Ahead of print articles
HBA1C IS ASSOCIATED WITH FRAILTY IN A GROUP OF ABORIGINAL AUSTRALIANS
Z. Hyde, K. Smith, L. Flicker, D. Atkinson, S. Fenner, L. Skeaf, R. Malay, D. Lo Giudice
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In this cross-sectional study of 141 Aboriginal Australians aged ≥45 years living in the remote Kimberley region of Western Australia, we explored whether glycated haemoglobin (HbA1c) levels were associated with frailty. Sixty-four participants (45.4%) had a HbA1c level ≥6.5% and 84 participants (59.6%) were frail. A significant trend was observed with regard to HbA1c levels and frailty, with those having HbA1c levels ≥6.5% having the greatest prevalence of frailty (70.3%). In binary logistic regression analyses, having a HbA1c level ≥6.5% was associated with being frail after adjustment for age, sex, and education. This association was attenuated after further adjustment for body mass index (BMI). Poorer glycaemic control is very common and a potential risk factor for frailty in remote-living Aboriginal Australians, and appears to be partly mediated by BMI, a known risk factor for diabetes mellitus. Obesity and diabetes mellitus are potentially important modifiable risk factors for frailty.
Z. Hyde ; K. Smith ; L. Flicker ; D. Atkinson ; S. Fenner ; L. Skeaf ; R. Malay ; D. Lo Giudice (2018): HbA1c is associated with frailty in a group of Aboriginal Australians. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.41
NOVEL FRAILTY SCREENING QUESTIONNAIRE (FSQ) PREDICTS 8-YEAR MORTALITY IN OLDER ADULTS IN CHINA
L. Ma, Z. Tang, P. Chan, J.D. Walston
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Background: Although frailty status greatly impacts health care in countries with rapidly aging populations, little is known about the frailty status in Chinese older adults. Objectives: Given the increased health care needs associated with frailty, we sought to develop an easily applied self-report screening tool based on four of the syndromic frailty components and sought to validate it in a population of older adults in China. Design: Prospective epidemiological cohort study. Setting: Community-dwelling residents living in Beijing, China. Participants: 1724 community-dwelling adults aged ≥60 years in 2004 with an 8-year follow up. Measurements: We developed a simple self-report frailty screening tool—the Frailty Screening Questionnaire (FSQ)—based on the modified Fried frailty components. The predictive ability for outcome was assessed by age and sex adjusted Cox proportional hazards model. Results: According to FSQ criteria, 7.1% of the participants were frail. Frailty was associated with poor physical function, fractures, falls, and mortality. Both frailty and pre-frailty were associated with a higher mortality rate: frailty—hazards ratio (HR), 3.94, 95% confidence interval (CI), 3.16–4.92, P<0.001; pre-frailty—HR, 1.89; 95% CI, 1.57–2.27, P <0.001; adjusted models for this variable did not affect the estimates of the association. Among the four frailty components, slowness was the strongest predictor of mortality. The combination of the four components provided the best risk prediction. Conclusions: FSQ is a self-report frailty measurement tool that can be rapidly performed to identify older adults with higher risk of adverse health outcomes.
L. Ma ; Z. Tang ; P. Chan ; J.D. Walston (2018): Novel Frailty Screening Questionnaire (FSQ) Predicts 8-year Mortality in Older Adults in China. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.38
CAN A PREBIOTIC FORMULATION REDUCE FRAILTY LEVELS IN OLDER PEOPLE?
O. Theou, K. Jayanama, J. Fernández-Garrido, C. Buigues, L. Pruimboom, A.J. Hoogland, R. Navarro-Martínez, K. Rockwood, O. Cauli
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Objective: The purpose of this study was to examine whether a prebiotic formulation reduces frailty index (FI) levels in older people. Design: We conducted secondary analysis of a placebo-controlled, randomized, double-blind design study. Setting/Participants: The study included non-demented people over the age of 65 who were living in nursing homes and were able to walk. Fifty participants completed the study (75.3±7.3 years, 70% females). Intervention: Participants were randomly assigned to either a group who received daily Darmocare Pre® (inulin and fructooligosaccharides) for 13 weeks or a placebo group (maltodextrin). Measurement: The primary outcome in this secondary analysis was change in level of a 62-item FI compared to baseline. Results: At the 13-week follow-up, the placebo group had higher FI levels (preFI 0.23±0.11, postFI 0.24±0.12, p=0.012) and the intervention group had lower FI levels (preFI 0.22±0.09, postFI 0.20±0.08, p<0.001). There was an average increase of 0.01±0.01 in the FI score in the placebo group (0.4 deficits; Cohen’s d 0.61; standardized response mean 0.59) and an average reduction of 0.02±0.02 in the intervention group (1.1 deficits; Cohen’s d -1.35; standardized response mean -1.16). Among the 28 participants in the intervention group, FI levels were reduced for 25 people; five of them had an FI reduction greater than 0.03. The moderately/severely frail participants (FI >0.3, N=5) had the greatest reduction in their FI (0.04±0.01). Conclusion: A prebiotic intervention can reduce frailty levels in nursing home residents especially in those with higher levels of frailty.
