Ahead of print articles
ASSOCIATIONS BETWEEN FRAILTY, BIOMARKERS OF CEREBRAL PATHOLOGY, COGNITIVE AND NEUROPSYCHIATRIC SYMPTOMS: A MEMORY CLINIC STUDY
Victor Gilles, Anthime Flaus, Achille Teillac, Marc Verny, Frédéric Blanc, Marc Paccalin, Thomas Desmidt, Sandrine Louchart de la Chapelle, Constance Dumay, Mathilde Sauvée, Sylvain Lehmann, Christophe Hirtz, François Cotton, Anthony Bathsavanis, Frédéric Gervais, Teddy Novais, Virginie Desestret, Nawele Boublay, Pierre Krolak-Salmon, Sophie Dautricourt, Antoine Garnier-Crussard
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BACKGROUND: Frailty is a prevalent condition among older adults with neurocognitive disorders.
OBJECTIVES: To ascertain whether frailty contributes to the severity of cognitive impairment and neuropsychiatric symptoms, and its association with cerebral pathology measured in vivo by fluid and imaging biomarkers.
DESIGN: We conducted cross-sectional and longitudinal analyses based on CLEM Study, a multicentre memory-clinic cohort that recruited participants between 2014 and 2018.
SETTING: CLEM Study occurred in eight memory centres in France (Lyon, Paris, Strasbourg, Poitiers, Tours, Grenoble) and Monaco.
PARTICIPANTS: A total of 168 participants (mean age 80.5 ± 4.8 years) with mild to moderate dementia due to at least one aetiological diagnosis between Alzheimer's disease, dementia with Lewy bodies or vascular dementia were included in the study.
MEASUREMENTS: The participants were evaluated at baseline and followed up for two years. The concept of frailty was operationalised using a 45-item Frailty Index. Cognition was assessed using the ADAS-cog scale, while neuropsychiatric symptoms were evaluated with the Neuropsychiatric Inventory. The cerebral pathological score, a proxy for brain pathologies, was a composite score based on the presence of several in vivo biomarkers: presynaptic dopaminergic denervation on 123I-FP-CIT SPECT (DaTscan®), vascular lesions on MRI, elevated blood-based pTau181, neurofilaments light-chain or glial fibrillary acid protein. Linear and mixed regression analyses were conducted to model the relationships between cognitive or neuropsychiatric symptoms, frailty and cerebral pathologic score, adjusted for age, sex and education.
RESULTS: The findings indicate an impact of both frailty (β = 0.28, 95 % CI [0.14–0.43], p < 0.001) and cerebral pathological score (β = 0.30, 95 % CI [0.13–0.47], p = 0.002) on cognitive impairment. However, only frailty was associated with neuropsychiatric symptoms (β = 0.28, 95 % CI [0.14–0.43], p < 0.001), particularly with apathy (β = 0.40, 95 % CI [0.26–0.53], p < 0.001). We found an association between cerebral pathological score and longitudinal cognitive decline (β = 0.36, 95 % CI [0.19–0.53], p < 0.001) in exploratory analyses with available longitudinal data at 24 months (n = 74).
CONCLUSIONS: Neurocognitive disorders are complex entities, where cognitive and neuropsychiatric symptoms are not fully influenced by the same factors. When cognitive symptoms seem more driven by cerebral pathology than frailty, neuropsychiatric symptoms appear to be more influenced by general state of frailty. Measuring and treating frailty might be a key factor in dealing with neuropsychiatric symptoms and their consequences.
CITATION:
Victor Gilles ; Anthime Flaus ; Achille Teillac ; Marc Verny ; Frédéric Blanc ; Marc Paccalin ; Thomas Desmidt ; Sandrine Louchart de la Chapelle ; Constance Dumay ; Mathilde Sauvée ; Sylvain Lehmann ; Christophe Hirtz ; François Cotton ; Anthony Bathsavanis ; Frédéric Gervais ; Teddy Novais ; Virginie Desestret ; Nawele Boublay ; Pierre Krolak-Salmon ; Sophie Dautricourt ; Antoine Garnier-Crussard (2026): Associations between frailty, biomarkers of cerebral pathology, cognitive and neuropsychiatric symptoms: a memory clinic study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100148
OLD DOG - VALIDATING THE DOG AS AN ANIMAL MODEL FOR HUMAN AGING STUDIES
Polina Zemko, Federico Bonsembiante, Marco Canevelli, Simona Buscarnera, Matteo Cesari, Tommaso Banzato
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Companion dogs represent a valuable and emerging translational model for human aging, as they share the human environment, receive comparable medical care - yet have much shorter lifespans. Despite their potential, a validated set of canine biomarkers of aging has not yet been established. The OLD-DOG Project, launched in 2023 at the University of Padua’s Veterinary Teaching Hospital, is a 30-month prospective study designed to identify and validate biomarkers of aging in companion dogs and to assess their predictive value for healthspan and lifespan, thereby evaluating the suitability of dogs as models for human aging research.
