03/2015 journal articles
PHARMACOLOGICAL INTERVENTIONS IN FRAILTY AND SARCOPENIA: REPORT BY THE INTERNATIONAL CONFERENCE ON FRAILTY AND SARCOPENIA RESEARCH TASK FORCE
M. Cesari, R. Fielding, O. Bénichou, R. Bernabei, S. Bhasin, J.M. Guralnik, A. Jette, F. Landi, M. Pahor, L. Rodriguez-Manas, Y. Rolland, R. Roubenoff, A.J. Sinclair, S. Studenski, T. Travison, B. Vellas, on behalf of the International Conference on Frailty and Sarcopenia Research Task Force
J Frailty Aging 2015;4(3):114-120Show summaryHide summary
Sarcopenia and frailty often co-exist and both have physical function impairment as a core component. Yet despite the urgency of the problem, the development of pharmaceutical therapies for sarcopenia and frailty has lagged, in part because of the lack of consensus definitions for the two conditions. A task force of clinical and basic researchers, leaders from the pharmaceutical and nutritional industries, and representatives from non-profit organizations was established in 2012 with the aim of addressing specific issues affecting research and clinical activities on frailty and sarcopenia. The task force came together on April 22, 2015 in Boston, Massachusetts, prior to the International Conference on Frailty and Sarcopenia Research (ICFSR). The theme of this meeting was to discuss challenges related to drugs designed to target the biology of frailty and sarcopenia as well as more general questions about designing efficient drug trials for these conditions. The present article reports the results of the task force’s deliberations based on available evidence and preliminary results of ongoing activities. Overall, the lack of a consensus definition for sarcopenia and frailty was felt as still present and severely limiting advancements in the field. However, agreement appears to be emerging that low mass alone provides insufficient clinical relevance if not combined with muscle weakness and/or functional impairment. In the next future, it will be important to build consensus on clinically meaningful functional outcomes and test/validate them in long-term observational studies.
M. Cesari ; R. Fielding ; O. Bénichou ; R. Bernabei ; S. Bhasin ; J.M. Guralnik ; A. Jette ; F. Landi ; M. Pahor ; L. Rodriguez-Manas ; Y. Rolland ; R. Roubenoff ; A.J. Sinclair ; S. Studenski ; T. Travison ; B. Vellas ; on behalf of the International Conference on Frailty and Sarcopenia Research Task Force (2015): PHARMACOLOGICAL INTERVENTIONS IN FRAILTY AND SARCOPENIA: 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.2015.64
SELECTIVE ANDROGEN RECEPTOR MODULATORS AS FUNCTION PROMOTING THERAPIES
J Frailty Aging 2015;4(3):121-122Show summaryHide summary
S. Bhasin ; (2015): Selective Androgen Receptor Modulators as Function Promoting Therapies. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.65
MOBILITY AND FUNCTIONAL OUTCOMES FOR SARCOPENIA TRIALS
J Frailty Aging 2015;4(3):123-124Show summaryHide summary
M. Pahor (2015): Mobility and Functional Outcomes for Sarcopenia Trials. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.61
USE OF BIOMARKERS
J Frailty Aging 2015;4(3):125-128Show summaryHide summary
Expanding the concept of frailty to the clinical settings has raised the concern about the accuracy of the current definitions for identifying frail individuals (not populations). The usual tools to assess frailty show, among other characteristics, a low sensitivity and a low Positive Predictive Value. One approach to overcome this challenge is using biological biomarkers to improve those characteristics, making feasible and accurate the assessment of frailty in clinical settings. Many biomarkers of frailty have been identified but few of them have been assessed as clinical markers with controversial results. Taking into account that frailty is caused by the failure in different systems, it is worthy to check if the combination of several of these biomarkers could be of help. In this effort, the EU-funded project FRAILOMIC is trying to assess the ability of different sets of biomarkers for improving the accuracy of classical definitions in determining the risk, the diagnosis and the prognosis of frailty.