O. Theou ; K. Jayanama ; J. Fernández-Garrido ; C. Buigues ; L. Pruimboom ; A.J. Hoogland ; R. Navarro-Martínez ; K. Rockwood ; O. Cauli (2018): Can a prebiotic formulation reduce frailty levels in older people?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.39
MAXIMUM WALKING SPEED CAN IMPROVE THE DIAGNOSTIC VALUE OF FRAILTY AMONG COMMUNITY-DWELLING OLDER ADULTS A CROSS-SECTIONAL STUDY
M. do Carmo Correia de Lima, T. Loffredo Bilton, W. Jefferson de Sousa Soares, L. Paccini Lustosa, E. Ferriolli, M. Rodrigues Perracini
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This study investigates the diagnostic accuracy of the combination of usual walking speed (UWS) and maximum walking speed (MWS) to identify frailty in community-dwelling older adults. A population-based study with 758 participants aged 65 and older was conducted. Frailty syndrome was determined using the Fried phenotype. UWS and MWS were evaluated in a 4.6-meter path. Both measures were categorized using the 1.0 m/s cut points, and participants were categorized into three groups: those with “very good”, “good” and “insufficient” walking reserve capacity (WRC). Of all participants, 9% were identified as frail and 47% as prefrail. The “insufficient” WRC presented a low sensitivity of 0.55, high specificity of 0.91 and moderately useful likelihood ratios (LR+ 6.57, LR- 0.48) to identify frailty. Based on Fagan’s nomogram, an elder’s corresponding post-test probability of being frail with an “insufficient” WRC would be around 40%, which substantially increased the diagnostic accuracy of frailty.
M. do Carmo Correia de Lima ; T. Loffredo Bilton ; W. Jefferson de Sousa Soares ; L. Paccini Lustosa ; E. Ferriolli ; M. Rodrigues Perracini (2018): Maximum walking speed can improve the diagnostic value of frailty among community-dwelling older adults a cross-sectional study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.44
THE TRIGGERING RECEPTOR EXPRESSED ON MYELOID CELLS-2 (TREM-2) AS EXPRESSION OF THE RELATIONSHIP BETWEEN MICROGLIA AND ALZHEIMER’S DISEASE: A NOVEL MARKER FOR A PROMISING PATHWAY TO EXPLORE
C. Gussago, M. Casati, E. Ferri, B. Arosio
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Alzheimer’s disease (AD) is a common neurodegenerative disorder, strongly related with age. It has been reported that genetic variants of the Triggering Receptor Expressed on Myeloid Cells-2 (TREM2), a cell-surface receptor expressed in microglial cells, greatly increase the risk of AD, thus suggesting an involvement of the microglia in the AD pathogenesis. The aim of this report is to provide an overview of the TREM2 and of its possible implication in the pathogenesis of AD.
