Ahead of print articles
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.
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
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.
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
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.
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
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.
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
COMPARISON OF FRAILTY SCORES IN NEWLY DIAGNOSED PATIENTS WITH MULTIPLE MYELOMA: A REVIEW
H. Mian, M. Brouwers, C.T. Kouroukis, T.M. Wildes
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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.
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
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
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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.
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
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
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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.
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
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
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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.
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
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
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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.
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
DRUG-INDUCED HYPONATREMIA: NSAIDS, A NEGLECTED CAUSE THAT SHOULD BE CONSIDERED
S. Damanti, L. Pasina, D. Consonni, D. Azzolino, M. Cesari
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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.
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
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
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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.
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
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
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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.
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
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
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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.
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
JFA N°03 - 2019
PROCEEDINGS OF THE CANADIAN FRAILTY NETWORK WORKSHOP: IDENTIFYING BIOMARKERS OF FRAILTY TO SUPPORT FRAILTY RISK ASSESSMENT, DIAGNOSIS AND PROGNOSIS. TORONTO, JANUARY 15, 2018
J. Muscedere, P.M. Kim, J. Afilalo, C. Balion, V.E. Baracos, D. Bowdish, M. Cesari, J. D. Erusalimsky, T. Fülöp, G. Heckman, S.E. Howlett, R.g. Khadaroo, J.L. Kirkland, L. Rodriguez Mañas, E. Marzetti, G. Paré, P. Raina, K. Rockwood, A. Sinclair, C. Skappak, C. Verschoor, S. Walter, for the Canadian Frailty Network
J Frailty Aging 2019;8(3):106-116Show summaryHide summary
The Canadian Frailty Network (CFN), a pan-Canadian not-for-profit organization funded by the Government of Canada through the Networks of Centres of Excellence Program, is dedicated to improving the care of older Canadians living with frailty. The CFN has partnered with the Canadian Longitudinal Study on Aging (CLSA) to measure potential frailty biomarkers in biological samples (whole blood, plasma, urine) collected in over 30,000 CLSA participants. CFN hosted a workshop in Toronto on January 15 2018, bringing together experts in the field of biomarkers, aging and frailty. The overall objectives of the workshop were to start building a consensus on potential frailty biomarker domains and identify specific frailty biomarkers to be measured in the CLSA biological samples. The workshop was structured with presentations in the morning to frame the discussions for the afternoon session, which was organized as a free-flowing discussion to benefit from the expertise of the participants. Participants and speakers were from Canada, Italy, Spain, United Kingdom and the United States. Herein we provide pertinent background information, a summary of all the presentations with key figures and tables, and the distillation of the discussions. In addition, moving forward, the principles CFN will use to approach frailty biomarker research and development are outlined. Findings from the workshop are helping CFN and CLSA plan and conduct the analysis of biomarkers in the CLSA samples and which will inform a follow-up data access competition.
J. Muscedere ; P.M. Kim ; J. Afilalo ; C. Balion ; V.E. Baracos ; D. Bowdish ; M. Cesari ; J. D. Erusalimsky ; T. Fülöp ; G. Heckman ; S.E. Howlett ; R.g. Khadaroo ; J.L. Kirkland ; L. Rodriguez Mañas ; E. Marzetti ; G. Paré ; P. Raina ; K. Rockwood ; A. Sinclair ; C. Skappak ; C. Verschoor ; S. Walter ; for the Canadian Frailty Network ; (2019): Proceedings of the Canadian Frailty Network Workshop: Identifying biomarkers of frailty to support frailty risk assessment, diagnosis and prognosis. Toronto, January 15, 2018. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.12
HIGHLIGHTS FROM THE 2019 INTERNATIONAL CONGRESS ON FRAILTY AND SARCOPENIA RESEARCH
M. Maltais, M. Aubertin-Leheudre, C. Dray, R.A. Fielding, Y. Rolland, M. Cesari, B. Vellas
J Frailty Aging 2019;8(3):117-119Show summaryHide summary
M. Maltais ; M. Aubertin-Leheudre ; C. Dray ; R.A. Fielding ; Y. Rolland ; M. Cesari ; B. Vellas (2019): Highlights from the 2019 International Congress on Frailty and Sarcopenia Research. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.13
DEVELOPMENT OF PHARMACOTHERAPIES FOR THE TREATMENT OF SARCOPENIA
D. Rooks, R. Roubenoff
J Frailty Aging 2019;8(3):120-130Show summaryHide summary
Sarcopenia, the associated loss of skeletal muscle mass and strength and impaired physical function seen with aging, is a growing, global public health challenge in need of accepted, proven treatments that address the needs of a broad range of older adults. While exercise, primarily resistance training, and increased dietary protein have been shown to delay and even reverse losses in muscle mass, strength and physical function seen with aging, proven treatments that are accessible globally, cost effective and sustainable by patients are needed. While no drug has yet demonstrated the substantial safety and clinical value needed to be the first pharmacological therapy registered for muscle wasting or sarcopenia, the field is active. Several approaches to treating the muscle loss and subsequent functional decline are being studied in a variety of patient populations across every continent. We provide a review of the leading programs and approaches and available findings from recent studies. In addition, we briefly discuss several related issues needed to facilitate the development of a safe and efficacious pharmacotherapeutic that could be used as part of a treatment plan for older men and women with sarcopenia.
