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02/2020 journal articles

SHOULD WE CARE MORE ABOUT FRAILTY WHEN WE TREAT DIABETES?

L. Orlandini, M. Cesari

J Frailty Aging 2020;9(2)66-67

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CITATION:
L. Orlandini ; M. Cesari (2020): Should we care more about frailty when we treat diabetes?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.5

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MOBILITY IN COMMUNITY DWELLING OLDER ADULTS: PREDICTING SUCCESSFUL MOBILITY USING AN INSTRUMENTED BATTERY OF NOVEL MEASURES

L. McInnes, E. Jones, L. Rochester, S. Lord, S.F.M. Chastin, A.W. Watson, L. Little, P. Briggs

J Frailty Aging 2020;9(2)68-73

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Mobility in older adults is associated with better quality of life. However, evidence suggests that older people spend less time out-of-home than younger adults. Traditional methods for assessing mobility have serious limitations. Wearable technologies provide the possibility of objectively assessing mobility over extended periods enabling better estimates of levels of mobility to be made and possible predictors to be explored. Eighty-six community dwelling older adults (mean age 79.8 years) had their mobility assessed for one week using GPS, accelerometry and self-report. Outcomes were: number of steps, time spent in dynamic outdoor activity, total distance travelled and total number of journeys made over the week. Assessments were also made of personal, cognitive, psychological, physical and social variables. Four regression models were calculated (one for each outcome). The models predicted 32 to 43% of the variance in levels of mobility. The ability to balance on one leg significantly predicted all four outcomes. In addition, cognitive ability predicted number of journeys made per week and time spent engaged in dynamic outdoor activity, and age significantly predicted total distance travelled. Overall estimates of mobility indicated step counts that were similar to those shown by previous research but distances travelled, measured by GPS, were lower. These findings suggest that mobility in this sample of older adults is predicted by the ability to balance on one leg. Possible interventions to improve out-of-home mobility could target balance. The fact that participants travelled shorter distances than those reported in previous studies is interesting since this high-functioning subgroup would be expected to demonstrate the highest levels.

CITATION:
L. McInnes ; E. Jones ; L. Rochester ; S. Lord ; S.F.M. Chastin ; A.W. Watson ; L. Little ; P. Briggs (2019): Mobility in community dwelling older adults: Predicting successful mobility using an instrumented battery of novel measures. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.35

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REPORTED WEIGHT CHANGE IN OLDER ADULTS AND PRESENCE OF FRAILTY

R.S. Crow, C.L. Petersen, S.B. Cook, C.J. Stevens, A.J. Titus, T.A. Mackenzie, J.A. Batsis

J Frailty Aging 2020;9(2)74-81

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ported weight change over the lifespan impacts rates of frailty in older adults. Methods: We identified 4,984 subjects ≥60 years with body composition measures from the National Health and Nutrition Examination Survey. An adapted version of Fried’s frailty criteria was used as the primary outcome. Self-reported weight was assessed at time current,1 and 10 years earlier and at age 25. Weight changes between each time point were categorized as ≥ 5%, ≤5% or neutral. Logistic regression assessed the impact of weight change on the outcome of frailty. Results: Among 4,984 participants, 56.5% were female, mean age was 71.1 years, and mean BMI was 28.2kg/m2. A weight loss of ≥ 5% had a higher association with frailty compared to current weight, age 25 (OR 2.94 [1.72,5.02]), 10 years ago (OR 1.68 [1.05,2.69]), and 1 year ago (OR 1.55 [1.02,2.36]). Weight gain in the last year was associated with increased rate of frailty (1.59 [1.09,2.32]). Conclusion: There is an association between frailty and reported weight loss over time while only weight gain in the last year has an association with frailty.