C. Gussago ; M. Casati ; E. Ferri ; B. Arosio (2018): The Triggering Receptor Expressed on Myeloid cells-2 (TREM-2) as expression of the relationship between microglia and Alzheimer’s disease: a novel marker for a promising pathway to explore. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.43
THE MANAGEMENT OF GERIATRIC AND FRAIL HIV PATIENTS. A 2017 UPDATE FROM THE ITALIAN GUIDELINES FOR THE USE OF ANTIRETROVIRAL AGENTS AND THE DIAGNOSTIC-CLINICAL MANAGEMENT OF HIV-1 INFECTED PERSONS
G. Guaraldi, S. Marcotullio, R. Maserati, M. Gargiulo, J. Milic, I. Franconi, A. Chirianni, M. Andreoni, M. Galli, A. Lazzarin, A. D’Arminio Monforte, G. Di Perri, C.-F. Perno, M. Puoti, S. Vella, A. Di Biagio, L. Maia, C. Mussi, M. Cesari, A. Antinori
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Objective: This article deals with the attempt to join HIV and geriatric care management in the 2017 edition of the Italian guidelines for the use of antiretrovirals and the diagnostic-clinical management of HIV-1 infected persons. Methods: The outlined recommendations are based on evidence from randomized clinical trials and observational studies published in peer-reviewed journals and/or presented at international scientific conferences in recent years. The principles of starting antiretroviral therapy in elderly patients and the viro-immunological goals are the same as in the general HIV population. However, there are some specificities to consider, related to the host as well as the therapy itself. HIV care in elderly patients must shift from a combined AntiRetroviral Therapy specific approach to a more comprehensive management, and from a disease-based model (list of co-morbidities) to a multi-morbidity and frailty standpoint. The implementation of a geriatric approach, based on the Comprehensive Geriatric Assessment, is essential and consists of a broader evaluation of health status. This multidimensional and multidisciplinary evaluation is focused on the development of a tailored intervention plan. Polypharmacy is a frequent condition in the older population and an independent risk factor for negative health-related outcomes. This can be overcome with a multidisciplinary and cooperative approach involving HIV specialists, geriatricians and primary care physicians. Conclusion: The inclusion of geriatric care becomes necessary due to the novel needs of an evolving patient population. It is important to underline that the HIV specialist will continue to lead multidimensional interventions and optimize quality of care for HIV-positive people.
G. Guaraldi ; S. Marcotullio ; R. Maserati ; M. Gargiulo ; J. Milic ; I. Franconi ; A. Chirianni ; M. Andreoni ; M. Galli ; A. Lazzarin ; A. D’Arminio Monforte ; G. Di Perri ; C.-F. Perno ; M. Puoti ; S. Vella ; A. Di Biagio ; L. Maia ; C. Mussi ; M. Cesari ; A. Antinori (2018): The management of geriatric and frail HIV patients. A 2017 update from the Italian guidelines for the use of antiretroviral agents and the diagnostic-clinical management of HIV-1 infected persons. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.42
PSYCHOSOCIOECONOMIC PRECARIOUSNESS AND FRAILTY: THE RESPECTIVE CONTRIBUTION IN PREDICTING MORTALITY
C. Ouvrard, C. Meillon, J.-F. Dartigues, M. Tabue Teguo, J.A. Avila-Funes, H. Amieva
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Background: Low socioeconomic status and frailty are factors of vulnerability in old age. They are both well-known risk factors of death. On the other hand, low socioeconomic status has been reported as a predictor of frailty, which questions the relationship between socioeconomic status, frailty and death. Objectives: The aim of this work was to explore the respective contribution of psychosocioeconomic precariousness – which covers socioeconomic status and also psychosocial vulnerability – and frailty in predicting mortality. Design: Prospective population-based study. Setting: Three-City (3C) Bordeaux study, France. Participants: The sample consisted of 1586 subjects aged 65 or older. Measurements: Psychosocioeconomic precariousness was assessed utilizing a structured instrument which assessed poor socioeconomic status, and psychosocial vulnerability. Frailty status was defined by Fried’s phenotype. Results: After 14 years of follow-up, 665 deaths (42%) occurred. Psychosocioeconomic precariousness and frailty had both an independent contribution to mortality prediction (hazard ratio (HR) 1.51 (95% confidence interval (CI) 1.11-2.07)) and (HR 1.68 (95% CI 1.19-2.38)), respectively. Such relationships were adjusted for age, sex, disability, and comorbidities. No interaction term was found between precariousness and frailty. Conclusions: If psychosocioeconomic precariousness and frailty are both aspects of vulnerability in old age, they have a non-overlapping contribution in the prediction of mortality. These findings emphasize the importance of considering both psychosocioeconomic precariousness and frailty when identifying elderly people at risk of death.
C. Ouvrard ; C. Meillon ; J.-F. Dartigues ; M. Tabue Teguo ; J.A. Avila-Funes ; H. Amieva (2018): Psychosocioeconomic precariousness and frailty: the respective contribution in predicting mortality. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.36
NEUROMUSCULAR CHANGES WITH AGING AND SARCOPENIA
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Sarcopenia was originally conceptualized as the age-related loss of skeletal muscle mass. Over the ensuing decades, the conceptual definition of sarcopenia has changed to represent a condition in older adults that is characterized by declining muscle mass and function, with “function” most commonly conceived as muscle weakness and/or impaired physical performance (e.g., slow gait speed). Findings over the past 15-years, however, have demonstrated that changes in grip and leg extensor strength are not primarily due to muscle atrophy per se, and that to a large extent, are reflective of declines in the integrity of the nervous system. This article briefly summarizes findings relating to the complex neuromuscular mechanisms that contribute to reductions in muscle function associated with advancing age, and the implications of these findings on the development of effective therapies.
