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A NOVEL TOOL FOR THE EARLY IDENTIFICATION OF FRAILTY IN ELDERLY PEOPLE: THE APPLICATION IN PRIMARY CARE SETTINGS

M. Maggio, M. Barbolini, Y. Longobucco , L. Barbieri, C. Benedetti, F. Bono, I. Cacciapuoti, A. Donatini, E. Lezzi, D. Papini, P.M. Rodelli , S. Tagliaferri, M.L. Moro

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Objectives: Frailty is a pre-disability condition in older persons providing a challenge to Health-Care Systems. Systematic reviews highlight the absence of a gold-standard for its identification. However, an approach based on initial screening by the General Practitioner (GP) seems particularly useful. On these premises, a 9-item Sunfrail Checklist (SC), was developed by a multidisciplinary group, in the context of European Sunfrail Project, and tested in the Community. Objectives: - to measure the concordance between the judgments of frailty (criterion-validity): the one formulated by the GP, using the SC, and the one subsequently expressed by a Comprehensive Geriatric Assessment Team (CGA-Team); - to determine the construct-validity through the correspondence between some checklist items related to the 3 domains (physical, cognitive and social) and the three tools used by the CGA-Team; - to measure the instrument’s performance in terms of positive predictive value (PPV) and negative predictive value (NPV). Design: Cross-sectional study, with a final sample-size of 95 subjects. Setting: Two Community-Health Centers of Parma, Italy. Participants: Subjects aged 75 years old or more, with no disability and living in the community. Measurements: We compared the screening capacity of the GP using the SC to that one of CGA-Team based on three tests: 4-meter Gait-Speed, Mini-Mental State Examination and Loneliness Scale. Results: 95 subjects (51 women), with a mean age of 81±4 years were enrolled. According to GPs 34 subjects were frail; the CGA-Team expressed a frailty judgment on 26 subjects. The criterion-validity presented a Cohen’s k of 0.353. Construct-validity was also low, with a maximum contingency-coefficient of 0.19. The analysis showed a PPV of 58.1% and a NPV equal to 84.6%. Conclusions: Our data showed a low agreement between the judgements of GP performed by SC and CGA-Team. However, the good NPV suggests the applicability of SC for screening activities in primary-care.

CITATION:
M. Maggio ; M. Barbolini ; Y. Longobucco ; L. Barbieri ; C. Benedetti ; F. Bono ; I. Cacciapuoti ; A. Donatini ; E. Iezzi ; D. Papini ; P.M. Rodelli ; S. Tagliaferri ; M.L. Moro (2019): A novel tool for the early identification of frailty in elderly people: the application in Primary Care Settings. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.41

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CONTRIBUTION OF PROTEIN INTAKE AND CONCURRENT EXERCISE TO SKELETAL MUSCLE QUALITY WITH AGING

N.D. Dicks, C.J. Kotarsky, K.A. Trautman, A.M. Barry, J.F. Keith, S. Mitchell, W. Byun, S.N. Stastny, K.J. Hackney

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Background: The use of magnetic resonance imaging (MRI) derived functional cross-sectional area (FCSA) and intramuscular adipose tissue (IMAT) to define skeletal muscle quality is of fundamental importance in order to understand aging and inactivity-related loss of muscle mass. Objectives: This study examined factors associated with lower-extremity skeletal muscle quality in healthy, younger, and middle-aged adults. Design: Cross-sectional study. Setting and Participants: Ninety-eight participants (53% female) were classified as younger (20-35 years, n=50) or middle-aged (50-65 years, n=48) as well as sedentary (≤1 day per week) or active (≥3 days per week) on self-reported concurrent exercise (aerobic and resistance). Measurements: All participants wore an accelerometer for seven days, recorded a three-day food diary, and participated in magnetic resonance imaging (MRI) of the lower limbs. Muscle cross-sectional area (CSA) was determined by tracing the knee extensors (KE) and plantar flexors, while muscle quality was established through the determination of FCSA and IMAT via color thresholding. Results: One-way analysis of variance and stepwise regression models were performed to predict FCSA and IMAT. KE-IMAT (cm2) was significantly higher among sedentary (3.74 ± 1.93) vs. active (1.85 ± 0.56) and middle-aged (3.14 ± 2.05) vs. younger (2.74 ± 1.25) (p < 0.05). Protein intake (g•kg•day-1) was significantly higher in active (1.63 ± 0.55) vs. sedentary (1.19 ± 0.40) (p < 0.05). Sex, age, concurrent exercise training status, and protein intake were significant predictors of KE FCSA (R2 = 0.71, p < 0.01), while concurrent exercise training status and light physical activity predicted 33% of the variance in KE IMAT (p < 0.01). Conclusion: Concurrent exercise training, dietary protein intake, and light physical activity are significant determinants of skeletal muscle health and require further investigation to mitigate aging and inactivity-related loss of muscle quality.

