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04/2019 journal articles

RELATIONSHIP OF PHYSICAL FRAILTY TO PHOSPHOCREATINE RECOVERY IN MUSCLE AFTER MILD EXERCISE STRESS IN THE OLDEST-OLD WOMEN

R. Varadhan, D.W. Russ, R.E. Gabr, J. Huang, R.R. Kalyani, Q.-L. Xue, A.R. Cappola, K.Bandeen-Roche, L.P. Fried

J Frailty Aging 2019;8(4)162-168

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Background: Physical frailty is a clinical syndrome associated with aging and manifesting as slowness, weakness, reduced physical activity, weight loss, and/or exhaustion. Frail older adults often report that their major problem is “low energy”, and there is indirect evidence to support the hypothesis that frailty is a syndrome of dysregulated energetics. We hypothesized that altered cellular energy production underlies compromised response to stressors in the frail. Methods: We conducted a pilot study to assess muscle energetics in response to a mild isometric exercise challenge in women (n=30) ages 84-93 years. The frailty status was assessed by a validated physical frailty instrument. Localized phosphorus (P31) magnetic resonance spectroscopy with a 1.5T magnet was used to assess the kinetics of Phosphocreatine recovery in the tibialis anterior muscle following maximal isometric contraction for 30 seconds. Results: Phosphocreatine recovery following exertion, age-adjusted, was slowest in the frail group (mean=189 sec; 95%CI: 150,228) compared to pre-frail (mean=152 sec; 95%CI: 107,197) and nonfrail subjects (mean=132 sec; 95%CI: 40,224). The pre-frail and frail groups had 20 sec (95%CI: -49,89) and 57 sec (95%CI: -31,147) slower phosphocreatine recovery, respectively, than the non-frail. This response was paralleled by dysregulation in glucose recovery in response to oral glucose tolerance test in women from the same study population. Conclusions: Impaired muscle energetics and energy metabolism might be implicated in the physical frailty syndrome.

CITATION:
R. Varadhan ; D.W. Russ ; R.E. Gabr ; J. Huang ; R.R. Kalyani ; Q.-L. Xue ; A.R. Cappola ; K.Bandeen-Roche ; L.P. Fried (2019): Relationship of physical frailty to phosphocreatine recovery in muscle after mild exercise stress in the oldest-old women. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.21

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FRAILTY AND THE METABOLIC SYNDROME – RESULTS OF THE BERLIN AGING STUDY II (BASE-II)

N. Buchmann, D. Spira, M. König, I. Demuth, E. Steinhagen-Thiessen

J Frailty Aging 2019;8(4)169-175

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Background: Frailty and the metabolic Syndrome (MetS) are frequently found in old subjects and have been associated with increased risk of functional decline and dependency. Moreover, central characteristics of the MetS like inflammation, obesity and insulin resistance have been associated with the frailty syndrome. However, the relationship between MetS and frailty has not yet been studied in detail. Aim of the current analysis within the Berlin Aging Study II (BASE-II) was to explore associations between MetS and frailty taking important co-variables such as nutrition (total energy intake, dietary vitamin D intake), physical activity and vitamin D-status into account. Methods: Complete cross-sectional data of 1,486 old participants (50.2% women, 68.7 (65.8-71.3) years) of BASE-II were analyzed. MetS was defined following the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity in 2009. Frailty was defined according to the Fried criteria. Limitations in physical performance were assessed via questionnaire, muscle mass was measured using dual energy X-ray absorptiometry (DXA) and grip strength using a Smedley dynamometer. Adjusted regression models were calculated to assess the association between MetS and Frailty. Results: MetS was prevalent in 37.6% of the study population and 31.9% were frail or prefrail according to the here calculated frailty index. In adjusted models the odds of being frail/prefrail were increased about 50% with presence of the MetS (OR1.5; 95% CI 1.2,1.9; p= 0.002). Moreover the odds of being prefrail/frail were significantly increased with low HDL-C (OR: 1.5 (95%CI: 1.0-2.3); p = 0.037); and elevated waist circumference (OR: 1.65 (95%CI: 1.1-2.3); p = 0.008). Conclusion: The current analysis supports an association between MetS and frailty. There are various metabolic, immune and endocrine alterations in MetS that also play a role in mechanisms underlying the frailty syndrome. To what extent cytokine alterations, inflammatory processes, vitamin D supply and hormonal changes in age and in special metabolic states as MetS influence the development of frailty should be subject of further research.

