Ahead of print articles
IDENTIFYING EXOSOME-DERIVED MICRORNAS AS CANDIDATE BIOMARKERS OF FRAILTY
B.R. Ipson, M.B. Fletcher, S.E. Espinoza, A.L. Fisher
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Frailty is a geriatric syndrome associated with progressive physical decline and significantly increases risk for falls, disability, hospitalizations, and death. However, much remains unknown regarding the biological mechanisms that contribute to aging and frailty, and to date, there are no clinically used prognostic or diagnostic molecular biomarkers. The present study profiled exosome-derived microRNAs isolated from the plasma of young, robust older, and frail older individuals and identified eight miRNAs that are uniquely enriched in frailty: miR-10a-3p, miR-92a-3p, miR-185-3p, miR-194-5p, miR-326, miR-532-5p, miR-576-5p, and miR-760. Furthermore, since exosomes can deliver miRNAs to alter cellular activity and behavior, these miRNAs may also provide insights into the biological mechanisms underlying frailty; KEGG analysis of their target genes revealed multiple pathways implicated in aging and age-related processes. Although further validation and research studies are warranted, our study identified eight novel candidate biomarkers of frailty that may help to elucidate the multifactorial pathogenesis of frailty.
B.R. Ipson ; M.B. Fletcher ; S.E. Espinoza ; A.L. Fisher (2017): Strong Relationship between Malnutrition and Cognitive Frailty in the Singapore Longitudinal Ageing Studies (SLAS-1 and SLAS-2). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.45
EDUCATING MEDICAL STUDENTS IN COUNSELLING OLDER ADULTS ABOUT EXERCISE: THE IMPACT OF A PHYSICAL ACTIVITY MODULE
A.D. Jadczak, K.L. Tam, R. Visvanathan
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Background: Exercise courses during medical school contribute to medical students’ confidence in promoting physical activity to their patients. However, there is still a lack of uniform physical activity education across medical school curricula to equip medical students with the necessary skills and knowledge to counsel their patients about exercise. Objective: To determine the effects of a 1.5-hour physical activity module including a one-hour exercise tutorial combined with a 30-minute practical counselling session on senior medical students’ perceptions of the importance of exercise and their perceived competence in advising older people about exercise. Design: Pre-post survey. Setting: University campus. Participants: 161 senior medical students taking part in the Queen Elizabeth Hospital Geriatric Medicine course in 2015 (control group) and 2016 (intervention group). Measurement: The modified Exercise and Physical Activity Competence Questionnaire (EPACQ) was administered before and after a 4.5-week Geriatric Medicine Course. Scores ranged from 1 (not important or competent) to 6 (very important or competent). The independent T-Test and repeated-measures ANOVA was used to determine differences between intervention and control group. Results: Medical students perceived exercise-related skills to be highly important (score ≥4) in both the intervention (4.85 ± 0.37) and control group (4.78 ± 0.67), pre-course. The overall perceived importance could not be significantly increased by the physical activity module (P=0.082). The physical activity module, however, improved medical students’ perceived competence in six out of ten exercise-related skills, and increased their overall perceived competence in counselling older people about exercise (P<0.001). Conclusion: A 1.5-hour physical activity module improves senior medical students’ perceived competence in counselling older people about exercise. This research proves that little teaching space is needed to impact positively on medical students’ exercise counselling abilities.
A.D. JADCZAK ; K.L. TAM ; R. VISVANATHAN ; (2017): EDUCATING MEDICAL STUDENTS IN COUNSELLING OLDER ADULTS ABOUT EXERCISE: THE IMPACT OF A PHYSICAL ACTIVITY MODULE . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.44
MUSCLE QUALITY IMPROVES WITH EXTENDED HIGH-INTENSITY RESISTANCE TRAINING AFTER HIP FRACTURE
R.A. Briggs, J.R. Houck, M.J. Drummond, J.M. Fritz, P.C. LaStayo, R.L. Marcus
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Background: Muscle mass deficits endure after hip fracture. Strategies to improve muscle quality may improve mobility and physical function. It is unknown whether training after usual care yields muscle quality gains after hip fracture. Objectives: To determine whether muscle quality improves after hip fracture with high-intensity resistance training and protein supplementation. Design: Case series. Setting: University of Utah Skeletal Muscle Exercise Research Facility. Participants: 17 community-dwelling older adults, 3.6+/-1.1 months post-hip fracture, recently discharged from usual-care physical therapy (mean age 77.0+/-12.0 years, 12 female), enrolled. Intervention: Participants underwent 12 weeks (3x/week) of unilaterally-biased resistance training. Methods/Materials: Participants were measured via a 3.0 Tesla whole-body MR imager for muscle lean and intramuscular adipose tissue (IMAT) of the quadriceps before and after resistance training. Peak isometric knee extension force output was measured with an isokinetic dynamometer. Muscle quality was calculated by dividing peak isometric knee extension force (N) by quadriceps lean muscle mass (cm2). In addition, common physical function variables were measured before and after training. Results: Surgical and nonsurgical lean quadriceps muscle mass improved among participants (mean change: 2.9 cm2+/-1.4 cm2, and 2.7 cm2+/-1.3 cm2, respectively), while IMAT remained unchanged. Peak force improved in the surgical limb by 43.1+/-23N, with no significant change in the nonsurgical limb. Significant gains in physical function were evident after training. Conclusion: Participants recovering from hip fracture demonstrated improvements in muscle mass, muscle strength, and muscle quality in the surgical limb after hip fracture. These were in addition to gains made in the first months after fracture with traditional care. Future studies should determine the impact that muscle quality has on long-term functional recovery in this population.
