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03/2020 journal articles

GERIATRIC SYNDROMES AND SARS-COV-2: MORE THAN JUST BEING OLD

I. Aprahamian, M. Cesari

J Frailty Aging 2020;9(3)127-129

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I. Aprahamian ; M. Cesari (2020): Geriatric syndromes and SARS-Cov-2: more than just being old. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.17

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PREVENTING FRAILTY PROGRESSION DURING THE COVID-19 PANDEMIC

K.F. Boreskie, J.L. Hay, T.A. Duhamel

J Frailty Aging 2020;9(3)130-131

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CITATION:
K.F. Boreskie ; J.L. Hay ; T.A. Duhamel (2020): Preventing frailty progression during the COVID-19 pandemic. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.29

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TIMELY LESSONS FROM A PANDEMIC ON THE BENEFITS OF PERSON CENTRIC CARE IN LONG TERM CARE FACILITIES

S.-L. Wee, P.L.K. Yap

J Frailty Aging 2020;9(3)132-133

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Since the outbreak of Coronavirus Disease 2019 (COVID-19), there have been few deadlier places than in nursing homes. As such, several useful guidelines on coping with COVID-19 in nursing homes have emerged. The critical immediate term measures mentioned in the guidelines have longer term implications especially on quality of care. We discuss how these measures instituted for infection control can be synergistic with person-centered care which has been synonymous with quality of care in nursing homes.

CITATION:
S.-L. Wee ; P.L.K. Yap (2020): Timely lessons from a pandemic on the benefits of person centric care in long term care facilities. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.28

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INCREASED INTRAMUSCULAR ADIPOSE TISSUE IS RELATED TO INCREASED CAPILLARIZATION IN OLDER ADULTS

O. Addison, A.S. Ryan, J. Blumenthal, S.J. Prior

J Frailty Aging 2020;9(3)134-138

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Background: High levels of intramuscular adipose tissue and low levels of capillarization are both predicative of low muscle and mobility function in older adults, however little is known about their relationship. Objectives: The purpose of this study was to examine the relationship of intramuscular adipose tissue and capillarization in older adults. Setting: An outpatient medical center. Participants: Forty-seven sedentary adults (age 59.9 ± 1.0 years, BMI 32.0 ± 0.7 kg/m2, VO2max 22.4 ± 0.7 ml/kg/min); Measurements: All participants underwent CT scans to determine intramuscular adipose tissue and muscle biopsies to determine capillarization in the mid-thigh. A step-wise hierarchical linear regression analysis was used to examine the contributions of age, sex, race, body mass index, 2-hour postprandial glucose, VO2max, and muscle capillarization, to the variability in intramuscular adipose tissue. Results: The predictors as a group accounted for 38.1% of the variance in intramuscular adipose tissue, with body mass index and capillarization each significantly contributing to the final model (P<0.001). The part correlation of body mass index with intramuscular adipose tissue was r = 0.47, and the part correlation of capillarization with intramuscular adipose tissue was r = 0.39, indicating that body mass index and capillarization explained 22.1%, and 15.2% of the variance in intramuscular adipose tissue. Conclusions: While increased muscle capillarization is typically thought of as a positive development, in some clinical conditions, such as tendinopathies, an increase in capillarization is part of the pathological process related to expansion of the extracellular matrix and fibrosis. This may also be an explanation for the surprising finding that high capillarization is related to high levels of intramuscular adipose tissue. Future studies are necessary to determine the relationship of changes in both capillarization and intramuscular adipose tissue after interventions, such as exercise.

