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04/2017 journal articles

PREVENTION OF FRAILTY IN AGING

B. Vellas, S. Sourdet

J Frailty Aging 2017;6(4):174-177

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CITATION:
B. Vellas ; S. Sourdet (2017): Prevention of Frailty in Aging. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.42

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RELATIONSHIP OF SERUM CARNITINE LEVEL WITH FALLS AND GAIT DISTURBANCE IN THE ELDERLY

K. Nagai, H. Koshiba, S. Shibata, A. Hirasawa, T. Ebihara, K. Kozaki

J Frailty Aging 2017;6(4):178-182

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Background: Gait disturbance and falls are serious events that can impair activities of daily living (ADL) in the elderly. On the other hand, carnitine plays essential roles in energy production, and carnitine deficiency leads to low activity levels. Objectives: We examined whether a lower serum carnitine concentration was correlated with falls and gait disturbances in the elderly. Design, Setting, and participants: We performed a cross-sectional study. One hundred and ninety-eight elderly patients (male, 83; female, 115; 81 ± 6 years old) were enrolled in this study. Measurements: Physical performance (hand grip strength, leg strength, walking speed, one-leg standing time, and tandem gait steps) and frailty status (The Edmonton Frail Scale: EFS) were evaluated. The serum total, free, and acylated carnitine levels were measured using an enzyme cycling method. We then investigated the associations between the serum carnitine level, history of falls, and the results of these physical examinations. Results: Of the 198 subjects, 56 (28%) had a history of falls within the past one year. The patients with a history of falls had lower serum total carnitine and free carnitine levels than those without a history of falls. Regarding the physical performance results, the patients with a history of falls had higher EFS scores, a weaker hand grip strength, a slower walking speed, a shorter one-leg standing time, and a smaller number of tandem gait steps than those without a history of falls. A logistic regression analysis showed that the low serum total carnitine concentration was identified as an independent factor associated with a history of falls, a slow walking speed after adjustments for age, sex and modified EFS. Conclusions: A low serum carnitine level is associated with a history of falls and gait disturbances in elderly people.

CITATION:
K. Nagai ; H. Koshiba ; S. Shibata ; A. Hirasawa ; T. Ebihara ; K. Kozaki (2017): Relationship of serum carnitine level with falls and gait disturbance in the elderly. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.36

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MUSCLE QUALITY, STRENGTH, AND LOWER EXTREMITY PHYSICAL PERFORMANCE IN THE BALTIMORE LONGITUDINAL STUDY OF AGING

N. Chiles Shaffer, E. Fabbri, L. Ferrucci, M. Shardell, E.M. Simonsick, S. Studenski

J Frailty Aging 2017;6(4):183-187

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Background: Muscle quality is defined as the force generated by each volumetric unit of muscle tissue. No consensus exists on an optimal measure of muscle quality, impeding comparison across studies and implementation in clinical settings. It is unknown whether muscle quality measures that rely on complex and expensive tests, such as isokinetic dynamometry and computerized tomography correlate with lower extremity performance (LEP) any better than measures derived from simpler and less expensive tests, such as grip strength (Grip) and appendicular lean mass (ALM) assessed by DXA. Additionally, whether muscle quality is more strongly associated with LEP than strength has not been fully tested. Objectives: This study compares the concurrent validity of alternative measures of muscle quality and characterizes their relationship with LEP. We also whether muscle quality correlates more strongly with LEP than strength alone. Design: Cross-sectional analysis. Setting: Community. Participants: 365 men and 345 women 65 years of age and older in the Baltimore Longitudinal Study of Aging. Measures: Thigh cross-sectional area (TCSA), isokinetic and isometric knee extension strength (ID), BMI adjusted ALM (ALMBMI) from DXA, and Grip. Concurrent validity was assessed as the percent variance of different measures of LEP explained by each muscle quality measure. In addition, we compared LEP relationships between each measure of strength and its correspondent value of muscle quality. Confidence intervals for differences in percent variance were calculated by bootstrapping. Results: Grip/ALMBMI explained as much variance as ID/TCSA across all LEP measures in women and most in men. Across all LEP measures, strength explained as much variance of LEP as muscle quality. Conclusions: Grip/ALMBMI and ID/TCSA measures had similar correlations with LEP. Muscle quality did not outperform strength. Although evaluating muscle quality may be useful to assess age-related mechanisms of change in muscle strength, measures of strength alone may suffice to understand the relationship between muscle and LEP.