CITATION:
R.S. Crow ; C.L. Petersen ; S.B. Cook ; C.J. Stevens ; A.J. Titus ; T.A. Mackenzie ; J.A. Batsis (2019): Reported Weight Change in Older Adults and Presence of Frailty. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.44

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ASSOCIATION OF MUSCLE STRENGTH AND GAIT SPEED WITH CROSS-SECTIONAL MUSCLE AREA DETERMINED BY MID-THIGH COMPUTED TOMOGRAPHY - A COMPARISON WITH SKELETAL MUSCLE MASS MEASURED BY DUAL-ENERGY X-RAY ABSORPTIOMETRY

K. Tsukasaki, Y. Matsui, H. Arai, A. Harada, M. Tomida, M. Takemura, R. Otsuka, F. Ando, H. Shimokata

J Frailty Aging 2020;9(2)82-89

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Background: Muscle mass is often mentioned not to reflect muscle strength. For muscle mass assessment skeletal muscle index (SMI) is often used. We have reported that dual-energy X-ray absorptiometry (DXA)-derived SMI does not change with age in women, whereas the cross-sectional muscle area (CSMA) derived from computed tomography (CT) does. Objectives: The present study aimed to compare CT and DXA for the assessment of muscle tissue. Design & Setting: Cross-sectional study in the local residents. Participants: A total of 1818 subjects (age 40-89 years) randomly selected from community dwellers underwent CT examination of the right mid-thigh to measure the cross-sectional muscle area (CSMA). Skeletal muscle mass (SMM) was measured by DXA. The subjects performed physical function tests such as grip strength, knee extension strength, leg extension strength, and gait speed. The correlation between CT-derived CSMA and DXA-derived SMM along with their association with physical function was examined. Results: After controlling for related factors, the partial correlation coefficient of muscle cross-sectional area (CSA) with physical function was larger than that of DXA-derived SMM for gait speed in men (p=0.002) and knee extension strength in women (p=0.03). The partial correlation coefficient of quadriceps (Qc) CSA with physical function was larger than that of DXA-derived SMM for leg extension power in both sexes (p=0.01), gait speed in men (p<0.001), and knee extension strength in women (p<0.001). Conclusion: Mid-thigh CT-derived CSMA, especially Qc CSA, showed significant associations with grip strength, knee extension strength, and leg extension power, which were equal to or stronger than those of DXA-derived SMM in community-dwelling middle-aged and older Japanese people. The mid-thigh CSMA may be a predictor of mobility disability, and is considered to be useful in the diagnosis of sarcopenia.

CITATION:
K. Tsukasaki ; Y. Matsui ; H. Arai ; A. Harada ; M. Tomida ; M. Takemura ; R. Otsuka ; F. Ando ; H. Shimokata (2020): Association of muscle strength and gait speed with cross-sectional muscle area determined by mid-thigh computed tomography - a comparison with skeletal muscle mass measured by dual-energy X-ray absorptiometry. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.16

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IMPACT OF FAT-FREE ADIPOSE TISSUE ON THE PREVALENCE OF LOW MUSCLE MASS ESTIMATED USING CALF CIRCUMFERENCE IN MIDDLE-AGED AND OLDER ADULTS

T. Abe, S.J. Dankel, Z.W. Bell, E. Fujita, Y. Yaginuma, T. Akamine, R.W. Spitz, V. Wong, R.B. Viana, J.P. Loenneke

J Frailty Aging 2020;9(2)90-93

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Previous studies proposed calf circumference cutoff values for predicting dual-energy X-ray absorptiometry (DXA)-derived low muscle mass. However, DXA-derived appendicular lean mass (aLM) includes non-skeletal muscle components such as the appendicular fat-free component of adipose tissue fat cells (aFFAT). The purpose of this study was to compare the calf circumference method of classification before (Model #1) and after (Model #2) eliminating the influence of FFAT in healthy Japanese adults (50 to 79 years; mean age 70 (SD 7) years). Model 1, and Model 2 for classifying low muscle mass had a sensitivity of 78% and 64%, specificity of 76% and 75%, positive predictive value of 31% and 28%, and negative predictive value of 96% and 93%, respectively. Appendicular fat-free component of adipose tissue has the potential to influence the ability of calf circumference to accurately classify individuals with low muscle mass. Consideration should be made when using this as a screening tool for low muscle mass.

