jfa journal ICFSR-2018

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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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JFA N°02 - 2018

 

SEASONAL VARIATION IN VITAMIN D STATUS AMONG FRAIL OLDER HOSPITALIZED PATIENTS

M. Pourhassan, R. Wirth

J Frailty Aging 2018;7(2):95-99

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Background and objectives: Seasonal variation in 25-hydroxyvitamin D [25(OH)D] levels is the result of sunlight dependent skin synthesis of vitamin D. However, its presence is not studied in frail older hospitalized patients. We sought to investigate whether seasonal variation in 25(OH)D levels is evident among these patients. Design and setting: This study investigated older participants who were consecutively admitted between February 2015 and December 2016 to the geriatric acute care ward. Results of routine measurements of 25(OH)D at hospital admission were retrospectively analyzed and stratified according to months and seasons. Previous intake of vitamin D supplementation was derived from the patients’ medical records. Results: The study group comprised 679 participants (mean age 82.1±8.2; 457 females), of which 78% had vitamin D deficiency. Older individuals not taking vitamin D supplements had a lower mean serum 25(OH)D than those receiving supplements. Of those patients with no vitamin D supplementation, 87.0% were vitamin D deficient and only 5% showing sufficient vitamin 25(OH)D. Further, there were neither monthly nor seasonal variations in vitamin 25(OH)D levels among these patients and their vitamin D levels stayed far below the recommended threshold of 20 ng/ml across the seasons. Conclusion: Vitamin D deficiency was very prevalent in the subgroup of older hospitalized patients without vitamin D supplementation, irrespective of season. Since no seasonal variations in mean 25(OH)D levels was observed, sunlight dependent skin synthesis is unlikely to contribute to vitamin D status in these patients. Supplementation seems to be necessary to maintain desirable vitamin D levels among this population throughout the year.

CITATION:
M. Pourhassan ; R. Wirth (2018): Seasonal variation in vitamin D status among frail older hospitalized patients. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.10

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IDENTIFYING EXOSOME-DERIVED MICRORNAS AS CANDIDATE BIOMARKERS OF FRAILTY

B.R. Ipson, M.B. Fletcher, S.E. Espinoza, A.L. Fisher

J Frailty Aging 2018;7(2):100-103

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Frailty is a geriatric syndrome associated with progressive physical decline and significantly increases risk for falls, disability, hospitalizations, and death. However, much remains unknown regarding the biological mechanisms that contribute to aging and frailty, and to date, there are no clinically used prognostic or diagnostic molecular biomarkers. The present study profiled exosome-derived microRNAs isolated from the plasma of young, robust older, and frail older individuals and identified eight miRNAs that are uniquely enriched in frailty: miR-10a-3p, miR-92a-3p, miR-185-3p, miR-194-5p, miR-326, miR-532-5p, miR-576-5p, and miR-760. Furthermore, since exosomes can deliver miRNAs to alter cellular activity and behavior, these miRNAs may also provide insights into the biological mechanisms underlying frailty; KEGG analysis of their target genes revealed multiple pathways implicated in aging and age-related processes. Although further validation and research studies are warranted, our study identified eight novel candidate biomarkers of frailty that may help to elucidate the multifactorial pathogenesis of frailty.

CITATION:
B.R. Ipson ; M.B. Fletcher ; S.E. Espinoza ; A.L. Fisher (2017): Strong Relationship between Malnutrition and Cognitive Frailty in the Singapore Longitudinal Ageing Studies (SLAS-1 and SLAS-2). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.45

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ACCURACY OF BODY MASS INDEX VERSUS LEAN MASS INDEX FOR PREDICTION OF SARCOPENIA IN OLDER WOMEN