CITATION:
O. Addison ; A.S. Ryan ; J. Blumenthal ; S.J. Prior (2020): Increased intramuscular adipose tissue is related to increased capillarization in older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.20

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ACCELEROMETER-DETERMINED INTENSITY AND DURATION OF HABITUAL PHYSICAL ACTIVITY AND WALKING PERFORMANCE IN WELL-FUNCTIONING MIDDLE-AGED AND OLDER WOMEN: A CROSS-SECTIONAL STUDY

R.S. Thiebaud, T. Abe, M. Ogawa, J.P. Loenneke, N. Mitsukawa

J Frailty Aging 2020;9(3)139-143

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Background: The association of physical activity (PA) intensities and duration spent in those activities with different walking tasks remains unclear. Objectives: To examine the association between the duration of PA intensities and three walking speeds (usual walking speed, maximal walking speed and zig-zag walking speed). Design: Multiple linear regression analysis was used to estimate the association of age, BMI, maximum knee extension strength, light PA, moderate PA and vigorous PA with walking speeds. Setting: University lab. Participants: Eighty-six older women (67 ± 7 years). Measurements: PA was measured for 30 consecutive days using the Lifecorder-EX accelerometer. Exercise intensity was categorized as light (levels 1-3), moderate (levels 4-6) and vigorous (levels 7-9) based on the manufacturer algorithms. Usual straight walking speed (20 m), maximal straight walking speed (20 m) and zig-zag walking speed tests (10 m) were performed by each participant. Results: For the usual straight walking speed model (R2 = 0.296, SEE = 0.15 m/s), the significant predictors were BMI, knee extension strength, light PA and vigorous PA. For the maximal straight walking speed model (R2 = 0.326, SEE = 0.20 m/s), only age was a significant predictor. For the zig-zag walking speed model (R2=0.417, SEE = 0.14 m/s), age and maximum knee strength were significant predictors in the model. Conclusions: Overall, the results of this study suggest that vigorous PA and maximal knee extension strength are two important factors that are associated with different walking speeds in older women.

CITATION:
R.S. Thiebaud ; T. Abe ; M. Ogawa ; J.P. Loenneke ; N. Mitsukawa (2019): Accelerometer-determined intensity and duration of habitual physical activity and walking performance in well-functioning middle-aged and older women: A cross-sectional study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.26

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THE INFLUENCE OF LIFESTYLE BEHAVIORS ON THE INCIDENCE OF FRAILTY

M.G. Borda, M.U. Pérez-Zepeda, R. Samper-Ternent, R.C. Gomez, J.A. Avila-Funes, C.A. Cano-Gutierrez

J Frailty Aging 2020;9(3)144-149

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Background: Frailty is a clinical state defined as an increase in an individual’s vulnerability to developing adverse health-related outcomes. Objectives: We propose that healthy behaviors could lower the incidence of frailty. The aim is to describe the association between healthy behaviors (physical activity, vaccination, tobacco use, and cancer screening) and the incidence of frailty. Design: This is a secondary longitudinal analysis of the Mexican Health and Aging Study (MHAS) cohort. Setting: MHAS is a population-based cohort, of community-dwelling Mexican older adults. With five assessments currently available, for purposes of this work, 2012 and 2015 waves were used. Participants: A total of 6,087 individuals 50-year or older were included. Measurements: Frailty was defined using a 39-item frailty index. Healthy behaviors were assessed with questions available in MHAS. Individuals without frailty in 2012 were followed-up three years in order to determine their frailty incidence, and its association with healthy behaviors. Multivariate logistic regression models were used to assess the odds of frailty occurring according to the four health-related behaviors mentioned above. Results: At baseline (2012), 55.2% of the subjects were male, the mean age was 62.2 (SD ± 8.5) years old. The overall incidence (2015) of frailty was 37.8%. Older adults physically active had a lower incidence of frailty (48.9% vs. 42.2%, p< 0.0001). Of the activities assessed in the adjusted multivariate models, physical activity was the only variable that was independently associated with a lower risk of frailty (odds ratio: 0.79, 95% confidence interval 0.71-0.88, p< 0.001). Conclusions: Physically active older adults had a lower 3-year incidence of frailty even after adjusting for confounding variables. Increasing physical activity could therefore represent a strategy for reducing the incidence of frailty. Other so-called healthy behaviors were not associated with incident frailty, however there is still uncertainty on the interpretation of those results.

