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01/2019 journal articles

PREVENTION OF DISABILITY IN THE FRAIL CHINESE OLDER POPULATION

J.K. Chhetri, P. Chan, L. Ma, D. Peng, L. Rodríguez-Mañas, M. Cesari, B. Vellas

J Frailty Aging 2018;8(1):2-6

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As aging is becoming a global phenomenon, the burden of population aging is increasing rapidly, and is soon expected to be the highest in low-and middle-income countries. China represents the world’s largest population, and will face the largest number of older individuals, while the economy still remains developing. There is an urgent need to address the negative consequences of aging such as disability, that creates a myriad of challenges, including financial burden to the economy. In order to achieve successful aging-i.e., aging without being frail or disabled, the traditional healthcare model based on a disease-centered approach is not enough, but require a more holistic course. Here, we briefly outline the current scenario of aging and disability in the Chinese older population, its impact and challenges. We strongly believe that public health initiatives centered on frailty, a clinically distinguishable state of extreme vulnerability in older adults, could be the most relevant approach to meet the current needs of the aging population. Such initiatives are immediately needed to reshape the existing model of geriatric healthcare, to promote healthy aging and to reduce the burden of disability in the Chinese population.

CITATION:
J.K. Chhetri ; P. Chan ; L. Ma ; D. Peng ; L. Rodríguez-Mañas ; M. Cesari ; B. Vellas (2018): PREVENTION OF DISABILITY IN THE FRAIL CHINESE OLDER POPULATION. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.27

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NEUROMUSCULAR CHANGES WITH AGING AND SARCOPENIA

B.C. Clark

J Frailty Aging 2018;8(1):7-9

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Sarcopenia was originally conceptualized as the age-related loss of skeletal muscle mass. Over the ensuing decades, the conceptual definition of sarcopenia has changed to represent a condition in older adults that is characterized by declining muscle mass and function, with “function” most commonly conceived as muscle weakness and/or impaired physical performance (e.g., slow gait speed). Findings over the past 15-years, however, have demonstrated that changes in grip and leg extensor strength are not primarily due to muscle atrophy per se, and that to a large extent, are reflective of declines in the integrity of the nervous system. This article briefly summarizes findings relating to the complex neuromuscular mechanisms that contribute to reductions in muscle function associated with advancing age, and the implications of these findings on the development of effective therapies.

CITATION:
B.C. Clark (2018): Neuromuscular changes with aging and sarcopenia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.35

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THE MANAGEMENT OF GERIATRIC AND FRAIL HIV PATIENTS. A 2017 UPDATE FROM THE ITALIAN GUIDELINES FOR THE USE OF ANTIRETROVIRAL AGENTS AND THE DIAGNOSTIC-CLINICAL MANAGEMENT OF HIV-1 INFECTED PERSONS

G. Guaraldi, S. Marcotullio, R. Maserati, M. Gargiulo, J. Milic, I. Franconi, A. Chirianni, M. Andreoni, M. Galli, A. Lazzarin, A. D’Arminio Monforte, G. Di Perri, C.-F. Perno, M. Puoti, S. Vella, A. Di Biagio, L. Maia, C. Mussi, M. Cesari, A. Antinori