D. Rooks ; R. Roubenoff (2019): Development of pharmacotherapies for the treatment of sarcopenia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.11
SERUM VITAMIN D AND AGE-RELATED MUSCLE LOSS IN AFRO-CARIBBEAN MEN: THE IMPORTANCE OF AGE AND DIABETIC STATUS
J. Hwang, J.M. Zmuda, A.L. Kuipers, C.H. Bunker, A.J. Santanasto, V.W. Wheeler, I. Miljkovic
J Frailty Aging 2019;8(3):131-137Show summaryHide summary
Background: Prospective studies examining the potential association of vitamin D with age-related muscle loss have shown inconsistent results. Objective: To examine the association between baseline serum 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)2D), and prospective change in lean mass with aging in African ancestry population. We also determined if associations were modulated by age and diabetes mellitus (DM). Design: Prospective observational cohort study. Setting: Data were collected from a random sub-sample of 574 men, participants of the Tobago Bone Health Study (TBHS). Participants: 574 Afro-Caribbean men, aged 43+ years (mean age: 59.1 ± 10.5), who were randomly selected as the participants in both the baseline and the follow-up visits. Measurements: Baseline fasting serum 25(OH)D was measured using liquid chromatography mass spectrometry (LC-MS/MS), and and 1,25(OH)2D was measured using radioimmunosassay (RIA). Changes in dual-energy X-ray absorptiometry (DXA)-measured appendicular lean mass (ALM), and total body lean mass (TBLM) were measured over an average of 6.0 ± 0.5 years. The associations of 25(OH)D and 1,25(OH)2D with ALM and TBLM were assessed by multiple linear regression model after adjusting for potential confounders. Results: When stratifying all men into two groups by age, greater baseline 25(OH)D and 1,25(OH)2D levels were associated with smaller losses of ALM and TBLM in older (age 60+ years) but not in younger (age 43 – 59 years) men. When stratifying by DM status, the associations of 25(OH)D and 1,25(OH)2D with declines in ALM and TBLM were statistically significant only in prediabetic, but not among normal glycemic or diabetic men. Conclusion: Higher endogenous vitamin D concentrations are associated with less lean mass loss with aging among older and prediabetic Afro-Caribbean men independent of potential confounders. Our findings raise a possibility that maintaining high serum vitamin D level might be important for musculoskeletal health in elderly and prediabetic African ancestry men.
J. Hwang ; J.M. Zmuda ; A.L. Kuipers ; C.H. Bunker ; A.J. Santanasto ; V.W. Wheeler ; I. Miljkovic (2018): Serum Vitamin D and Age-related Muscle Loss in Afro-Caribbean Men: The Importance of Age and Diabetic Status. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.40
RELATING THE MNA MOBILITY SINGLE ITEM TO USUAL WALKING SPEED IN HOSPITALIZED AND COMMUNITY-DWELLING GERIATRIC PATIENTS
S. De Breucker, T. Mets, T. Pepersack
J Frailty Aging 2019;8(3):138-140Show summaryHide summary
Usual walking speed (WS) is a relatively easy and reproducible tool for detecting mobility impairment. For some reasons, however, geriatric patients might not be able to perform walking tests. Therefore, a subjective assessment could be an alternative method to screen for mobility impairment. In the present paper, we explore the use of the mobility item from the Mini Nutritional Assessment-short form (MNA-sf) to assess mobility and its congruence with walking speed in hospitalized and ambulatory patients. We analyzed retrospective data from 357 patients and found a highly significant correlation between WS and the MNA-sf mobility item. After dichotomization of the MNA-sf mobility score (mobility impairment ≤1 and no impairment >1), AUC for ROC curves showed that the mobility item derived from the MNA-sf reflects fairly well the mobility of geriatric hospitalized patients (AUC = 0.773), while it performs better in ambulatory patients (AUC = 0.838).