AN INTERNATIONAL POSITION STATEMENT ON THE MANAGEMENT OF FRAILTY IN DIABETES MELLITUS: SUMMARY OF RECOMMENDATIONS 2017
A.J. Sinclair, A. Abdelhafiz, T. Dunning, M. Izquierdo, L. Rodriguez Manas, I. Bourdel-Marchasson, J.E. Morley, M. Munshi, J. Woo, B. Vellas
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Aim: the the International Position Statement provides the opportunity to summarise all existing clinical trial and best practice evidence for older people with frailty and diabetes. It is the first document of its kind and is intended to support clinical decisions that will enhance safety in management and promote high quality care. Methods: the Review Group sought evidence from a wide range of studies that provide sufficient confidence (in the absence of grading) for the basis of each recommendation. This was supported by a given rationale and key references for our recommendations in each section, all of which have been reviewed by leading international experts. Searches for any relevant clinical evidence were generally limited to English language citations over the previous 15 years. The following databases were examined: Embase, Medline/PubMed, Cochrane Trials Register, Cinahl, and Science Citation. Hand searching of 16 key major peer-reviewed journals was undertaken by two reviewers (AJS and AA) and these included Lancet, Diabetes, Diabetologia, Diabetes Care, British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Journal of Frailty & Aging, Journal of the American Medical Directors Association, and Journals of Gerontology - Series A Biological Sciences and Medical Sciences. Results: two scientific supporting statements have been provided that relate to the area of frailty and diabetes; this is accompanied by evidence-based decisions in 9 clinical domains. The Summary has been supported by diagrammatic figures and a table relating to the inter-relations between frailty and diabetes, a frailty assessment pathway, an exercise-based programme of intervention, a glucose-lowering algorithm with a description of available therapies. Conclusions: we have provided an up to date evidence-based approach to practical decision-making for older adults with frailty and diabetes. This Summary document includes a user-friendly set of recommendations that should be considered for implementation in primary, community-based and secondary care settings.
A.J. Sinclair ; A. Abdelhafiz ; T. Dunning ; M. Izquierdo ; L. Rodriguez Manas ; I. Bourdel-Marchasson ; J.E. Morley ; M. Munshi ; J. Woo ; B. Vellas (2017): An International Position Statement on the Management of Frailty in Diabetes Mellitus: Summary of Recommendations 2017. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.39
PRELIMINARY STUDY ON PREVALENCE AND ASSOCIATED FACTORS WITH SARCOPENIA IN A GERIATRIC HOSPITALIZED REHABILITATION SETTING
K. Pongpipatpaiboon, I. Kondo, K. Onogi, S. Mori, K. Ozaki, A. Osawa, H. Matsuo, N. Itoh, M. Tanimoto
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The reported prevalence of sarcopenia has shown a wide range, crucially based on the diagnostic criteria and setting. This cross-sectional study evaluated the prevalence of sarcopenia and sought to identify factors associated with sarcopenia on admission in a specialized geriatric rehabilitation setting based on the newly developed the Asian Working Group for Sarcopenia algorithm. Among 87 participants (mean age, 76.05 ± 7.57 years), 35 (40.2%) were classified as showing sarcopenia on admission. Prevalence was high, particularly among participants ≥80 years old, with tendencies toward lower body mass index, smoking habit, lower cognitive function, and greater functional impairment compared with the non-sarcopenic group. Identification of sarcopenia in elderly patients before rehabilitation and consideration of risk factors may prove helpful in achieving rehabilitation outcomes.