L. Rodríguez-Mañas (2015): Use of biomarkers. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.46
FRAILTY AND SARCOPAENIA TRIALS IN PRIMARY CARE – IDENTIFYING AND OVERCOMING KEY BARRIERS TO SUCCESSFUL CLINICIAN PARTICIPATION
J Frailty Aging 2015;4(3):129-130Show summaryHide summary
Primary care research involving older people brings together a wide range of primary care practitioners. Key areas of activity include: health promotion, disease prevention, screening and early diagnosis, as well as the management of common and long-term conditions such as frailty and sarcopaenia which are under-researched domains of health in this setting. Few interventional studies have identified frail or sarcopaenic patients as the target population based on recent definitions of either condition. Several barriers to successful research in the primary care area exist and overcoming such barriers is not straightforward but involves a multidimensional approach that attempts to enhance the confidence and opportunity to engage in research of primary care staff and the consideration of factors that allow external leads of research to coordinate their programme.
A. Sinclair (2015): Frailty and Sarcopaenia Trials in Primary Care – Identifying and Overcoming Key barriers to Successful Clinician Participation. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.62
CO-PRESENCE OF MULTIMORBIDITY AND DISABILITY WITH FRAILTY: AN EXAMINATION OF HETEROGENEITY IN THE FRAIL OLDER POPULATION
S. Aarts, K.V. Patel, M. E. Garcia, M. van den Akker, F.R.J. Verhey, J.F.M. Metsemakers, M.P.J. van Boxtel, V. Gudnason, M.K. Jonsdottir, K. Siggeirsdottir, P.V. Jonsson, T. B. Harris, L.J. Launer
J Frailty Aging 2015;4(3):131-138Show summaryHide summary
Background: Frailty is often associated with multimorbidity and disability. Objectives: We investigated heterogeneity in the frail older population by characterizing five subpopulations according to quantitative biological markers, multimorbidity and disability, and examined their association with mortality and nursing home admission. Design: Observational study. Participants: Participants (n=4,414) were from the population-based Age Gene/Environment Susceptibility Reykjavik Study. Measurements: Frailty was defined by ≥ 3 of five characteristics: weight loss, weakness, reduced energy levels, slowness and physical inactivity. Multimorbidity was assessed using a simple disease count, based on 13 prevalent conditions. Disability was assessed by five activities of daily living; participants who had difficulty with one or more tasks were considered disabled. Differences among frail subpopulations were based on the co-presence of multimorbidity and disability. Differences among the following subpopulations were examined: 1) Non-frail (reference group); 2) Frail only; 3) Frail with disability; 4) Frailty with multimorbidity; 5) Frail with disability and multimorbidity. Results: Frailty was present in 10.7% (n=473). Frailty was associated with increased risk for mortality (OR 1.40; 95% CI 1.15-1.69) and nursing home admission (OR 1.50; 95% CI 1.16-1.93); risks differed by subpopulations. Compared to the non-frail, the frail only group had poorer cognition and increased inflammation levels but did not have increased risk for mortality (OR 1.40; 95% CI 0.84-2.33) or nursing home admission (OR 1.01; 95% CI 0.46-2.21). Compared to the non-frail, the other frail subpopulations had significantly poorer cognition, increased inflammation levels, more white matter lesions, higher levels of calcium, glucose and red cell distribution width and increased risk for mortality and nursing home admission. Conclusions: The adverse health risks associated with frailty in the general older adult population may primarily be driven by increased disease burden and disability.