A cohort of 209 privately owned dogs aged ≥ 5 years was enrolled and underwent comprehensive evaluations every six months, including clinical examinations, physical fitness testing, blood and fecal sampling, and owner questionnaires. Collected data encompass physiological, biochemical, hematological, and behavioral parameters, as well as microbiota profiles, telomere length, and DNA methylation patterns. Surplus biological material is stored to establish a long-term biobank.
Preliminary cross-sectional analyses have identified consistent age-related patterns across multiple domains, including hematological and biochemical indices, inflammatory markers, and measures of physical and cognitive performance. Ongoing longitudinal analyses aim to determine the predictive value of these candidate biomarkers for morbidity and mortality, as well as to assess the influence of environmental and lifestyle factors on aging trajectories. Ultimately, the project seeks to construct an integrative model of biological age in dogs, thereby strengthening their value as a robust translational model for human aging research.
CITATION:
Polina Zemko ; Federico Bonsembiante ; Marco Canevelli ; Simona Buscarnera ; Matteo Cesari ; Tommaso Banzato (2026): OLD DOG - Validating the dog as an animal model for human aging studies. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100145
LONGITUDINAL NORMS OF FRAILTY MEASURED BY THE FRAILTY INDEX: A CROSS-NATIONAL COMPARISON USING DATA FROM THE SURVEY OF HEALTH, AGING, AND RETIREMENT IN EUROPE (SHARE)
Alejandra Marroig, Fernando Massa, Ángela Gutiérrez, Adil Supiyev, Bar?? Sevi, Graciela Muniz-Terrera
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BACKGROUND: Frailty, a geriatric syndrome commonly used to identify vulnerable older adults, is a public health priority. However, the lack of cross-national comparisons of frailty trajectories and their distribution constrains current understanding of normative changes in frailty for residents across different countries.
OBJECTIVE: To derive longitudinal percentiles of frailty using a consistent cross-country approach.
DESIGN: Observational study using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) between 2004 and 2020.
SETTING: We fit the distribution of the FI by Generalized Additive Models for Location, Scale, and Shape (GAMLSS), assessed the role of sex (male/female), education (in years), and migration status (migrant/non-migrant), and estimated the longitudinal percentiles of frailty using a consistent cross-country approach for 16 countries.
PARTICIPANTS: Individuals aged ≥65 years (N = 42,951) at study entry.
MEASUREMENTS: Frailty index (FI) based on the accumulation of deficits in 40 items.
RESULTS: The results show that education is protective against frailty in all countries (a decrease of 1.1 pp. in Switzerland to 5.7 pp. in Slovenia, all p < 0.001). In most countries, women are frailer than men and migrant individuals have higher levels of frailty than non-migrants. FI trajectories showed heterogeneity across countries. The quantiles for women and migrants suggest frailer trajectories than men and non-migrants respectively.
CONCLUSIONS: Findings from this cross-national comparison provide a framework within which the longitudinal norms of frailty trajectories from different countries can be interpreted.
CITATION:
Alejandra Marroig ; Fernando Massa ; Ángela Gutiérrez ; Adil Supiyev ; Barış Sevi ; Graciela Muniz-Terrera (2026): Longitudinal norms of frailty measured by the frailty index: A cross-national comparison using data from the survey of health, aging, and retirement in Europe (SHARE). The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100144
THE MEDIATING ROLE OF CHRONIC DISEASE IN SOCIOECONOMIC INEQUALITIES IN FRAILTY: A LONGITUDINAL COHORT STUDY OF OLDER ADULTS IN LAUSANNE, SWITZERLAND
Carlos de Mestral, Saman Khalatbari-Soltani, Patrick Bodenmann, Yves Henchoz, Mauricio Avendano
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BACKGROUND: Frailty is a major public health concern in aging populations. Socioeconomic disadvantage increases the risk of frailty, yet the mechanisms underlying this association remain unclear.
OBJECTIVES: To examine the mediating role of chronic diseases in the longitudinal association between socioeconomic disadvantage and frailty.
DESIGN: Population-based cohort study.
SETTING: Lausanne, Switzerland.
PARTICIPANTS: 4731 community-dwelling adults aged 65–70 years at recruitment (2004, 2010, and 2014), followed for up to 16 years, as part of the Lausanne Cohort 65+.
INTERVENTION: None.
