jfa journal ICFSR-2018

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MEASURING FRAILTY AMONG OLDER PEOPLE: FURTHER EVALUATION OF THE BRODY FRAILTY INDEX

U. Jakobsson

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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.

CITATION:
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

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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.

CITATION:
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

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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.

CITATION:
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

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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.

CITATION:
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

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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.

CITATION:
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

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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

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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.

CITATION:
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

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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.

CITATION:
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

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THE FEASIBILITY OF STANDARDISED GERIATRIC ASSESSMENT TOOLS AND PHYSICAL EXERCISES IN FRAIL OLDER ADULTS

A.D. Jadczak, N. Mahajan, R. Visvanathan

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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.

CITATION:
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

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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.

CITATION:
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

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REFERENCE VALUES FOR KNEE EXTENSION STRENGTH OBTAINED BY HAND-HELD DYNAMOMETRY FROM APPARENTLY HEALTHY OLDER ADULTS: A META-ANALYSIS

R.W. Bohannon

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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.

CITATION:
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

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MUSCLE QUALITY IMPROVES WITH EXTENDED HIGH-INTENSITY RESISTANCE TRAINING AFTER HIP FRACTURE

R.A. Briggs, J.R. Houck, M.J. Drummond, J.M. Fritz1, , 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.

CITATION:
R.A. Briggs ; J.R. Houck ; M.J. Drummond ; J.M. Fritz ; P.C. LaStayo ; R.L. Marcus (2017): MUSCLE QUALITY IMPROVES WITH EXTENDED HIGH-INTENSITY RESISTANCE TRAINING AFTER HIP FRACTURE. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.31

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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.

CITATION:
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

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FRAILTY IS NOT ASSOCIATED WITH MISTREATMENT

S.D. Piña-Escudero, J.M.A. García-Lara, J.A. Avila-Funes

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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.

CITATION:
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

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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

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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.

CITATION:
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

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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

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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.

CITATION:
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

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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

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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.

CITATION:
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

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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

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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.

CITATION:
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

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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

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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.

CITATION:
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

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JFA N°03 - 2017

 

CO-LOCALIZATION OF MACROPHAGE INHIBITORY FACTOR AND NIX IN SKELETAL MUSCLE OF THE AGED MALE INTERLEUKIN 10 NULL MOUSE

P. Abadir, F. Ko, R. Marx, L. Powell, E. Kieserman, H. Yang, J. Walston

J Frailty Aging 2017;6(3):118-121

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Chronic inflammation is associated with muscle weakness and frailty in older adults. The antagonistic cross-talk between macrophage migration inhibitory factor (Mif), an anti-apoptotic cytokine and NIP3-like protein X (Nix), a pro-apoptotic mitochondrial protein, may play a role in mitochondrial free radical homeostasis and inflammatory myopathies. We examined Nix-Mif interaction in inflammation and aging using young and old, IL-10tm/tm (a rodent model of chronic inflammation) and C57BL/6 mice. In this study, we observed that Nix and Mif were co-localized in skeletal muscles of aged and inflamed mice. We show an inflammation- and age-related association between Nix and Mif gene expression, with the strongest positive correlation observed in old IL-10tm/tm skeletal muscles. The IL-10tm/tm skeletal muscles also had the highest levels of oxidative stress damage. These observations suggest that Nix-Mif cross-talk may play a role in the interface between chronic inflammation and oxidative stress in aging skeletal muscles.

CITATION:
P. Abadir ; F. Ko ; R. Marx ; L. Powell ; E. Kieserman ; H. Yang ; J. Walston (2017): Co-localization of Macrophage Inhibitory Factor and Nix in Skeletal Muscle of the Aged Male Interleukin 10 Null Mouse. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.18

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PREVALENCE OF FRAILTY IN NURSING HOME RESIDENTS ACCORDING TO VARIOUS DIAGNOSTIC TOOLS