S. De Breucker ; T. Mets ; T. Pepersack (2019): Relating the MNA mobility single item to usual walking speed in hospitalized and community-dwelling geriatric patients. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.14
DECREASED HANDGRIP STRENGTH IS ASSOCIATED WITH IMPAIRMENTS IN EACH AUTONOMOUS LIVING TASK FOR AGING ADULTS IN THE UNITED STATES
R. McGrath, K. M. Erlandson, B.M. Vincent, K.J. Hackney, S.D. Herrmann, B.C. Clark
J Frailty Aging 2019;8(3):141-145Show summaryHide summary
Objectives: The primary purpose of this study was to determine the time-varying associations between decreased handgrip strength (HGS) and individual instrumental activities of daily living (IADL) impairments for a nationally-representative sample of aging adults in the United States. Design: Longitudinal-Panel. Setting: Detailed interviews were completed in person and core interviews were typically completed over the telephone. Participants: A total of 15,336 participants aged at least 50 years who participated in the 2006 wave of the Health and Retirement Study were followed biennially for 8-years. Measurements: A hand-held dynamometer assessed HGS and performance in IADLs were self-reported. Results: Every 5-kilogram decrease in HGS was associated with an increased odds ratio for the following IADL impairments: 1.11 (95% confidence interval (CI): 1.09, 1.13) for using a map, 1.10 (CI: 1.07, 1.12) for grocery shopping, 1.09 (CI: 1.05, 1.14) for taking medications, 1.07 (CI: 1.05, 1.09) for preparing hot meals, 1.06 (CI: 1.04, 1.08) for managing money, and 1.05 (CI: 1.02, 1.09) for using a telephone. Conclusions: Decreased HGS was associated with each IADL impairment, and slightly different associations were observed in individual IADL tasks for aging adults in the United States. Our findings suggest that decreased HGS, which is reflective of reduced function of the neuromuscular system, is associated with diminished performance in autonomous living tasks during aging. Losses in HGS may lead to the development of an IADL impairment. Therefore, health-care providers working with aging adults should utilize measures of HGS as a screening tool for identifying future deficits in neuromuscular functioning. Interventions designed to preserve IADLs in aging adults should also include measures of HGS for detecting early changes in IADL capacity, and intervening at the onset of HGS declines may help aging adults retain their ability to live autonomously.
R. McGrath ; K. M. Erlandson ; B.M. Vincent ; K.J. Hackney ; S.D. Herrmann ; B.C. Clark (2018): Decreased Handgrip Strength is Associated With Impairments in Each Autonomous Living Task for Aging Adults in the United States. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.47
ADHERENCE TO A MEDITERRANEAN DIET IS NOT ASSOCIATED WITH RISK OF SARCOPENIC SYMPTOMOLOGY: A CROSS-SECTIONAL ANALYSIS OF OVERWEIGHT AND OBESE OLDER ADULTS IN AUSTRALIA
A. Stanton, J. Buckley, A. Villani
J Frailty Aging 2019;8(3):146-149Show summaryHide summary
Adherence to a Mediterranean Diet (MedDiet) is inversely associated with sarcopenia. The aim of this study was to examine the association between adherence to a MedDiet and sarcopenic symptomology in obese older adults. For confirmation of sarcopenia, low appendicular skeletal muscle (ASM: males, ≤7.25kg/m2; females, ≤5.5kg/m2) accompanied low handgrip strength (males, ≤30kg; females, ≤20kg) or low physical performance (Short Physical Performance Battery [SPPB]: ≤8; or gait speed: ≤0.8m/sec). Adherence to a MedDiet was determined using the Mediterranean Diet Adherence Screener (MEDAS). Sixty-five older adults were included. Adherence to a MedDiet was not associated with a decreased risk of sarcopenic symptomology (SPPB: OR = 0.20; 95% CI: 0.01-3.1; P = 0.234; Muscle strength: OR = 1.81; 95% CI: 0.32-10.15; P = 0.499; Gait speed: OR = 0.58; 95% CI: 0.13-2.50; P = 0.468). Future research should investigate whether a Mediterranean-style intervention can prevent or improve sarcopenic symptomology, including in non-Mediterranean populations.