CITATION:
N.D. Dicks ; C.J. Kotarsky ; K.A. Trautman ; A.M. Barry ; J.F. Keith ; S. Mitchell ; W. Byun ; S.N. Stastny ; K.J. Hackney (2019): Contribution of Protein Intake and Concurrent Exercise to Skeletal Muscle Quality with Aging. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.40

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THE SUSTAINED IMPACT OF A MEDICAL SCHOOL-BASED PHYSICAL ACTIVITY MODULE ON INTERNS’ PERCEIVED COMPETENCE IN ADVISING OLDER ADULTS ABOUT EXERCISE

A.D. Jadczak, R. Visvanathan

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The study aimed to examine the sustained impact of a 1.5-hour medical school-based physical activity (PA) module on interns’ perceived competence and importance in advising older adults about exercise. The modified Exercise and Physical Activity Competence Questionnaire (EPACQ) was administered in 2017 (CG: control group) and 2018 (IG: intervention group) two years post-course. The perceived competence of both, CG (n=23) and IG (n=18), decreased significantly over two years (p≤0.05) with no difference between the groups (p>0.05). However, 72.2% (n=13) of the interns who attended the PA module still felt competent in advising older adults about exercise (4.21±0.66) compared to 47.8% (n=11) of the CG (3.89±0.67). The perceived importance decreased significantly in both groups (p≤0.05) with no difference between the groups (p>0.05). However, both groups still perceived exercise for older people as important (CG:4.55±0.61; IG:4.83±0.47). Subsequently, continued professional development is likely to be a key requirement for ensuring sustainability over time.

CITATION:
A.D. Jadczak ; R. Visvanathan (2019): The sustained impact of a medical school-based physical activity module on interns’ perceived competence in advising older adults about exercise. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.39

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ASSOCIATION BETWEEN THE USE OF ANGIOTENSIN-BLOCKING MEDICATIONS WITH HIP FRACTURE AND DEATH IN OLDER PEOPLE

C. Shea, M.D. Witham

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ASSOCIATION BETWEEN THE USE OF ANGIOTENSIN-BLOCKING MEDICATIONS WITH HIP FRACTURE AND DEATH IN OLDER PEOPLE

C. Shea, M.D. Witham

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It is unclear if angiotensin blocking drugs (angiotensin converting enzyme inhibitors and angiotensin receptor blockers) reduce or increase the risk of falls and fractures. We retrospectively analysed routinely-collected, linked health and social care data for patients aged 65 and over from Tayside, Scotland, including hospital discharge diagnoses, biochemistry, deaths, care package provision and community prescribing. We conducted unadjusted and adjusted Cox regression analyses for time to hip fracture and time to death, for any exposure to angiotensin blocking drugs and for time-dependent exposure to angiotensin blocking drugs. We analysed data on 16782 patients. Angiotensin blocking drug use was associated with an exposure-dependent lower risk of hip fracture (hazard ratio 0.988 [95%CI 0.982-0.994] per year of exposure; p<0.001) and death (hazard ratio 0.986 [95%CI 0.983-0.989] per year of exposure; p<0.001). These findings call into question the appropriateness of stopping angiotensin blocking drugs for older people at risk of falls.

