties of goal-setting instruments that are applied within geriatric rehabilitation. PubMed Medline and Embase were systematically searched for eligible articles. Studies were included if they were conducted in a somatic or neurological rehabilitation setting, included patients aged ≥55 years and provided data on instruments’ psychometric properties (validity, reliability, responsiveness), utility and/or feasibility. Eleven studies were included. Seven studies, all conducted by one research group, evaluated Goal-Attainment Scaling (GAS), two studies assessed the Canadian Occupational Performance Measure (COPM) and one study the Self-Identified Goals Assessment (SIGA), which is based on the COPM. One study assessed a core set of the International Classification of Functioning, Disability and Health (ICF) framework. High concurrent, content and predictive validity and inter-rater reliability were found for GAS. Responsiveness appears to be excellent. Concurrent validity and inter-rater reliability of the COPM and content validity of both the COPM and SIGA appear to be good. Responsiveness of both instruments seems to be poor. Content validity of the ICF core set was found to be fair; responsiveness appears to be very poor. There is little published data on goal-setting instruments in geriatric rehabilitation. Evidence for its psychometric properties may support GAS as goal-setting instrument and additional outcome measure. However, more research is required in order to evaluate GAS, as research conducted in other health care settings may provide important additional findings. Before the COPM (or SIGA) can be recommended as goal-setting instrument, its psychometric properties require further research.

CITATION:
R. van Seben ; L. Reichardt ; S. Smorenburg ; B. Buurman (2016): Goal-setting instruments in geriatric rehabilitation: a systematic review. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.103

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ASSESSING THE APPROPRIATENESS OF ORAL ANTICOAGULATION FOR ATRIAL FIBRILLATION IN ADVANCED FRAILTY: USE OF STROKE AND BLEEDING RISK-PREDICTION MODELS

R. O’Caoimh, E. Igras, A. Ramesh, B. Power, K. O’Connor, R. Liston

J Frailty Aging 2017;6(1):46-52

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Background: Atrial fibrillation (AF) is common among frail older adults. Oral anticoagulation (OAC) is particularly challenging for these due to overlapping stroke and bleeding risk factor profiles. Objective: To compare the utility of stroke and haemorrhage risk-prediction instruments in the treatment of AF among frail older adults. Design: Cross-sectional study. Settings and participants: Frail residents in four nursing homes with a Clinical Frailty Scale score ≥5 (median 7±0). Measurements: The prevalence of AF was assessed by ECG and chart review. Stroke (CHADS2 and CHA2DS2-VASc) and bleeding (HASBLED and HEMORR2HAGES) risk-prediction scores were then applied. A validated, risk-based, colour-coded decision support tool, incorporating these instruments, was then used to create a risk matrix and assess the appropriateness of OAC. Results: In total, 225 patients were included. The distribution of CFS scores was similar irrespective of AF status. In all, 86/225 (38%) had any history of AF. Of these, only 15/86 (17%) were prescribed OAC. All those in AF scored ≥2 on the CHA2DS2-VASc. One-third also scored high-risk of bleeding using HAS-BLED or HEMORR2HAGES. Risk-prediction scores were similar between those with ‘known’ (documented) and occult (only on ECG) AF. The colour-coded decision tree suggested that OAC would be recommended for the majority in AF when HAS-BLED (60/86, 70%) was used as the bleeding risk-prediction instrument. Despite this, only 12/60 (20%) were anticoagulated. When HEMORR2HAGES was incorporated instead, one patient was advised OAC, the remainder no treatment (57%) or an antiplatelet (42%). Discussion: Stroke risk was high and bleeding risk levels comparatively low, suggesting that the balance of risk may favor OAC for AF in this cohort of patients with advanced frailty. Despite this and the high prevalence of AF, OAC prescription rates were low. The decision-support tool used showed mixed results, depending on the bleeding-risk score incorporated, suggesting that while useful, they should not replace clinical judgement.

CITATION:
R. O’Caoimh ; E. Igras ; A. Ramesh ; B. Power ; K. O’Connor ; R. Liston (2016): Assessing the appropriateness of oral anticoagulation for atrial fibrillation in advanced frailty: use of stroke and bleeding risk-prediction models. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.118

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HIGH VERSUS LOW LOAD RESISTANCE TRAINING: THE EFFECT OF 24 WEEKS DETRAINING ON SERUM BRAIN DERIVED-NEUROTROPHIC FACTOR (BDNF) IN OLDER ADULTS

L. Nuvagah Forti, E. Van Roie, R. Njemini, W. Coudyzer, I. Beyer, C. Delecluse, I. Bautmans

J Frailty Aging 2017;6(1):53-58

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Background: Previously we showed that 12 weeks of mixed-low resistance training (LOW+) significantly increased circulating BDNF in older male individuals. Objectives: To examine the impact of 24 weeks detraining on circulating BDNF. Design: Randomized intervention study. Setting: Community-dwelling older adults. Participants and Methods: Forty-seven out of 56 participants stopped training (detraining) after 12 weeks of resistance exercise (3x/week) at either HIGH-resistance (5 Males, 5 Females, 2x10-15 repetitions at 80%1RM), LOW-resistance (6 Males, 7 Females, 1x80-100 repetitions at 20%1RM), or mixed-low LOW+-resistance (6 Males, 8 Females, 1x60 repetitions at 20%1RM followed by 1x10-20 repetitions at 40%1RM), of whom 37 (aged 68±5 years) provided sufficient serum samples for BDNF analysis at baseline, 12 week and at 36 weeks (24 weeks detraining). Results: BDNF had initially increased by 31% (from 33.4±10.9 ng/mL to 44.5±13.2 ng/mL, p=0.005) after 12 weeks in the LOW+ exercise group in males and decreased by 26% (from 44.5±13.2 ng/mL to 32.9±10.7 ng/mL) after detraining, though not statistically significant (p=0.082). In females, no significant change in BDNF was found in any of the intervention groups (p>0.05), neither after training, nor detraining. At 36 weeks all of the subgroups showed BDNF levels comparable (all p>0.10) to baseline (before the exercise intervention). Conclusions: Our results show that a 12-weeks LOW+ resistance exercise increases circulating BDNF in older male subjects but that this reduces back to baseline levels after 24 weeks of detraining. Continuous exercise adherence seems to be needed to sustain the training-induced effects on BDNF in older persons. Additional studies are needed to unravel the underlying mechanisms, as well as to confirm the observed sex difference.

CITATION:
L. Nuvagah Forti ; E. Van Roie ; R. Njemini ; W. Coudyzer ; I. Beyer ; C. Delecluse ; I. Bautmans (2017): High versus low load resistance training: the effect of 24 weeks detraining on serum brain derived-neurotrophic factor (BDNF) in older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.2

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