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01/2020 journal articles

EDITORIAL: THE NEED TO IMPLEMENT FRAILTY IN THE INTERNATIONAL CLASSIFICATION OF DISEASE (ICD)

J. Muscedere

J Frailty Aging 2020;9(1)2-3

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CITATION:
J. Muscedere (2020): Editorial: The Need to Implement Frailty in the International Classification of Disease (ICD) . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.2

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ICFSR TASK FORCE PERSPECTIVE ON BIOMARKERS FOR SARCOPENIA AND FRAILTY

L. Rodriguez-Mañas, I. Araujo de Carvalho, S. Bhasin, H.A. Bischoff-Ferrari, M. Cesari, W. Evans, J.M. Hare, M. Pahor, A. Parini, Y. Rolland, R.A. Fielding, J. Walston, B. Vellas, and the ICFSR Task Force

J Frailty Aging 2020;9(1)4-8

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Biomarkers of frailty and sarcopenia are essential to advance the understanding of these conditions of aging and develop new diagnostic tools and effective treatments. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force – a group of academic and industry scientists from around the world -- met in February 2019 to discuss the current state of biomarker development for frailty and sarcopenia. The D3Cr dilution method, which assesses creatinine excretion as a biochemical measure of muscle mass, was suggested as a more accurate measure of functional muscle mass than assessment by dual energy x-ray absorptiometry (DXA). Proposed biomarkers of frailty include markers of inflammation, the hypothalamic-pituitary-adrenal (HPA) axis response to stress, altered glucose insulin dynamics, endocrine dysregulation, aging, and others, acknowledging the complex multisystem etiology that contributes to frailty. Lack of clarity regarding a regulatory pathway for biomarker development has hindered progress; however, there are currently several international efforts to develop such biomarkers as tools to improve the treatment of individuals presenting these conditions.

CITATION:
L. Rodriguez-Mañas ; I. Araujo de Carvalho ; S. Bhasin ; H.A. Bischoff-Ferrari ; M. Cesari ; W. Evans ; J.M. Hare ; M. Pahor ; A. Parini ; Y. Rolland ; R.A. Fielding ; J. Walston ; B. Vellas ; and the ICFSR Task Force (2019): ICFSR Task Force Perspective on Biomarkers for Sarcopenia and Frailty. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.32

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CLINICALLY MEANINGFUL CHANGE FOR PHYSICAL PERFORMANCE: PERSPECTIVES OF THE ICFSR TASK FORCE

J. Guralnik, K. Bandeen-Roche, S.A.R. Bhasin, S. Eremenco, F. Landi, J. Muscedere, S. Perera, J.-Y. Reginster, L. Woodhouse, B. Vellas, and the ICFSR Task Force

J Frailty Aging 2020;9(1)9-13

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For clinical studies of sarcopenia and frailty, clinically meaningful outcome measures are needed to monitor disease progression, evaluate efficacy of interventions, and plan clinical trials. Physical performance measures including measures of gait speed and other aspects of mobility and strength have been used in many studies, although a definition of clinically meaningful change in performance has remained unclear. The International Conference on Frailty and Sarcopenia Research Task Force (ICFSR-TF), a group of academic and industry scientists investigating frailty and sarcopenia, met in Miami Beach, Florida, USA in February 2019 to explore approaches for establishing clinical meaningfulness in a manner aligned with regulatory authorities. They concluded that clinical meaningful change is contextually dependent, and that both anchor- based and distribution-based methods of quantifying physical function are informative and should be evaluated relative to patient-reported outcomes. In addition, they identified additional research needed to enable setting criteria for clinical meaningful change in trials.

CITATION:
J. Guralnik ; K. Bandeen-Roche ; S.A.R. Bhasin ; S. Eremenco ; F. Landi ; J. Muscedere ; S. Perera ; J.-Y. Reginster ; L. Woodhouse ; B. Vellas ; and the ICFSR Task Force (2019): Clinically Meaningful Change for Physical Performance: Perspectives of the ICFSR Task Force. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.33

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MOVING TOWARDS COMMON DATA ELEMENTS AND CORE OUTCOME MEASURES IN FRAILTY RESEARCH

J. Muscedere, J. Afilalo, I. Araujo de Carvalho, M. Cesari, A. Clegg, H.E. Eriksen, K.R. Evans, G. Heckman, J.P. Hirdes, P.M. Kim, B. Laffon, J. Lynn, F. Martin, J.C. Prorok, K. Rockwood, L. Rodrigues Mañas, D. Rolfson, G. Shaw, B. Shea, S. Sinha, O. Theou, P. Tugwell, V. Valdiglesias, B. Vellas, N. Veronese, L.M.K. Wallace, P.R. Williamson, For the Canadian Frailty Network