MEASUREMENTS: Socioeconomic disadvantage was assessed using indicators of education, occupation, income, health insurance subsidy, and financial strain. Frailty was measured using the Fried phenotype (unintentional weight loss, exhaustion, low physical activity, weakness, and slow walking speed). Chronic conditions (obesity, diabetes, hypertension, cardiovascular and respiratory disease, and multimorbidity [≥2 conditions]) were assessed at baseline using standardized self-reported physician diagnoses. Counterfactual mediation using Cox proportional hazards models estimated the proportion of the socioeconomic disadvantage–frailty association mediated by each condition.
RESULTS: Socioeconomic disadvantage was associated with a 1.5–2.5-fold higher risk of incident frailty. Obesity mediated 13–55% of this association, diabetes 11–22%, and multimorbidity 21–39%, whereas hypertension, cardiovascular, and respiratory disease showed minimal or no mediation.
CONCLUSIONS: Chronic diseases—particularly obesity and diabetes—partly explain the long-term impact of socioeconomic disadvantage on frailty, underscoring stark inequities in healthy aging. Early detection and management of these conditions in socioeconomically vulnerable older adults, alongside population-level prevention and efforts to address adverse socioeconomic conditions as root causes, could help reduce these inequalities.
CITATION:
Carlos de Mestral ; Saman Khalatbari-Soltani ; Patrick Bodenmann ; Yves Henchoz ; Mauricio Avendano (2026): The mediating role of chronic disease in socioeconomic inequalities in frailty: A longitudinal cohort study of older adults in Lausanne, Switzerland. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100134
LOW RELATIVE SIT-TO-STAND POWER IN COLOMBIAN OLDER ADULTS: CUT-OFF POINTS AND ASSOCIATIONS WITH FRAILTY AND FUNCTIONAL DECLINE
Robinson Ramírez-Vélez, Miguel Germán Borda, Juan Carlos Calderón-González, Albeiro Dávila-Grisales, Gonzalo Romero-Martínez, Mikel Izquierdo, Miguel A. Pérez-Sousa
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OBJECTIVES: To examine the association between relative sit-to-stand (STS) power and age, establish sex-specific cut-off points, and evaluate their associations with adverse outcomes in Colombian older adults.
DESIGN: Cross-sectional, population-based study.
SETTING: Health, Well-being, and Aging Study (SABE-Colombia, 2014–2015).
PARTICIPANTS: 3051 community-dwelling adults aged ≥60 years (56.6 % women; mean age 68.6 ± 6.4 years).
MEASUREMENTS: Relative STS power (W·kg⁻¹) was estimated using a validated equation. Quantile regression examined age-related changes across percentiles (Q10–Q90). Receiver operating characteristic (ROC) curves with the Youden index determined cut-off points. Age-adjusted logistic regression tested associations with frailty, functionality as gait speed and handgrip strength (HGS), and depression.
RESULTS: Optimal cut-offs for low relative STS power were 2.11 W·kg⁻¹ for men and 1.63 W·kg⁻¹ for women. Prevalence of low STS power was 34.3 % in men and 34.8 % in women, increasing with age in both sexes. Quantile regression revealed steeper age-related declines at higher percentiles, particularly among men. Low relative STS power was significantly associated with frailty and low functionality.
CONCLUSION: Relative STS power is a simple, clinically feasible biomarker to identify functional impairment in older adults. The sex-specific thresholds reported for Colombian populations reflect demographic differences in muscle physiology and decline. Their integration into geriatric practice may enhance early detection, guide preventive interventions, and ultimately improve health outcomes in aging populations.
CITATION:
Robinson Ramírez-Vélez ; Miguel Germán Borda ; Juan Carlos Calderón-González ; Albeiro Dávila-Grisales ; Gonzalo Romero-Martínez ; Mikel Izquierdo ; Miguel A. Pérez-Sousa (2026): Low relative sit-to-stand power in Colombian older adults: Cut-off points and associations with frailty and functional decline. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100141
JFA N°02 - 2026
INSIGHTS ON GEROSCIENCE PRE-CLINICAL AND CLINICAL TRIALS TO PROMOTE HEALTHY AGING FROM THE INTRINSIC CAPACITY, FRAILTY AND SARCOPENIA RESEARCH TASK FORCE 2025
Luca Tagliafico, Marco Canevelli, Philipe De Souto Barreto, Matteo Cesari, Luigi Ferrucci, Bruno Vellas, Yves Rolland, ICFSR Task Force
J Frailty Aging 2026;15(2)
Show summaryHide summaryThe Intrinsic Capacity, Frailty and Sarcopenia Research (ICFSR) Task Force convened in March 2025 to discuss geroscience-oriented pre-clinical and clinical trials aimed at promoting healthy aging. Key topics included the use of aging biomarkers in clinical trials, senotherapeutics, metabolism-targeting medications, and therapeutic strategies beyond pharmacological approaches. The discussions highlighted the growing interest in, and accumulating evidence for, geroscience interventions. Several future challenges were identified, including the need for a deeper understanding of the biology of aging and the validation of aging biomarkers against relevant clinical outcomes, such as frailty and intrinsic capacity. Furthermore, to accelerate innovation in the field, there is a need to enhance clinical trial methodologies and harmonization—for example, by defining a minimum common dataset of biological, physiological, and clinical factors for geroscience clinical studies—and to foster a paradigm shift, particularly among regulatory authorities.