F. Buckinx, J.-Y. Reginster, S. Gillain, J. Petermans, T. Brunois, O. Bruyère

J Frailty Aging 2017;6(3):122-128

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Background: Although the theoretical foundations of frailty are well established in the literature, it remains an evolving concept lacking any unique definition or diagnostic criteria for use in clinical practice and epidemiological research. No consensus exists about the accurate prevalence rates of frailty. The various operational definitions of frailty can at least partly explain such discrepancies. Objective: To compare the prevalence of frailty, measured with different diagnostic tools, among elderly nursing home residents. Design: This is an analysis of baseline data collected among the SENIOR (Sample of Nursing home Elderly Individuals: an Observational Research) cohort. Setting: Nursing homes. Population: A total of 662 volunteer subjects from 28 nursing homes were included in this analysis. Among them, the mean age was 83.2 ± 8.99 years and 484 (72.5%) of them were women. Measurement: The percentages of frail and non-frail subjects were calculated according to 10 different definitions. Results: Prevalence of frailty varies from 1.70% (Frailty Index) to 76.3% (Groningen Frailty Indicator) depending on the tool used. Conclusions: The prevalence of frailty is highly dependent on the diagnostic tool used. It would be necessary to reach a consensus on which diagnostic tools to use if one wishes to have comparable data obtained in epidemiological studies.

CITATION:
F. Buckinx ; J.-Y. Reginster ; S. Gillain ; J. Petermans ; T. Brunois ; O. Bruyère (2017): Prevalence of frailty in nursing home residents according to various diagnostic tools. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.20

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GENDER AND AGE DIFFERENCES IN LEVELS, TYPES AND LOCATIONS OF PHYSICAL ACTIVITY AMONG OLDER ADULTS LIVING IN CAR-DEPENDENT NEIGHBORHOODS

W. Li, E. Procter-Gray, L. Churchill, S.E. Crouter, K. Kane, J. Tian, P.D. Franklin, J.K. Ockene, J. Gurwitz

J Frailty Aging 2017;6(3):129-135

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Background: A thorough understanding of gender differences in physical activity is critical to effective promotion of active living in older adults. Objectives: To examine gender and age differences in levels, types and locations of physical activity. Design: Cross-sectional observation. Setting: Car-dependent urban and rural neighborhoods in Worcester County, Massachusetts, USA. Participants: 111 men and 103 women aged 65 years and older. Measurements: From 2012 to 2014, participants were queried on type, frequency and location of physical activity. Participants wore an accelerometer for 7 consecutive days. Results: Compared to women, men had a higher mean daily step count (mean (SD) 4385 (2122) men vs. 3671(1723) women, p=0.008). Men reported higher frequencies of any physical activity and moderate-to-vigorous physical activity, and a lower frequency of physical activity inside the home. Mean daily step counts and frequency of physical activity outside the home decreased progressively with age for both men and women. Women had a sharper decline in frequencies of self-reported physical activity. Men had a significant decrease in utilitarian walking, which women did not (p=0.07). Among participants who reported participation in any physical activity (n=190), more women indicated exercising indoors more often (59% vs. 44%, p=0.04). The three most commonly cited locations for physical activity away from home for both genders were streets or sidewalks, shopping malls, and membership-only facilities (e.g., YMCA or YWCA). The most common types of physical activity, performed at least once in a typical month, with over 40% of both genders reporting, included light housework, brisk walking, leisurely walking, and stretching. Conclusion: Levels, types and location preferences of physical activity differed substantially by gender. Levels of physical activity decreased progressively with age, with greater decline among women. Consideration of these gender differences is necessary to improve the effectiveness of active living promotion programs among older adults.

CITATION:
W. Li ; E. Procter-Gray ; L. Churchill ; S.E. Crouter ; K. Kane ; J. Tian ; P.D. Franklin ; J.K. Ockene ; J. Gurwitz (2017): Gender and age differences in levels, types and locations of physical activity among older adults living in car-dependent neighborhoods . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.15

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FRAILTY AND FEAR OF FALLING: THE FISTAC STUDY

M. Esbrí-Víctor, I. Huedo-Rodenas, M. López-Utiel, J.L. Navarro-López, M. Martínez-Reig, J.A. Serra-Rexach, L. Romero-Rizos, P. Abizanda

