03/2018 journal articles
DESIGNING DRUG TRIALS FOR FRAILTY: ICFSR TASK FORCE 2018
M. PAHOR, S.B. KRITCHEVSKY, D.L. WATERS, D.T. VILLAREAL, J. MORLEY, J.M. HARE, B. VELLAS
J Frailty Aging 2018;7(3):150-154Show summaryHide summary
To reduce disability and dependence in older adults, frailty may represent an appropriate target for intervention. While preventing frailty through lifestyle interventions may be the optimal public health approach for many population groups, pharmacological approaches will likely be needed for individuals who meet frailty criteria or who have comorbid conditions that contribute to and complicate the frailty syndrome, and for those who are not compliant with lifestyle interventions. Barriers to successful development of drug treatments for frailty include variability in how the frailty syndrome is defined, lack of agreement on the best diagnostic tools and outcome measures, and the paucity of sensitive, reliable, and validated biomarkers. The International Conference on Frailty and Sarcopenia Research Task Force met in Miami, Florida, on February 28, 2018, to consider the status of treatments under development for frailty and discuss potential strategies for advancing the field. They concluded that at the present time, there may be a more productive regulatory pathway for adjuvant treatments or trials targeting specific functional outcomes such as gait speed. They also expressed optimism that several studies currently underway may provide the insight needed to advance drug development for frailty.
M. Pahor ; S.B. Kritchevsky ; D.L. Waters ; D.T. Villareal ; J. Morley ; J.M. Hare ; B. Vellas ; and the ICFSR Task Force (2018): Designing Drug Trials for Frailty: ICFSR Task Force 2018. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.20
THE EFFECT OF HIGH DOSE VITAMIN D3 ON PHYSICAL PERFORMANCE IN FRAIL OLDER ADULTS. A FEASIBILITY STUDY
N.W. Bray, T.J. Doherty, M. Montero-Odasso
J Frailty Aging 2018;7(3):155-161Show summaryHide summary
Background: Vitamin D deficiency is ubiquitous in frailty but the effectiveness of vitamin D supplementation to improve outcomes in frail individuals is unclear. It has been postulated that higher than the current recommended doses (800 IU/day) may be needed to achieve a neuromuscular effect in frail individuals. Objectives: 1) determine if 4000 IU per day of vitamin D3 is safe for frail older adults; and 2) establish the efficacy of this dose to improve physical performance outcomes in this population. Design: Open-label, feasibility study. Setting: Community retirement centre. Participants: 40 older adults with frail or pre-frail characteristics. Intervention: 4000 IU of vitamin D3 and 1200 mcg of calcium carbonate daily for four months. Measurements: Physical performance (grip strength, gait speed and short physical performance battery score), cognitive health and vitamin D and iPTH serum levels before and after the intervention. Results: Frail individuals improved short physical performance battery score (1.19, p = 0.005), fast gait speed (4.65, p = 0.066) and vitamin D levels (7.81, p = 0.011). Only frail females made a significant improvement in grip strength (1.92, p = 0.003). Stratifying the sample by baseline vitamin D levels revealed that participants with vitamin D insufficiency (≤ 75 nmol/L) significantly improved short physical performance battery score (1.06, p = 0.04), fast gait speed (6.28, p = 0.004) and vitamin D levels (25.73, p = <0.0001). Pre-frail individuals, as well as those with sufficient vitamin D levels (> 75 nmol/L) made no significant improvement in any outcome. Conclusions: Vitamin D supplementation using 4000 IU/daily is safe and has a modest beneficial effect on physical performance for frail individuals and those with insufficient vitamin D levels. Participants with vitamin D insufficiency (≤ 75 nmol/L) showed greater benefits. Our feasibility study provides results to help calculate effect size for a future RCT.