CITATION:
C. Shea ; M.D. Witham (2019): Association between the use of angiotensin-blocking medications with hip fracture and death in older people. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.38

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ASSOCIATION BETWEEN THE USE OF ANGIOTENSIN-BLOCKING MEDICATIONS WITH HIP FRACTURE AND DEATH IN OLDER PEOPLE

C. Shea, M.D. Witham

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ASSOCIATION BETWEEN THE USE OF ANGIOTENSIN-BLOCKING MEDICATIONS WITH HIP FRACTURE AND DEATH IN OLDER PEOPLE

C. Shea, M.D. Witham

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It is unclear if angiotensin blocking drugs (angiotensin converting enzyme inhibitors and angiotensin receptor blockers) reduce or increase the risk of falls and fractures. We retrospectively analysed routinely-collected, linked health and social care data for patients aged 65 and over from Tayside, Scotland, including hospital discharge diagnoses, biochemistry, deaths, care package provision and community prescribing. We conducted unadjusted and adjusted Cox regression analyses for time to hip fracture and time to death, for any exposure to angiotensin blocking drugs and for time-dependent exposure to angiotensin blocking drugs. We analysed data on 16782 patients. Angiotensin blocking drug use was associated with an exposure-dependent lower risk of hip fracture (hazard ratio 0.988 [95%CI 0.982-0.994] per year of exposure; p<0.001) and death (hazard ratio 0.986 [95%CI 0.983-0.989] per year of exposure; p<0.001). These findings call into question the appropriateness of stopping angiotensin blocking drugs for older people at risk of falls.

CITATION:
C. Shea ; M.D. Witham (2019): Association between the use of angiotensin-blocking medications with hip fracture and death in older people. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.38

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THE INFLUENCE OF LIFESTYLE BEHAVIORS ON THE INCIDENCE OF FRAILTY

M.G. Borda, M.U. Pérez-Zepeda, R. Samper-Ternent, R.C. Gomez, J.A. Avila-Funes, C.A. Cano-Gutierrez

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Background: Frailty is a clinical state defined as an increase in an individual’s vulnerability to developing adverse health-related outcomes. Objectives: We propose that healthy behaviors could lower the incidence of frailty. The aim is to describe the association between healthy behaviors (physical activity, vaccination, tobacco use, and cancer screening) and the incidence of frailty. Design: This is a secondary longitudinal analysis of the Mexican Health and Aging Study (MHAS) cohort. Setting: MHAS is a population-based cohort, of community-dwelling Mexican older adults. With five assessments currently available, for purposes of this work, 2012 and 2015 waves were used. Participants: A total of 6,087 individuals 50-year or older were included. Measurements: Frailty was defined using a 39-item frailty index. Healthy behaviors were assessed with questions available in MHAS. Individuals without frailty in 2012 were followed-up three years in order to determine their frailty incidence, and its association with healthy behaviors. Multivariate logistic regression models were used to assess the odds of frailty occurring according to the four health-related behaviors mentioned above. Results: At baseline (2012), 55.2% of the subjects were male, the mean age was 62.2 (SD ± 8.5) years old. The overall incidence (2015) of frailty was 37.8%. Older adults physically active had a lower incidence of frailty (48.9% vs. 42.2%, p< 0.0001). Of the activities assessed in the adjusted multivariate models, physical activity was the only variable that was independently associated with a lower risk of frailty (odds ratio: 0.79, 95% confidence interval 0.71-0.88, p< 0.001). Conclusions: Physically active older adults had a lower 3-year incidence of frailty even after adjusting for confounding variables. Increasing physical activity could therefore represent a strategy for reducing the incidence of frailty. Other so-called healthy behaviors were not associated with incident frailty, however there is still uncertainty on the interpretation of those results.