CITATION:
T. Abe ; S.J. Dankel ; Z.W. Bell ; E. Fujita ; Y. Yaginuma ; T. Akamine ; R.W. Spitz ; V. Wong ; R.B. Viana ; J.P. Loenneke (2019): Impact of fat-free adipose tissue on the prevalence of low muscle mass estimated using calf circumference in middle-aged and older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.34

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THE ASSOCIATION OF FRAILTY WITH HOSPITALIZATIONS AND MORTALITY AMONG COMMUNITY DWELLING OLDER ADULTS WITH DIABETES

J. Ferri-Guerra, R. Aparicio-Ugarriza, D. Salguero, D. Baskaran, Y.N. Mohammed, H. Florez, J.G. Ruiz

J Frailty Aging 2020;9(2)94-100

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Background: Diabetes (DM) is associated with an accelerated aging that promotes frailty, a state of vulnerability to stressors, characterized by multisystem decline that results in diminished intrinsic reserve and is associated with morbidity, mortality and utilization. Research suggests a bidirectional relationship between frailty and diabetes. Frailty is associated with mortality in patients with diabetes, but its prevalence and impact on hospitalizations are not well known. Objectives: Determine the association of frailty with all-cause hospitalizations and mortality in older Veterans with diabetes. Design: Retrospective cohort. Setting: Outpatient. Participants: Veterans 65 years and older with diabetes who were identified as frail through calculation of a 44-item frailty index. Measurements: The FI was constructed as a proportion of healthcare variables (demographics, comorbidities, medications, laboratory tests, and ADLs) at the time of the screening. At the end of follow up, data was aggregated on all-cause hospitalizations and mortality and compared non-frail (robust, FI≤ .10 and prefrail FI=>.10, <.21) and frail (FI≥.21) patients. After adjusting for age, race, ethnicity, median income, history of hospitalizations, comorbidities, duration of DM and glycemic control, the association of frailty with all-cause hospitalizations was carried out according to the Andersen-Gill model, accounting for repeated hospitalizations and the association with all-cause mortality using a multivariate Cox proportional hazards regression model. Results: We identified 763 patients with diabetes, mean age 72.9 (SD=6.8) years, 50.5% were frail. After a median follow-up of 561 days (IQR=172), 37.0% they had 673 hospitalizations. After adjustment for covariates, frailty was associated with higher all-cause hospitalizations, hazard ratio (HR)=1.71 (95%CI:1.31-2.24), p<.0001, and greater mortality, HR=2.05 (95%CI:1.16-3.64), p=.014. Conclusions: Frailty was independently associated with all-cause hospitalizations and mortality in older Veterans with diabetes. Interventions to reduce the burden of frailty may be helpful to improve outcomes in older patients with diabetes.

CITATION:
J. Ferri-Guerra ; R. Aparicio-Ugarriza ; D. Salguero1 ; D. Baskaran ; Y.N. Mohammed ; H. Florez ; J.G. Ruiz (2019): The Association of Frailty with Hospitalizations and Mortality among Community Dwelling Older Adults with Diabetes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.31

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A NOVEL TOOL FOR THE EARLY IDENTIFICATION OF FRAILTY IN ELDERLY PEOPLE: THE APPLICATION IN PRIMARY CARE SETTINGS

M. Maggio, M. Barbolini, Y. Longobucco , L. Barbieri, C. Benedetti, F. Bono, I. Cacciapuoti, A. Donatini, E. Lezzi, D. Papini, P.M. Rodelli , S. Tagliaferri, M.L. Moro