B.C. Clark (2018): Neuromuscular changes with aging and sarcopenia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.35
THE ASSOCIATION BETWEEN PHYSICAL ACTIVITY AND METABOLIC SYNDROME IN OLDER ADULTS WITH OBESITY
F. Xu, S.A. Cohen, I.E. Lofgren, G.W. Greene, M.J. Delmonico, M.L. Greaney
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Background: Physical activity reduces the likelihood of developing metabolic syndrome (MetS). However, the association between different physical activity levels and MetS remains unclear in older adults with obesity. Methods: This cross-sectional study used four waves of data (2007-2008, 2009-2010, 2011-2012, 2013-2014) from two datasets: The National Health and Nutrition Examination Survey and United Sates Department of Agriculture’s Food Patterns Equivalents Database. The sample included adults 60+ years of age (n= 613) with obesity who had physical activity and MetS data. Physical activity was assessed using the Global Physical Activity Questionnaire and categorized into three physical activity levels (low, medium, and high); and medium or high physical activity levels are aligned with or exceed current physical activity recommendations. Participants were classified as having MetS using a commonly agreed upon definition. Multiple logistic regression models examined the association between the three physical activity levels and MetS risk factors and MetS. All analyses adjusted for potential confounding variables and accounted for complex sampling. Results: Of 613 respondents, 72.1% (n=431) were classified as having MetS, and 44.3% (n = 263) had not met physical activity recommendations. Participants with high levels of physical activity had a lower risk of MetS (OR = 0.31, 95%CI: 0.13, 0.72) and more healthful levels of high-density lipoprotein cholesterol (OR = 0.39, 95%CI: 0.18, 0.84), blood pressure (OR = 0.39, 95%CI: 0.20, 0.77), fasting glucose (OR = 0.34, 95%CI: 0.15, 0.78) than participants categorized as having low physical activity. Conclusions: Physical activity is associated with lower risk of MetS only for participants with the highest level of physical activity, which suggests that physical activity dosage is important to reduce MetS risk in older adults with obesity.
F. Xu ; S.A. Cohen ; I.E. Lofgren ; G.W. Greene ; M.J. Delmonico ; M.L. Greaney (2018): The Association between Physical Activity and Metabolic Syndrome in Older Adults with Obesity. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.34
PREVENTION OF DISABILITY IN THE FRAIL CHINESE OLDER POPULATION
J.K. Chhetri, P. Chan, L. Ma, D. Peng, L. Rodríguez-Mañas, M. Cesari, B. Vellas
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As aging is becoming a global phenomenon, the burden of population aging is increasing rapidly, and is soon expected to be the highest in low-and middle-income countries. China represents the world’s largest population, and will face the largest number of older individuals, while the economy still remains developing. There is an urgent need to address the negative consequences of aging such as disability, that creates a myriad of challenges, including financial burden to the economy. In order to achieve successful aging-i.e., aging without being frail or disabled, the traditional healthcare model based on a disease-centered approach is not enough, but require a more holistic course. Here, we briefly outline the current scenario of aging and disability in the Chinese older population, its impact and challenges. We strongly believe that public health initiatives centered on frailty, a clinically distinguishable state of extreme vulnerability in older adults, could be the most relevant approach to meet the current needs of the aging population. Such initiatives are immediately needed to reshape the existing model of geriatric healthcare, to promote healthy aging and to reduce the burden of disability in the Chinese population.