CITATION:
M.G. Borda ; M.U. Pérez-Zepeda ; R. Samper-Ternent ; R.C. Gomez ; J.A. Avila-Funes ; C.A. Cano-Gutierrez (2019): THE INFLUENCE OF LIFESTYLE BEHAVIORS ON THE INCIDENCE OF FRAILTY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.37

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IMPACT OF FAT-FREE ADIPOSE TISSUE ON THE PREVALENCE OF LOW MUSCLE MASS ESTIMATED USING CALF CIRCUMFERENCE IN MIDDLE-AGED AND OLDER ADULTS

T. Abe, S.J. Dankel, Z.W. Bell, E. Fujita, Y. Yaginuma, T. Akamine, R.W. Spitz, V. Wong, R.B. Viana, J.P. Loenneke

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Previous studies proposed calf circumference cutoff values for predicting dual-energy X-ray absorptiometry (DXA)-derived low muscle mass. However, DXA-derived appendicular lean mass (aLM) includes non-skeletal muscle components such as the appendicular fat-free component of adipose tissue fat cells (aFFAT). The purpose of this study was to compare the calf circumference method of classification before (Model #1) and after (Model #2) eliminating the influence of FFAT in healthy Japanese adults (50 to 79 years; mean age 70 (SD 7) years). Model 1, and Model 2 for classifying low muscle mass had a sensitivity of 78% and 64%, specificity of 76% and 75%, positive predictive value of 31% and 28%, and negative predictive value of 96% and 93%, respectively. Appendicular fat-free component of adipose tissue has the potential to influence the ability of calf circumference to accurately classify individuals with low muscle mass. Consideration should be made when using this as a screening tool for low muscle mass.

CITATION:
T. Abe ; S.J. Dankel ; Z.W. Bell ; E. Fujita ; Y. Yaginuma ; T. Akamine ; R.W. Spitz ; V. Wong ; R.B. Viana ; J.P. Loenneke (2019): Impact of fat-free adipose tissue on the prevalence of low muscle mass estimated using calf circumference in middle-aged and older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.34

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CLINICALLY MEANINGFUL CHANGE FOR PHYSICAL PERFORMANCE: PERSPECTIVES OF THE ICFSR TASK FORCE

J. Guralnik, K. Bandeen-Roche, S.A.R. Bhasin, S. Eremenco, F. Landi, J. Muscedere, S. Perera, J.-Y. Reginster, L. Woodhouse, B. Vellas, and the ICFSR Task Force

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For clinical studies of sarcopenia and frailty, clinically meaningful outcome measures are needed to monitor disease progression, evaluate efficacy of interventions, and plan clinical trials. Physical performance measures including measures of gait speed and other aspects of mobility and strength have been used in many studies, although a definition of clinically meaningful change in performance has remained unclear. The International Conference on Frailty and Sarcopenia Research Task Force (ICFSR-TF), a group of academic and industry scientists investigating frailty and sarcopenia, met in Miami Beach, Florida, USA in February 2019 to explore approaches for establishing clinical meaningfulness in a manner aligned with regulatory authorities. They concluded that clinical meaningful change is contextually dependent, and that both anchor- based and distribution-based methods of quantifying physical function are informative and should be evaluated relative to patient-reported outcomes. In addition, they identified additional research needed to enable setting criteria for clinical meaningful change in trials.

CITATION:
J. Guralnik ; K. Bandeen-Roche ; S.A.R. Bhasin ; S. Eremenco ; F. Landi ; J. Muscedere ; S. Perera ; J.-Y. Reginster ; L. Woodhouse ; B. Vellas ; and the ICFSR Task Force (2019): Clinically Meaningful Change for Physical Performance: Perspectives of the ICFSR Task Force. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.33

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ICFSR TASK FORCE PERSPECTIVE ON BIOMARKERS FOR SARCOPENIA AND FRAILTY

L. Rodriguez-Mañas, I. Araujo de Carvalho, S. Bhasin, H.A. Bischoff-Ferrari, M. Cesari, W. Evans, J.M. Hare, M. Pahor, A. Parini, Y. Rolland, R.A. Fielding, J. Walston, B. Vellas, and the ICFSR Task Force