J Frailty Aging 2020;9(1)14-22

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With aging populations around the world, frailty is becoming more prevalent increasing the need for health systems and social systems to deliver optimal evidence based care. However, in spite of the growing number of frailty publications, high-quality evidence for decision making is often lacking. Inadequate descriptions of the populations enrolled including frailty severity and frailty conceptualization, lack of use of validated frailty assessment tools, utilization of different frailty instruments between studies, and variation in reported outcomes impairs the ability to interpret, generalize and implement the research findings. The utilization of common data elements (CDEs) and core outcome measures (COMs) in clinical trials is increasingly being adopted to address such concerns. To catalyze the development and use of CDEs and COMs for future frailty studies, the Canadian Frailty Network (www.cfn-nce.ca; CFN), a not-for-profit pan-Canadian nationally-funded research network, convened an international group of experts to examine the issue and plan the path forward. The meeting was structured to allow for an examination of current frailty evidence, ability to learn from other COMs and CDEs initiatives, discussions about specific considerations for frailty COMs and CDEs and finally the identification of the necessary steps for a COMs and CDEs consensus initiative going forward. It was agreed at the onset of the meeting that a statement based on the meeting would be published and herein we report the statement.

CITATION:
J. Muscedere ; J. Afilalo ; I. Araujo de Carvalho ; M. Cesari ; A. Clegg ; H.E. Eriksen ; K.R. Evans ; G. Heckman ; J.P. Hirdes ; P.M. Kim ; B. Laffon ; J. Lynn ; F. Martin ; J.C. Prorok ; K. Rockwood ; L. Rodrigues Mañas ; D. Rolfson ; G. Shaw ; B. Shea ; S. Sinha ; O. Theou ; P. Tugwell ; V. Valdiglesias ; B. Vellas ; N. Veronese ; L.M.K. Wallace ; P.R. Williamson ; For the Canadian Frailty Network (2019): Moving towards common data elements and core outcome measures in frailty research. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.43

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MUSCLE STRENGTH AS A PREDICTOR OF GAIT VARIABILITY AFTER TWO YEARS IN COMMUNITY-LIVING OLDER ADULTS

B. Bogen, R. Moe-Nilssen, M.K. Aaslund, A.H. Ranhoff

J Frailty Aging 2020;9(1)23-29

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Background: Stride-to-stride fluctuations, or gait variability, can be captured easily using body worn inertial sensors. Previously, sensor-measured gait variability has been found to be associated with fall risk and central nervous changes. However, further research is needed to clarify the clinical relevance of this method. Objectives: In this study, we look at how gait variability is associated with muscle strength, measured two years earlier. Design, setting and participants: This is study of longitudinal associations. Participants were community-dwelling volunteers between 70-81 years. Measurements: Participants were tested while walking with a single sensor at their lower back, and they walked back and forth over a distance of 6.5 meters under four conditions: at preferred speed, at fast speed, with an added cognitive task, and while walking across an uneven surface. Gait variability in the anteroposterior (AP), mediolateral (ML) and vertical (V) directions was identified. A muscle strength score was composed by transforming hand grip strength, isometric knee extension strength and the 30 second chair rise-test to z-scores and adding them. Results: 56 individuals were analysed (mean age at baseline 75.8 (SD 3.43), 60 percent women). In a backwards regression method using age, gender and baseline walking speed as covariates, muscle strength predicted gait variability after two years for AP variability during preferred speed (Beta= .314, p=.025) and uneven surface walking (Beta=.326, p=.018). Further, muscle strength was associated with ML variability during preferred speed (Beta=.364, p=.048) and fast speed (Beta=.419, p=.042), and V variability during preferred speed (Beta=.402, p=.002), fast speed (Beta=.394, p=.004) and uneven surface walking (Beta=.369, p=.004). Conclusions: Sensor-measured gait variability tended to be associated with muscle strength measured two years earlier. This finding could emphasize the relevance of this relatively novel measure of gait in older adults for both research and clinical practice.