J.K. Chhetri ; P. Chan ; L. Ma ; D. Peng ; L. Rodríguez-Mañas ; M. Cesari ; B. Vellas (2018): PREVENTION OF DISABILITY IN THE FRAIL CHINESE OLDER POPULATION. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.27
A COMPARISON BETWEEN 6-POINT DIXON MRI AND MR SPECTROSCOPY TO QUANTIFY MUSCLE FAT IN THE THIGH OF SUBJECTS WITH SARCOPENIA
A. Grimm, H. Meyer, M.D. Nickel, M. Nittka, E. Raithel, O. Chaudry, A. Friedberger, M. Uder, W. Kemmler, K. Engelke, H.H. Quick
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Background: Changes in muscle fat composition as for example observed in sarcopenia, affect physical performance and muscular function, like strength and power. Objectives: The purpose of this study was to compare 6-point Dixon magnetic resonance imaging and multi-echo magnetic resonance spectroscopy sequences to quantify muscle fat. Setting, participants and measurements: Two groups were recruited (G1: 23 healthy young men (28 ± 4 years), G2: 56 men with sarcopenia (80 ± 5 years)). Proton density fat fraction was measured with a 6-point product and a 6-point prototype Dixon sequence in the left thigh muscle and with a high-speed multi-echo T2*-corrected H1 magnetic resonance spectroscopy sequence within the semitendinosus muscle of the left thigh. To evaluate the comparability among the different methods, Bland-Altman and linear regression analyses of the proton density fat fraction results were performed. Results: Mean differences ± 1.96 * standard deviation between spectroscopy and 6pt Dixon sequences were 1.9 ± 3.3% and 1.5 ± 3.6% for the product and prototype sequences, respectively. High correlations were measured between the proton density fat fraction results of the 6-point Dixon sequences and spectroscopy (R = 0.95 for the product sequence and R = 0.97 for the prototype sequence). Conclusions: Dixon imaging and spectroscopy sequences show comparable accuracy for fat measurements in the thigh. Spectroscopy is a local measurement, whereas Dixon sequences provide maps of the fat distribution. The high correlations of the 6-point Dixon sequences with spectroscopy support their clinical use. They provide higher spatial resolution than spectroscopy, but are not suitable for a more complicated spectral analysis to separate extra- and intramyocellular lipids.
A. Grimm ; H. Meyer ; M.D. Nickel ; M. Nittka ; E. Raithel ; O. Chaudry ; A. Friedberger ; M. Uder ; W. Kemmler ; K. Engelke ; H.H. Quick ; (2018): A Comparison between 6-point Dixon MRI and MR Spectroscopy to Quantify Muscle Fat in the Thigh of Subjects with Sarcopenia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.16
JFA N°04 - 2018
TIME TO ADDRESS “FRAILTY CREEPAGE” IN THE CANADIAN HEALTHCARE SYSTEM
J Frailty Aging 2018;7(4):206-207Show summaryHide summary
J. Young (2018): Time to address “frailty creepage” in the Canadian healthcare system. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.28
IMPLEMENTING FRAILTY MEASURES IN THE CANADIAN HEALTHCARE SYSTEM
D.B. Rolfson, G.A. Heckman, S.M. Bagshaw, D. Robertson, J.P. Hirdes, On behalf of Canadian Frailty Network
J Frailty Aging 2018;7(4):208-216Show summaryHide summary
Canadian healthcare is changing to include individuals living with frailty, but frailty must be better operationalized and better framed by sound data standards and policy. Frailty results from deficit accumulation in multiple body systems, with exaggerated vulnerability to external stressors. A growing consensus on defining frailty sets the stage for consensus on operationalization and widespread implementation in care settings. Frailty measurement is not yet integrated into daily clinical practice in Canada. Here, we will present how this integration might occur. We hope to demonstrate that implementation must appeal to inter-professional practice needs in different settings or circumstances. In some settings, methods for frailty case finding are expected to evolve as deemed to be most appropriate to the front-line users. In this “hands-off” approach, care providers, supported by emerging knowledge translation on frailty operationalization, would be informed by their setting and local practices to establish patterns of ad hoc case finding and component definition of frailty. This more nimble case finding strategy would be opportunistic, and would appeal to expert clinicians and self-directed teams who emphasize an individualized health care experience for their patients. In other settings, we can shape frailty case finding by building care algorithms around existing standardized practices and data repositories, leading to a systematic application of frailty measures and a more coordinated process of component definition and care protocols. Here, recommended instruments and data standards must be endorsed by health networks locally, provincially and nationally. The interRAI suite of assessment instruments has pan-Canadian standards in place and its pervasiveness makes it the most obvious starting point, especially in home care and long-term care. We anticipate the evolution of an integrated model informed by stakeholders and settings, where policy makers focus on system supports for frailty case finding, while front-line clinicians use case finding strategies to pinpoint and act on key frailty components.
D.B. Rolfson ; G.A. Heckman ; S.M. Bagshaw ; D. Robertson ; J.P. Hirdes ; On behalf of Canadian Frailty Network (2018): Implementing Frailty Measures in the Canadian Healthcare System. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.29
SOCIAL AND SOCIETAL IMPLICATIONS OF FRAILTY, INCLUDING IMPACT ON CANADIAN HEALTHCARE SYSTEMS
M.K. Andrew, S. Dupuis-Blanchard, C. Maxwell, A. Giguere, J. Keefe, K. Rockwood, P. St. John, On behalf of Canadian Frailty Network
J Frailty Aging 2018;7(4):217-223Show summaryHide summary
Frailty has many social and societal implications. Social circumstances are key both as contributors to frail older adults’ health outcomes and as practical facilitators or barriers to intervention and supports. Frailty also has important societal implications for health systems and social care policy. In this discussion paper, we use a social ecology framework to consider the social and societal implications and impact of frailty at each level, from the individual, through relationships with family and friend caregivers, institutions, health systems, neighborhoods and communities, to society at large. We conclude by arguing that attention to these issues at a policy level is critical. We identify three target actions: 1) Social dimensions of frailty should be systematically considered when frailty is assessed. 2) Action is needed at the level of policies and programs to improve support for caregivers. 3) Policy review across all portfolios will benefit from a social frailty lens.