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Biomarkers of frailty and sarcopenia are essential to advance the understanding of these conditions of aging and develop new diagnostic tools and effective treatments. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force – a group of academic and industry scientists from around the world -- met in February 2019 to discuss the current state of biomarker development for frailty and sarcopenia. The D3Cr dilution method, which assesses creatinine excretion as a biochemical measure of muscle mass, was suggested as a more accurate measure of functional muscle mass than assessment by dual energy x-ray absorptiometry (DXA). Proposed biomarkers of frailty include markers of inflammation, the hypothalamic-pituitary-adrenal (HPA) axis response to stress, altered glucose insulin dynamics, endocrine dysregulation, aging, and others, acknowledging the complex multisystem etiology that contributes to frailty. Lack of clarity regarding a regulatory pathway for biomarker development has hindered progress; however, there are currently several international efforts to develop such biomarkers as tools to improve the treatment of individuals presenting these conditions.

CITATION:
L. Rodriguez-Mañas ; I. Araujo de Carvalho ; S. Bhasin ; H.A. Bischoff-Ferrari ; M. Cesari ; W. Evans ; J.M. Hare ; M. Pahor ; A. Parini ; Y. Rolland ; R.A. Fielding ; J. Walston ; B. Vellas ; and the ICFSR Task Force (2019): ICFSR Task Force Perspective on Biomarkers for Sarcopenia and Frailty. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.32

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THE ASSOCIATION OF FRAILTY WITH HOSPITALIZATIONS AND MORTALITY AMONG COMMUNITY DWELLING OLDER ADULTS WITH DIABETES

J. Ferri-Guerra, R. Aparicio-Ugarriza, D. Salguero, D. Baskaran, Y.N. Mohammed, H. Florez, J.G. Ruiz

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Background: Diabetes (DM) is associated with an accelerated aging that promotes frailty, a state of vulnerability to stressors, characterized by multisystem decline that results in diminished intrinsic reserve and is associated with morbidity, mortality and utilization. Research suggests a bidirectional relationship between frailty and diabetes. Frailty is associated with mortality in patients with diabetes, but its prevalence and impact on hospitalizations are not well known. Objectives: Determine the association of frailty with all-cause hospitalizations and mortality in older Veterans with diabetes. Design: Retrospective cohort. Setting: Outpatient. Participants: Veterans 65 years and older with diabetes who were identified as frail through calculation of a 44-item frailty index. Measurements: The FI was constructed as a proportion of healthcare variables (demographics, comorbidities, medications, laboratory tests, and ADLs) at the time of the screening. At the end of follow up, data was aggregated on all-cause hospitalizations and mortality and compared non-frail (robust, FI≤ .10 and prefrail FI=>.10, <.21) and frail (FI≥.21) patients. After adjusting for age, race, ethnicity, median income, history of hospitalizations, comorbidities, duration of DM and glycemic control, the association of frailty with all-cause hospitalizations was carried out according to the Andersen-Gill model, accounting for repeated hospitalizations and the association with all-cause mortality using a multivariate Cox proportional hazards regression model. Results: We identified 763 patients with diabetes, mean age 72.9 (SD=6.8) years, 50.5% were frail. After a median follow-up of 561 days (IQR=172), 37.0% they had 673 hospitalizations. After adjustment for covariates, frailty was associated with higher all-cause hospitalizations, hazard ratio (HR)=1.71 (95%CI:1.31-2.24), p<.0001, and greater mortality, HR=2.05 (95%CI:1.16-3.64), p=.014. Conclusions: Frailty was independently associated with all-cause hospitalizations and mortality in older Veterans with diabetes. Interventions to reduce the burden of frailty may be helpful to improve outcomes in older patients with diabetes.