J Frailty Aging 2018;8(1):10-16

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Objective: This article deals with the attempt to join HIV and geriatric care management in the 2017 edition of the Italian guidelines for the use of antiretrovirals and the diagnostic-clinical management of HIV-1 infected persons. Methods: The outlined recommendations are based on evidence from randomized clinical trials and observational studies published in peer-reviewed journals and/or presented at international scientific conferences in recent years. The principles of starting antiretroviral therapy in elderly patients and the viro-immunological goals are the same as in the general HIV population. However, there are some specificities to consider, related to the host as well as the therapy itself. HIV care in elderly patients must shift from a combined AntiRetroviral Therapy specific approach to a more comprehensive management, and from a disease-based model (list of co-morbidities) to a multi-morbidity and frailty standpoint. The implementation of a geriatric approach, based on the Comprehensive Geriatric Assessment, is essential and consists of a broader evaluation of health status. This multidimensional and multidisciplinary evaluation is focused on the development of a tailored intervention plan. Polypharmacy is a frequent condition in the older population and an independent risk factor for negative health-related outcomes. This can be overcome with a multidisciplinary and cooperative approach involving HIV specialists, geriatricians and primary care physicians. Conclusion: The inclusion of geriatric care becomes necessary due to the novel needs of an evolving patient population. It is important to underline that the HIV specialist will continue to lead multidimensional interventions and optimize quality of care for HIV-positive people.

CITATION:
G. Guaraldi ; S. Marcotullio ; R. Maserati ; M. Gargiulo ; J. Milic ; I. Franconi ; A. Chirianni ; M. Andreoni ; M. Galli ; A. Lazzarin ; A. D’Arminio Monforte ; G. Di Perri ; C.-F. Perno ; M. Puoti ; S. Vella ; A. Di Biagio ; L. Maia ; C. Mussi ; M. Cesari ; A. Antinori (2018): The management of geriatric and frail HIV patients. A 2017 update from the Italian guidelines for the use of antiretroviral agents and the diagnostic-clinical management of HIV-1 infected persons. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.42

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HBA1C IS ASSOCIATED WITH FRAILTY IN A GROUP OF ABORIGINAL AUSTRALIANS

Z. Hyde, K. Smith, L. Flicker, D. Atkinson, S. Fenner, L. Skeaf, R. Malay, D. Lo Giudice

J Frailty Aging 2018;8(1):17-20

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In this cross-sectional study of 141 Aboriginal Australians aged ≥45 years living in the remote Kimberley region of Western Australia, we explored whether glycated haemoglobin (HbA1c) levels were associated with frailty. Sixty-four participants (45.4%) had a HbA1c level ≥6.5% and 84 participants (59.6%) were frail. A significant trend was observed with regard to HbA1c levels and frailty, with those having HbA1c levels ≥6.5% having the greatest prevalence of frailty (70.3%). In binary logistic regression analyses, having a HbA1c level ≥6.5% was associated with being frail after adjustment for age, sex, and education. This association was attenuated after further adjustment for body mass index (BMI). Poorer glycaemic control is very common and a potential risk factor for frailty in remote-living Aboriginal Australians, and appears to be partly mediated by BMI, a known risk factor for diabetes mellitus. Obesity and diabetes mellitus are potentially important modifiable risk factors for frailty.

CITATION:
Z. Hyde ; K. Smith ; L. Flicker ; D. Atkinson ; S. Fenner ; L. Skeaf ; R. Malay ; D. Lo Giudice (2018): HbA1c is associated with frailty in a group of Aboriginal Australians. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.41

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A COMPARISON BETWEEN 6-POINT DIXON MRI AND MR SPECTROSCOPY TO QUANTIFY MUSCLE FAT IN THE THIGH OF SUBJECTS WITH SARCOPENIA

A. Grimm, H. Meyer, M.D. Nickel, M. Nittka, E. Raithel, O. Chaudry, A. Friedberger, M. Uder, W. Kemmler, K. Engelke, H.H. Quick