CITATION:
N. Buchmann ; D. Spira ; M. König ; I. Demuth ; E. Steinhagen-Thiessen (2019): Frailty and the Metabolic Syndrome – Results of the Berlin Aging Study II (BASE-II). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.15

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DISCORDANCE ABOUT FRAILTY DIAGNOSIS BETWEEN SURROGATES AND PHYSICIANS AND ITS RELATIONSHIP TO HOSPITAL MORTALITY IN CRITICALLY ILL OLDER ADULTS

A.A. Hope, M. Ng Gong

J Frailty Aging 2019;8(4)176-179

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The preponderance of studies on frailty assessment in critically ill adults have used the Clinical Frailty Scale (CFS) to quantify frailty and previous research suggests that surrogates were more likely to be optimistic than physicians in their CFS scores. Whether discordance between surrogates and physicians was relevant to prognosis has been underexplored. Therefore, in a prospective observational cohort of 298 critically ill older adults, we aimed 1) to describe factors related to discordance and 2) to estimate the relationship between such discordance and hospital mortality and other short-term outcomes. Discordance between surrogates and physician was present in 89/298 (29.9%) and independently associated with a higher risk of hospital mortality. Discordance was not associated with markers of intensity of treatment such as intubation, blood transfusion, incident dialysis for acute renal failure and prolonged hospital length of stay. Understanding factors relevant to discordance between physicians and surrogates may lend further insights into short-term prognosis for older adults with critical illness.

CITATION:
A.A. Hope ; M. Ng Gong (2019): Discordance about Frailty Diagnosis between Surrogates and Physicians and its relationship to Hospital Mortality in Critically Ill Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.20

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CAN THE COMBINED USE OF TWO SCREENING INSTRUMENTS IMPROVE THE PREDICTIVE POWER OF DEPENDENCY IN (INSTRUMENTAL) ACTIVITIES OF DAILY LIVING, MORTALITY AND HOSPITALIZATION IN OLD AGE?

L.P.M. Op het Veld, E. van Rossum, G.I.J.M. Kempen, A.J.H.M. Beurskens, K.J. Hajema, H.C.W. de Vet

J Frailty Aging 2019;8(4)180-185

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Background: Due to differences in the definition of frailty, many different screening instruments have been developed. However, the predictive validity of these instruments among community-dwelling older people remains uncertain. Objective: To investigate whether combined (i.e. sequential or parallel) use of available frailty instruments improves the predictive power of dependency in (instrumental) activities of daily living ((I)ADL), mortality and hospitalization. Design, setting and participants: A prospective cohort study with two-year follow-up was conducted among pre-frail and frail community-dwelling older people in the Netherlands. Measurements: Four combinations of two highly specific frailty instruments (Frailty Phenotype, Frailty Index) and two highly sensitive instruments (Tilburg Frailty Indicator, Groningen Frailty Indicator) were investigated. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for all single instruments as well as for the four combinations, sequential and parallel. Results: 2,420 individuals participated (mean age 76.3 ± 6.6 years, 60.5% female) in our study. Sequential use increased the levels of specificity, as expected, whereas the PPV hardly increased. Parallel use increased the levels of sensitivity, although the NPV hardly increased. Conclusions: Applying two frailty instruments sequential or parallel might not be a solution for achieving better predictions of frailty in community-dwelling older people. Our results show that the combination of different screening instruments does not improve predictive validity. However, as this is one of the first studies to investigate the combined use of screening instruments, we recommend further exploration of other combinations of instruments among other study populations.

CITATION:
L.P.M. Op het Veld ; E. van Rossum ; G.I.J.M. Kempen ; A.J.H.M. Beurskens ; K.J. Hajema ; H.C.W. de Vet (2019): Can the combined use of two screening instruments improve the predictive power of dependency in (instrumental) activities of daily living, mortality and hospitalization in old age?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.17

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DEVELOPMENT OF SIMPLE, OBJECTIVE CHAIR-STANDING ASSESSMENT OF PHYSICAL FUNCTION IN OLDER INDIVIDUALS USING A KINECTTM SENSOR