K. Pongpipatpaiboon ; I. Kondo ; K. Onogi ; S. Mori ; K. Ozaki ; A. Osawa ; H. Matsuo ; N. Itoh ; M. Tanimoto (2017): Preliminary study on prevalence and associated factors with sarcopenia in a geriatric hospitalized rehabilitation setting. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.40
DEVELOPMENT OF THE NUTRITION AND FUNCTIONALITY ASSESSMENT (NFA) AMONG OLDER ADULTS IN JAPAN
Y. Okubo, M. Nemoto, Y. Osuka, S. Jung, S. Seino, R. Figueroa, G. Vinyes-Pares, E.A. Offord, M. Shevlyakova, D. Breuille, K. Tanaka
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Objective: Develop and evaluate the feasibility and validity of the Nutrition and Functionality Assessment (NFA) which identifies “target” older adults who could benefit from a personalized program following evaluation of their nutrition status and physical functionality. Design: Cross-sectional study. Setting: Community and geriatric day-care centers and university in Japan. Participants: 267 older adults aged 65-90. Measurements: The “target” individuals were screened based on gait speed (0.6-1.5 m/s). Nutrition (Mini Nutrition Assessment-short form and protein intake), strength (30s chair sit-to-stand and hand-grip strength) and endurance (6-minute walk) were assessed. Physical activity was monitored using a tri-axil accelerometer for a week. Fried frailty phenotype was also assessed. Results: Out of 267 individuals, 185 (69%) had gait speed between 0.6-1.5 m/s, corresponding to our “target” group from which, 184 (95%) completed the nutrition and physical functionality assessments with the physical activity monitoring. The NFA was completed in approximately 30 minutes. No adverse events directly due to the NFA were reported. NFA physical functionality and global scores were significantly related to frailty phenotype but nutrition score was not related to frailty phenotype. Conclusion: The study demonstrated that the NFA is a safe and feasible tool to screen target older adults and simultaneously evaluate their nutritional status and physical functionality. Validity of the NFA was partially confirmed by the significant association of the global and physical functionality scores with frailty phenotype. More studies are required to validate and maximize the applicability of the NFA in communities and institutions in Japan and elsewhere.
Y. Okubo ; M. Nemoto ; Y. Osuka ; S. Jung ; S. Seino ; R. Figueroa ; G. Vinyes-Pares ; E.A. Offord ; M. Shevlyakova ; D. Breuille ; K. Tanaka (2017): Development of the Nutrition and Functionality Assessment (NFA) among older adults in Japan . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.38
PRECIPITANTS OF DELIRIUM IN OLDER INPATIENTS ADMITTED IN SURGERY FOR POST-FALL HIP FRACTURE: AN OBSERVATIONAL STUDY
E. Levinoff, A. Try, J. Chabot, L. Lee, D. Zukor, O. Beauchet
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Background: Hip fractures precipitate several acute adverse outcomes in elderly people, thus leading to chronic adverse outcomes. Objectives: The objective of our study was to examine the clinical characteristics associated with incident delirium in community dwelling elderly individuals who have a hip fracture. Design: Retrospective observational cohort study. Setting: Data was collected from an academic tertiary hospital affiliated with McGill University. Participants: 114 elderly individuals who were above 65 years of age, who underwent surgery for a fractured hip. Measurements: The main outcome variable was incident delirium, which was assessed by chart reviews of notes and observations recorded by nurses and physicians when patients were admitted post operatively to the surgical unit. Covariates included age, sex, length of stay, delay to surgery, number of medical comorbidities, number of medications and hip fracture location, and were extracted from medical records. Baseline mobility and functional status, preoperative cognitive impairment, postoperative complications, regular psychotropic medications, psychotropic medications in hospital, and location of discharge were also assessed through chart review. Results: The results demonstrated that 17.5% of participants with a diagnosis of delirium had a longer length of hospitalization (p = 0.01), a lower baseline functional status (p = 0.03) and pre-operative cognitive impairment (p = 0.01). Patients receiving new psychotropic medications in hospital were more likely to have delirium (OR = 4.6, p = 0.01) which was independent of pre-operative cognitive impairment. Conclusion: We have shown that an association exists between psychotropic medication prescription and incident delirium in patients with hip fractures, even when adjusting for cognitive impairment. Hence, the prescription of psychotropic drugs should be judicious in these patients so as minimize the risk of adverse outcomes.