J Frailty Aging 2018;8(1):21-26

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Background: Changes in muscle fat composition as for example observed in sarcopenia, affect physical performance and muscular function, like strength and power. Objectives: The purpose of this study was to compare 6-point Dixon magnetic resonance imaging and multi-echo magnetic resonance spectroscopy sequences to quantify muscle fat. Setting, participants and measurements: Two groups were recruited (G1: 23 healthy young men (28 ± 4 years), G2: 56 men with sarcopenia (80 ± 5 years)). Proton density fat fraction was measured with a 6-point product and a 6-point prototype Dixon sequence in the left thigh muscle and with a high-speed multi-echo T2*-corrected H1 magnetic resonance spectroscopy sequence within the semitendinosus muscle of the left thigh. To evaluate the comparability among the different methods, Bland-Altman and linear regression analyses of the proton density fat fraction results were performed. Results: Mean differences ± 1.96 * standard deviation between spectroscopy and 6pt Dixon sequences were 1.9 ± 3.3% and 1.5 ± 3.6% for the product and prototype sequences, respectively. High correlations were measured between the proton density fat fraction results of the 6-point Dixon sequences and spectroscopy (R = 0.95 for the product sequence and R = 0.97 for the prototype sequence). Conclusions: Dixon imaging and spectroscopy sequences show comparable accuracy for fat measurements in the thigh. Spectroscopy is a local measurement, whereas Dixon sequences provide maps of the fat distribution. The high correlations of the 6-point Dixon sequences with spectroscopy support their clinical use. They provide higher spatial resolution than spectroscopy, but are not suitable for a more complicated spectral analysis to separate extra- and intramyocellular lipids.

CITATION:
A. Grimm ; H. Meyer ; M.D. Nickel ; M. Nittka ; E. Raithel ; O. Chaudry ; A. Friedberger ; M. Uder ; W. Kemmler ; K. Engelke ; H.H. Quick ; (2018): A Comparison between 6-point Dixon MRI and MR Spectroscopy to Quantify Muscle Fat in the Thigh of Subjects with Sarcopenia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.16

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THE ASSOCIATION BETWEEN PHYSICAL ACTIVITY AND METABOLIC SYNDROME IN OLDER ADULTS WITH OBESITY

F. Xu, S.A. Cohen, I.E. Lofgren, G.W. Greene, M.J. Delmonico, M.L. Greaney

J Frailty Aging 2018;8(1):27-32

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Background: Physical activity reduces the likelihood of developing metabolic syndrome (MetS). However, the association between different physical activity levels and MetS remains unclear in older adults with obesity. Methods: This cross-sectional study used four waves of data (2007-2008, 2009-2010, 2011-2012, 2013-2014) from two datasets: The National Health and Nutrition Examination Survey and United Sates Department of Agriculture’s Food Patterns Equivalents Database. The sample included adults 60+ years of age (n= 613) with obesity who had physical activity and MetS data. Physical activity was assessed using the Global Physical Activity Questionnaire and categorized into three physical activity levels (low, medium, and high); and medium or high physical activity levels are aligned with or exceed current physical activity recommendations. Participants were classified as having MetS using a commonly agreed upon definition. Multiple logistic regression models examined the association between the three physical activity levels and MetS risk factors and MetS. All analyses adjusted for potential confounding variables and accounted for complex sampling. Results: Of 613 respondents, 72.1% (n=431) were classified as having MetS, and 44.3% (n = 263) had not met physical activity recommendations. Participants with high levels of physical activity had a lower risk of MetS (OR = 0.31, 95%CI: 0.13, 0.72) and more healthful levels of high-density lipoprotein cholesterol (OR = 0.39, 95%CI: 0.18, 0.84), blood pressure (OR = 0.39, 95%CI: 0.20, 0.77), fasting glucose (OR = 0.34, 95%CI: 0.15, 0.78) than participants categorized as having low physical activity. Conclusions: Physical activity is associated with lower risk of MetS only for participants with the highest level of physical activity, which suggests that physical activity dosage is important to reduce MetS risk in older adults with obesity.