CITATION:
Luca Tagliafico ; Marco Canevelli ; Philipe De Souto Barreto ; Matteo Cesari ; Luigi Ferrucci ; Bruno Vellas ; Yves Rolland ; ICFSR Task Force (2026): Insights on geroscience pre-clinical and clinical trials to promote healthy aging from the Intrinsic Capacity, Frailty and Sarcopenia Research Task Force 2025. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100147
IDENTIFYING SARCOPENIA AND SARCOPENIC OBESITY IN A LOWER EXTREMITY ARTHROPLASTY CLINICAL SETTING: A PRAGMATIC PILOT STUDY
K. Godziuk, I. Hollyer, G. Loughran, N.J. Giori
J Frailty Aging 2026;15(2)
Show summaryHide summarySarcopenia and sarcopenic obesity may increase surgical complications and impact recovery and function after total joint arthroplasty (TJA). We assessed the feasibility of identifying these conditions in an orthopedic practice setting using published consensus criteria. Patients in a lower extremity TJA clinic were assessed for sarcopenia and sarcopenic obesity using EWGSOP2 and ESPEN/EASO diagnostic frameworks, respectively. Low strength testing involved maximal handgrip strength (HGS) and number of chair sit-to-stands in 30 seconds (CSTS). Same day dual-energy x-ray absorptiometry (DXA) testing was used to assess for low muscle mass (i.e. appendicular lean soft tissue) in patients with low strength. One hundred-one of a possible 128 patients were assessed in clinic (93% male, mean age 69.6±8.9 years and BMI 31.7±7.9 kg/m2). HGS was completed in 99% of screened patients; only 44.5% completed CSTS due to joint pain and balance limitations. Thirty-nine patients had low strength and were recommended for DXA. In 16 patients who completed DXA, 3 had sarcopenia and 5 had sarcopenic obesity. Screening for sarcopenia and sarcopenic obesity was challenging to complete in all patients during routine clinic flow with dedicated personnel. Despite our pragmatic approach and limited screening completion in all patients, we identified sarcopenic and sarcopenic obesity in 6.25% of patients. This is likely a lower bound for the true prevalence but suggests an opportunity to assess and intervene for these conditions before surgery to improve total joint arthroplasty outcomes.
CITATION:
K. Godziuk ; I. Hollyer ; G. Loughran ; N.J. Giori (2026): Identifying sarcopenia and sarcopenic obesity in a lower extremity arthroplasty clinical setting: a pragmatic pilot study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100125
IMPACT OF PHYSICAL ACTIVITY AND FRAILTY ON MORTALITY AND UTILIZATION AMONG MIDDLE-AGED AND OLDER ADULTS IN SOUTH KOREA
Ho-Jun Kim, Kyu-Ri Hong, Xiao-Lin Wen, Da-San Kim, Jung-Min Lee
J Frailty Aging 2026;15(2)
Show summaryHide summaryThis study examined the influence of frailty status and physical activity (PA) compliance on all-cause mortality and healthcare utilization among Korean adults aged 45 years and older. Data from 2104 participants in the Korean Longitudinal Study of Aging (KLoSA; 2006 - 2022) were analyzed. Frailty was assessed using a 38-item frailty index (FI), and PA was defined according to adherence to the World Health Organization guideline of at least 150 min per week. Participants were classified as robust, pre-frail, or frail. Cox proportional hazards models and generalized linear mixed models were used to evaluate associations with mortality and healthcare utilization. Compared with robust individuals, frail participants exhibited a markedly higher risk of all-cause mortality (hazard ratio [HR] = 3.37, 95% confidence interval [CI]: 2.42–4.69), while pre-frail individuals also showed an elevated mortality risk (HR = 1.72, 95% CI: 1.43–2.07). Frailty was consistently associated with greater healthcare utilization across outpatient visits, hospital admissions, length of hospital stay, and healthcare costs. Adherence to PA guidelines was not independently associated with reduced mortality among pre-frail and frail individuals after multivariable adjustment; however, a significant interaction indicated higher healthcare costs among frail individuals who met PA guidelines. In addition, higher BMI was associated with lower mortality risk, consistent with patterns described as the obesity paradox. These findings highlight frailty as a key, independent predictor of mortality and healthcare utilization beginning in midlife. Standardized PA recommendations alone may be insufficient for physiologically vulnerable populations, underscoring the importance of early frailty screening and individualized, function-sensitive intervention strategies to promote healthy aging.