M.K. Andrew ; S. Dupuis-Blanchard ; C. Maxwell ; A. Giguere ; J. Keefe ; K. Rockwood ; P. St. John ; On behalf of Canadian Frailty Network (2018): Social and societal implications of frailty, including impact on Canadian healthcare systems. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.30
ETHICAL AND LEGAL IMPLICATIONS OF FRAILTY SCREENING
L. Reid, W. Lahey, B. Livingstone, M. McNally, On behalf of Canadian Frailty Network
J Frailty Aging 2018;7(4):224-232Show summaryHide summary
Goals of screening for frailty include (a) promoting healthy aging, (b) addressing frailty with preventive and targeted interventions, (c) better aligning social and medical responses to frailty with the needs of frail older adults and (d) preventing harms to frail older adults from excessive and inappropriate medical interventions that are insensitive to the implications of frailty. However, the medicalization of frailty and outcomes of the screening process also risk harming frail older adults and their autonomy through stereotyping and by legitimizing denial of care. This risk of harm gives rise to ethical and legal questions and considerations that this paper addresses. Frailty screening that is ethically defensible will situate and support healthcare that is consistent with people’s needs, circumstances and capacity to benefit from the care provided. We also call for an informed consent process that incorporates supported or shared decision making in order to protect the autonomy of frail older adults.
L. Reid ; W. Lahey ; B. Livingstone ; M. McNally ; On behalf of Canadian Frailty Network (2018): Ethical and Legal Implications of Frailty Screening. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.31
POLICY AND ECONOMIC CONSIDERATIONS FOR FRAILTY SCREENING IN THE CANADIAN HEALTHCARE SYSTEM
K. Grimes, J. Kitts, B. Tholl, C. Samuelson-Kiraly, J.I. Mitchell, On behalf of Canadian Frailty Network
J Frailty Aging 2018;7(4):233-239Show summaryHide summary
Canada faces significant policy and economic challenges related to healthcare for frail older adults. Annual per capita healthcare costs for people over age 65 are five times those for people under 65. Flat economic growth and an aging workforce decrease tax revenue, which funds 70% of health spending. Governments are shifting policy to enhance person-centered care and shifting spending from hospitals to primary and community care. Recognizing that frailty and evidence-based frailty screening can contribute directly to reform initiatives, what are the policy and economic considerations, both nationally and internationally, around frailty screening that will benefit patients, families and/or the wider health system? Based on key informant interviews, we present recommendations for approaching policy and economic challenges in frailty through the following healthcare policy instruments: financing, funding, legislation, regulation, technology, interdisciplinary care, person-centered service and health promotion.
K. Grimes ; J. Kitts ; B. Tholl ; C. Samuelson-Kiraly ; J.I. Mitchell ; On behalf of Canadian Frailty Network (2018): Policy and Economic Considerations for Frailty Screening in the Canadian Healthcare System. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.32
IMPROVING END-OF-LIFE CARE AND ADVANCE CARE PLANNING FOR FRAIL OLDER ADULTS IN CANADA
J. Downar, P. Moorhouse, R. Goldman, D. Grossman, S. Sinha, T. Sussman, S. Kaasalainen, S. MacDonald, A. Moser, J.J. You, On behalf of Canadian Frailty Network
J Frailty Aging 2018;7(4):240-246Show summaryHide summary
We present five Key Concepts that describe priorities for improving end-of-life care for frail older adults in Canada, and recommendations based on each Key Concept. Key Concept #1: Our end-of-life care system is focused on cancer, not frailty. Key Concept #2: We need better strategies to systematically identify frail older adults who would benefit from a palliative approach. Key Concept #3: The majority of palliative and end-of-life care will be, and should be, provided by clinicians who are not palliative care specialists. Key Concept #4: Organizational change and innovative funding models could deliver far better end-of-life care to frail individuals for less than we are currently spending. Key Concept #5: Improving the quality and quantity of advance care planning for frail older adults could reduce unwanted intensive care and costs at the end of life, and improve the experience for individuals and family members alike.