E. Levinoff ; A. Try ; J. Chabot ; L. Lee ; D. Zukor ; O. Beauchet (2017): Precipitants of delirium in older inpatients admitted in surgery for post-fall hip fracture: An observational study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.37
IMPACT OF SARCOPENIA ON ONE-YEAR MORTALITY AMONG OLDER HOSPITALIZED PATIENTS WITH IMPAIRED MOBILITY
M. Pourhassan, K. Norman, M. J Müller, R. Dziewas, R. Wirth
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Objectives: However, the information regarding the impact of sarcopenia on mortality in older individuals is rising, there is a lack of knowledge concerning this issue among geriatric hospitalized patients. Therefore, aim of the present study was to investigate the associations between sarcopenia and 1-year mortality in a prospectively recruited sample of geriatric inpatients with different mobility and dependency status. Design and setting: Sarcopenia was diagnosed using the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP). Hand grip strength and skeletal muscle mass were measured using Jamar dynamometer and bioelectrical impedance analysis, respectively. Physical function was assessed with the Short Physical Performance Battery. Dependency status was defined by Barthel-Index (BI). Mobility limitation was defined according to walking ability as described in BI. The survival status was ascertained by telephone interview. Results: The recruited population comprised 198 patients from a geriatric acute ward with a mean age of 82.8 ± 5.9 (70.2% females). 50 (25.3%) patients had sarcopenia, while 148 (74.7%) had no sarcopenia. 14 (28%) patients died among sarcopenic subjects compared with 28 (19%) non-sarcopenic subjects (P=0.229). After adjustment for potential confounders, sarcopenia was associated with increased mortality among patients with limited mobility prior to admission (n=138, hazard ratio, HR: 2.52, 95% CI: 1.17-5.44) and at time of discharge (n=162, HR: 1.93, 95% CI: 0.67-3.22). In a sub-group of patients with pre-admission BI<60 (n=45), <70 (n=73) and <80 (n=108), the risk of death was 3.63, 2.80 and 2.55 times higher in sarcopenic patients, respectively. In contrast, no significant relationships were observed between sarcopenia and mortality across the different scores of BI during admission and at time of discharge. Conclusion: Sarcopenia is significantly associated with higher risk of mortality among sub-groups of older patients with limited mobility and impaired functional status, independently of age and other clinical variables.
M. Pourhassan ; K. Norman ; M. J Müller ; R. Dziewas ; R. Wirth (2017): Impact of sarcopenia on one-year mortality among older hospitalized patients with impaired mobility. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.35
THE VICIOUS CYCLE OF MYOSTATIN SIGNALING IN SARCOPENIC OBESITY: MYOSTATIN ROLE IN SKELETAL MUSCLE GROWTH, INSULIN SIGNALING AND IMPLICATIONS FOR CLINICAL TRIALS
L.A. Consitt, B.C. Clark
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The age-related loss of skeletal muscle (sarcopenia) is a major health concern as it is associated with physical disability, metabolic impairments, and increased mortality. The coexistence of sarcopenia with obesity, termed ‘sarcopenic obesity’, contributes to skeletal muscle insulin resistance and the development of type 2 diabetes, a disease prevalent with advancing age. Despite this knowledge, the mechanisms contributing to sarcopenic obesity remain poorly understood, preventing the development of targeted therapeutics. This article will discuss the clinical and physiological consequences of sarcopenic obesity and propose myostatin as a potential candidate contributing to this condition. A special emphasis will be placed on examining the role of myostatin signaling in impairing both skeletal muscle growth and insulin signaling. In addition, the role of myostatin in regulating muscle-to fat cross talk, further exacerbating metabolic dysfunction in the elderly, will be highlighted. Lastly, we discuss how this knowledge has implications for the design of myostatin-inhibitor clinical trials.
L.A. Consitt ; B.C. Clark (2017): The vicious cycle of myostatin signaling in sarcopenic obesity: myostatin role in skeletal muscle growth, insulin signaling and implications for clinical trials. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.33
IMPLICATIONS OF ICD-10 FOR SARCOPENIA CLINICAL PRACTICE AND CLINICAL TRIALS: REPORT BY THE INTERNATIONAL CONFERENCE ON FRAILTY AND SARCOPENIA RESEARCH TASK FORCE
B. Vellas, R.A. Fielding, C. Bens, R. Bernabei, P.M. Cawthon, T. Cederholm, A.J. Cruz-Jentoft, S. del Signore, S. Donahue, J. Morley, M. Pahor, J.-Y. Reginster, L. Rodriguez Mañas, Y. Rolland, R. Roubenoff, A. Sinclair, M. Cesari, on behalf of the International Conference on Frailty and Sarcopenia Research Task Force
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Establishment of an ICD-10-CM code for sarcopenia in 2016 was an important step towards reaching international consensus on the need for a nosological framework of age-related skeletal muscle decline. The International Conference on Frailty and Sarcopenia Research Task Force met in April 2017 to discuss the meaning, significance, and barriers to the implementation of the new code as well as strategies to accelerate development of new therapies. Analyses by the Sarcopenia Definitions and Outcomes Consortium are underway to develop quantitative definitions of sarcopenia. A consensus conference is planned to evaluate this analysis. The Task Force also discussed lessons learned from sarcopenia trials that could be applied to future trials, as well as lessons from the osteoporosis field, a clinical condition with many constructs similar to sarcopenia and for which ad hoc treatments have been developed and approved by regulatory agencies.