CITATION:
J. Ferri-Guerra ; R. Aparicio-Ugarriza ; D. Salguero1 ; D. Baskaran ; Y.N. Mohammed ; H. Florez ; J.G. Ruiz (2019): The Association of Frailty with Hospitalizations and Mortality among Community Dwelling Older Adults with Diabetes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.31

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CIRCULATING INTERLEUKIN-6 IS ASSOCIATED WITH SKELETAL MUSCLE STRENGTH, QUALITY, AND FUNCTIONAL ADAPTATION WITH EXERCISE TRAINING IN MOBILITY-LIMITED OLDER ADULTS

G.J. Grosicki, B.B. Barrett, D.A. Englund, C. Liu, T.G. Travison, T. Cederholm, A. Koochek, Å. von Berens, T. Gustafsson, T. Benard, K.F. Reid, R.A. Fielding

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Background: Human aging is characterized by a chronic, low-grade inflammation suspected to contribute to reductions in skeletal muscle size, strength, and function. Inflammatory cytokines, such as interleukin-6 (IL-6), may play a role in the reduced skeletal muscle adaptive response seen in older individuals. Objectives: To investigate relationships between circulating IL-6, skeletal muscle health and exercise adaptation in mobility-limited older adults. Design: Randomized controlled trial. Setting: Exercise laboratory on the Health Sciences campus of an urban university. Participants: 99 mobility-limited (Short Physical Performance Battery (SPPB) ≤9) older adults. Intervention: 6-month structured physical activity with or without a protein and vitamin D nutritional supplement. Measurements: Circulating IL-6, skeletal muscle size, composition (percent normal density muscle tissue), strength, power, and specific force (strength/CSA) as well as physical function (gait speed, stair climb time, SPPB-score) were measured pre- and post-intervention. Results: At baseline, Spearman’s correlations demonstrated an inverse relationship (P<0.05) between circulating IL-6 and thigh muscle composition (r = -0.201), strength (r = -0.311), power (r = -0.210), and specific force (r = -0.248), and positive association between IL-6 and stair climb time (r = 0.256; P<0.05). Although the training program did not affect circulating IL-6 levels (P=0.69), reductions in IL-6 were associated with gait speed improvements (r = -0.487; P<0.05) in “higher” IL-6 individuals (>1.36 pg/ml). Moreover, baseline IL-6 was inversely associated (P<0.05) with gains in appendicular lean mass and improvements in SPPB score (r = -0.211 and -0.237, respectively). Conclusions: These findings implicate age-related increases in circulating IL-6 as an important contributor to declines in skeletal muscle strength, quality, function, and training-mediated adaptation. Given the pervasive nature of inflammation among older adults, novel therapeutic strategies to reduce IL-6 as a means of preserving skeletal muscle health are enticing.

CITATION:
G.J. Grosicki ; B.B. Barrett ; D.A. Englund ; C. Liu ; T.G. Travison ; T. Cederholm ; A. Koochek ; Å. von Berens ; T. Gustafsson ; T. Benard ; K.F. Reid ; R.A. Fielding (2019): Circulating Interleukin-6 is Associated with Skeletal Muscle Strength, Quality, and Functional Adaptation with Exercise Training in Mobility-Limited Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.30

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OBESITY DEFINITIONS IN SARCOPENIC OBESITY: DIFFERENCES IN PREVALENCE, AGREEMENT AND ASSOCIATION WITH MUSCLE FUNCTION