S. Aarts ; K.V. Patel ; M. E. Garcia ; M. van den Akker ; F.R.J. Verhey ; J.F.M. Metsemakers ; M.P.J. van Boxtel ; V. Gudnason ; M.K. Jonsdottir ; K. Siggeirsdottir ; P.V. Jonsson ; T. B. Harris ; L.J. Launer (2015): CO-PRESENCE OF MULTIMORBIDITY AND DISABILITY WITH FRAILTY: AN EXAMINATION OF HETEROGENEITY IN THE FRAIL OLDER POPULATION . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.45
RISK FACTORS FOR LOW GAIT SPEED: A NESTED CASE-CONTROL SECONDARY ANALYSIS OF THE MEXICAN HEALTH AND AGING STUDY
M.U. Pérez-Zepeda, J.G. González-Chavero, R. Salinas-Martinez, L.M. Gutiérrez-Robledo
J Frailty Aging 2015;4(3):139-143Show summaryHide summary
Background: Physical performance tests play a major role in the geriatric assessment. In particular, gait speed has shown to be useful for predicting adverse outcomes. However, risk factors for slow gait speed (slowness) are not clearly described. Objectives: To determine risk factors associated with slowness in Mexican older adults. Design: A two-step process was adopted for exploring the antecedent risk factors of slow gait speed. First, the cut-off values for gait speed were determined in a representative sample of Mexican older adults. Then, antecedent risk factors of slow gait speed (defined using the identified cut-points) were explored in a nested cohort case-control study. Setting, participants: One representative sample of a cross-sectional survey for the first step and the Mexican Health and Aging Study (a cohort characterized by a 10-year follow-up). Measurements: A 4-meter usual gait speed test was conducted. Lowest gender and height-stratified groups were considered as defining slow gait speed. Sociodemographic characteristics, comorbidities, psychological and health-care related variables were explored to find those associated with the subsequent development of slow gait speed. Unadjusted and adjusted logistic regression models were performed. Results: In the final model, age, diabetes, hypertension, and history of fractures were associated with the development of slow gait speed. Conclusions: Early identification of subjects at risk of developing slow gait speed may halt the path to disability due to the robust association of this physical performance test with functional decline.
M.U. Pérez-Zepeda ; J.G. González-Chavero ; R. Salinas-Martinez ; L.M. Gutiérrez-Robledo (2015): Risk Factors for low Gait Speed: a Nested Case-Control Secondary Analysis of the Mexican Health and Aging Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.63
FRAILTY AND PAIN: TWO RELATED CONDITIONS
H. Nessighaoui, M. Lilamand, K.V. Patel, B. Vellas, M.L. Laroche, T. Dantoine, M. Cesari
J Frailty Aging 2015;4(3):144-148Show summaryHide summary
Frailty is a multidimensional syndrome, involving functional, nutritional, biological and psychological aspects. This condition, defined as a decreased resistance to internal and external stressors, is predictive of adverse health outcomes, including disability and mortality. Importantly, the frailty syndrome is usually considered a reversible condition, thus amenable of specific preventive interventions. Persistent pain in older adults is very common and has multiple determinants. This symptom represents a determinant of accelerated aging. In the present paper, we discuss available evidence examining the association between these two conditions. Despite the high prevalence of these two conditions and their shared underlying mechanisms, our search only retrieved few relevant studies. Most of them reported a relationship between pain (or analgesics consumption) and different operational definitions of frailty. Pain may represent a relevant risk factor as well as a potential target for interventions against the frailty syndrome, but further studies are needed.
H. Nessighaoui ; M. Lilamand ; K.V. Patel ; B. Vellas ; M.L. Laroche ; T. Dantoine ; M. Cesari (2015): Frailty and pain: two related conditions. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.53
COMPONENTS OF THE RISK INSTRUMENT FOR SCREENING IN THE COMMUNITY (RISC) THAT CORRELATE WITH PUBLIC HEALTH NURSES’ PERCEPTION OF RISK
P. Leahy-Warren, R. O’Caoimh, C. FitzGerald, A. Cochrane, A. Svendrovski, U. Cronin, E. O’Herlihy, N. Cornally, Y. Gao, E. Healy, E. O’Connell, G. O’Keeffe, S. Coveney, J. McGlynn, C. Fitzgerald, R. Clarnette, D. W. Molloy
J Frailty Aging 2015;4(3):149-154Show summaryHide summary
Background: Functional decline and frailty are common in community-dwelling older adults, leading to an increased risk of adverse outcomes. Objective: To examine the factors that public health nurses perceive to cause risk of three adverse outcomes: institutionalisation, hospitalisation, and death, in older adults, using the Risk Instrument for Screening in the Community (RISC). Design: A quantitative, correlational, descriptive design was used. Setting and Participants: A sample of 803 community-dwellers, aged over 65 years receiving regular follow-up by public health nurses. Procedure and Measurements: Public health nurses (n=15) scored the RISC and the Clinical Frailty Scale (CFS) on patients in their caseload. We examined and compared correlations between the severity of concern and ability of the caregiver network to manage these concerns with public health nurses’ perception of risk of the three defined adverse outcomes. Results: In total, 782 RISC scores were available. Concern was higher for the medical state domain (686/782,88%) compared with the mental state (306/782,39%) and activities of daily living (595/782,76%) domains. Concern was rated as severe for only a small percentage of patients. Perceived risk of institutionalisation had the strongest correlation with concern over patients mental state,(r=0.53), while risk of hospitalisation,(r=0.53) and death,(r=0.40) correlated most strongly with concern over the medical state. Weaker correlations were found for the other domains and RISC scores. The CFS most strongly correlated with the ADL domain,(r=0.78). Conclusion: Although the prevalence of concern was high, it was mostly rated as mild. Perceived risk of institutionalisation correlated most with concern over the ability of caregiver networks to manage patients’ mental state, while risk of hospitalisation and death correlated with patients’ medical state. The findings suggest the importance of including an assessment of the caregiver network when examining community-dwelling older adults. Validation of the RISC and public health nurses’ ratings are now required.