CITATION:
B. Bogen ; R. Moe-Nilssen ; M.K. Aaslund ; A.H. Ranhoff (2019): Muscle strength as a predictor of gait variability after two years in community-living older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.24

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NEUROMUSCULAR ATTRIBUTES ARE ASSOCIATED WITH POOR MOBILITY IN OLDER ADULTS WITH VASCULAR RISK CONDITIONS

A.J. Jor’dan, M.E. Jacob, E. Leritz, J.F. Bean

J Frailty Aging 2020;9(1)30-36

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Background: The mobility of older adults is limited by the compounding effects of vascular health conditions, or vascular risk burden. However, little is known about the role of neuromuscular attributes among those in which vascular risk burden contributes to mobility limitations. Objective: We investigated (1) the relationship between the absence/presence of type 2 diabetes, hypertension, and/or obesity and mobility measures and neuromuscular attributes, and (2) whether the association between vascular risk burden and mobility is mediated by lower limb neuromuscular attributes. Design: Cross-sectional analysis of baseline data from 430 older adults within the Boston RISE Study. Measurements: Measures of mobility were the Short Physical Performance Battery, habitual gait speed, and functional mobility as measured by the Late Life Function Instrument. We also evaluated lower limb neuromuscular attributes, namely leg strength, leg velocity, trunk extensor muscle endurance, knee and ankle range of motion, and sensory loss. Results: Participants self-reported the presence of None (n=93), One (n=179), Two (n=114), or Three (n=44) of the following conditions: diabetes, hypertension, and obesity. Multivariable regression models indicated that those with a greater vascular risk burden had worse performance on the Short Physical Performance Battery (p=0.01), slower gait speed (p=0.0003) and lower Basic and Advanced Late Life Function Instrument scores (p<0.003). These associations were independent of multiple covariates. Vascular risk burden was also found to be negatively associated with leg strength (p=0.0002) and knee flexion range of motion (p<0.0001) and an associated non-significant trend was observed with leg velocity (p=0.06). In addition, the association between vascular risk burden and mobility outcomes were found to be partially mediated by leg strength, leg velocity, and knee flexion range of motion. Conclusions: Among older adults with vascular risk burden and mobility problems, neuromuscular impairments in attributes such as leg strength, leg velocity, and knee range of motion may need to be treatment priorities.

CITATION:
A.J. Jor’dan ; M.E. Jacob ; E. Leritz ; J.F. Bean (2019): Neuromuscular Attributes are Associated with Poor Mobility in Older Adults with Vascular Risk Conditions . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.42

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OBESITY DEFINITIONS IN SARCOPENIC OBESITY: DIFFERENCES IN PREVALENCE, AGREEMENT AND ASSOCIATION WITH MUSCLE FUNCTION

E.Q. Khor, J.P. Lim, L. Tay, A. Yeo, S. Yew, Y.Y. Ding, W.S. Lim

J Frailty Aging 2020;9(1)37-43

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Background: Sarcopenic obesity (SO) is associated with poorer physical performance in the elderly and will increase in relevance with population ageing and the obesity epidemic. The lack of a consensus definition for SO has resulted in variability in its reported prevalence, poor inter-definitional agreement, and disagreement on its impact on physical performance, impeding further development in the field. While sarcopenia definitions have been compared, the impact of obesity definitions in SO has been less well-studied. Objectives: To compare 3 widely-adopted definitions of obesity in terms of SO prevalence, inter-definitional agreement, and association with muscle function. Design: Cross-sectional. Setting: GERILABS study, Singapore Participants: 200 community-dwelling, functionally-independent older adults. Measurements: We utilized three commonly-used definitions of obesity: body mass index (BMI), waist circumference (WC) and DXA-derived fat mass percentage (FM%). Sarcopenia was defined using Asian Working Group for Sarcopenia criteria. For muscle function, we assessed handgrip strength, gait speed and Short Physical Performance Battery (SPPB). Subjects were classified into 4 body composition phenotypes (normal, obese, sarcopenic and SO), and outcomes were compared between groups. Results: The prevalence rate for SO was lowest for BMI (0.5%) compared to FM% (10.0%) and WC (10.5%). Inter-definitional agreement was lowest between BMI and WC (κ=0.364), and at best moderate between FM% and WC (κ=0.583). SO performed the worst amongst body composition phenotypes in handgrip strength, gait speed and SPPB (all p<0.01) only when defined using WC. In regression analyses, SO was associated with decreased SPPB scores (β=-0.261, p=0.001) only for the WC definition. Conclusion: There is large variation in the prevalence of SO across different obesity definitions, with low-to-moderate agreement between them. Our results corroborate recent evidence that WC, and thus central obesity, is best associated with poorer muscle function in SO. Thus, WC should be further explored in defining obesity for accurate and early characterization of SO among older adults in Asian populations.