J Frailty Aging 2020;9(2)101-106

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Objectives: Frailty is a pre-disability condition in older persons providing a challenge to Health-Care Systems. Systematic reviews highlight the absence of a gold-standard for its identification. However, an approach based on initial screening by the General Practitioner (GP) seems particularly useful. On these premises, a 9-item Sunfrail Checklist (SC), was developed by a multidisciplinary group, in the context of European Sunfrail Project, and tested in the Community. Objectives: - to measure the concordance between the judgments of frailty (criterion-validity): the one formulated by the GP, using the SC, and the one subsequently expressed by a Comprehensive Geriatric Assessment Team (CGA-Team); - to determine the construct-validity through the correspondence between some checklist items related to the 3 domains (physical, cognitive and social) and the three tools used by the CGA-Team; - to measure the instrument’s performance in terms of positive predictive value (PPV) and negative predictive value (NPV). Design: Cross-sectional study, with a final sample-size of 95 subjects. Setting: Two Community-Health Centers of Parma, Italy. Participants: Subjects aged 75 years old or more, with no disability and living in the community. Measurements: We compared the screening capacity of the GP using the SC to that one of CGA-Team based on three tests: 4-meter Gait-Speed, Mini-Mental State Examination and Loneliness Scale. Results: 95 subjects (51 women), with a mean age of 81±4 years were enrolled. According to GPs 34 subjects were frail; the CGA-Team expressed a frailty judgment on 26 subjects. The criterion-validity presented a Cohen’s k of 0.353. Construct-validity was also low, with a maximum contingency-coefficient of 0.19. The analysis showed a PPV of 58.1% and a NPV equal to 84.6%. Conclusions: Our data showed a low agreement between the judgements of GP performed by SC and CGA-Team. However, the good NPV suggests the applicability of SC for screening activities in primary-care.

CITATION:
M. Maggio ; M. Barbolini ; Y. Longobucco ; L. Barbieri ; C. Benedetti ; F. Bono ; I. Cacciapuoti ; A. Donatini ; E. Iezzi ; D. Papini ; P.M. Rodelli ; S. Tagliaferri ; M.L. Moro (2019): A novel tool for the early identification of frailty in elderly people: the application in Primary Care Settings. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.41

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ASSOCIATION BETWEEN THE USE OF ANGIOTENSIN-BLOCKING MEDICATIONS WITH HIP FRACTURE AND DEATH IN OLDER PEOPLE

C. Shea, M.D. Witham

J Frailty Aging 2020;9(2)107-110

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It is unclear if angiotensin blocking drugs (angiotensin converting enzyme inhibitors and angiotensin receptor blockers) reduce or increase the risk of falls and fractures. We retrospectively analysed routinely-collected, linked health and social care data for patients aged 65 and over from Tayside, Scotland, including hospital discharge diagnoses, biochemistry, deaths, care package provision and community prescribing. We conducted unadjusted and adjusted Cox regression analyses for time to hip fracture and time to death, for any exposure to angiotensin blocking drugs and for time-dependent exposure to angiotensin blocking drugs. We analysed data on 16782 patients. Angiotensin blocking drug use was associated with an exposure-dependent lower risk of hip fracture (hazard ratio 0.988 [95%CI 0.982-0.994] per year of exposure; p<0.001) and death (hazard ratio 0.986 [95%CI 0.983-0.989] per year of exposure; p<0.001). These findings call into question the appropriateness of stopping angiotensin blocking drugs for older people at risk of falls.

CITATION:
C. Shea ; M.D. Witham (2019): Association between the use of angiotensin-blocking medications with hip fracture and death in older people. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.38

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MULTI-COMPONENT EXERCISE WITH HIGH-INTENSITY, FREE-WEIGHT, FUNCTIONAL RESISTANCE TRAINING IN PRE-FRAIL FEMALES: A QUASI-EXPERIMENTAL, PILOT STUDY