CITATION:
Ho-Jun Kim ; Kyu-Ri Hong ; Xiao-Lin Wen ; Da-San Kim ; Jung-Min Lee (2026): Impact of physical activity and frailty on mortality and utilization among middle-aged and older adults in South Korea. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100142
ASSOCIATION OF ALLOSTATIC LOAD WITH FRAILTY TRAJECTORIES AND THE MEDIATING ROLE OF DEPRESSIVE SYMPTOMS
Mohammad Azizzadeh, Agnes Pirker-Kees, Emiel F.M. Wouters, Emiel F.M. Wouters, Daisy J.A. Janssen, Bart Spaetgens, Robab Breyer-Kohansal, Marie-Kathrin Breyer
J Frailty Aging 2026;15(2)
Show summaryHide summaryBACKGROUND: Frailty is a dynamic, age-related condition marked by progressive loss of resilience. Its risk factors include socioeconomic status and physiological stress burden, such as allostatic load score (ALS), remain unclear. This study aims to examine the role of depression in the association between ALS and frailty trajectories.
METHODS: We analyzed data from 5885 LEAD cohort participants aged 25–82 years at baseline and from 3564 participants with follow-up data. Frailty status (robust, pre-frail, frail) was defined using the Fried phenotype, and transitions between visits were assessed. ALS was calculated from 14 parameters spanning cardiovascular, metabolic, and body composition measures. Associations of ALS with frailty status at baseline and with frailty transitions at follow-up were examined, and depressive symptoms were tested as a mediator.
RESULTS: At baseline, 62.3% of participants were robust, 36.2% pre-frail, and 1.5% frail. Between visits, 16.3% transitioned to a worse frailty stage, while 17.7% improved. Higher ALS was linked to increased odds of being pre-frail/frail at baseline (OR 1.11; 95% CI: 1.08–1.15), and to a higher risk of transitioning from robust to pre-frail/frail (RRR 1.06; 95% CI: 1.02–1.09). Depressive symptoms mediated 35% (95% CI: 25–47%) of the cross-sectional and 17% (95% CI: 6.6–43%) of the longitudinal association between ALS and frailty.
CONCLUSIONS: Socioeconomic factors influenced frailty onset but not its progression, whereas depressive symptoms mediated approximately 17% of the effect of ALS on frailty development over time. These findings highlight the importance of exploring the effect of interventions for depression on frailty progression.
CITATION:
Mohammad Azizzadeh ; Agnes Pirker-Kees ; Emiel F.M. Wouters ; Daisy J.A. Janssen ; Bart Spaetgens ; Robab Breyer-Kohansal ; Marie-Kathrin Breyer (2026): Association of allostatic load with frailty trajectories and the mediating role of depressive symptoms. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100132
SCREENING AND MANAGING FRAILTY IN OLDER NURSING HOME RESIDENTS WITH FRAIL-VIG INDEX: FEASIBILITY, RELIABILITY AND PREDICTIVE VALIDITY FOR MORTALITY
Cristina Jiménez-Domínguez, Lourdes Rexach-Cano, Carlos Verdejo-Bravo, Manuel Vicente Mejía-Ramírez-Arellano, Carlota Manuela Zárate-Saez, Mª Nieves Vaquero Pinto, Cristina Roldán-Plaza, Nuria Pérez-Panizo, Mª Loreto Álvarez-Nebreda
J Frailty Aging 2026;15(2)
Show summaryHide summaryFrailty is prevalent among older nursing home residents, although there is limited evidence regarding frailty screening and management in this setting.
OBJECTIVE: To evaluate the measurement properties of the Frail Index based on the Comprehensive Geriatric Assessment (Frail-VIG).
DESIGN: Prospective observational longitudinal study of 571 residents from 3 nursing homes. Frail-VIG scores were calculated at baseline and at 6 and 12 months. Sociodemographic variables were studied. Feasibility was assessed based on simplicity of application and requirements for score calculation. Reliability was evaluated through inter-rater agreement and test-retest assessments. Construct and content validity were examined by comparing it with other frailty indexes. Predictive validity was evaluated using log-rank tests and AUC-ROC curves for mortality prediction.
RESULTS: Mean (SD) resident age was 88.2 (6.5) years, and 80.6 % were women. The mortality rate was 11.4 % at 6 months and 20 % at 12 months. Calculating Frail-VIG scores required 5.15 min and no additional space or equipment, and there was low risk of missing data. The inter-rater consistency and score stability over time indicate strong reliability. The Frail-VIG maintains the characteristics of other established frailty indexes and shows strong convergent validity with the FRAIL-NH and CFS scales. Baseline scores have an AUC-ROC curve (confidence interval) of 0.69 (95 % CI, 0.63–0.76) at 6 months and 0.65 (95 % CI, 0.6–0.71) at 12 months.