B. Vellas ; R.A. Fielding ; C. Bens ; R. Bernabei ; P.M. Cawthon ; T. Cederholm ; A.J. Cruz-Jentoft ; S. del Signore ; S. Donahue ; J. Morley ; M. Pahor ; J.-Y. Reginster ; L. Rodriguez Mañas ; Y. Rolland ; R. Roubenoff ; A. Sinclair ; M. Cesari ; on behalf of the International Conference on Frailty and Sarcopenia Research Task Force (2017): IMPLICATIONS OF ICD-10 FOR SARCOPENIA CLINICAL PRACTICE AND CLINICAL TRIALS: REPORT BY THE INTERNATIONAL CONFERENCE ON FRAILTY AND SARCOPENIA RESEARCH TASK FORCE . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.30
JFA N°04 - 2017
PREVENTION OF FRAILTY IN AGING
B. Vellas, S. Sourdet
J Frailty Aging 2017;6(4):174-177Show summaryHide summary
B. Vellas ; S. Sourdet (2017): Prevention of Frailty in Aging. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.42
RELATIONSHIP OF SERUM CARNITINE LEVEL WITH FALLS AND GAIT DISTURBANCE IN THE ELDERLY
K. Nagai, H. Koshiba, S. Shibata, A. Hirasawa, T. Ebihara, K. Kozaki
J Frailty Aging 2017;6(4):178-182Show summaryHide summary
Background: Gait disturbance and falls are serious events that can impair activities of daily living (ADL) in the elderly. On the other hand, carnitine plays essential roles in energy production, and carnitine deficiency leads to low activity levels. Objectives: We examined whether a lower serum carnitine concentration was correlated with falls and gait disturbances in the elderly. Design, Setting, and participants: We performed a cross-sectional study. One hundred and ninety-eight elderly patients (male, 83; female, 115; 81 ± 6 years old) were enrolled in this study. Measurements: Physical performance (hand grip strength, leg strength, walking speed, one-leg standing time, and tandem gait steps) and frailty status (The Edmonton Frail Scale: EFS) were evaluated. The serum total, free, and acylated carnitine levels were measured using an enzyme cycling method. We then investigated the associations between the serum carnitine level, history of falls, and the results of these physical examinations. Results: Of the 198 subjects, 56 (28%) had a history of falls within the past one year. The patients with a history of falls had lower serum total carnitine and free carnitine levels than those without a history of falls. Regarding the physical performance results, the patients with a history of falls had higher EFS scores, a weaker hand grip strength, a slower walking speed, a shorter one-leg standing time, and a smaller number of tandem gait steps than those without a history of falls. A logistic regression analysis showed that the low serum total carnitine concentration was identified as an independent factor associated with a history of falls, a slow walking speed after adjustments for age, sex and modified EFS. Conclusions: A low serum carnitine level is associated with a history of falls and gait disturbances in elderly people.
K. Nagai ; H. Koshiba ; S. Shibata ; A. Hirasawa ; T. Ebihara ; K. Kozaki (2017): Relationship of serum carnitine level with falls and gait disturbance in the elderly. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.36
MUSCLE QUALITY, STRENGTH, AND LOWER EXTREMITY PHYSICAL PERFORMANCE IN THE BALTIMORE LONGITUDINAL STUDY OF AGING
N. Chiles Shaffer, E. Fabbri, L. Ferrucci, M. Shardell, E.M. Simonsick, S. Studenski
J Frailty Aging 2017;6(4):183-187Show summaryHide summary
Background: Muscle quality is defined as the force generated by each volumetric unit of muscle tissue. No consensus exists on an optimal measure of muscle quality, impeding comparison across studies and implementation in clinical settings. It is unknown whether muscle quality measures that rely on complex and expensive tests, such as isokinetic dynamometry and computerized tomography correlate with lower extremity performance (LEP) any better than measures derived from simpler and less expensive tests, such as grip strength (Grip) and appendicular lean mass (ALM) assessed by DXA. Additionally, whether muscle quality is more strongly associated with LEP than strength has not been fully tested. Objectives: This study compares the concurrent validity of alternative measures of muscle quality and characterizes their relationship with LEP. We also whether muscle quality correlates more strongly with LEP than strength alone. Design: Cross-sectional analysis. Setting: Community. Participants: 365 men and 345 women 65 years of age and older in the Baltimore Longitudinal Study of Aging. Measures: Thigh cross-sectional area (TCSA), isokinetic and isometric knee extension strength (ID), BMI adjusted ALM (ALMBMI) from DXA, and Grip. Concurrent validity was assessed as the percent variance of different measures of LEP explained by each muscle quality measure. In addition, we compared LEP relationships between each measure of strength and its correspondent value of muscle quality. Confidence intervals for differences in percent variance were calculated by bootstrapping. Results: Grip/ALMBMI explained as much variance as ID/TCSA across all LEP measures in women and most in men. Across all LEP measures, strength explained as much variance of LEP as muscle quality. Conclusions: Grip/ALMBMI and ID/TCSA measures had similar correlations with LEP. Muscle quality did not outperform strength. Although evaluating muscle quality may be useful to assess age-related mechanisms of change in muscle strength, measures of strength alone may suffice to understand the relationship between muscle and LEP.