N. Takeshima, T. Kohama, M. Kusunoki, E. Fujita, S. Okada, Y. Kato, K. Kofuku, M.M. Islam, W.F. Brechue

J Frailty Aging 2019;8(4)186-191

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Background: With increasing interest in addressing quality of life of older individuals, tests such as the Functional Independence Measure (FIM) are widely used measures of infirmity and burden of care. However, these scales are largely qualitative and especially problematic when assessing movement-based tasks. While effective, reliable analysis of human movement is technically complicated and expensive; an infrared depth sensor is potentially a low-cost, portable devise which may provide a quantitative aspect to clinical testing. Objective: to assess the utility of the KinectTM sensor in providing an objective evaluation of human movement using an oft measured ADL (chair stand). Design: Cross-sectional study. Setting: Community, geriatric day-care center in Japan. Participants: Men (n=136) and women (n=266) between 50 and 93 years of age, consisting of healthy (HE; n=312) and physically frail (FR; n= 90) individuals. Measurements: Subjects completed two trials of the chair stand, conducted without assistance. Trials were timed and recorded with KinectTM v2. Coronal plane angle (CPA) was determined by a line transecting the shoulder-center and waist relative to the vertical axis and was used to assess quality of the chair stand movement pattern. Results: Age, height, and body mass were not different between groups. CPA was significantly greater in FR (29.3 ± 8.3°) than HE (19.5 ± 6.5°). CPA and age were significantly related (r=0.148, p<0.01). An optimal threshold for CPA identifying frailty was determined by a receiver-operator characteristic curve with a CPA of 23.1° providing the greatest combination of sensitivity (79%) and specificity (73%). Conclusion: During the chair stand, frail older adults adopted a forward lean position (increased CPA) compared to healthy older adults. This compensatory posture appears to facilitate torso rotation while reducing lower-limb muscular effort during standing. As such, CPA serves as an indicator of reduced lower-body function in older, frail adults.

CITATION:
N. Takeshima ; T. Kohama ; M. Kusunoki ; E. Fujita ; S. Okada ; Y. Kato ; K. Kofuku ; M.M. Islam ; W.F. Brechue (2019): Development of simple, objective chair-standing assessment of physical function in older individuals using a KinectTM sensor. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.23

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THE RELATIONSHIP BETWEEN PHYSICAL FRAILTY AND MILD COGNITIVE IMPAIRMENT IN THE ELDERLY: A SYSTEMATIC REVIEW

M. Kiiti Borges, N. Oiring de Castro Cezar, A. Silva Santos Siqueira, M. Yassuda, M. Cesari, I. Aprahamian

J Frailty Aging 2019;8(4)192-197

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Introduction: Physical frailty (PF) appears to be associated with low cognitive performance and mild cognitive impairment (MCI). This review evaluated and synthesized the evidence of studies investigating the association between PF and MCI, the prevalence of both conditions and the rate of conversion of healthy older adult to one of them during the follow-up. Methods: A systematic review was performed according to the PRISMA recommendations in the Pubmed, SciELO and LILACS databases. Five studies were eligible according to inclusion and exclusion criteria. Results: Regarding the study design, cross-sectional studies prevailed. Most studies showed a positive association between PF and MCI. Moreover, PF seems to predict a worse cognitive trajectory among participants with MCI and it is associated to a higher risk of developing MCI. Conclusion: Our findings suggest a significant association between PF and MCI. Further longitudinal studies are needed to better explore causality.

CITATION:
M. Kiiti Borges ; N. Oiring de Castro Cezar ; A. Silva Santos Siqueira ; M. Yassuda ; M. Cesari ; I. Aprahamian (2019): The relationship between physical frailty and mild cognitive impairment in the elderly: a systematic review. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.29

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LIVING WITH FAMILY YET EATING ALONE IS ASSOCIATED WITH FRAILTY IN COMMUNITY-DWELLING OLDER ADULTS: THE KASHIWA STUDY