CONCLUSIONS: The measurement properties of the Frail-VIG in older nursing home residents validate its use in this population and setting. Its predictive ability for mortality suggests important implications for advanced care planning.
CITATION:
Cristina Jiménez-Domínguez ; Lourdes Rexach-Cano ; Carlos Verdejo-Bravo ; Manuel Vicente Mejía-Ramírez-Arellano ; Carlota Manuela Zárate-Saez ; Mª Nieves Vaquero Pinto ; Cristina Roldán-Plaza ; Nuria Pérez-Panizo ; Mª Loreto Álvarez-Nebreda (2026): Screening and managing frailty in older nursing home residents with Frail-VIG index: Feasibility, reliability and predictive validity for mortality. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100130
PREPARATION FOR HEALTHY AGEING: AN INTEGRATED EDUCATIONAL INTERVENTION FOR ENHANCING KNOWLEDGE AND SELF-EFFICACY IN INTRINSIC CAPACITY PRESERVATION, MIDLIFE CONDITION MANAGEMENT, AND CAREGIVING IN MIDLIFE WOMEN
Ruby Yu, Matthew Yu, Cecilia Tong, Florence Ho, Angel Hui, Emily Lui, Jean Woo
J Frailty Aging 2026;15(2)
Show summaryHide summaryOBJECTIVES: Midlife women often experience concurrent declines in intrinsic capacity (IC) and increasing caregiving responsibilities. This study evaluated the effectiveness of an educational intervention designed to enhance knowledge of IC preservation, self-care efficacy, and caregiving competencies among midlife women.
METHODS: The Pursuit of Wellness Program was developed and evaluated through a multicentre mixed methods study. This program comprised nine modules addressing IC domains (cognitive, vitality, psychological) and six modules focused on priority midlife conditions (e.g., urinary incontinence). Each module integrated health education, self care practices, and caregiving training. Program's effectiveness was assessed using a mixed methods evaluation. Outcomes included pre- and post-changes in domain- or condition-specific knowledge (summative score range: 0–3) and self-care efficacy (visual analogue scale: 0–10), post-intervention caregiving confidence (Likert scale: 1–5), and qualitative feedback from program coordinators.
RESULTS: A total of 690 women aged 50–64 years were assessed. Pre-tests revealed knowledge gaps in pain management, bladder health, and dementia care, with mean health knowledge scores ranging from 1.3–1.6. Post-intervention improvements were most significant for bladder health (+69.0%, p<0.001), followed by nutrition for muscle & bone health (+56.3%, p<0.001). Self efficacy increased significantly across all IC domains and midlife conditions (ps<0.01), while caregiving confidence reached from 68.7 to 89.3% agreement, highest for skin and bathing care (89.3%) and dementia support (86.3%). Qualitative findings from program coordinators (n=18) confirmed high participant engagement with nutrition strategies and stress management techniques, corroborating quantitative outcomes.
CONCLUSIONS: The program significantly enhanced knowledge related to IC preservation and management of midlife conditions, self-care practices, and caregiving competencies among midlife women. It addresses a critical gap by concurrently promoting IC preservation and caregiving proficiency during the midlife transition.
CITATION:
Ruby Yu ; Matthew Yu ; Cecilia Tong ; Florence Ho ; Angel Hui ; Emily Lui ; Jean Woo (2026): Preparation for healthy ageing: An integrated educational intervention for enhancing knowledge and self-efficacy in intrinsic capacity preservation, midlife condition management, and caregiving in midlife women. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100126
ASSOCIATION BETWEEN THE FRAILTY INDEX AND ALL-CAUSE AND CARDIOVASCULAR MORTALITY IN A POPULATION WITH CARDIOVASCULAR-KIDNEY-METABOLIC SYNDROME: INSIGHTS FROM THE NHANES 2011-2018
Xin Wang, Xinrui Hai, Ali Ma, Xiaolan Liang, Hua Cheng, Peng Wu, Yu Hao, Dapeng Chen, Ning Yan
J Frailty Aging 2026;15(2)
Show summaryHide summaryBACKGROUND: The Frailty Index (FI) is a well-established predictor of accelerated biological aging and a reliable tool for estimating all-cause and cardiovascular disease (CVD) mortality in older adults in the United States. However, its predictive value remains unclear in other U.S. population subgroups. This study aimed to examine the association between FI levels and both all-cause and CVD mortality among patients diagnosed with Cardiovascular-Kidney-Metabolic Syndrome (CKM syndrome).