N.W. Bray, G.J. Jones, K.L. Rush, C.A. Jones, J.M. Jakobi

J Frailty Aging 2020;9(2)111-117

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Background: No study has performed an exercise intervention that included high-intensity, free-weight, functional resistance training, and assessed frailty status as an inclusion criteria and outcome measure via original, standardized tools, in pre-frail females. Objectives: Determine if the intervention strategy is not only feasible and safe, but can also improve frailty status, functional task performance, and muscle strength. Design: Pilot, quasi-experimental. Setting: Community. Participants: 20 older-adults with pre-frailty characteristics. Intervention: 12-weeks (3 days/week, 45-60 minutes/session) of multi-component exercise, inclusive of aerobic, resistance, balance and flexibility exercises. The crux of the program was balance and resistance exercises, the latter utilized high-intensity, free-weight, functional resistance training. The control group maintained their usual care. Measurements: 1) Feasibility and safety (dropout, adherence, and adverse event); 2) Frailty (Frailty Phenotype, Clinical Frailty Scale, and gait speed); 3) Functional task performance (grip strength and sit-to-stand time); and 4) Isometric and isotonic strength of the knee extensors and elbow flexors. Results: No participants dropped out of the intervention or experienced an adverse event, and adherence averaged 88.3%. The exercise group became less frail, whereas the control group became more frail. There was a significant within-group improvement in exercise participants gait speed (p ≤ 0.01, +0.24 m/sec), grip strength (p ≤ 0.01, +3.9 kg), and sit-to-stand time (p ≤ 0.01, -5.0 sec). There was a significant within-group improvement in exercise participants knee extension isometric torque (p ≤ 0.05, +7.4 Nm) and isotonic velocity (p = ≤ 0.01, +37.5 ˚/sec). Elbow flexion isotonic velocity significantly declined within the control group (p ≤ 0.01, -20.2 ˚/sec) and demonstrated a significant between-group difference (p ≤ 0.05, 40.73 ˚/sec) post-intervention. Conclusions: The intervention strategy appears to be feasible and safe, and may also improve frailty status, functional task performance, and muscle strength. These results help calculate effect size for a future randomized controlled trial.

CITATION:
N.W. Bray ; G.J. Jones ; K.L. Rush ; C.A. Jones ; J.M. Jakobi (2020): Multi-component exercise with high-intensity, free-weight, functional Resistance Training in pre-frail females: A quasi-experimental, pilot study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.13

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PRACTICAL IMPLICATIONS FOR STRENGTH AND CONDITIONING OF OLDER PRE-FRAIL FEMALES

N.W. Bray, G.J. Jones, K.L. Rush, C.A. Jones, J.M. Jakobi

J Frailty Aging 2020;9(2)118-121

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Approaches to and benefits from resistance training for non-compromised older adults are well known. Less is understood about resistance training with pre-frail older adults, and even less information is available on the practical approaches to delivery. Herein, we describe an approach in pre-frail females who undertook a multi-component exercise intervention, inclusive of high-intensity, free-weight, functional resistance training. Capitalizing on the principle of overload is possible and safe for pre-frail females through constant reassurance of ability and adjustments in technique. Making exercise functionally relevant, for example, a squat is the ability to get on and off a toilet, resonates meaning. Older pre-frail females are affected by outside (clinical) influences. The exercise participant, and extraneous persons need to be educated on exercise approaches, to increase awareness, debunk myths, and enhance support for participation. Identification of individuality in a group session offers ability to navigate barriers for successful implementation.

CITATION:
N.W. Bray ; G.J. Jones ; K.L. Rush ; C.A. Jones ; J.M. Jakobi (2020): Practical Implications for Strength and Conditioning of Older Pre-Frail Females. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.15

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LETTER TO THE EDITOR: USE OF A HIGH-INTENSITY RESISTANCE EXERCISE PROGRAM TO IMPROVE LOWER EXTREMITY STRENGTH AND MOBILITY IN A 105-YEAR OLDER WOMAN: A CASE REPORT

M.D. Basco

J Frailty Aging 2020;9(2)122-123

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CITATION:
M.D. Basco (2020): Letter to the editor: Use of a high-intensity resistance exercise program to improve lower extremity strength and mobility in a 105-year older woman: a case report. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.3

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