J. Downar ; P. Moorhouse ; R. Goldman ; D. Grossman ; S. Sinha ; T. Sussman ; S. Kaasalainen ; S. MacDonald ; A. Moser ; J.J. You ; On behalf of Canadian Frailty Network (2018): Improving End-of-Life Care and Advance Care Planning for Frail Older Adults in Canada. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.33
NUTRITIONAL INTERVENTION IN SARCOPENIA: REPORT FROM THE INTERNATIONAL CONFERENCE ON FRAILTY AND SARCOPENIA RESEARCH TASK FORCE
F. Landi, C. Sieber, R.A. Fielding, Y. Rolland, J. Guralnik, and the ICFSR Task Force
J Frailty Aging 2018;7(4):247-252Show summaryHide summary
Research suggests that poor nutrition is an underlying cause of sarcopenia and frailty, and that dietary interventions may prevent or treat age-related loss of muscle mass and strength. In February 2018, the International Conference on Frailty and Sarcopenia Research Task Force explored the current status of research on nutritional interventions for sarcopenia as well as gaps in knowledge, including whether nutritional supplements must be combined with physical activity, and the role of nutritional intervention in sarcopenic obese individuals. The lack of consistency across trials in terms of target populations, assessments, health-care settings, control groups, and choice of outcomes has made it difficult to draw meaningful conclusions from recent studies. The Task Force recommended large randomized controlled trials in heterogeneous, real-world populations to enable sub-group analysis. The field also needs to reach consensus on what outcomes are most meaningful and what represents clinically meaningful change.
F. Landi ; C. Sieber ; R.A. Fielding ; Y. Rolland ; J. Guralnik ; and the ICFSR Task Force (2018): Nutritional Intervention in Sarcopenia: Report from the International Conference on Frailty and Sarcopenia Research Task Force. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.26
ASSOCIATION BETWEEN HIGH LEVELS OF PARATHYROID HORMONE AND FRAILTY: THE NEPEAN OSTEOPOROSIS AND FRAILTY (NOF) STUDY
L. Murthy, P. Dreyer, P. Suriyaarachchi, F. Gomez, C.L. Curcio, D. Boersma, G, Duque
J Frailty Aging 2018;7(4):253-257Show summaryHide summary
Background: Frailty is associated with poor outcomes hence identification of risks factors is pivotal. Since the independent role of parathyroid hormone (PTH) in frailty remains unexplored, we aimed to determine this in a population of older individuals with a history of falling. Design: Cross-sectional study. Setting: Falls and Fracture Clinic, Nepean Hospital (Penrith, Australia). Participants: 692 subjects (mean age=79, 65% women) assessed between 2009-2015. Measurements: Assessment included clinical examination, mood, nutrition, grip strength, gait velocity, bone densitometry and posturography. Chemistry included serum PTH, calcium, vitamin D (25(OH)D3), creatinine and albumin. Normocalcemic subjects were divided into 4 groups: (1) Normal: 25(OH)D3 >50nmol/L and PTH between 1.6-6.8pmol/L; (2) PTH responsive: low 25(OH)D3 (<50nmol/L) and high PTH (>6.8pmol/L); (3) PTH unresponsive: low 25(OH)D3 and normal PTH; (4) Hyper PTH (>6.8pmol/L) with normal 25(OH)D3. Frailty was defined using Fried’s criteria. Difference between the groups was assessed using one-way ANOVA and X2 analysis. Multinomial logistic regression evaluated the association between the groups and the number of Fried’s criteria adjusted for age, BMI, renal function, 25(OH)D3 levels, and albumin. Results: 22.6% subjects had high PTH levels (>6.8pmol/L). All subjects in the high PTH groups had significantly lower grip strength, gait velocity, limits of stability, and higher BMI. The PTH responsive group had a higher risk of pre-frailty (β=3.8, 95% CI = 3.42 - 5.22, p< 0.01) and frailty (β=8.26, 95% CI = 2.8-16.1, p<0.01). The risk of frailty was also higher in the Hyper PTH group (β=2.3, 95% CI = 1.74-4.32, p<0.01). Conclusion: We have reported an independent association of high PTH levels with high number of falls and with the clinical components of physical frailty in community dwelling older persons. Our results suggest a possible role of PTH in frailty that deserves further exploration.