P. Leahy-Warren ; R. O’Caoimh ; C. FitzGerald ; A. Cochrane ; A. Svendrovski ; U. Cronin ; E. O’Herlihy ; N. Cornally ; Y. Gao ; E. Healy ; E. O’Connell ; G. O’Keeffe ; S. Coveney ; J. McGlynn ; C. Fitzgerald ; R. Clarnette ; D. W. Molloy (2015): Components of the Risk Instrument for Screening in the Community (RISC) that correlate with public health nurses’ perception of risk . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.56
EFFECTS OF CALORIC RESTRICTION WITH OR WITHOUT RESISTANCE TRAINING IN DYNAPENIC-OVERWEIGHT AND OBESE MENOPAUSAL WOMEN: A MONET STUDY
E. Normandin, M. Sénéchal, D. Prud’homme, R. Rabasa-Lhoret, M. Brochu
J Frailty Aging 2015;4(3):155-162Show summaryHide summary
Objective: The dynapenic (DYN)-obese phenotype is associated with an impaired metabolic profile. However, there is a lack of evidences regarding the effect of lifestyle interventions on the metabolic profile of individual with dynapenic phenotype. The objective was to investigate the impact of caloric restriction (CR) with or without resistance training (RT) on body composition, metabolic profile and muscle strength in DYN and non-dynapenic (NDYN) overweight and obese menopausal women. Design: 109 obese menopausal women (age 57.9 ± 9.0 yrs; BMI 32.1 ± 4.6 kg/m2) were randomized to a 6-month CR intervention with or without a RT program. Participants were categorized as DYN or NDYN based on the lowest tertile of relative muscle strength in our cohort (< 4.86 kg/BMI). Measurements: Body composition was measured by DXA, body fat distribution by CT scan, glucose homeostasis at fasting state and during an euglycemic-hyperinsulinemic clamp, fasting lipids, resting blood pressure, fasting inflammation markers and maximal muscle strength. Results: No difference was observed between groups at baseline for body composition and the metabolic profile. Overall, a treatment effect was observed for all variables of body composition and some variables of the metabolic profile (fasting insulin, glucose disposal, triglyceride levels, triglycerides/HDL-Chol ratio and resting diastolic blood pressure) (P between 0.05 and 0.001). No Group X Treatment interaction was observed for variables of body composition and the metabolic profile. However, an interaction was observed for muscle strength; which significantly improved more in the CR+RT NDYN group (all P ≤ 0.05). Conclusions: In the present study, dynapenia was not associated with a worse metabolic profile at baseline in overweight and obese menopausal women. DYN and NDYN menopausal women showed similar cardiometabolic benefit from CR or CR+RT interventions. However, our results showed that the addition of RT to CR was more effective in improving maximal strength in DYN and NDYN obese menopausal women.
E. Normandin ; M. Sénéchal ; D. Prud’homme ; R. Rabasa-Lhoret ; M. Brochu (2015): Effects of Caloric Restriction with or without Resistance Training in Dynapenic-Overweight and Obese Menopausal Women: A MONET Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2015.54