CITATION:
E.Q. Khor ; J.P. Lim ; L. Tay ; A. Yeo ; S. Yew ; Y.Y. Ding ; W.S. Lim (2019): Obesity definitions in sarcopenic obesity: Differences in prevalence, agreement and association with muscle function. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.28

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THE USE OF POSTUROGRAPHY IN INVESTIGATING THE RISK OF FALLING IN FRAIL OR PREFRAIL OLDER PEOPLE WITH DIABETES

H. Domergue, L. Rodríguez-Mañas, O. Laosa Zafra, K. Hood, D. Gasq, S. Regueme, A.J. Sinclair, I. Bourdel-Marchasson

J Frailty Aging 2020;9(1)44-50

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Background: In older people, diabetes is associated with an increased risk of falls and frailty. The value of using posturography for evaluating the risk of falling is unclear. In theory, a time-scale analysis should increase the metrological properties of the posturography assessment. Objectives: This study aimed to determine which posturographic parameters can be used to identify fall-risk patients in a frail diabetic older population and to assess their interest in comparison to usual clinical trials for gait and balance. Design: This is a prospective observational cohort. Settings: frail or pre-frail diabetic patients, in Bordeaux, France. Participants: 84 patients were included in the study (mean age 80.09 years, 64.5% of men).Criteria for inclusion were: age over 70 years, diabetes mellitus for over 2 years, and at least one of the Fried’s frailty criteria. Measurements: Gait and balance assessments were undertaken at baseline: Static posturography, the timed up and go test, short physical performance battery, and (gait) walking speed. Raw data from posturography were used for wavelet analysis. Data on self reported new falls were collected prospectively during 6 months. Results: The posturography parameter most useful was area of 90% confidence ellipse of statokinesigram (COP90area): area under the ROC curve AUC = 0.617 (95% CI, 0.445-0.789) and OR=1.003 (95%CI 1.000-1.005) p =0.05. The optimum clinical test was the time to walk over 4m AUC=0.735 (95%CI, 0.587-0.882) and OR=1.42 (95%CI 1.08-1.87) p= 0.013. Conclusion: Posturography has limited utility for assessment of falls risk in frail older people with diabetes. Gait and balance clinical assessments such as walking speed continue to retain their value.

CITATION:
H. Domergue ; L. Rodríguez-Mañas ; O. Laosa Zafra ; K. Hood ; D. Gasq ; S. Regueme ; A.J. Sinclair ; I. Bourdel-Marchasson (2019): The use of posturography in investigating the risk of falling in frail or prefrail older people with diabetes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.27

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CONTRIBUTION OF PROTEIN INTAKE AND CONCURRENT EXERCISE TO SKELETAL MUSCLE QUALITY WITH AGING

N.D. Dicks, C.J. Kotarsky, K.A. Trautman, A.M. Barry, J.F. Keith, S. Mitchell, W. Byun, S.N. Stastny, K.J. Hackney

J Frailty Aging 2020;9(1)51-56

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Background: The use of magnetic resonance imaging (MRI) derived functional cross-sectional area (FCSA) and intramuscular adipose tissue (IMAT) to define skeletal muscle quality is of fundamental importance in order to understand aging and inactivity-related loss of muscle mass. Objectives: This study examined factors associated with lower-extremity skeletal muscle quality in healthy, younger, and middle-aged adults. Design: Cross-sectional study. Setting and Participants: Ninety-eight participants (53% female) were classified as younger (20-35 years, n=50) or middle-aged (50-65 years, n=48) as well as sedentary (≤1 day per week) or active (≥3 days per week) on self-reported concurrent exercise (aerobic and resistance). Measurements: All participants wore an accelerometer for seven days, recorded a three-day food diary, and participated in magnetic resonance imaging (MRI) of the lower limbs. Muscle cross-sectional area (CSA) was determined by tracing the knee extensors (KE) and plantar flexors, while muscle quality was established through the determination of FCSA and IMAT via color thresholding. Results: One-way analysis of variance and stepwise regression models were performed to predict FCSA and IMAT. KE-IMAT (cm2) was significantly higher among sedentary (3.74 ± 1.93) vs. active (1.85 ± 0.56) and middle-aged (3.14 ± 2.05) vs. younger (2.74 ± 1.25) (p < 0.05). Protein intake (g•kg•day-1) was significantly higher in active (1.63 ± 0.55) vs. sedentary (1.19 ± 0.40) (p < 0.05). Sex, age, concurrent exercise training status, and protein intake were significant predictors of KE FCSA (R2 = 0.71, p < 0.01), while concurrent exercise training status and light physical activity predicted 33% of the variance in KE IMAT (p < 0.01). Conclusion: Concurrent exercise training, dietary protein intake, and light physical activity are significant determinants of skeletal muscle health and require further investigation to mitigate aging and inactivity-related loss of muscle quality.