E.Q. Khor, J.P. Lim, L. Tay, A. Yeo, S. Yew, Y.Y. Ding, W.S. Lim

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Background: Sarcopenic obesity (SO) is associated with poorer physical performance in the elderly and will increase in relevance with population ageing and the obesity epidemic. The lack of a consensus definition for SO has resulted in variability in its reported prevalence, poor inter-definitional agreement, and disagreement on its impact on physical performance, impeding further development in the field. While sarcopenia definitions have been compared, the impact of obesity definitions in SO has been less well-studied. Objectives: To compare 3 widely-adopted definitions of obesity in terms of SO prevalence, inter-definitional agreement, and association with muscle function. Design: Cross-sectional. Setting: GERILABS study, Singapore Participants: 200 community-dwelling, functionally-independent older adults. Measurements: We utilized three commonly-used definitions of obesity: body mass index (BMI), waist circumference (WC) and DXA-derived fat mass percentage (FM%). Sarcopenia was defined using Asian Working Group for Sarcopenia criteria. For muscle function, we assessed handgrip strength, gait speed and Short Physical Performance Battery (SPPB). Subjects were classified into 4 body composition phenotypes (normal, obese, sarcopenic and SO), and outcomes were compared between groups. Results: The prevalence rate for SO was lowest for BMI (0.5%) compared to FM% (10.0%) and WC (10.5%). Inter-definitional agreement was lowest between BMI and WC (κ=0.364), and at best moderate between FM% and WC (κ=0.583). SO performed the worst amongst body composition phenotypes in handgrip strength, gait speed and SPPB (all p<0.01) only when defined using WC. In regression analyses, SO was associated with decreased SPPB scores (β=-0.261, p=0.001) only for the WC definition. Conclusion: There is large variation in the prevalence of SO across different obesity definitions, with low-to-moderate agreement between them. Our results corroborate recent evidence that WC, and thus central obesity, is best associated with poorer muscle function in SO. Thus, WC should be further explored in defining obesity for accurate and early characterization of SO among older adults in Asian populations.

CITATION:
E.Q. Khor ; J.P. Lim ; L. Tay ; A. Yeo ; S. Yew ; Y.Y. Ding ; W.S. Lim (2019): Obesity definitions in sarcopenic obesity: Differences in prevalence, agreement and association with muscle function. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.28

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THE USE OF POSTUROGRAPHY IN INVESTIGATING THE RISK OF FALLING IN FRAIL OR PREFRAIL OLDER PEOPLE WITH DIABETES

H. Domergue, L. Rodríguez-Mañas, O. Laosa Zafra, K. Hood, D. Gasq, S. Regueme, A.J. Sinclair, I. Bourdel-Marchasson

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Background: In older people, diabetes is associated with an increased risk of falls and frailty. The value of using posturography for evaluating the risk of falling is unclear. In theory, a time-scale analysis should increase the metrological properties of the posturography assessment. Objectives: This study aimed to determine which posturographic parameters can be used to identify fall-risk patients in a frail diabetic older population and to assess their interest in comparison to usual clinical trials for gait and balance. Design: This is a prospective observational cohort. Settings: frail or pre-frail diabetic patients, in Bordeaux, France. Participants: 84 patients were included in the study (mean age 80.09 years, 64.5% of men).Criteria for inclusion were: age over 70 years, diabetes mellitus for over 2 years, and at least one of the Fried’s frailty criteria. Measurements: Gait and balance assessments were undertaken at baseline: Static posturography, the timed up and go test, short physical performance battery, and (gait) walking speed. Raw data from posturography were used for wavelet analysis. Data on self reported new falls were collected prospectively during 6 months. Results: The posturography parameter most useful was area of 90% confidence ellipse of statokinesigram (COP90area): area under the ROC curve AUC = 0.617 (95% CI, 0.445-0.789) and OR=1.003 (95%CI 1.000-1.005) p =0.05. The optimum clinical test was the time to walk over 4m AUC=0.735 (95%CI, 0.587-0.882) and OR=1.42 (95%CI 1.08-1.87) p= 0.013. Conclusion: Posturography has limited utility for assessment of falls risk in frail older people with diabetes. Gait and balance clinical assessments such as walking speed continue to retain their value.

CITATION:
H. Domergue ; L. Rodríguez-Mañas ; O. Laosa Zafra ; K. Hood ; D. Gasq ; S. Regueme ; A.J. Sinclair ; I. Bourdel-Marchasson (2019): The use of posturography in investigating the risk of falling in frail or prefrail older people with diabetes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.27

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ACCELEROMETER-DETERMINED INTENSITY AND DURATION OF HABITUAL PHYSICAL ACTIVITY AND WALKING PERFORMANCE IN WELL-FUNCTIONING MIDDLE-AGED AND OLDER WOMEN: A CROSS-SECTIONAL STUDY