METHODS: This study utilized the data from the National Health and Nutrition Examination Survey (NHANES 2011–2018), which included 7049 participants with complete information for CKM staging (stages 0–4). We employed multivariate Cox proportional hazards models in conjunction with restricted cubic splines (RCS) to account for potential non-linear relationships in the data. Additionally, segmented Cox proportional hazards models were used to examine the association between FI levels and both all-cause and CVD mortality in the CKM syndrome population. Subgroup analyses stratified by demographic and clinical factors, along with interaction tests, were performed to evaluate the consistency of these associations.
RESULTS: After adjusting for potential confounding variables, a nonlinear association was observed between the FI and CKM syndrome. Multivariable Cox regression analysis based on nationally representative data demonstrated that higher FI levels were significantly associated with increased risks of both all-cause and CVD mortality among patients with CKM syndrome. Multivariable analysis indicated a robust association between higher FI levels and the presence of CKM syndrome. Among patients diagnosed with CKM syndrome, each 10-unit increase in the FI was associated with a 54% higher risk of CVD mortality (HR = 1.54, 95% CI: 1.24–1.91; P < 0.001) and a 55% higher risk of all-cause mortality (HR = 1.55; 95% CI: 1.38–1.73, P < 0.0001). Stratified analyses revealed no significant interaction effects between the FI and demographic or clinical factors on mortality outcomes.
CONCLUSION: The results highlight a robust and statistically significant association between FI and increased risk of both all-cause and CVD mortality among individuals with KM syndrome. Notably, FI may serve as a valuable marker for CKM stage stratification and for identifying high-risk patients.
CITATION:
Xin Wang ; Xinrui Hai ; Ali Ma ; Xiaolan Liang ; Hua Cheng ; Peng Wu ; Yu Hao ; Dapeng Chen ; Ning Yan (2026): Association between the frailty index and all-cause and cardiovascular mortality in a population with cardiovascular-kidney-metabolic syndrome: Insights from the NHANES 2011-2018. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100131
FACTORS ASSOCIATED WITH SOCIAL FRAILTY IN OLDER ADULTS IN COLOMBIA
Carmen-Lucia Curcio, Sebastian Villada, Laura Chica, Claudia Liliana Valencia
J Frailty Aging 2026;15(2)
Show summaryHide summaryOBJECTIVES: Social frailty (SF) has gained increasing attention in recent years. While several studies have examined SF among older adults living in the community, most have been conducted in specific countries, primarily in Asia, with limited research in Latin America. The main objective of this study was to identify the relationship between SF and demographic, health, and functional conditions among older adults in Colombia.
METHODS: This study is a secondary analysis of the SABE Colombia study. Social frailty (SF) was assessed using the adapted HALFE Social Frailty Index. The main independent variables included demographic factors and health status indicators such as self-rated health, chronic conditions, depression, ADL/IADL dependence, mobility disability, and life-space assessment. Bivariate analysis and logistic regression in multivariate models were applied.
RESULTS: The overall prevalence of SF was 66.3%, increasing with advancing age. Compared to individuals without SF, those with SF were more likely to have a low level of education (<6 years), mobility disability, dependence on IADLs, restricted life space (<55.5), be female, and report poor or very poor self-rated health. In multivariate logistic regression analyses, SF was associated with higher odds of years of education (<6), dependence for IADL, restricted life-space, being female, mobility disability, and bad and very bad self-rated health. In contrast, depressive symptoms, rural areas, and marital status lose significance.
CONCLUSION: SF is prevalent among Colombian elderly individuals, affecting nearly seven in ten community-dwelling older adults. It is also significantly associated with demographic, health, and functional conditions. Additionally, social issues such as economic status, social isolation, loneliness, and social participation are increasingly prominent among older adults. Thus, SF resulting from social issues requires greater attention, particularly in non-developed countries. Consequently, to promote healthy aging, it is imperative to implement measures aimed at preventing and mitigating SF among older adults in light of these findings.