U. Suthutvoravut, T. Tanaka, K. Takahashi, M. Akishita, K. Iijima

J Frailty Aging 2019;8(4)198-204

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Objectives: Eating alone is related to depression, nutritional risk, and mortality. These effects are also influenced by living status. However, little is known about the relationship between eating alone despite living with family and frailty. This study explores the relationship of eating alone and living status with frailty in community-dwelling older adults. Design: Cross-sectional study. Setting and Participants: Kashiwa city, Chiba prefecture, Japan; randomly selected community-dwelling older adults (aged 65 years and over). Measurements: Eating status was assessed by the question, “Do you eat meals with anyone, at least once a day: yes or no?” Frailty was defined by Kihon Checklist (KCL) score 8 or over. Domains of frailty were divided into instrumental activities of daily living (IADL), physical strength, nutrition, eating, socialization, memory, and mood, based on KCL categories. Binary logistic regression analysis was used, adjusting for age, years of education, chronic diseases, number of teeth and cognitive function. Results: Among the total of 1,914 participants, 49.8% were male, and the overall mean age was 72.9 ± 5.5 years. Of all participants, 56 (5.9%) of men and 112 (11.7%) of women were frail. Older adults who ate alone despite living with others were more likely to be frail (OR 2.49, 95%CI 1.1–5.5 for men and OR 2.16, 95%CI 1.0–4.5 for women). Of particular note, eating and living status were associated with lower physical strength and mood in men, whereas in women these statuses were associated with lower scores for IADL, socialization, memory, and mood. Conclusions: Eating alone despite living with others was associated with high frailty in both genders; however, the pathways were different between genders. These results might help yield a simple, fundamental intervention approach to multifaceted frailty, reflecting gender and associated high-risk domains.

CITATION:
U. Suthutvoravut ; T. Tanaka ; K. Takahashi ; M. Akishita ; K. Iijima (2019): Living with Family yet Eating Alone is Associated with Frailty in Community-Dwelling Older Adults: The Kashiwa Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.22

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AN INDIVIDUALIZED LOW-INTENSITY WALKING CLINIC LEADS TO IMPROVEMENT IN FRAILTY CHARACTERISTICS IN OLDER VETERANS

S.E. Espinoza, B. Orsak, C.-P. Wang, D. MacCarthy, D. Kellogg, B. Powers, A. Conde, M. Moris, P.R. Padala, K.P. Padala

J Frailty Aging 2019;8(4)205-209

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Background: Sedentary lifestyle leads to worse health outcomes with aging, including frailty. Older adults can benefit from regular physical activity, but exercise promotion in the clinical setting is challenging. Objectives: The objective of this clinical demonstration project was to implement a Geriatric Walking Clinic for older adults and determine whether this clinical program can lead to improvements in characteristics of frailty. Design: This was a clinical demonstration project/quality improvement project. Setting: Outpatient geriatrics clinic at the South Texas Veterans Health Care System (STVHCS). Participants: Older Veterans, aged ≥60 years. Intervention: A 6-week structured walking program, delivered by a registered nurse and geriatrician. Patients received a pedometer and a comprehensive safety evaluation at an initial face-to-face visit. They were subsequently followed with weekly phone calls and participated in a final face-to-face follow-up visit at 6 weeks. Measurements: Grip strength (handheld dynamometer), gait speed (10-ft walk), Timed Up and Go (TUG), and body mass index (BMI) were assessed at baseline and follow-up. Frailty status for gait speed was assessed using Fried criteria. Results: One hundred eighty five patients completed the program (mean age: 68.4 ±7 years, 88% male). Improvements from baseline to follow-up were observed in average steps/day, gait speed, TUG, and BMI. Improvement in gait speed (1.13 ±0.20 vs. 1.24 ± 0.23 meter/second, p<0.0001) resulted in reduced odds of meeting frailty criteria for slow gait at follow-up compared to the baseline examination (odds ratio = 0.31, 95% confidence interval: 0.13-0.72, p = 0.01). Conclusions: Our findings demonstrate that a short duration, low-intensity walking intervention improves gait speed and TUG. This new clinical model may be useful for the promotion of physical activity, and for the prevention or amelioration of frailty characteristics in older adults.

CITATION:
S.E. Espinoza ; B. Orsak ; C.-p. Wang ; D. MacCarthy ; D. Kellogg ; B. Powers ; A. Conde ; M. Moris ; P.R. Padala ; K.P. Padala (2019): An Individualized Low-Intensity Walking Clinic Leads to Improvement in Frailty Characteristics in Older Veterans. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.16

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A QUALITATIVE INVESTIGATION OF THE IMPACT OF HOME-BASED PRIMARY CARE ON FAMILY CAREGIVERS