N. Chiles Shaffer ; E. Fabbri ; L. Ferrucci ; M. Shardell ; E.M. Simonsick ; S. Studenski (2017): Muscle Quality, Strength, and Lower Extremity Physical Performance in the Baltimore Longitudinal Study of Aging. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.24
VARIOUS DIAGNOSTIC MEASURES OF FRAILTY AS PREDICTORS FOR FALLS, WEIGHT CHANGE, QUALITY OF LIFE, AND MORTALITY AMONG OLDER FINNISH MEN
N.M. Perttila, K.H. Pitkala, H. Kautiainen, R. Tilvis , T. Strandberg
J Frailty Aging 2017;6(4):188-194Show summaryHide summary
Background: Frailty predisposes individuals to a variety of complications. However, there is no consensus on the definition of frailty. Objectives: To examine whether various frailty measures are equivalent in identifying the same individuals as being frail and whether the measures also predict similar outcomes. Design, Setting and Participants: The Helsinki Businessmen Study cohort, which is a long-term observational study of men born in 1919-1934, was used as the population. We investigated these men by their postal questionnaire responses in 2000 and 2005. The mean age of the men (N=480) was 73 years at the start of follow-up. Measurements: We compared two phenotypic frailty measures, the Helsinki Businessmen Study measure (HBS), the modified Women’s Health Initiative Observational Study (WHI-OS), and the Frailty Index (FI) comprising 20 items. All three measurements were applied to Helsinki Businessmen Study cohort data collected via simple postal questionnaire from 480 men. We investigated how effectively these three measures distinguished between the not frail, prefrail, and frail individuals, and predicted mortality, falls, weight change, and health-related quality of life (HRQoL, 15D instrument) during a 5-year follow-up. Results: The HBS and the modified WHI-OS identified 35 persons (7.3%) each as frail but their respective sets comprised different groupings of individuals that partly overlapped. The FI identified 86 persons (17.9%) as frail. One-hundred-and-two (21.3%) men were classified as frail by at least one of the measures. All three measures significantly predicted higher mortality, higher number of fallers, and lower HRQoL for frail participants. None of the measures showed different results for weight change between the frailty groups or frailty stages. Conclusions: All three measures identified somewhat different sets of participants as frail. They all predicted increased mortality, falls and reduced HRQoL for the frail groups.
N.M. PERTTILA ; K.H. PITKALA ; H. KAUTIAINEN ; R. TILVIS ; T. STRANDBERG (2017): VARIOUS DIAGNOSTIC MEASURES OF FRAILTY AS PREDICTORS FOR FALLS, WEIGHT CHANGE, QUALITY OF LIFE, AND MORTALITY AMONG OLDER FINNISH MEN . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.26
THE FEASIBILITY OF STANDARDISED GERIATRIC ASSESSMENT TOOLS AND PHYSICAL EXERCISES IN FRAIL OLDER ADULTS
A.D. Jadczak, N. Mahajan, R. Visvanathan
J Frailty Aging 2017;6(4):195-198Show summaryHide summary
Geriatric assessment tools are applicable to the general geriatric population; however, their feasibility in frail older adults is yet to be determined. The study aimed to determine the feasibility of standardised geriatric assessment tools and physical exercises in hospitalised frail older adults. Various assessment tools including the FRAIL Screen, the Charlson Comorbidity Index, the SF-36, the Trail Making Test (TMT), the Rapid Cognitive Screen, the Self Mini Nutritional Assessment (MNA-SF) and the Lawton iADL as well as standard physical exercises were assessed using observational protocols. The FRAIL Screen, MNA-SF, Rapid Cognitive Screen, Lawton iADL and the physical exercises were deemed to be feasible with only minor comprehension, execution and safety issues. The TMT was not considered to be feasible and the SF-36 should be replaced by its shorter form, the SF-12. In order to ensure the validity of these findings a study with a larger sample size should be undertaken.