CITATION:
M.G. Borda ; M.U. Pérez-Zepeda ; R. Samper-Ternent ; R.C. Gomez ; J.A. Avila-Funes ; C.A. Cano-Gutierrez (2019): THE INFLUENCE OF LIFESTYLE BEHAVIORS ON THE INCIDENCE OF FRAILTY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.37

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FRAILTY AND RISK OF FALLS IN COMMUNITY-DWELLING OLDER ADULTS LIVING IN A RURAL SETTING. THE ATAHUALPA PROJECT

O.H. Del Brutto, R.M. Mera, C.D. Peinado, M. Zambrano, M.J. Sedler

J Frailty Aging 2020;9(3)150-154

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Background: Data supporting a link between frailty and risk of falls is mostly confined to individuals living in urban centers, where risk factors and lifestyles are different from that of rural settings. Objective: To assess the association between frailty and risk of falls in older adults living in rural Ecuador. Design: Population-based cross-sectional study. Participants: Community-dwellers aged ≥60 years living in a rural Ecuadorian village, in whom frail status and risk of falls were assessed. Measurements: Frailty was evaluated by the Edmonton Frailty Scale (EFS) and risk of falls by the Downton Fall Risk Index (DFRI). Multivariate models were fitted to evaluate whether frailty was associated with risk of falls (dependent variable), after adjusting for demographics, alcohol intake, cardiovascular risk factors, sleep quality, symptoms of depression, and history of an overt stroke. Correlation coefficients were constructed to assess confounders modifying this association. Results: A total of 324 participants (mean age: 70.5±8 years) were included. The mean EFS score was 4.4±2.5 points, with 180 (56%) participants classified as robust, 76 (23%) as pre-frail and 68 (21%) as frail. The DFRI was positive in 87 (27%) participants. In univariate analysis, the EFS score was higher among participants with a positive DFRI (p<0.001). The number of frail individuals was higher (p<0.001), while that of robust individuals was lower (p<0.001) among those with a positive DFRI. Adjusted logistic regression models showed no association between frailty and the DFRI. Correlation coefficients showed that age, high glucose levels, and history of an overt stroke tempered the association between frailty and the risk of falls found in univariate analyses. Conclusions: Frailty is not independently associated with risk of falls in older adults living in a remote rural setting. Further studies are needed to assess the impact of frailty on the risk of falls in these populations.

CITATION:
O.H. Del Brutto ; R.M. Mera ; C.D. Peinado ; M. Zambrano ; M.J. Sedler (2019): Frailty and risk of falls in community-dwelling older adults living in a rural setting. The Atahualpa Project. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.36

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THE SUSTAINED IMPACT OF A MEDICAL SCHOOL-BASED PHYSICAL ACTIVITY MODULE ON INTERNS’ PERCEIVED COMPETENCE IN ADVISING OLDER ADULTS ABOUT EXERCISE

A.D. Jadczak, R. Visvanathan

J Frailty Aging 2020;9(3)155-157

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The study aimed to examine the sustained impact of a 1.5-hour medical school-based physical activity (PA) module on interns’ perceived competence and importance in advising older adults about exercise. The modified Exercise and Physical Activity Competence Questionnaire (EPACQ) was administered in 2017 (CG: control group) and 2018 (IG: intervention group) two years post-course. The perceived competence of both, CG (n=23) and IG (n=18), decreased significantly over two years (p≤0.05) with no difference between the groups (p>0.05). However, 72.2% (n=13) of the interns who attended the PA module still felt competent in advising older adults about exercise (4.21±0.66) compared to 47.8% (n=11) of the CG (3.89±0.67). The perceived importance decreased significantly in both groups (p≤0.05) with no difference between the groups (p>0.05). However, both groups still perceived exercise for older people as important (CG:4.55±0.61; IG:4.83±0.47). Subsequently, continued professional development is likely to be a key requirement for ensuring sustainability over time.