J Frailty Aging 2017;6(3):136-140

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Objective: To analyze the association between frailty and Fear of Falling (FoF) in a cohort of older adults with previous falls. Design: Cross-sectional study (FISTAC). Setting: Falls Unit, Complejo Hospitalario Universitario of Albacete (Spain). Participants: 183 adults older than 69 years, from the Falls Unit, with a history of a previous fall in the last year. Measurements: FoF was assessed at baseline using the Falls Efficacy Scale International (FES-I) and three questions previously validated. Frailty was assessed with the frailty phenotype criteria. Age, gender, comorbidity, nutritional status, cognitive status and risk of depression were determined. Results: Mean age 78.4, 80.3% women. FoF was present in 140 (76.5%) participants with the three questions and 102 (55.7%) presented high concern of falling with the FES-I. 88.8% of frail older adults presented FoF compared to 62.4% of those who were not frail, and only 37.8% of non frail had a high concern of falling, compared to 77.2% of those who were frail measured with the FES-I. Frail participants had an adjusted risk of FoF that was 3.18 (95% CI 1.32 to 7.65) higher compared to those who were not frail assessed with the three questions and 3.93 (95% CI 1.85 to 8.36) higher concern of falling when using the FES-I scale. Only female sex and depression risk were also associated to FoF in the final adjusted models. Conclusion: Frailty is independently associated with the FoF syndrome in older faller subjects.

CITATION:
M. Esbrí-Víctor ; I. Huedo-Rodenas ; M. López-Utiel ; J.L. Navarro-López ; M. Martínez-Reig ; J.A. Serra-Rexach ; L. Romero-Rizos ; P. Abizanda (2017): FRAILTY AND FEAR OF FALLING: THE FISTAC STUDY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.19

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TWO-WAY BRIDGE BETWEEN MUSCULAR DYSFUNCTION AND COGNITIVE IMPAIRMENT: SECONDARY ANALYSES OF SABE – BOGOTA STUDY

E. Garcia-Cifuentes, D. G. David-Pardo, M. G. Borda, M.U. Perez-Zepeda, C.A. Cano-Gutiérrez

J Frailty Aging 2017;6(3):141-143

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Background and objective: Muscular dysfunction and cognitive impairment are both disabling states, affecting especially the elderly. Thus, are important subjects of research. Our goal is to describe the association between these two entities in the elderly. Methods: This is a secondary analysis from the SABE 2012 Bogota survey, which is a cross-sectional study. We define muscular dysfunction as an abnormal result in gait speed and/or handgrip strength tasks. Cognitive impairment was defined as an abnormal result in Mini Mental State Examination. Other independent variables were measured. Results: A total of 1,564 older adults were included in the analysis. Cognitive impairment showed statistically significant association with both low handgrip strength (OR: 2.25; CI 1.52 – 3.33) and low gait speed (OR: 2.76; CI 1.83 – 4.15) in the adjusted model. Conclusion: In older adults, muscular dysfunction is associated with cognitive impairment. New studies should address the causality and temporality of this relationship.

CITATION:
E. Garcia-Cifuentes ; D. G. David-Pardo ; M. G. Borda ; M.U. Perez-Zepeda ; C.A. Cano-Gutiérrez (2017): TWO-WAY Bridge between muscular dysfunction and cognitive impairment: Secondary analyses of SABE – Bogota study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.17

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DEPRESSIVE SYMPTOMS, FALLS, AND FEAR OF FALLING IN OLD KOREAN ADULTS: THE KOREAN LONGITUDINAL STUDY ON HEALTH AND AGING (KLOSHA)

Y. Park, N.-J. Paik, K.W. Kim, H.-C. Jang, J.-Y. Lim

J Frailty Aging 2017;6(3):144-147

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Fall is a common cause of disability and death in old adults, and much research has been focused on identifying risk factors and developing preventive measures. Yet the majority of preceding research has been focused on physical performance. This study aims to evaluate the association between fall and depressive symptoms in community-dwelling elderly. Cross-sectional data of 431 men and 546 women was collected from old Korean adults living in Seongnam, Korea. Geriatric fall assessment was conducted by self-report questionnaires. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale. Results indicated that depressive symptoms were associated with both fall and fear of falling in old adults. A clear gender difference was newly discovered, as depression played a stronger role in women. These results imply that clinicians should consider the negative affect of geriatric patients when assessing fall risk. Also, measures against depression might be effective in reducing falls.