CITATION:
F. Xu ; S.A. Cohen ; I.E. Lofgren ; G.W. Greene ; M.J. Delmonico ; M.L. Greaney (2018): The Association between Physical Activity and Metabolic Syndrome in Older Adults with Obesity. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.34

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NOVEL FRAILTY SCREENING QUESTIONNAIRE (FSQ) PREDICTS 8-YEAR MORTALITY IN OLDER ADULTS IN CHINA

L. Ma, Z. Tang, P. Chan, J.D. Walston

J Frailty Aging 2018;8(1):33-38

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Background: Although frailty status greatly impacts health care in countries with rapidly aging populations, little is known about the frailty status in Chinese older adults. Objectives: Given the increased health care needs associated with frailty, we sought to develop an easily applied self-report screening tool based on four of the syndromic frailty components and sought to validate it in a population of older adults in China. Design: Prospective epidemiological cohort study. Setting: Community-dwelling residents living in Beijing, China. Participants: 1724 community-dwelling adults aged ≥60 years in 2004 with an 8-year follow up. Measurements: We developed a simple self-report frailty screening tool—the Frailty Screening Questionnaire (FSQ)—based on the modified Fried frailty components. The predictive ability for outcome was assessed by age and sex adjusted Cox proportional hazards model. Results: According to FSQ criteria, 7.1% of the participants were frail. Frailty was associated with poor physical function, fractures, falls, and mortality. Both frailty and pre-frailty were associated with a higher mortality rate: frailty—hazards ratio (HR), 3.94, 95% confidence interval (CI), 3.16–4.92, P<0.001; pre-frailty—HR, 1.89; 95% CI, 1.57–2.27, P <0.001; adjusted models for this variable did not affect the estimates of the association. Among the four frailty components, slowness was the strongest predictor of mortality. The combination of the four components provided the best risk prediction. Conclusions: FSQ is a self-report frailty measurement tool that can be rapidly performed to identify older adults with higher risk of adverse health outcomes.

CITATION:
L. Ma ; Z. Tang ; P. Chan ; J.D. Walston (2018): Novel Frailty Screening Questionnaire (FSQ) Predicts 8-year Mortality in Older Adults in China. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.38

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MAXIMUM WALKING SPEED CAN IMPROVE THE DIAGNOSTIC VALUE OF FRAILTY AMONG COMMUNITY-DWELLING OLDER ADULTS A CROSS-SECTIONAL STUDY

M. do Carmo Correia de Lima, T. Loffredo Bilton, W. Jefferson de Sousa Soares, L. Paccini Lustosa, E. Ferriolli, M. Rodrigues Perracini

J Frailty Aging 2018;8(1):39-41

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This study investigates the diagnostic accuracy of the combination of usual walking speed (UWS) and maximum walking speed (MWS) to identify frailty in community-dwelling older adults. A population-based study with 758 participants aged 65 and older was conducted. Frailty syndrome was determined using the Fried phenotype. UWS and MWS were evaluated in a 4.6-meter path. Both measures were categorized using the 1.0 m/s cut points, and participants were categorized into three groups: those with “very good”, “good” and “insufficient” walking reserve capacity (WRC). Of all participants, 9% were identified as frail and 47% as prefrail. The “insufficient” WRC presented a low sensitivity of 0.55, high specificity of 0.91 and moderately useful likelihood ratios (LR+ 6.57, LR- 0.48) to identify frailty. Based on Fagan’s nomogram, an elder’s corresponding post-test probability of being frail with an “insufficient” WRC would be around 40%, which substantially increased the diagnostic accuracy of frailty.

CITATION:
M. do Carmo Correia de Lima ; T. Loffredo Bilton ; W. Jefferson de Sousa Soares ; L. Paccini Lustosa ; E. Ferriolli ; M. Rodrigues Perracini (2018): Maximum walking speed can improve the diagnostic value of frailty among community-dwelling older adults a cross-sectional study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.44

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PSYCHOSOCIOECONOMIC PRECARIOUSNESS AND FRAILTY: THE RESPECTIVE CONTRIBUTION IN PREDICTING MORTALITY