CITATION:
A.D. Jadczak ; R. Visvanathan (2019): The sustained impact of a medical school-based physical activity module on interns’ perceived competence in advising older adults about exercise. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.39

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CLINICAL CHARACTERISTICS OF FRAILTY IN JAPANESE RHEUMATOID ARTHRITIS PATIENTS

I. Yoshii, M. Kondo

J Frailty Aging 2020;9(3)158-164

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Objective: The relationship between clinical characteristics and frailty was investigated in rheumatoid arthritis (RA) patients >40 years old. Methods: RA patients followed for >1 year were interviewed and diagnosed as frail according to a 5-item frailty score index: (1) weight loss >2 kg within 6 months (WL); (2) slower gait speed (GS); (3) exercise less than once per week (EX); (4) decline in short-term memory (SM); and (5) general fatigue in the past 2 weeks (GF). The relationship between frailty status and background parameters was evaluated. Results: Among 739 subjects, frail patients comprised 221, pre-frail patients comprised 203, and robust comprised 315. The most common symptom in the Frailty group was GS, followed by SM, GF, EX, and WL, whereas the most common symptom in the Pre-frailty group was GS followed by SM, GF, WL, and EX. Frailty was significantly correlated with aging. Elderly onset rheumatoid arthritis, disease activity, serum C-reactive protein concentration, degree of joint deformity, activities in daily living (ADL), dementia treated, and glucocorticoid steroid administration demonstrated significant correlations with frailty status, although all factors also demonstrated significant correlation with aging. In addition, the EuroQol score (EQ5D) was significantly correlated with both aging and frailty. Conclusion: The results suggest that a remission state for disease activity, ADL, and dementia is correlated with frailty. The most common and primary symptom is GS. Elderly RA patients require careful attention for symptoms of frailty, which may damage the EQ5D score, specifically, the quality of life for RA patients.

CITATION:
I. Yoshii ; M. Kondo (2020): Clinical Characteristics of frailty in Japanese rheumatoid arthritis patients. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.1

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IMPLEMENTATION OF A COMMUNITY WALKING PROGRAM (WALK ON!) FOR FUNCTIONALLY-LIMITED OLDER ADULTS

B.J. Nicklas, E.A. Chmelo, J. Sheedy, J.B. Moore

J Frailty Aging 2020;9(3)165-171

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Background: Walking interventions improve physical function, reduce fall risk, and prevent mobility disability—even in those with compromised walking ability. However, most prior studies have been conducted in controlled research settings, with no dissemination of an evidence-based walking program for older adults who have mobility limitations and/or are socially isolated. Objectives: This study reports data on the feasibility and acceptability of a community-based walking program (Walk On!) for older adults who are functionally limited, and assesses changes in physical function among attendees. The program sessions focused on long-distance walking, and took place for one-hour, for two days/week, and for 12 weeks at a time. Design: Pilot implementation study. Setting: Local church in Winston-Salem, NC. Participants: 49 program participants; Measurements: Physical function battery and satisfaction survey data, as well as formative evaluation data from six attendees of a focus group, are reported. Results: The majority of the participants were >75 years (71%), female (65%), and presented with low levels of physical function (usual gait speed=0.79±0.16; 30.6% used an assistive device). Satisfaction with the program was high (100% would recommend it to others) and focus group results were overwhelmingly positive. Mean attendance to scheduled sessions was 77%±21%, and 63% of participants attended at least 75% of scheduled sessions (n=8 attended 100%). On average, participants improved their 6-min walk distance by 8.9%, their SPPB score by 15.4%, their timed-up-go time by 9.0%, and their usual gait speed by 11.4%. Conclusion: The results of the initial evaluation of Walk On! show high feasibility and acceptability of the program, as well as efficacy for improving physical function. Further research is needed to evaluate a delivery method for wider implementation of the program and to definitively test its effectiveness for improving function and other health benefits.