CITATION:
N. Chiles Shaffer ; E. Fabbri ; L. Ferrucci ; M. Shardell ; E.M. Simonsick ; S. Studenski (2017): Muscle Quality, Strength, and Lower Extremity Physical Performance in the Baltimore Longitudinal Study of Aging. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.24

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VARIOUS DIAGNOSTIC MEASURES OF FRAILTY AS PREDICTORS FOR FALLS, WEIGHT CHANGE, QUALITY OF LIFE, AND MORTALITY AMONG OLDER FINNISH MEN

N.M. Perttila, K.H. Pitkala, H. Kautiainen, R. Tilvis , T. Strandberg

J Frailty Aging 2017;6(4):188-194

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Background: Frailty predisposes individuals to a variety of complications. However, there is no consensus on the definition of frailty. Objectives: To examine whether various frailty measures are equivalent in identifying the same individuals as being frail and whether the measures also predict similar outcomes. Design, Setting and Participants: The Helsinki Businessmen Study cohort, which is a long-term observational study of men born in 1919-1934, was used as the population. We investigated these men by their postal questionnaire responses in 2000 and 2005. The mean age of the men (N=480) was 73 years at the start of follow-up. Measurements: We compared two phenotypic frailty measures, the Helsinki Businessmen Study measure (HBS), the modified Women’s Health Initiative Observational Study (WHI-OS), and the Frailty Index (FI) comprising 20 items. All three measurements were applied to Helsinki Businessmen Study cohort data collected via simple postal questionnaire from 480 men. We investigated how effectively these three measures distinguished between the not frail, prefrail, and frail individuals, and predicted mortality, falls, weight change, and health-related quality of life (HRQoL, 15D instrument) during a 5-year follow-up. Results: The HBS and the modified WHI-OS identified 35 persons (7.3%) each as frail but their respective sets comprised different groupings of individuals that partly overlapped. The FI identified 86 persons (17.9%) as frail. One-hundred-and-two (21.3%) men were classified as frail by at least one of the measures. All three measures significantly predicted higher mortality, higher number of fallers, and lower HRQoL for frail participants. None of the measures showed different results for weight change between the frailty groups or frailty stages. Conclusions: All three measures identified somewhat different sets of participants as frail. They all predicted increased mortality, falls and reduced HRQoL for the frail groups.

CITATION:
N.M. PERTTILA ; K.H. PITKALA ; H. KAUTIAINEN ; R. TILVIS ; T. STRANDBERG (2017): VARIOUS DIAGNOSTIC MEASURES OF FRAILTY AS PREDICTORS FOR FALLS, WEIGHT CHANGE, QUALITY OF LIFE, AND MORTALITY AMONG OLDER FINNISH MEN . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.26

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THE FEASIBILITY OF STANDARDISED GERIATRIC ASSESSMENT TOOLS AND PHYSICAL EXERCISES IN FRAIL OLDER ADULTS

A.D. Jadczak, N. Mahajan, R. Visvanathan

J Frailty Aging 2017;6(4):195-198

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Geriatric assessment tools are applicable to the general geriatric population; however, their feasibility in frail older adults is yet to be determined. The study aimed to determine the feasibility of standardised geriatric assessment tools and physical exercises in hospitalised frail older adults. Various assessment tools including the FRAIL Screen, the Charlson Comorbidity Index, the SF-36, the Trail Making Test (TMT), the Rapid Cognitive Screen, the Self Mini Nutritional Assessment (MNA-SF) and the Lawton iADL as well as standard physical exercises were assessed using observational protocols. The FRAIL Screen, MNA-SF, Rapid Cognitive Screen, Lawton iADL and the physical exercises were deemed to be feasible with only minor comprehension, execution and safety issues. The TMT was not considered to be feasible and the SF-36 should be replaced by its shorter form, the SF-12. In order to ensure the validity of these findings a study with a larger sample size should be undertaken.

CITATION:
A.D. Jadczak ; N. Mahajan ; R. Visvanathan (2017): The feasibility of standardised geriatric assessment tools and physical exercises in frail older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.34

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REFERENCE VALUES FOR KNEE EXTENSION STRENGTH OBTAINED BY HAND-HELD DYNAMOMETRY FROM APPARENTLY HEALTHY OLDER ADULTS: A META-ANALYSIS

R.W. Bohannon

J Frailty Aging 2017;6(4):199-201

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Normative reference values for knee extension strength obtained by hand-held dynamometry from adults 60 to 79 years were derived using summary data from 3 studies. The studies, which were identified through PubMed and a hand-search, contributed data from between 3 and 29 individuals for each age, gender, and side stratum. Meta-analysis was employed to consolidate knee extension strength data. Strength, normalized against body weight, ranged 35.6% for the nondominant side of 70 to 79 year old women to 48.8% for the nondominant side of 60 to 69 year old men. These values are more informative than those previously published in individual studies. However, reference values derived from a large population-based sample are needed.