A. Stanton ; J. Buckley ; A. Villani (2018): Adherence to a Mediterranean Diet is not associated with risk of sarcopenic symptomology: A cross-sectional analysis of overweight and obese older adults in Australia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.46
RELATIONSHIP BETWEEN GRIP STRENGTH AND NONALCOHOLIC FATTY LIVER DISEASE IN MEN LIVING WITH HIV REFERRED TO A METABOLIC CLINIC
P. Debroy, J.E. Lake, A. Malagoli, G. Guaraldi, for the Modena HIV Metabolic Cohort Team
J Frailty Aging 2019;8(3):150-153Show summaryHide summary
This study aimed to assess the relationship between grip strength (GS) and nonalcoholic fatty liver (NAFLD) in treated HIV-infected men. We included 169 HIV-infected men. GS was assessed using a hand-grip dynamometer. NALFD was defined by liver-spleen attenuation ratio <1.1 on computed tomography. Mean (SD) age was 57 (6) years and BMI 24.5 (2.9) kg/m2. NAFLD was diagnosed in 33% of men; sarcopenia was present in 28%. Mean (SD) hand grip strength in the dominant hand was 37.5 (7.6) kg. In multivariate logistic regression, intermediate and low GS were associated with higher risk of NAFLD (OR 3.05; CI 1.27-7.61, p=0.01; OR 2.47; CI 1.01-6.19, p=0.05, respectively). GS has an inverse association with NAFLD prevalence in HIV-infected men. Specific mechanisms through which muscle weakness and NAFLD are related require further exploration but are not accounted for merely by the burden of comorbid illness, HIV disease stage, or ART exposure.
P. Debroy ; J.E. Lake ; A. Malagoli ; G. Guaraldi ; for the Modena HIV Metabolic Cohort Team ; (2018): Relationship between grip strength and nonalcoholic fatty liver disease in men living with HIV referred to a metabolic clinic. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.37
THE GROWTH HORMONE RELEASING HORMONE ANALOGUE, TESAMORELIN, DECREASES MUSCLE FAT AND INCREASES MUSCLE AREA IN ADULTS WITH HIV
S. Adrian, A. Scherzinger, A. Sanyal, J.E. Lake, J. Falutz, M.P. Dubé, T. Stanley, S. Grinspoon, J.-C. Mamputu, C. Marsolais, T.T. Brown, K.M. Erlandson
J Frailty Aging 2019;8(3):154-159Show summaryHide summary
Background: Tesamorelin, a growth hormone-releasing hormone analogue, decreases visceral adipose tissue in people living with HIV, however, the effects on skeletal muscle fat and area are unknown. Objectives: The goals of this exploratory secondary analysis were to determine the effects of tesamorelin on muscle quality (density) and quantity (area). Design: Secondary, exploratory analysis of two previously completed randomized (2:1), clinical trials. Setting: U.S. and Canadian sites. Participants: People living with HIV and with abdominal obesity. Tesamorelin participants were restricted to responders (visceral adipose tissue decrease ≥8%).Intervention: Tesamorelin or placebo. Measurements: Computed tomography scans (at L4-L5) were used to quantify total and lean density (Hounsfield Units, HU) and area (centimeters2) of four trunk muscle groups using a semi-automatic segmentation image analysis program. Differences between muscle area and density before and after 26 weeks of tesamorelin or placebo treatment were compared and linear regression models were adjusted for baseline and treatment arm. Results: Tesamorelin responders (n=193) and placebo (n=148) participants with available images were similar at baseline; most were Caucasian (83%) and male (87%). In models adjusted for baseline differences and treatment arm, tesamorelin was associated with significantly greater increases in density of four truncal muscle groups (coefficient 1.56-4.86 Hounsfield units; all p<0.005), and the lean anterolateral/abdominal and rectus muscles (1.39 and 1.78 Hounsfield units; both p<0.005) compared to placebo. Significant increases were also seen in total area of the rectus and psoas muscles (0.44 and 0.46 centimeters2; p<0.005), and in the lean muscle area of all four truncal muscle groups (0.64-1.08 centimeters2; p<0.005). Conclusions: Among those with clinically significant decrease in visceral adipose tissue on treatment, tesamorelin was effective in increasing skeletal muscle area and density. Long term effectiveness of tesamorelin among people with and without HIV, and the impact of these changes in daily life should be further studied.
S. Adrian ; A. Scherzinger ; A. Sanyal ; J.E. Lake ; J. Falutz ; M.P. Dubé ; T. Stanley ; S. Grinspoon ; J.-C. Mamputu ; C. Marsolais ; T.T. Brown ; K.M. Erlandson (2018): The Growth Hormone Releasing Hormone Analogue, Tesamorelin, Decreases Muscle Fat and Increases Muscle Area in Adults with HIV. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.45