N.W. Bray ; T.J. Doherty ; M. Montero-Odasso (2018): The Effect of High Dose Vitamin D3 on Physical Performance in Frail Older Adults. A Feasibility Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.18
EXAMINING DIFFERENCES IN RECOVERY OUTCOMES BETWEEN MALE AND FEMALE HIP FRACTURE PATIENTS: DESIGN AND BASELINE RESULTS OF A PROSPECTIVE COHORT STUDY FROM THE BALTIMORE HIP STUDIES
D. Orwig, M.C. Hochberg, A.L. Gruber-Baldini, B. Resnick, R.R. Miller, G.E. Hicks, A.R. Cappola, M. Shardell, R. Sterling, J.R. Hebel, R. Johnson, J. Magaziner
J Frailty Aging 2018;7(3):162-169Show summaryHide summary
Background: Incidence of hip fractures in men is expected to increase, yet little is known about consequences of hip fracture in men compared to women. It is important to investigate differences at time of fracture using the newest technologies and methodology regarding metabolic, physiologic, neuromuscular, functional, and clinical outcomes, with attention to design issues for recruiting frail older adults across numerous settings. Objectives: To determine whether at least moderately-sized sex differences exist across several key outcomes after a hip fracture. Design, Setting, & Participants: This prospective cohort study (Baltimore Hip Studies 7th cohort [BHS-7]) was designed to include equal numbers of male and female hip fracture patients to assess sex differences across various outcomes post-hip fracture. Participants were recruited from eight hospitals in the Baltimore metropolitan area within 15 days of admission and were assessed at baseline, 2, 6 and 12 months post-admission. Measurements: Assessments included questionnaire, functional performance evaluation, cognitive testing, measures of body composition, and phlebotomy. Results: Of 1709 hip fracture patients screened from May 2006 through June 2011, 917 (54%) were eligible and 39% (n=362) provided informed consent. The final analytic sample was 339 (168 men and 171 women). At time of fracture, men were sicker (mean Charlson score= 2.4 vs. 1.6; p<0.001) and had worse cognition (3MS score= 82.3 vs. 86.2; p<0.05), and prior to fracture were less likely to be on bisphosphonates (8% vs. 39%; p<0.001) and less physically active (2426 kilocalories/week vs. 3625; p<0.001). Conclusions: This paper provides the study design and methodology for recruiting and assessing hip fracture patients and evidence of baseline and pre-injury sex differences which may affect eventual recovery one year later.
D. Orwig ; M.C. Hochberg ; A.L. Gruber-Baldini ; B. Resnick ; R.R. Miller ; G.E. Hicks ; A.R. Cappola ; M. Shardell ; R. Sterling ; J.R. Hebel ; R. Johnson ; J. Magaziner (2018): Examining Differences in Recovery Outcomes between Male and Female Hip Fracture Patients: Design and Baseline Results of a Prospective Cohort Study from the Baltimore Hip Studies. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.15
SPOUSAL CAREGIVING IS ASSOCIATED WITH AN INCREASED RISK OF FRAILTY: A CASE-CONTROL STUDY
F. Potier, J.-M. Degryse, G. Aubouy, S. Henrard, B. Bihin, F. Debacq-Chainiaux, H. Martens, M. de Saint-Hubert
J Frailty Aging 2018;7(3):170-175Show summaryHide summary
Background: Evidence suggests that providing care for a disabled elderly person may have implications for the caregiver’s own health (decreased immunity, hypertension, and depression). Objective: Explore if older spousal caregivers are at greater risks of frailty compared to older people without a load of care. Design: Case-control study. Setting: Participants were assessed at home in Wallonia, Belgium. Participants: Cases: community-dwelling spousal caregivers of older patients, recruited mainly by the geriatric outpatient clinic. Controls: people living at home with an independent spouse at the functional and cognitive level matched for age, gender and comorbidities. Measurements: Mini nutritional assessment-short form (MNA-SF), short physical performance battery (SPPB), frailty phenotype (Fried), geriatric depression scale (GDS-15), clock drawing test, sleep quality, and medications. The multivariable analysis used a conditional logistic regression. Results: Among 79 caregivers, 42 were women; mean age and Charlson comorbidity index were 79.4±5.3 and 4.0±1.2, respectively. Among care-receivers (mean age 81.4±5.2), 82% had cognitive impairment. Caregiving was associated with a risk of frailty (Odd Ratio (OR) 6.66; 95% confidence interval (CI) 2.20-20.16), the consumption of antidepressants (OR 4.74; 95% CI 1.32 -17.01), shorter nights of sleep (OR 3.53; 95% CI 1.37-9.13) and more difficulties maintaining a social network (OR 5.25; 95% CI 1.68-16.40). Conclusions: Spousal caregivers were at an increased risk of being frail, having shorter nights of sleep, taking antidepressants and having difficulties maintaining their social network, compared to non-caregiver controls. Older spousal caregivers deserve the full attention of professionals to prevent functional decline and anticipate a care breakdown.