A.D. Jadczak ; N. Mahajan ; R. Visvanathan (2017): The feasibility of standardised geriatric assessment tools and physical exercises in frail older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.34
REFERENCE VALUES FOR KNEE EXTENSION STRENGTH OBTAINED BY HAND-HELD DYNAMOMETRY FROM APPARENTLY HEALTHY OLDER ADULTS: A META-ANALYSIS
J Frailty Aging 2017;6(4):199-201Show summaryHide summary
Normative reference values for knee extension strength obtained by hand-held dynamometry from adults 60 to 79 years were derived using summary data from 3 studies. The studies, which were identified through PubMed and a hand-search, contributed data from between 3 and 29 individuals for each age, gender, and side stratum. Meta-analysis was employed to consolidate knee extension strength data. Strength, normalized against body weight, ranged 35.6% for the nondominant side of 70 to 79 year old women to 48.8% for the nondominant side of 60 to 69 year old men. These values are more informative than those previously published in individual studies. However, reference values derived from a large population-based sample are needed.
R.W. Bohannon (2017): Reference Values for Knee Extension Strength Obtained by Hand-held Dynamometry from Apparently Healthy Older Adults: A Meta-analysis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.32
FRAILTY IS NOT ASSOCIATED WITH MISTREATMENT
S.D. Piña-Escudero, J.M.A. García-Lara, J.A. Avila-Funes
J Frailty Aging 2017;6(4):202-205Show summaryHide summary
Muscle Frailty has been previously associated with increased vulnerability for adverse health-related outcomes that could lead to social consequences such as mistreatment. The aim of this cross-sectional study is to determine the association between frailty and mistreatment in 852 community-dwelling persons aged 70 or older. Mistreatment was defined as one positive answer in the Geriatric Mistreatment Scale and frailty was used as a continuum where the greater number of positive criteria according to Fried et al. indicates a higher frailty score. Multivariate logistic regression models were run to establish this association. The mean age of participants was 77.7 years (SD=6.1). Prevalence of frailty phenotype and mistreatment were 13.9% and 20% respectively. Unadjusted analysis showed frailty score was associated with mistreatment (OR = 1.16; 95% CI 1.02 to 1.3, p=0.022). However, after adjustment, the association was no longer present. The results showed that in the presence of other geriatric syndromes such as disability or depression, frailty did not show association with mistreatment in this population.
S.D. Piña-Escudero ; J.M.A. García-Lara ; J.A. Avila-Funes (2017): Frailty is not associated with mistreatment. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.29
AUGMENTED REALITY: SUSTAINING AUTONOMOUS WAY-FINDING IN THE COMMUNITY FOR OLDER PERSONS WITH COGNITIVE IMPAIRMENT
K. Sejunaite, C. Lanza, S. Ganders, A. Iljaitsch, M.W. Riepe
J Frailty Aging 2017;6(4):206-211Show summaryHide summary
Background: Impairment of autonomous way-finding subsequent to a multitude of neurodegenerative and other diseases impedes independence of older persons and their everyday activities. Objective: It was the goal to use augmented reality to aid autonomous way-finding in a community setting. Design: A spatial map and directional information were shown via head-up display to guide patients from the start zone on the hospital campus to a bakery in the nearby community. Setting: Hospital campus and nearby community. Participants: Patients with mild cognitive impairment (age 63 to 89). Interventions: A head-up display was used to help patients find their way. Measurements: Time needed to reach goal and number of assists needed. Results: With use of augmented reality device, patients preceded along the correct path in 113 out of 120 intersections. Intermittent reassurance was needed for most patients. Patients affirmed willingness to use such an augmented reality device in everyday life if needed or even pay for it. Conclusion: Augmented reality guided navigation is a promising means to sustain autonomous way-finding as a prerequisite for autonomy of older persons in everyday activities. Thus, this study lays ground for a field trial in the community using assistive technology for older persons with cognitive impairment.
K. Sejunaite ; C. Lanza ; S. Ganders ; A. Iljaitsch ; M.W. Riepe (2017): Augmented reality: sustaining autonomous way-finding in the community for older persons with cognitive impairment . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.25
MANAGEMENT OF MUSCULOSKELETAL CONDITIONS IN RURAL SOUTH AUSTRALIA: A RANDOMISED CONTROLLED TRIAL
E. Dent, E. Hoon, J. Karnon, A. Kitson, J. Dollard, J. Newbury, G. Harvey, T. Gill, J. Beilby
J Frailty Aging 2017;6(4):212-215Show summaryHide summary
With age, the prevalence of musculoskeletal conditions increases markedly. This rural-based study determined the benefits of two approaches for managing musculoskeletal conditions: a multiple-component ‘Self-management Plus’ intervention, and usual care. The intervention combined self-management education with physical activity and health professional support. 6-month outcomes included: Clinical Global Impression-Improvement Scale (CGI-IS) and Quality of Life (QoL). A total of 145 people were recruited; mean (SD) age was 66.1 (11.1) and 63.3 (10.9) years for intervention and control groups respectively. The intervention resulted in greater improvements in global functioning (CGI-IS mean (SD) = 3.2 (1.3)) than usual care (CGI-IS mean (SD) = 4.2 (1.5)). There was no difference in QoL improvement between study groups. A multiple-component ‘Self-management Plus’ intervention had a positive effect on physical functioning for older adults with musculoskeletal conditions. However, recruitment and retention of participants was problematic, which raises questions about the intervention’s feasibility in its current form.