M.J. Benton, A.L. Silva-Smith

J Frailty Aging 2018;7(2):104-107

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We compared accuracy of body mass index (BMI) versus lean mass index (LMI) to predict sarcopenia in 58 community-dwelling women (74.1±0.9 years). Lean mass was measured with multi-frequency bioelectrical impedance analysis, and strength was measured with Arm Curl test, Chair Stand test, and handgrip dynamometry. Sarcopenia was defined as low LMI. When categorized by BMI, normal women had less absolute lean mass (37.6±1.0 vs. 42.6±0.9 kg; P<0.001) and less relative lean mass (14.1±0.2 vs. 16.1±0.2 kg/m2; P<0.001) compared to overweight/obese women, but no differences in strength. When categorized by LMI, normal women had more absolute lean mass (44.0±0.7 vs. 35.7±0.7 kg; P<0.001), more relative lean mass (16.2±0.2 vs. 13.8±0.2 kg/m2; P<0.001), and greater upper body strength (16.7±0.9 vs. 14.2±0.6 arm curls; P<0.05) compared to women with low LMI. BMI failed to accurately predict low values of lean mass and strength. For clinical assessment, calculation of LMI rather than BMI is appropriate.

CITATION:
M.J. Benton ; A.L. Silva-Smith (2018): Accuracy of Body Mass Index versus Lean Mass Index for Prediction of Sarcopenia in Older Women. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.1

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POLYPHARMACY BUT NOT POTENTIAL INAPPROPRIATE PRESCRIPTION WAS ASSOCIATED WITH FRAILTY IN OLDER ADULTS FROM A MIDDLE-INCOME COUNTRY OUTPATIENT CLINIC

I. Aprahamian, M.M. Biella, G. Vano Aricó de Almeida, F. Pegoraro, A.V. Alves Pedrini, B. Cestari, L.H. Bignotto, B. Alvarez Ribeiro de Melo, J.E. Martinelli

J Frailty Aging 2018;7(2):108-112

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cy and pre-frailty or frailty in a middle-income country sample of older adults; and (2) evaluate the prevalence of potential inappropriate prescription (PIP) and its association with pre-frailty or frailty. Design: Cross-sectional observational study. Setting: Outpatient center at a university-based hospital in the state of São Paulo, Brazil. Participants: 629 older adults from both sexes evaluated between June 2014 and July 2016. Measurements: Frailty was identified through the FRAIL scale. All medications received were analyzed by research staff. Presence of PIP was evaluated according to the 2015 updated Beers list. Binary logistic regression tested the association between 4 definitions of polypharmacy (≥ 3, 4, 5, and 6 drugs), and presence of PIP, and the dependent variable pre-frailty and frailty. Results: 15.7% of participants were frail. Polypharmacy was present in 219 (34.8%), and PIP was observed in 184 (29.3%) older adults. All definitions of polypharmacy were significantly associated with frailty (OR between 2.05 to 2.34, p < 0.001). Polypharmacy with 4 or 5 or more drugs were associated with pre-frailty (OR 1.53 and 1.47, respectively). PIP was not associated with frailty (OR 1.47, p = 0.149). Conclusions: Several definitions of polypharmacy were associated with frailty, but only two were associated with pre-frailty. The presence of PIP was not associated with pre-frailty or frailty.

CITATION:
I. Aprahamian ; M.M. Biella ; G. Vano Aricó de Almeida ; F. Pegoraro ; A.V. Alves Pedrini ; B. Cestari ; L.H. Bignotto ; B. Alvarez Ribeiro de Melo ; J.E. Martinelli (2018): Polypharmacy but not potential inappropriate prescription was associated with frailty in older adults from a middle-income country outpatient clinic. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.5

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EDUCATING MEDICAL STUDENTS IN COUNSELLING OLDER ADULTS ABOUT EXERCISE: THE IMPACT OF A PHYSICAL ACTIVITY MODULE