R.S. Thiebaud, T. Abe, M. Ogawa, J.P. Loenneke, N. Mitsukawa

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Background: The association of physical activity (PA) intensities and duration spent in those activities with different walking tasks remains unclear. Objectives: To examine the association between the duration of PA intensities and three walking speeds (usual walking speed, maximal walking speed and zig-zag walking speed). Design: Multiple linear regression analysis was used to estimate the association of age, BMI, maximum knee extension strength, light PA, moderate PA and vigorous PA with walking speeds. Setting: University lab. Participants: Eighty-six older women (67 ± 7 years). Measurements: PA was measured for 30 consecutive days using the Lifecorder-EX accelerometer. Exercise intensity was categorized as light (levels 1-3), moderate (levels 4-6) and vigorous (levels 7-9) based on the manufacturer algorithms. Usual straight walking speed (20 m), maximal straight walking speed (20 m) and zig-zag walking speed tests (10 m) were performed by each participant. Results: For the usual straight walking speed model (R2 = 0.296, SEE = 0.15 m/s), the significant predictors were BMI, knee extension strength, light PA and vigorous PA. For the maximal straight walking speed model (R2 = 0.326, SEE = 0.20 m/s), only age was a significant predictor. For the zig-zag walking speed model (R2=0.417, SEE = 0.14 m/s), age and maximum knee strength were significant predictors in the model. Conclusions: Overall, the results of this study suggest that vigorous PA and maximal knee extension strength are two important factors that are associated with different walking speeds in older women.

CITATION:
R.S. Thiebaud ; T. Abe ; M. Ogawa ; J.P. Loenneke ; N. Mitsukawa (2019): Accelerometer-determined intensity and duration of habitual physical activity and walking performance in well-functioning middle-aged and older women: A cross-sectional study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.26

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MUSCLE STRENGTH AS A PREDICTOR OF GAIT VARIABILITY AFTER TWO YEARS IN COMMUNITY-LIVING OLDER ADULTS

B. Bogen, R. Moe-Nilssen, M.K. Aaslund, A.H. Ranhoff

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Background: Stride-to-stride fluctuations, or gait variability, can be captured easily using body worn inertial sensors. Previously, sensor-measured gait variability has been found to be associated with fall risk and central nervous changes. However, further research is needed to clarify the clinical relevance of this method. Objectives: In this study, we look at how gait variability is associated with muscle strength, measured two years earlier. Design, setting and participants: This is study of longitudinal associations. Participants were community-dwelling volunteers between 70-81 years. Measurements: Participants were tested while walking with a single sensor at their lower back, and they walked back and forth over a distance of 6.5 meters under four conditions: at preferred speed, at fast speed, with an added cognitive task, and while walking across an uneven surface. Gait variability in the anteroposterior (AP), mediolateral (ML) and vertical (V) directions was identified. A muscle strength score was composed by transforming hand grip strength, isometric knee extension strength and the 30 second chair rise-test to z-scores and adding them. Results: 56 individuals were analysed (mean age at baseline 75.8 (SD 3.43), 60 percent women). In a backwards regression method using age, gender and baseline walking speed as covariates, muscle strength predicted gait variability after two years for AP variability during preferred speed (Beta= .314, p=.025) and uneven surface walking (Beta=.326, p=.018). Further, muscle strength was associated with ML variability during preferred speed (Beta=.364, p=.048) and fast speed (Beta=.419, p=.042), and V variability during preferred speed (Beta=.402, p=.002), fast speed (Beta=.394, p=.004) and uneven surface walking (Beta=.369, p=.004). Conclusions: Sensor-measured gait variability tended to be associated with muscle strength measured two years earlier. This finding could emphasize the relevance of this relatively novel measure of gait in older adults for both research and clinical practice.

CITATION:
B. Bogen ; R. Moe-Nilssen ; M.K. Aaslund ; A.H. Ranhoff (2019): Muscle strength as a predictor of gait variability after two years in community-living older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.24

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JFA N°04 - 2019

 

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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