L. Murthy ; P. Dreyer ; P. Suriyaarachchi ; F. Gomez ; C.L. Curcio ; D. Boersma ; G, Duque (2018): Association between High Levels of Parathyroid Hormone and Frailty: The Nepean Osteoporosis and Frailty (NOF) Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.22
THE ROLE OF ULTRASOUND AS A DIAGNOSTIC TOOL FOR SARCOPENIA
H.J. Stringer, D. Wilson
J Frailty Aging 2018;7(4):258-261Show summaryHide summary
Sarcopenia is the progressive loss of skeletal mass and strength, particularly in older adults, with consequent reduction in function and independence. Changing population demographics, have resulted in increased prevalence of sarcopenia and this is associated with a considerable economic burden. Whilst simple, effective, non-intrusive management of this condition exists, no routine diagnosis takes place either in the UK or in many other countries, partly due to an absence of pragmatic clinical diagnostic tools to support the early identification of the syndrome. This position paper aims to provide a short overview proposing the potential case for developing ultrasound as a new and alternative diagnostic tool for identifying sarcopenia.
H.J. Stringer ; D. Wilson (2018): The role of ultrasound as a diagnostic tool for sarcopenia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.24
SINGLE PHYSICAL PERFORMANCE MEASURES CANNOT IDENTIFY GERIATRIC OUTPATIENTS WITH SARCOPENIA
S.M.L.M. Looijaard, S.J. Oudbier, E.M. Reijnierse, G.J. Blauw, C.G.M. Meskers, A.B. Maier
J Frailty Aging 2018;7(4):262-267Show summaryHide summary
Background: Sarcopenia is highly prevalent in the older population and is associated with several adverse health outcomes. Equipment to measure muscle mass and muscle strength to diagnose sarcopenia is often unavailable in clinical practice due to the related expenses while an easy physical performance measure to identify individuals who could potentially have sarcopenia is lacking. Objectives: This study aimed to assess the association between physical performance measures and definitions of sarcopenia in a clinically relevant population of geriatric outpatients. Design, setting and participants: A cross-sectional study was conducted, consisting of 140 community-dwelling older adults that were referred to a geriatric outpatient clinic. No exclusion criteria were applied. Measurements: Physical performance measures included balance tests (side-by-side, semi-tandem and tandem test with eyes open and -closed), four-meter walk test, timed up and go test, chair stand test, handgrip strength and two subjective questions on mobility. Direct segmental multi-frequency bioelectrical impedance analysis was used to measure muscle mass. Five commonly used definitions of sarcopenia were applied. Diagnostic accuracy was determined by sensitivity, specificity and area under the curve.Results: Physical performance measures, i.e. side-by-side test, tandem test, chair stand test and handgrip strength, were associated with at least one definition of sarcopenia. Diagnostic accuracy of these physical performance measures was poor. Conclusions: Single physical performance measures could not identify older individuals with sarcopenia, according to five different definitions of sarcopenia.
S.M.L.M. Looijaard ; S.J. Oudbier ; E.M. Reijnierse ; G.J. Blauw ; C.G.M. Meskers ; A.B. Maier (2018): Single physical performance measures cannot identify geriatric outpatients with sarcopenia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.19
OLDER ADULTS’ PERCEPTIONS OF THE BUILT ENVIRONMENT AND ASSOCIATIONS WITH FRAILTY: A FEASIBILITY AND ACCEPTABILITY STUDY
B. Arakawa Martins, H. Barrie, J. Dollard, N. Mahajan, R. Visvanathan
J Frailty Aging 2018;7(4):268-271Show summaryHide summary
It is essential to evaluate frail older adults understanding and execution of survey tools to improve data quality and accurate representation in research. The study tested the feasibility and acceptability of a survey that assesses various measures of functional status in frail older people. The study evaluated: 1) recruitment rate; 2) time to complete questionnaires and difficulties encountered; and 3) acceptability by participants. Validated tools including: FRAIL Scale, EuroQoL 5D-5L, Charlson’s Comorbidities Index, Baecke’s Physical Activity Questionnaire, Life-Space Assessment, Katz and Lawton ADL and NEWS Walkability Scale were assessed. Twenty-five older patients (63% recruitment rate) of a post-acute restorative program (residential Transition Care Program) in Adelaide, South Australia were interviewed. Although not statistically different, time to complete the overall questionnaire differed between robust, pre-frail and frail participants. Overall, the survey was considered acceptable and feasible, with consideration with NEWS and Life-Space assessment regarding length, phrasing and layout.
B. Arakawa Martins ; H. Barrie ; J. Dollard ; N. Mahajan ; R. Visvanathan (2018): Older adults’ perceptions of the built environment and associations with frailty: a feasibility and acceptability study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.23