A.D. Jadczak, K.L. Tam, R. Visvanathan

J Frailty Aging 2018;7(2):113-119

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Background: Exercise courses during medical school contribute to medical students’ confidence in promoting physical activity to their patients. However, there is still a lack of uniform physical activity education across medical school curricula to equip medical students with the necessary skills and knowledge to counsel their patients about exercise. Objective: To determine the effects of a 1.5-hour physical activity module including a one-hour exercise tutorial combined with a 30-minute practical counselling session on senior medical students’ perceptions of the importance of exercise and their perceived competence in advising older people about exercise. Design: Pre-post survey. Setting: University campus. Participants: 161 senior medical students taking part in the Queen Elizabeth Hospital Geriatric Medicine course in 2015 (control group) and 2016 (intervention group). Measurement: The modified Exercise and Physical Activity Competence Questionnaire (EPACQ) was administered before and after a 4.5-week Geriatric Medicine Course. Scores ranged from 1 (not important or competent) to 6 (very important or competent). The independent T-Test and repeated-measures ANOVA was used to determine differences between intervention and control group. Results: Medical students perceived exercise-related skills to be highly important (score ≥4) in both the intervention (4.85 ± 0.37) and control group (4.78 ± 0.67), pre-course. The overall perceived importance could not be significantly increased by the physical activity module (P=0.082). The physical activity module, however, improved medical students’ perceived competence in six out of ten exercise-related skills, and increased their overall perceived competence in counselling older people about exercise (P<0.001). Conclusion: A 1.5-hour physical activity module improves senior medical students’ perceived competence in counselling older people about exercise. This research proves that little teaching space is needed to impact positively on medical students’ exercise counselling abilities.

CITATION:
A.D. JADCZAK ; K.L. TAM ; R. VISVANATHAN ; (2017): EDUCATING MEDICAL STUDENTS IN COUNSELLING OLDER ADULTS ABOUT EXERCISE: THE IMPACT OF A PHYSICAL ACTIVITY MODULE . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.44

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HOW TO MANAGE FRAIL OLDER ADULTS IN THE COMMUNITY? PROPOSAL OF A HEALTH PROMOTION PROGRAM EXPERIENCED IN A CITY OF 16,638 INHABITANTS IN FRANCE

J. de Kerimel, N. Tavassoli, C. Lafont, M. Soto, M. Pedra, F. Nourhashemi, C. Lagourdette, L. Bouchon, A. Chaléon, S. Sourdet, Y. Rolland, M. Cesari, B. Vellas

J Frailty Aging 2018;7(2):120-126

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Background: Health promotion programs could prevent and delay frailty and functional decline. However, in practice, the planning and establishment of such a program is a challenge for health care providers. We report an experimental model of screening and management for frail elderly conducted in Cugnaux, city of 16,638 inhabitants in France, by the Toulouse Gerontopole and the social care service of the Cugnaux City Hall. Methods: A frailty screening self-administered questionnaire (FiND questionnaire) was sent to community-dwelling residents of 70 years old and over of Cugnaux. The completed questionnaires were analyzed and the subjects were classed into three groups: robust, frail, mobility disability, based on their score. Frail subjects and those with mobility disability invited to undergo a frailty assessment in the premises of the town hall realized by a nurse in order to identify the causes of their frailty and propose them a personalized intervention plan (PIP). Results: The FiND questionnaire was sent to the residents of Cugnaux of 70 years old and over (n=2,003). After two mailings, 860 (42.9%) completed questionnaires were received. Mean age of the responders was 79.0 ± 6.2 years and 59.6% women (n= 511). According to the questionnaires analysis, 393 (45.7%) were robust, 212 (24.6%) frail, 240 (27.9%) had a mobility disability and 15 (1.7%) could not be classified due to missing data. 589 (68.5%) subjects accepted to be contacted by the Gerontopole nurse. The assessment by the nurse was proposed to frail subjects and those with mobility disability (n=313). Until 31 December 2016, 136 patients have been evaluated. The mean age was 80.1±5.4 and most patients were women (69.9%). The mean ADL score was 5.8±0.5 and the IADL showed a mean score of 6.9±1.7. According to Fried definition of frailty, 76 patients (55.9%) were pre-frail, and 35 (25.7%) frail. Concerning the frailty domains identified, 75 patients (55.1%) showed the alteration of physical performance, 70 (51.5%) thymic disorders and 46 (33.8%) sensory disorders. Preventive interventions proposed in the PIP were mostly physical interventions (86.8%, n=118) followed by cognitive (61.8%, n=84) and nutritional (39.7%, n=54) interventions. Discussion: This project shows the feasibility to implement a care model in the community. It permitted a large identification of frail elderly people in the city population, insuring their assessment and clinical follow up to maintain their capacities and referring them to social services.