E. Wool, J.L. Shotwell, J. Slaboda, A. Kozikowski, K.L. Smith, K. Abrashkin, K.V. Rhodes, G.J. Norman, R. Pekmezaris

J Frailty Aging 2019;8(4)210-214

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Background: Home-based primary care (HBPC) provides team-based clinical care for homebound patients who have difficulty accessing typical outpatient care. Interdisciplinary team members also provide social and emotional support and serve as a resource for family caregivers, who often experience significant emotional stress. Objectives: This qualitative study explores the impact of HBPC on family caregivers to identify aspects of the program that caregivers find most helpful and meaningful as well as areas for improvement. Design: Semi structured recorded interviews were conducted with family caregivers of frail, elderly homebound patients. Interviews included the following topics: overall program satisfaction and suggestions for improvement. Setting: A HBPC program serving patients in Queens, Nassau and Suffolk counties in New York. Participants: Nineteen family caregivers: 13 women, 6 men; 10 were adult children; 6 were spouses, and 3 were other family members of patients in a HBPC program. Measurements: Thematic coding of all recorded transcribed interviews was prepared by 3 qualitative coders. Interrater reliability was conducted to ensure reliability across coders before themes were disseminated and discussed until consensus was achieved with the larger group of investigators. Results: Three main themes were identified: the importance of staff emotional support; the burden of caring for homebound patients; and the need for a broader range of home-based services. Multiple family members noted that the program not only had saved their loved one’s life, but had also metaphorically saved their own. Conclusions: Family caregivers value the communication and accessibility of HBPC and report that the program has a positive impact on their stress and mental health. Results can inform key aspects that need to be retained or enhanced with the expansion in HBPC programs.

CITATION:
E. Wool ; J.L. Shotwell ; J. Slaboda ; A. Kozikowski ; K.L. Smith ; K. Abrashkin ; K.V. Rhodes ; G.J. Norman ; R. Pekmezaris (2019): A Qualitative Investigation of the Impact of Home-Based Primary Care on Family Caregivers. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.19

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COMPARISON OF FRAILTY SCORES IN NEWLY DIAGNOSED PATIENTS WITH MULTIPLE MYELOMA: A REVIEW

H. Mian, M. Brouwers, C.T. Kouroukis, T.M. Wildes

J Frailty Aging 2019;8(4)215-221

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Multiple myeloma is a malignant plasma cell disease, which typically affects older patients, with a median age at diagnosis of 70 years. The challenge in treating older patients is to accurately identify ‘fit’ patients that can tolerate more intensive treatment to maximize disease control, while simultaneously identifying vulnerable or ‘frail’ patients who may develop toxicity with significant morbidity and mortality, requiring different treatment options or dose modification. Multiple frailty scores have been devised for multiple myeloma over the years in newly-diagnosed patients. This paper gives an overview of the three common frailty measurements: the International Myeloma Working Group Frailty Score, Mayo Clinic Frailty Score and the Revised Myeloma Co-Morbidity Index. We will summarize the derivation, validation, usability and applicability of these scores in different clinical settings, emphasizing the main strengths and limitations for each index score. We will also highlight future directions in the operationalization of frailty in multiple myeloma.

CITATION:
H. Mian ; M. Brouwers ; C.T. Kouroukis ; T.M. Wildes (2019): Comparison of Frailty Scores in Newly Diagnosed Patients with Multiple Myeloma: A Review. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.25

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DRUG-INDUCED HYPONATREMIA: NSAIDS, A NEGLECTED CAUSE THAT SHOULD BE CONSIDERED

S. Damanti, L. Pasina, D. Consonni, D. Azzolino, M. Cesari

J Frailty Aging 2019;8(4)222-223

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Hyponatremia is the most common electrolyte disorder. It may have serious consequences in asyntomatic patients with a mild disease. Therefore, an evaluation of unsual causes is of paramount importance. Polypharmacy is highly prevalent in older people and many drugs can cause hyponatremia as a collateral effect. In our retrospective analysis of geriatric medical records dated 2015 we found that 39 out of the 273 hospitalized patients had hyponatremia. Polipharmacy was highly prevalent, especially in hyponatremic patients. Non-steroidal anti-inflammatory drugs, which are seldom considered as a cause of hyponatremia were instead found to be associated to an increased risk of the disorder (adjustedOR 3.61, 95% CI 1 – 12.99, p = 0.05). In-hospital mortality was higher in patients with moderate or severe hyponatremia at hospital admission. Our study underlines the importance of considering rare but potentially reversible causes of hyponatremia, which can lead to serious consequences.

CITATION:
S. Damanti ; L. Pasina ; D. Consonni ; D. Azzolino ; M. Cesari (2019): Drug-induced hyponatremia: NSAIDs, a neglected cause that should be considered. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.18

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