CITATION:
R.W. Bohannon (2017): Reference Values for Knee Extension Strength Obtained by Hand-held Dynamometry from Apparently Healthy Older Adults: A Meta-analysis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.32

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FRAILTY IS NOT ASSOCIATED WITH MISTREATMENT

S.D. Piña-Escudero, J.M.A. García-Lara, J.A. Avila-Funes

J Frailty Aging 2017;6(4):202-205

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Muscle Frailty has been previously associated with increased vulnerability for adverse health-related outcomes that could lead to social consequences such as mistreatment. The aim of this cross-sectional study is to determine the association between frailty and mistreatment in 852 community-dwelling persons aged 70 or older. Mistreatment was defined as one positive answer in the Geriatric Mistreatment Scale and frailty was used as a continuum where the greater number of positive criteria according to Fried et al. indicates a higher frailty score. Multivariate logistic regression models were run to establish this association. The mean age of participants was 77.7 years (SD=6.1). Prevalence of frailty phenotype and mistreatment were 13.9% and 20% respectively. Unadjusted analysis showed frailty score was associated with mistreatment (OR = 1.16; 95% CI 1.02 to 1.3, p=0.022). However, after adjustment, the association was no longer present. The results showed that in the presence of other geriatric syndromes such as disability or depression, frailty did not show association with mistreatment in this population.

CITATION:
S.D. Piña-Escudero ; J.M.A. García-Lara ; J.A. Avila-Funes (2017): Frailty is not associated with mistreatment. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.29

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AUGMENTED REALITY: SUSTAINING AUTONOMOUS WAY-FINDING IN THE COMMUNITY FOR OLDER PERSONS WITH COGNITIVE IMPAIRMENT

K. Sejunaite, C. Lanza, S. Ganders, A. Iljaitsch, M.W. Riepe

J Frailty Aging 2017;6(4):206-211

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Background: Impairment of autonomous way-finding subsequent to a multitude of neurodegenerative and other diseases impedes independence of older persons and their everyday activities. Objective: It was the goal to use augmented reality to aid autonomous way-finding in a community setting. Design: A spatial map and directional information were shown via head-up display to guide patients from the start zone on the hospital campus to a bakery in the nearby community. Setting: Hospital campus and nearby community. Participants: Patients with mild cognitive impairment (age 63 to 89). Interventions: A head-up display was used to help patients find their way. Measurements: Time needed to reach goal and number of assists needed. Results: With use of augmented reality device, patients preceded along the correct path in 113 out of 120 intersections. Intermittent reassurance was needed for most patients. Patients affirmed willingness to use such an augmented reality device in everyday life if needed or even pay for it. Conclusion: Augmented reality guided navigation is a promising means to sustain autonomous way-finding as a prerequisite for autonomy of older persons in everyday activities. Thus, this study lays ground for a field trial in the community using assistive technology for older persons with cognitive impairment.

CITATION:
K. Sejunaite ; C. Lanza ; S. Ganders ; A. Iljaitsch ; M.W. Riepe (2017): Augmented reality: sustaining autonomous way-finding in the community for older persons with cognitive impairment . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.25

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MANAGEMENT OF MUSCULOSKELETAL CONDITIONS IN RURAL SOUTH AUSTRALIA: A RANDOMISED CONTROLLED TRIAL

E. Dent, E. Hoon, J. Karnon, A. Kitson, J. Dollard, J. Newbury, G. Harvey, T. Gill, J. Beilby

J Frailty Aging 2017;6(4):212-215

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With age, the prevalence of musculoskeletal conditions increases markedly. This rural-based study determined the benefits of two approaches for managing musculoskeletal conditions: a multiple-component ‘Self-management Plus’ intervention, and usual care. The intervention combined self-management education with physical activity and health professional support. 6-month outcomes included: Clinical Global Impression-Improvement Scale (CGI-IS) and Quality of Life (QoL). A total of 145 people were recruited; mean (SD) age was 66.1 (11.1) and 63.3 (10.9) years for intervention and control groups respectively. The intervention resulted in greater improvements in global functioning (CGI-IS mean (SD) = 3.2 (1.3)) than usual care (CGI-IS mean (SD) = 4.2 (1.5)). There was no difference in QoL improvement between study groups. A multiple-component ‘Self-management Plus’ intervention had a positive effect on physical functioning for older adults with musculoskeletal conditions. However, recruitment and retention of participants was problematic, which raises questions about the intervention’s feasibility in its current form.