CITATION:
J. de Kerimel ; N. Tavassoli ; C. Lafont ; M. Soto ; M. Pedra ; F. Nourhashemi ; C. Lagourdette ; L. Bouchon ; A. Chaléon ; S. Sourdet ; Y. Rolland ; M. Cesari ; B. Vellas (2017): How to Manage Frail Older Adults in the Community? Proposal of a Health Promotion Program Experienced in a City of 16,638 Inhabitants in France . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.47

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THE USE OF FIGURATIVE LANGUAGE TO DESCRIBE FRAILTY IN OLDER ADULTS

B. Buta, D. Leder, R. Miller, N.L. Schoenborn, A.R. Green, R. Varadhan

J Frailty Aging 2018;7(2):127-133

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Introduction: Frailty affects 15% of non-institutionalized older adults in the United States, yet confusion remains in defining and, in turn, assessing frailty. Figurative language, such as metaphor, can help to explain difficult scientific concepts and to form new theories. We aimed to examine the use of figurative language to describe frailty and to identify themes in the way figurative expressions are used. Understanding how frailty is described figuratively may offer insights for developing useful communication approaches in research settings. Methods: We performed a comprehensive review of editorials in the scientific literature to explore figurative language used to describe frailty in older adults. We categorized themes among the figurative expressions, which may help to inform how to effectively communicate about frailty. Results: We found 24 editorials containing 32 figurative expressions. The figurative expressions conceptualized frailty in six ways: 1) a complex, multifaceted concept; 2) an important issue in health and medicine; 3) indicative of something that is failing or faulty; 4) indicative of fragility; 5) representative of vulnerable, ignored persons; and 6) an opportunity for self-awareness and reflection. Discussion: Our review highlights the heterogeneity in depictions of frailty, which is consonant with the lack of a standardized definition of frailty. We also found a novel aspect to the concept of frailty, which merits attention: frailty characterized as an opportunity for self-awareness and reflection. Figurative language, which often juxtaposes familiar with challenging, complex concepts, can offer insights on issues in frailty research and holds potential as a tool for researchers to improve communication about this important and debated medical condition.

CITATION:
B. Buta ; D. Leder ; R. Miller ; N.L. Schoenborn ; A.R. Green ; R. Varadhan (2018): The Use of Figurative Language to Describe Frailty in Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.9

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QUALITY OF LIFE IN OLDER ADULTS ATTENDING A UNIVERSITY FAMILY PRACTICE CENTRE IN SRI LANKA

R.E. Ediriweera de Silva, M.S.A. Perera

J Frailty Aging 2018;7(2):134-137

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Background: This study aimed to assess the quality of life (QoL) and identify factors influencing it in older adults attending a University Family Practice situated in a semi-urban area in Sri Lanka, a lower middle income country. Objectives: To describe the QoL among older adults attending the Family Practice Centre, University of Sri Jayewardenepura. Design: A descriptive cross sectional study. Setting Family Practice Centre, University of Sri Jayewardenepura, Sri Lanka. Participants: 140 registered older adults >60years who attended the centre over 3 months in 2012. Results: The majority of participants (51.4%) were between 60-69years, females (65%), 67.9% were married, and (88.6%) lived with their families. QoL was satisfactory, with spiritual and functional aspects being the most satisfactory and physical QoL being the least satisfactory, however latter too had a mean score (>50). Better QoL was seen in males, with better education, married and living with spouse, and perceived adequacy of income. Poorer QoL was seen in participants living alone, presence of 3 or more health problems, being admitted to hospital or, and accidents and falls in the past one year. Conclusions: QoL in this group of older adults was satisfactory with spiritual and functional aspects being the most satisfactory and the physical aspect being the least. Preventing unnecessary hospital admissions and accidents could help to improve QoL in older adults.