E. Dent ; E. Hoon ; J. Karnon ; A. Kitson ; J. Dollard ; J. Newbury ; G. Harvey ; T. Gill ; J. Beilby (2017): Management of Musculoskeletal Conditions in Rural South Australia: a Randomised Controlled Trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.27
MOBILE APPLICATION REMOVES SOCIETAL BARRIERS TO P4 MEDICINE
J Frailty Aging 2017;6(4):216-218Show summaryHide summary
The overlap between one innovative paradigm (P4 medicine: predictive, personalized, participatory and preventive) and another (a new definition of “Healthy ageing”) is fertile ground for new technologies; a new mobile application (app) that could broaden our scientific knowledge of the ageing process and help us to better analyse the impact of possible interventions in slowing the ageing decline. A novel mobile application is here presented as a game including questions and tests will allow in 10 minutes the assessment of the following domains: robustness, flexibility (lower muscle strength), balance, mental and memory complaints, semantic memory and visual retention. This game is completed by specific measurements, which could allow establishing precise information on functional and cognitive abilities. A global evaluation precedes advice and different types of exercises. The repetition of the tests and measures will allow a long follow up of the individual performances which could be shared (on specific request) with family members and general practitioners.
J.-P. Michel ; (2017): Mobile application removes societal barriers to P4 medicine. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.43
FRAILTY EXISTS IN YOUNGER ADULTS ADMITTED AS SURGICAL EMERGENCY LEADING TO ADVERSE OUTCOMES
R. Smart, B. Carter, J. McGovern, S. Luckman, A. Connelly, J. Hewitt, T. Quasim, S. Moug
J Frailty Aging 2017;6(4):219-223Show summaryHide summary
Background: Frailty is prevalent in the older adult population (≥65 years of age) and results in adverse outcomes in the emergency general surgical population. Objective: To determine whether frailty exists in the younger adult emergency surgical population (<65 years) and what influence frailty may have on patient related outcomes. Design: Prospective observational cohort study. Setting: Emergency general surgical admissions. Participants: All patients ≥40 years divided into 2 groups: younger adults (40-64.9 years) and older adult comparative group (≥65). Measurements: Over a 6-month time frame the following data was collected: demographics; Scottish Index of Multiple Deprivation (SIMD); blood markers; multi-morbidities, polypharmacy and cognition. Frailty was assessed by completion of the Canadian Study of Health and Ageing (CSHA). Each patient was followed up for 90 days to allow determination of length of stay, re-admission and mortality. Results: 82 young adults were included and the prevalence of frailty was 16% (versus older adults 38%; p=0.001) and associated with: multi-morbidity; poly-pharmacy; cognitive impairment; and deprivation. Frailty in older adults was only significantly associated with increasing age. Conclusions: This novel study has found that frailty exists in 16% of younger adults admitted to emergency general surgical units, potentially leading to adverse short and long-term outcomes. Strategies need to be developed that identify and treat frailty in this vulnerable younger adult population.
R. Smart ; B. Carter ; J. McGovern ; S. Luckman ; A. Connelly ; J. Hewitt ; T. Quasim ; S. Moug (2017): Frailty exists in younger adults admitted as surgical emergency leading to adverse outcomes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.28
MEASURING FRAILTY AMONG OLDER PEOPLE: FURTHER EVALUATION OF THE BRODY FRAILTY INDEX
J Frailty Aging 2017;6(4):224-227Show summaryHide summary
Background & Objective: The study aimed to evaluate the predictive validity of the Brody self-report frailty index among older people. Design, setting & measurements: A longitudinal cohort study (2-years) conducted in Sweden, which included 1141 respondents, aged 65–103 years. Data were collected during 2011-2013 through a postal questionnaire with questions about demographic data, living conditions, self-reported health, ADL dependency (ADL-staircase) and frailty (the Brody frailty index). Results: The total sample was comprised of 53 percent women and the mean age was 74.5 years (SD 7.0). The mean frailty index score at baseline was 0.12 and increased with higher age (rs= 0.819) as well as with increased ADL dependency (rs = 0.740). The analyses showed high percentage of correctly classified cases (97.1-98.2), high specificity (98.1-98.4) but low sensitivity (22.2-66.7). Conclusion: The self-report frailty index seems to be a valid measure of current frailty, but its predictive validity was found to be non-acceptable especially regarding the instrument’s sensitivity. Such instrument can be useful to predict frailty and allocate resources in the care of older people.
U. Jakobsson (2017): Measuring frailty among older people: further evaluation of the Brody frailty index. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.41