CITATION:
Y. Park ; N.-J. Paik ; K.W. Kim ; H.-C. Jang ; J.-Y. Lim (2017): Depressive symptoms, falls, and fear of falling in old Korean adults: the Korean Longitudinal Study on Health and Aging (KLoSHA). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.21

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INFLUENCE OF AGE ON DECISION-MAKING PROCESS TO LIMIT OR WITHDRAW LIFE-SUSTAINING TREATMENT IN THE INTENSIVE CARE UNIT – A SINGLE CENTER PROSPECTIVE OBSERVATIONAL STUDY

G. Ducos, O. Mathe, L. Balardy, S. Lozano, M. Kurrek, J. Ruiz, B. Riu-Poulenc, O. Fourcade, S. Silva, V. Minville

J Frailty Aging 2017;6(3):148-153

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Background: The increasing age in the industrialized countries places significant demands on intensive care unit (ICU) resources and this triggers debates about end-of-life care for the elderly. Objectives: We sought to determine the impact of age on the decision-making process to limit or withdraw life-sustaining treatment (DWLST) in an ICU in France. We hypothesized that there are differences in the decision-making process for young and old patients. Design, setting, participants: We prospectively studied end-of-life decision-making for all consecutive admissions (n=390) to a tertiary care university ICU in Toulouse, France over a period of 11 months between January and October 2011. Results: Among the 390 patients included in the study (age ≥70yo, n=95; age <70yo, n=295) DWLST were more common for patients 70 years or older (43% for age ≥70yo vs. 16% for age <70yo, p <0.0001). Reasons for DWLST were different in the 2 groups, with the ‘no alternative treatment options’ and ‘severity of illness’ as the most frequent reasons cited for the younger group whereas it was ‘severity of illness’ for the older group. ‘Advanced age’ led to DWLSTs in 43% of the decisions in the group ≥70yo (vs. 0% in the group <70yo, p <0.0001). Multivariate logistic regression showed a high SAPS II score and age ≥70yo as independent risk factors for DWLSTs in the ICU. We did not find age ≥70yo as an independent risk factor for mortality in ICU. Conclusion: We found that age ≥70yo was an independent risk factor for DWLSTs for patients in the ICU, but not for their mortality. Reasons leading to DWLSTs are different according to the age of patients.

CITATION:
G. Ducos ; O. Mathe ; L. Balardy ; S. Lozano ; M. Kurrek ; J. Ruiz ; B. Riu-Poulenc ; O. Fourcade ; S. Silva ; V. Minville (2017): Influence of age on decision-making process to limit or withdraw life-sustaining treatment in the intensive care unit – A single center prospective observational study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.22

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ORAL HEALTH AND THE FRAIL ELDERLY

L. Rapp, S. Sourdet, B. Vellas, M.-H. Lacoste-Ferré

J Frailty Aging 2017;6(3):154-160

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Introduction: The relationships between oral health conditions and frailty have rarely been explored. A systematic review of frailty components and oral health concluded that differences in study population endpoint criteria and study design cannot establish a relationship between frailty and oral health. Objective: This study aims to describe the distribution of the OHAT (Oral Health Assessment Tool) score in a population of frail subjects and to assess associated parameters (age, socio-economic status, living conditions, education level, nutritional habits, cognitive functioning, autonomy). Design: Cross-sectional observational study among patients referred to the Geriatric Frailty Clinic. Measurements: 1314 patients participated in different standardized tests to evaluate their health status, cognitive and affective functioning, adaptation to usual daily activities, nutritional status, and oral health status. Results: The risk of oral health deterioration was higher with the appearance of frailty: the OHAT increased significantly with the Fried Frailty Score (p<0.001). Physical performance and oral health were correlated (p<0.001). The OHAT score and the MNA (Mini Nutritional Assessment) score were significantly correlated: oral status seemed better for malnourished subjects (p<0.001). Dementia significantly increased the risk of an unhealthy oral status (p<0.001). There was no significant correlation between oral status and depression, just a trend. Conclusion: This pilot study establishes a relationship between the OHAT and Fried Frailty Criteria in a population of frail elderly. It must be expanded to follow the distribution of the different items composing the OHAT score (items assessing lips; tongue; gums and tissues; saliva; natural teeth; dentures; oral cleanliness; and dental pain) with different parameters (age, socio-economic status, living conditions, educational level, medical history, drug treatment, nutritional habits, cognitive functioning, disabilities and handicaps).