CITATION:
R.E. Ediriweera de Silva ; M.S.A. Perera (2018): Quality of life in older adults attending a University Family Practice Centre in Sri Lanka. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.8

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THE UTILITY OF THE FRAILTY INDEX IN CLINICAL DECISION MAKING

K. Khatry, N.M. Peel, L.C. Gray, R.E. Hubbard

J Frailty Aging 2018;7(2):138-141

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Using clinical vignettes, this study aimed to determine if a measure of patient frailty would impact management decisions made by geriatricians regarding commonly encountered clinical situations. Electronic surveys consisting of three vignettes derived from cases commonly seen in an acute inpatient ward were distributed to geriatricians. Vignettes included patients being considered for intensive care treatment, rehabilitation, or coronary artery bypass surgery. A frailty index was generated through Comprehensive electronic Geriatric Assessment. For each vignette, respondents were asked to make a recommendation for management, based on either a brief or detailed amount of clinical information and to reconsider their decision after the addition of the frailty index. The study suggests that quantification of frailty might aid the clinical judgment now employed daily to proceed with usual care, or to modify it based on the vulnerability of the person to whom it is aimed.

CITATION:
K. Khatry ; N.M. Peel ; L.C. Gray ; R.E. Hubbard (2018): The Utility of the Frailty Index in Clinical Decision Making. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.7

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EFFECTS OF FERMENTED PAPAYA PREPARATION (FPP) ON SAFETY OUTCOMES IN OLDER ADULTS – A SHORT REPORT OF A PLACEBO-CONTROLLED CLINICAL TRIAL

R.T. Mankowski, C. Leeuwenburgh, T.M. Manini, A.J. Woods, S.D. Anton

J Frailty Aging 2018;7(2):142-146

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Fermented Papaya Preparation (FPP®) has shown antioxidative and anti-inflammatory effects in preclinical and clinical aging studies. However, clinical trials are needed to fully evaluate the safety of FPP® in moderate-functioning, generally healthy older adults. In this randomized (9g/day of FPP® or placebo), crossover design study, we enrolled 30 older moderate-functioning older adults (70-100 years old). The participants completed both a treatment and a placebo condition. After eight (8) weeks on each of these regimens (with a 4-week wash-out period in between), participants had their venous blood drawn for assessment of blood chemistries, metabolic outcomes and inflammatory biomarkers. Participants were asked to report any adverse events during the course of the study and complete post-treatment outcome assessments for anthropometric and metabolic outcomes. The major finding related to safety was that there were no adverse changes in blood chemistries and few adverse events in the FPP® condition, which did not differ from placebo (p>0.05). There were no serious adverse effects in either condition. Twenty-nine (29) participants (mean age 78.2±5.3 yrs) completed the study with 94% adherence to the dosing regimen. There were no significant effects of FPP® on anthropometric and metabolic outcomes. In addition, no effects on markers of inflammation were observed. Our trial demonstrates FPP® supplementation is safe and feasible in adults ages 70 years and older. Based on these findings and the positive effects FPP has demonstrated in previous trials, future trials should examine the effects of FPP® in older adults with impaired health status and/or older adults who may have insufficient anti-oxidant protection due to their genetic background.

CITATION:
R.T. Mankowski ; C. Leeuwenburgh ; T.M. Manini ; A.J. Woods ; S.D. Anton ; J.E. Martinelli (2018): Effects of fermented papaya preparation (FPP) on safety outcomes in older adults – a short report of a placebo-controlled clinical trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.6

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