C. Ouvrard, C. Meillon, J.-F. Dartigues, M. Tabue Teguo, J.A. Avila-Funes, H. Amieva

J Frailty Aging 2018;8(1):42-47

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Background: Low socioeconomic status and frailty are factors of vulnerability in old age. They are both well-known risk factors of death. On the other hand, low socioeconomic status has been reported as a predictor of frailty, which questions the relationship between socioeconomic status, frailty and death. Objectives: The aim of this work was to explore the respective contribution of psychosocioeconomic precariousness – which covers socioeconomic status and also psychosocial vulnerability – and frailty in predicting mortality. Design: Prospective population-based study. Setting: Three-City (3C) Bordeaux study, France. Participants: The sample consisted of 1586 subjects aged 65 or older. Measurements: Psychosocioeconomic precariousness was assessed utilizing a structured instrument which assessed poor socioeconomic status, and psychosocial vulnerability. Frailty status was defined by Fried’s phenotype. Results: After 14 years of follow-up, 665 deaths (42%) occurred. Psychosocioeconomic precariousness and frailty had both an independent contribution to mortality prediction (hazard ratio (HR) 1.51 (95% confidence interval (CI) 1.11-2.07)) and (HR 1.68 (95% CI 1.19-2.38)), respectively. Such relationships were adjusted for age, sex, disability, and comorbidities. No interaction term was found between precariousness and frailty. Conclusions: If psychosocioeconomic precariousness and frailty are both aspects of vulnerability in old age, they have a non-overlapping contribution in the prediction of mortality. These findings emphasize the importance of considering both psychosocioeconomic precariousness and frailty when identifying elderly people at risk of death.

CITATION:
C. Ouvrard ; C. Meillon ; J.-F. Dartigues ; M. Tabue Teguo ; J.A. Avila-Funes ; H. Amieva (2018): Psychosocioeconomic precariousness and frailty: the respective contribution in predicting mortality. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.36

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CAN A PREBIOTIC FORMULATION REDUCE FRAILTY LEVELS IN OLDER PEOPLE?

O. Theou, K. Jayanama, J. Fernández-Garrido, C. Buigues, L. Pruimboom, A.J. Hoogland, R. Navarro-Martínez, K. Rockwood, O. Cauli

J Frailty Aging 2018;8(1):48-52

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Objective: The purpose of this study was to examine whether a prebiotic formulation reduces frailty index (FI) levels in older people. Design: We conducted secondary analysis of a placebo-controlled, randomized, double-blind design study. Setting/Participants: The study included non-demented people over the age of 65 who were living in nursing homes and were able to walk. Fifty participants completed the study (75.3±7.3 years, 70% females). Intervention: Participants were randomly assigned to either a group who received daily Darmocare Pre® (inulin and fructooligosaccharides) for 13 weeks or a placebo group (maltodextrin). Measurement: The primary outcome in this secondary analysis was change in level of a 62-item FI compared to baseline. Results: At the 13-week follow-up, the placebo group had higher FI levels (preFI 0.23±0.11, postFI 0.24±0.12, p=0.012) and the intervention group had lower FI levels (preFI 0.22±0.09, postFI 0.20±0.08, p<0.001). There was an average increase of 0.01±0.01 in the FI score in the placebo group (0.4 deficits; Cohen’s d 0.61; standardized response mean 0.59) and an average reduction of 0.02±0.02 in the intervention group (1.1 deficits; Cohen’s d -1.35; standardized response mean -1.16). Among the 28 participants in the intervention group, FI levels were reduced for 25 people; five of them had an FI reduction greater than 0.03. The moderately/severely frail participants (FI >0.3, N=5) had the greatest reduction in their FI (0.04±0.01). Conclusion: A prebiotic intervention can reduce frailty levels in nursing home residents especially in those with higher levels of frailty.

CITATION:
O. Theou ; K. Jayanama ; J. Fernández-Garrido ; C. Buigues ; L. Pruimboom ; A.J. Hoogland ; R. Navarro-Martínez ; K. Rockwood ; O. Cauli (2018): Can a prebiotic formulation reduce frailty levels in older people?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.39

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