CITATION:
Carmen-Lucia Curcio ; Sebastian Villada ; Laura Chica ; Claudia Liliana Valencia (2026): Factors associated with social frailty in older adults in Colombia. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100133
ASSESSING FRAILTY WITH CLINICAL AND LABORATORY MEASURES IN HOSPITALIZED OLDER ADULTS: A COMPARISON OF ALL-CAUSE MORTALITY ACROSS TWO GERIATRIC DEPARTMENTS
Giulia Venturelli, Francesco Canepa, Luca Tagliafico, Silvia Ottaviani, Stefania Peruzzo, Alessio Nencioni, Aldo Bellora, Fiammetta Monacelli
J Frailty Aging 2026;15(2)
Show summaryHide summaryBy 2030, one in six people globally will be over 60, potentially increasing the burden of frailty, a condition characterized by reduced physiological resilience and poor clinical outcomes. Although frailty affects up to 49 % of hospitalized patients, it is frequently under-recognized. Tools like the Clinical Frailty Scale (CFS) and the FI-Lab aim to assess frailty, though each has limitations. This retrospective cohort study evaluated the predictive value of CFS and FI-Lab, separately and in combination, for in-hospital and three-month post-discharge mortality in older adults. The study included 410 hospitalized patients (median age 87) admitted to two geriatric units between 2023 and 2025. Frailty was assessed using the CFS and a 22-item FI-Lab derived from blood tests within 48 h of admission. In-hospital and post-discharge mortality rates were 12.6 % and 24.7 %, respectively. Both FI-Lab and CFS were independently associated with increased mortality risk. A weak correlation between the two tools (r = 0.19, p < 0.001) suggests they capture distinct but complementary aspects of frailty. These findings support the combined use of FI-Lab and CFS for more accurate risk stratification in acutely ill older adults. FI-Lab may reflect acute physiological stress not captured by clinical measures alone, aiding early identification of vulnerable patients. Despite limitations, including modest sample size and lack of adjustment for multimorbidity, this study highlights the potential utility of integrating lab-based frailty assessments into routine hospital care for personalized geriatric management.
CITATION:
Giulia Venturelli ; Francesco Canepa ; Luca Tagliafico ; Silvia Ottaviani ; Stefania Peruzzo ; Alessio Nencioni ; Aldo Bellora ; Fiammetta Monacelli (2026): Assessing frailty with clinical and laboratory measures in hospitalized older adults: A comparison of all-cause mortality across two geriatric departments. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100128
IMPLEMENTATION OF A BEST PRACTICE ADVISORY ALERT FOR INPATIENT FRAILTY SCREENING AND INTERVENTION: A PILOT QUALITY IMPROVEMENT PROGRAM
L.M. Teo, J.A. Abengana, H. Tan, Z.Y. Koh, A.P. Chew, T.L. Tan
J Frailty Aging 2026;15(2)
Show summaryHide summaryBACKGROUND: Frailty is highly prevalent in hospitalized older adults and predicts adverse health outcomes but remains under-recognized. Manual screening tools previously employed were challenging in high-volume settings and reliant on individuals’ knowledge on frailty. With the development of electronic health records (EHRs), there is a potential to automate screening for frailty in hospitalized older adults. We introduce a quality improvement initiative that utilizes an EHR-automated Best Practice Advisory (BPA) alert to identify inpatients who may benefit from geriatric intervention and encourage timely Geriatric referral to a Mobile Frailty Intervention Team (MFIT).
METHODS: MFIT was piloted at Woodlands Hospital, an integrated acute and community hospital in Singapore. BPA was automatically triggered to encourage referral to MFIT if any of the following criteria were met a) Clinical Frailty Scale (CFS) 7 b) CFS 5–6 with presence of either of cognitive impairment / high falls risk / high readmission risk c) Age 60 with presence of delirium, regardless of CFS status. The MFIT team conducted Comprehensive Geriatric Assessments (CGA) as part of routine review with the diagnosed geriatric syndromes and discharge dispositions recorded.
RESULTS: On MFIT review, 81.3 % (N = 248) of patients referred had a geriatric syndrome and 68.5 % (N = 209) had multiple syndromes. MFIT further identified syndromes which may be neglected during acute admission such as underlying dementia (87 %, N = 83), osteoporosis (13.4 %, N = 41) and urinary incontinence (9.8 %, N = 30). MFIT also provided discharge recommendations which were adhered to in 79.2 % (N = 232) of patients. 32.8 % (N = 100) were given specialized outpatient clinic follow-up with Geriatric medicine, suggesting the potential to divert patients from away from primary care services and unplanned readmissions. Further studies are needed to investigate whether this transition effectively optimizes resource allocation.
CONCLUSION: A CFS-based BPA alert may be feasible in providing an automated and scalable method to identify hospitalized older adults with frailty that would benefit from timely geriatric intervention.
CITATION:
L.M. Teo ; J.A. Abengana ; H. Tan ; Z.Y. Koh ; A.P. Chew ; T.L. Tan (2026): Implementation of a best practice advisory alert for inpatient frailty screening and intervention: A pilot quality improvement program. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100146
LETTER TO THE EDITOR: BEYOND MORTALITY PREDICTION: FRAIL-VIG AS A TRIGGER FOR PROACTIVE MULTIDOMAIN INTERVENTIONS IN NURSING HOME RESIDENTS
Jorge A. Sánchez-Duque
J Frailty Aging 2026;15(2)
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CITATION:
Jorge A. Sánchez-Duque (2026): Letter to the Editor: Beyond mortality prediction: Frail-VIG as a trigger for proactive multidomain interventions in nursing home residents. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100143