F. Potier ; J.-M. Degryse ; G. Aubouy ; S. Henrard ; B. Bihin ; F. Debacq-Chainiaux ; H. Martens ; M. de Saint-Hubert (2018): Spousal caregiving is associated with an increased risk of frailty: a case-control study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.11
SUBJECTIVE SLEEP QUALITY AMONG SARCOPENIC AND NON-SARCOPENIC OLDER ADULTS: RESULTS FROM THE SARCOPHAGE COHORT
M. Locquet, C. Beaudart, L. Delandsheere, J.-Y. Reginster, O. Bruyère
J Frailty Aging 2018;7(3):176-181Show summaryHide summary
Background: It seems that sleep quality could impact the physiological process related to loss of muscle mass. Objectives: We seek to compare subjective sleep quality of sarcopenic and non-sarcopenic subjects diagnosed according to 6 definitions. Design: Cross-sectional data used in this analysis were collected from the SarcoPhAge (Sarcopenia & Physical Impairment with Advancing Age) cohort, a prospective study aiming to assess clinical parameters linked to sarcopenia. Participants: The present study was interested in community-dwelling older adults with and without sarcopenia. Measurements – A diagnosis of sarcopenia was established according to 6 definitions. Three assessments were carried out: an evaluation of lean mass, a measurement of muscle strength and an assessment of physical performance. In addition, to evaluate the parameters of subjective sleep, we used the Pittsburgh Sleep Quality Index (PSQI), a self-administered questionnaire evaluating 7 components of sleep architecture. Results: A total of 255 individuals aged 74.7±5.8 years were included. Based on the 6 different definitions, the prevalence of sarcopenia ranged from 5.9% to 32.5%. There was no significant difference between sarcopenic and non-sarcopenic subjects regarding most of the components of subjective sleep quality. However, the definition of Cruz-Jentoft et al. (2010) indicated that sarcopenic subjects had higher scores than non-sarcopenic subjects for two components: sleep latency and day-time dysfunction (p=0.03 and p=0.04, adjusted for confounders). Moreover, some parameters of sleep quality were correlated with components of sarcopenia. Conclusions: Some properties of subjective sleep quality seem to be associated with sarcopenia and seem correlated with at least one of the three components of the condition.
M. Locquet ; C. Beaudart ; L. Delandsheere ; J.-Y. Reginster ; O. Bruyère (2018): ubjective sleep quality among sarcopenic and non-sarcopenic older adults: results from the SarcoPhAge cohort. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.13
CONGREGATE MEALS: OPPORTUNITIES TO HELP VULNERABLE OLDER ADULTS ACHIEVE DIET AND PHYSICAL ACTIVITY RECOMMENDATIONS
J.M. Beasley, M.A. Sevick, L. Kirshner, M. Mangold, J. Chodosh
J Frailty Aging 2018;7(3):182-186Show summaryHide summary
Background: Through diet and exercise interventions, community centers offer an opportunity to address health-related issues for some of the oldest, most vulnerable members of our society. Objectives: The purpose of this investigation is to draw upon nationwide data to better characterize the population served by the congregate meals program and to gather more detailed information on a local level to identify opportunities for service enhancement to improve the health and well-being of older adults. Design: We examined community center data from two sources: 2015 National Survey of Older Americans Act and surveys from two New York City community centers. To assess nationwide service delivery, we analyzed participant demographics, functional status defined by activities of daily living, and perceptions of services received. Measurements: Participants from the two New York City community centers completed a four-day food record. Functional measures included the short physical performance battery, self-reported physical function, grip strength, and the Montreal Cognitive Assessment. Results: Nationwide (n=901), most participants rated the meal quality as good to excellent (91.7%), and would recommend the congregate meals program to a friend (96.0%). Local level data (n=22) were collected for an in-depth understanding of diet, physical activity patterns, body weight, and objective functional status measures. Diets of this small, local convenience sample were higher in fat, cholesterol, and sodium, and lower in calcium, magnesium, and fiber than recommended by current United States Dietary Guidelines. Average time engaged in moderate physical activity was 254 minutes per week (SD=227), exceeding the recommended 150 minutes per week, but just 41% (n=9) and 50% (n=11) of participants engaged in strength or balance exercises, respectively. Conclusion: Research is warranted to test whether improvements in the nutritional quality of food served and access/supports for engaging in strength training within community centers could help older adults achieve diet and physical activity recommendations.