CITATION:
N.D. Dicks ; C.J. Kotarsky ; K.A. Trautman ; A.M. Barry ; J.F. Keith ; S. Mitchell ; W. Byun ; S.N. Stastny ; K.J. Hackney (2019): Contribution of Protein Intake and Concurrent Exercise to Skeletal Muscle Quality with Aging. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.40

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CIRCULATING INTERLEUKIN-6 IS ASSOCIATED WITH SKELETAL MUSCLE STRENGTH, QUALITY, AND FUNCTIONAL ADAPTATION WITH EXERCISE TRAINING IN MOBILITY-LIMITED OLDER ADULTS

G.J. Grosicki, B.B. Barrett, D.A. Englund, C. Liu, T.G. Travison, T. Cederholm, A. Koochek, Å. von Berens, T. Gustafsson, T. Benard, K.F. Reid, R.A. Fielding

J Frailty Aging 2020;9(1)57-63

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Background: Human aging is characterized by a chronic, low-grade inflammation suspected to contribute to reductions in skeletal muscle size, strength, and function. Inflammatory cytokines, such as interleukin-6 (IL-6), may play a role in the reduced skeletal muscle adaptive response seen in older individuals. Objectives: To investigate relationships between circulating IL-6, skeletal muscle health and exercise adaptation in mobility-limited older adults. Design: Randomized controlled trial. Setting: Exercise laboratory on the Health Sciences campus of an urban university. Participants: 99 mobility-limited (Short Physical Performance Battery (SPPB) ≤9) older adults. Intervention: 6-month structured physical activity with or without a protein and vitamin D nutritional supplement. Measurements: Circulating IL-6, skeletal muscle size, composition (percent normal density muscle tissue), strength, power, and specific force (strength/CSA) as well as physical function (gait speed, stair climb time, SPPB-score) were measured pre- and post-intervention. Results: At baseline, Spearman’s correlations demonstrated an inverse relationship (P<0.05) between circulating IL-6 and thigh muscle composition (r = -0.201), strength (r = -0.311), power (r = -0.210), and specific force (r = -0.248), and positive association between IL-6 and stair climb time (r = 0.256; P<0.05). Although the training program did not affect circulating IL-6 levels (P=0.69), reductions in IL-6 were associated with gait speed improvements (r = -0.487; P<0.05) in “higher” IL-6 individuals (>1.36 pg/ml). Moreover, baseline IL-6 was inversely associated (P<0.05) with gains in appendicular lean mass and improvements in SPPB score (r = -0.211 and -0.237, respectively). Conclusions: These findings implicate age-related increases in circulating IL-6 as an important contributor to declines in skeletal muscle strength, quality, function, and training-mediated adaptation. Given the pervasive nature of inflammation among older adults, novel therapeutic strategies to reduce IL-6 as a means of preserving skeletal muscle health are enticing.

CITATION:
G.J. Grosicki ; B.B. Barrett ; D.A. Englund ; C. Liu ; T.G. Travison ; T. Cederholm ; A. Koochek ; Å. von Berens ; T. Gustafsson ; T. Benard ; K.F. Reid ; R.A. Fielding (2019): Circulating Interleukin-6 is Associated with Skeletal Muscle Strength, Quality, and Functional Adaptation with Exercise Training in Mobility-Limited Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.30

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ICSFR: 10th International Conference on Frailty & Sarcopenia Research. March 11-13, 2020, Toulouse – France

Symposia - Conferences - Oral Communications

J Frailty Aging 2020;9(S1):S1-S45

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CITATION:
(2020): ICSFR: 10th International Conference on Frailty & Sarcopenia Research. March 11-13, 2020, Toulouse – France. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.8

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ICSFR: 10th International Conference on Frailty, Sarcopenia Research & Geroscience. March 11-13, 2020, Toulouse – France

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CITATION:
I. Posters (2020): 10th International Conference on Frailty, Sarcopenia Research & Geroscience (ICFSR), March 11-13, 2020, Toulouse, France. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.9

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