CITATION:
E. Dent ; E. Hoon ; J. Karnon ; A. Kitson ; J. Dollard ; J. Newbury ; G. Harvey ; T. Gill ; J. Beilby (2017): Management of Musculoskeletal Conditions in Rural South Australia: a Randomised Controlled Trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.27

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MOBILE APPLICATION REMOVES SOCIETAL BARRIERS TO P4 MEDICINE

J.-P. Michel

J Frailty Aging 2017;6(4):216-218

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The overlap between one innovative paradigm (P4 medicine: predictive, personalized, participatory and preventive) and another (a new definition of “Healthy ageing”) is fertile ground for new technologies; a new mobile application (app) that could broaden our scientific knowledge of the ageing process and help us to better analyse the impact of possible interventions in slowing the ageing decline. A novel mobile application is here presented as a game including questions and tests will allow in 10 minutes the assessment of the following domains: robustness, flexibility (lower muscle strength), balance, mental and memory complaints, semantic memory and visual retention. This game is completed by specific measurements, which could allow establishing precise information on functional and cognitive abilities. A global evaluation precedes advice and different types of exercises. The repetition of the tests and measures will allow a long follow up of the individual performances which could be shared (on specific request) with family members and general practitioners.

CITATION:
J.-P. Michel ; (2017): Mobile application removes societal barriers to P4 medicine. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.43

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FRAILTY EXISTS IN YOUNGER ADULTS ADMITTED AS SURGICAL EMERGENCY LEADING TO ADVERSE OUTCOMES

R. Smart, B. Carter, J. McGovern, S. Luckman, A. Connelly, J. Hewitt, T. Quasim, S. Moug

J Frailty Aging 2017;6(4):219-223

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Background: Frailty is prevalent in the older adult population (≥65 years of age) and results in adverse outcomes in the emergency general surgical population. Objective: To determine whether frailty exists in the younger adult emergency surgical population (<65 years) and what influence frailty may have on patient related outcomes. Design: Prospective observational cohort study. Setting: Emergency general surgical admissions. Participants: All patients ≥40 years divided into 2 groups: younger adults (40-64.9 years) and older adult comparative group (≥65). Measurements: Over a 6-month time frame the following data was collected: demographics; Scottish Index of Multiple Deprivation (SIMD); blood markers; multi-morbidities, polypharmacy and cognition. Frailty was assessed by completion of the Canadian Study of Health and Ageing (CSHA). Each patient was followed up for 90 days to allow determination of length of stay, re-admission and mortality. Results: 82 young adults were included and the prevalence of frailty was 16% (versus older adults 38%; p=0.001) and associated with: multi-morbidity; poly-pharmacy; cognitive impairment; and deprivation. Frailty in older adults was only significantly associated with increasing age. Conclusions: This novel study has found that frailty exists in 16% of younger adults admitted to emergency general surgical units, potentially leading to adverse short and long-term outcomes. Strategies need to be developed that identify and treat frailty in this vulnerable younger adult population.

CITATION:
R. Smart ; B. Carter ; J. McGovern ; S. Luckman ; A. Connelly ; J. Hewitt ; T. Quasim ; S. Moug (2017): Frailty exists in younger adults admitted as surgical emergency leading to adverse outcomes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.28

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MEASURING FRAILTY AMONG OLDER PEOPLE: FURTHER EVALUATION OF THE BRODY FRAILTY INDEX

U. Jakobsson

J Frailty Aging 2017;6(4):224-227

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Background & Objective: The study aimed to evaluate the predictive validity of the Brody self-report frailty index among older people. Design, setting & measurements: A longitudinal cohort study (2-years) conducted in Sweden, which included 1141 respondents, aged 65–103 years. Data were collected during 2011-2013 through a postal questionnaire with questions about demographic data, living conditions, self-reported health, ADL dependency (ADL-staircase) and frailty (the Brody frailty index). Results: The total sample was comprised of 53 percent women and the mean age was 74.5 years (SD 7.0). The mean frailty index score at baseline was 0.12 and increased with higher age (rs= 0.819) as well as with increased ADL dependency (rs = 0.740). The analyses showed high percentage of correctly classified cases (97.1-98.2), high specificity (98.1-98.4) but low sensitivity (22.2-66.7). Conclusion: The self-report frailty index seems to be a valid measure of current frailty, but its predictive validity was found to be non-acceptable especially regarding the instrument’s sensitivity. Such instrument can be useful to predict frailty and allocate resources in the care of older people.

CITATION:
U. Jakobsson (2017): Measuring frailty among older people: further evaluation of the Brody frailty index. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.41

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