J.M. Beasley ; M.A. Sevick ; L. Kirshner ; M. Mangold ; J. Chodosh (2018): Congregate Meals: Opportunities to help vulnerable older adults achieve diet and physical activity recommendations. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.21
OLDER PEOPLE WHO ARE FREQUENT USERS OF ACUTE CARE: A SYMPTOM OF FRAGMENTED CARE? A CASE SERIES REPORT ON PATIENTS’ PATHWAYS OF CARE
J. Dollard, G. Harvey, E. Dent, L. Trotta, N. Williams, J. Beilby, E. Hoon, A. Kitson, C. Seiboth, J. Karnon5
Frailty Aging 2018;7(3):193-195Show summaryHide summary
Older frequent users of acute care can experience fragmented care. There is a need to understand the issues in a local context before attempting to address fragmented care. 0.5% (n=61) of the population in a defined local government area were identified as having ≥4 unplanned emergency department (ED) presentations/admissions to an acute-care hospital over 13 months. A retrospective case-series study was conducted to examine detailed pathways of care for 17 patients within the identified population. The two dominant presentation reasons were clinical symptoms associated with a declining/significant loss of capacity in fundamental self-care activities and chronic cardiac/respiratory conditions. Of patients discharged home, 21% of discharge letters were delayed >7 days and only 19% received a written discharge plan. Half of community dwelling patients received home nursing and/or assistance. Frequent users of acute care can experience untimely hospital communication and may require more coordinated care provided in the community to assist self-care and manage chronic conditions.
J. Dollard ; G. Harvey ; E. Dent ; L. Trotta ; N. Williams ; J. Beilby ; E. Hoon ; A. Kitson ; C. Seiboth ; J. Karnon (2018): Older people who are frequent users of acute care: A symptom of fragmented care? A case series report on patients’ pathways of care. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.12
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
Frailty Aging 2018;7(3):187-192Show summaryHide summary
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.
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
NUTRITIONAL STATUS IN FRAIL CIRRHOTIC PATIENTS UNDERGOING LIVER TRANSPLANTATION
D. Azzolino, S. Damanti, M. Cesari
Frailty Aging 2018;7(3):196-197Show summaryHide summary
D. Azzolino ; S. Damanti ; M. Cesari (2018): Nutritional status in frail cirrhotic patients undergoing liver transplantation. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.14
FEASIBILITY OF WEIGHTED VEST USE DURING A DIETARY WEIGHT LOSS INTERVENTION AND EFFECTS ON BODY COMPOSITION AND PHYSICAL FUNCTION IN OLDER ADULTS
E. Normandin, D. Yow, C. Crotts, J. Kiel, K.M. Beavers, B.J. Nicklas
Frailty Aging 2018;7(3):198-203Show summaryHide summary
Background: While intentional weight loss in older adults with obesity yields clinically important health benefits there is a need to minimize the negative effects of weight loss on concomitant loss of muscle mass and strength. Data show wearing weighted vests during exercise improves lean mass and lower extremity strength, however the efficacy of wearing a weighted vest during a period of weight loss to mitigate muscle and strength loss is not known. Objectives: This study examined the feasibility of daily weighted vest use during a dietary weight loss intervention, and examined effects of vest use on body composition and physical function in well-functioning older adults with obesity. Design: Randomized, controlled pilot study. Setting: Wake Forest Baptist Medical Center in Winston-Salem, NC. Participants: 37 older (age=65-79 yrs), obese (BMI=30-40 kg/m2) sedentary men and women. Interventions: 22-week behavioral diet intervention (targeting 10% weight loss, 1100-1300 kcals/day) with (Diet+Vest; n=20) or without (Diet; n=17) weighted vest use (goal of 10 hours/day with weight added weekly according to individual loss of body mass). Measurements: Body composition by dual-energy x-ray absorptiometry and measures of physical function, mobility, and muscle strength/power. Results: Average weighted vest use was 6.7±2.2 hours/day and the vest-wear goal of 10 hrs/day was achieved for 67±22% of total intervention days. Five participants reported adverse events from wearing the vest (all back pain or soreness). Both groups lost a similar amount of weight (Diet= -11.2±4.4 kg; Diet+Vest = -11.0±6.3 kg; p<0.001), with no differences between groups (p=0.25). Fat mass, lean mass, and % body fat decreased significantly (p<0.0001), with no differences between groups. Compared to Diet+Vest, the Diet intervention resulted in greater decreases in leg power (p<0.02), with no other between group differences in physical function. Conclusion: This pilot study showed that vest use during dietary weight loss is feasible and safe in well-functioning older adults with obesity. Larger studies are needed to definitively determine whether external replacement of lost weight during caloric restriction may preserve lower extremity muscle strength and power.
E. Normandin ; D. Yow ; C. Crotts ; J. Kiel ; K.M. Beavers ; B.J. Nicklas (2018): Feasibility of weighted vest use during a dietary weight loss intervention and effects on body composition and physical function in older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.17