CITATION:
L. Rapp ; S. Sourdet ; B. Vellas ; M.-H. Lacoste-Ferré (2017): ORAL HEALTH AND THE FRAIL ELDERLY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.9

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MUSCLE MEASURES AND NUTRITIONAL STATUS AT HOSPITAL ADMISSION PREDICT SURVIVAL AND INDEPENDENT LIVING OF OLDER PATIENTS – THE EMPOWER STUDY

S. Verlaan, J.M. Van Ancum, V.D. Pierik, J.P. van Wijngaarden, K. Scheerman, C.G.M. Meskers, A.B. Maier

J Frailty Aging 2017;6(3):161-166

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Objectives: Older adults with sarcopenia and malnutrition are at risk for co-morbidities, hospitalization, institutionalization, and mortality. In case of hospitalization, risks may be further increased, especially in case of suboptimal dietary intake. The aim of our study was to assess whether muscle mass, muscle strength, functional performance, and nutritional status at hospital admission were associated with survival and independent living among older patients three months after discharge. Design, Setting, Participants: The EMPOWER study was an observational, prospective and longitudinal inception cohort of patients older than 70 years admitted to the VU University Medical Centre in Amsterdam, the Netherlands. Measurements: Patients were assessed for demographic and clinical characteristics, measurements of muscle mass (by bioelectrical impedance analysis), handgrip strength (by dynamometry), functional performance (self-reported ability to walk), and screened for risk of malnutrition (by SNAQ). Three months after hospital discharge, survival and living situation were assessed by a follow-up telephone interview. Results: The majority of the 378 patients enrolled were living independently at the time of hospitalization (90%) and three months post-discharge (83%). Fifty-two patients died in the period from hospital admission to three months after discharge (survival rate 86%). Higher absolute muscle mass measures and not being malnourished at admission were significantly associated with the likelihood of survival. Handgrip strength and self-reported ability to walk were positively associated with a higher chance of living independently three months after discharge, but not with survival. Conclusions: Older patients with greater muscle mass and without malnutrition at hospital admission had a higher survival rate, while measures of muscle strength and functional performance were predictive for living independently three months after hospital discharge. Different components of muscle health relate to different relevant outcomes and therefore require investigation of specifically targeted interventions in the hospitalized older population.

CITATION:
S. Verlaan ; J.M. Van Ancum ; V.D. Pierik ; J.P. van Wijngaarden ; K. Scheerman ; C.G.M. Meskers ; A.B. Maier (2017): Muscle measures and nutritional status at hospital admission predict survival and independent living of older patients – the EMPOWER study . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.23

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EFFECT OF A COMBINED TAI CHI, RESISTANCE TRAINING AND DIETARY INTERVENTION ON COGNITIVE FUNCTION IN OBESE OLDER WOMEN

F. Xu, M.J. Delmonico, I.E. Lofgren, K.M. Uy, S.A. Maris, D. Quintanilla, A.G. Taetzsch, J. Letendre, L. Mahler

J Frailty Aging 2017;6(3):167-171

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Cognitive decline in older adults is a major public health problem and can compromise independence and quality of life. Exercise and diet have been studied independently and have shown to be beneficial for cognitive function, however, a combined Tai Chi, resistance training, and diet intervention and its influence on cognitive function has not been undertaken. The current study used a 12-week non-randomized research design with experiment and control groups to examine the effect of a combined Tai Chi, resistance training, and diet intervention on cognitive function in 25 older obese women. Results revealed improvements in domain specific cognitive function in our sample. Baseline cognitive function was correlated with changes in dietary quality. These findings suggest that Tai Chi and resistance training combined with diet intervention might be beneficial for community-based programs aiming to improve cognitive function.

CITATION:
F. Xu ; M.J. Delmonico ; I.E. Lofgren ; K.M. Uy ; S.A. Maris ; D. Quintanilla ; A.G. Taetzsch ; J. Letendre ; L. Mahler (2017): Effect of a Combined Tai Chi, Resistance Training and Dietary Intervention on Cognitive Function in Obese Older Women. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.16

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