CITATION:
B.J. Nicklas ; E.A. Chmelo ; J. Sheedy ; J.B. Moore (2020): Implementation of a Community Walking Program (Walk On!) for Functionally-Limited Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.12

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CHARACTERIZING INTERVENTION OPPORTUNITIES AMONG HOME-DELIVERED MEALS PROGRAM PARTICIPANTS: RESULTS FROM THE 2017 NATIONAL SURVEY OF OLDER AMERICANS ACT PARTICIPANTS AND A NEW YORK CITY SURVEY

M. El Shatanofy, J. Chodosh, M.A. Sevick, J. Wylie-Rosett, L. DeLuca, J.M. Beasley

J Frailty Aging 2020;9(3)172-178

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Background: The Home Delivered Meals Program (HDMP) serves a vulnerable population of adults aged 60 and older who may benefit from technological services to improve health and social connectedness. Objective: The objectives of this study are (a) to better understand the needs of HDMP participants, and (b) to characterize the technology-readiness and the utility of delivering information via the computer. Design: We analyzed data from the 2017 NSOAAP to assess the health and functional status and demographic characteristics of HDMP participants. We also conducted a telephone survey to assess technology use and educational interests among NYC HDMP participants. Measurements: Functional measures of the national sample included comorbidities, recent hospitalizations, and ADL/IADL limitations. Participants from our local NYC sample completed a modified version of the validated Computer Proficiency Questionnaire. Technology readiness was assessed by levels of technology use, desired methods for receiving health information, and interest in learning more about virtual senior centers. Results: About one-third (32.4%) of national survey HDMP participants (n=902) reported insufficient resources to buy food and 17.1% chose between food or medications. Within the NYC HDMP participant survey sample (n=33), over half reported having access to the internet (54.5%), 48.5% used a desktop or laptop, and 30.3% used a tablet, iPad, or smartphone. Conclusion: The HDMP provides an opportunity to reach vulnerable older adults and offer additional resources that can enhance social support and improve nutrition and health outcomes. Research is warranted to compare technological readiness of HDMP participants across urban and rural areas in the United States.

CITATION:
M. El Shatanofy ; J. Chodosh ; M.A. Sevick ; J. Wylie-Rosett ; L. DeLuca ; J.M. Beasley (2020): Characterizing intervention opportunities among Home-Delivered Meals Program participants: Results from the 2017 National Survey of Older Americans Act Participants and a New York City survey. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.25

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EFFECTS OF HIGH-SPEED POWER TRAINING ON NEUROMUSCULAR AND GAIT FUNCTIONS IN FRAIL ELDERLY WITH MILD COGNITIVE IMPAIRMENT DESPITE BLUNTED EXECUTIVE FUNCTIONS: A RANDOMIZED CONTROLLED TRIAL

D. W. Lee, D. H. Yoon, J.-Y. Lee, S.B. Panday, J. Park, W. Song

J Frailty Aging 2020;9(3)179-184

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Background: Physical frailty and impaired executive function of the brain show similar pathophysiology. Both of these factors lead to dysfunction of neuromuscular and abilities in elderly. High-speed power training (HSPT) has been determined to have positive effects on neuromuscular function and gait performance, as well as executive function in the elderly. Objectives: The purpose of this study was to investigate the effects of 8-week HSPT on neuromuscular, gait and executive functions in frail elderly with mild cognitive impairment (MCI). Design, setting and participants: We performed a randomized controlled trial of frail elderly from community and medical center in republic of Korea. Forty-two physically frail elderly with MCI were randomly allocated to control (n=22, age=74.22±4.46) and intervention groups (n=18, age=73.77±4.64). The intervention group was subjected to HSPT, 3 times weekly for 8 weeks. Measurements: Isometric contraction of knee extension and flexion with electromyography (EMG) was measured to determine the neuromuscular function such as knee extensor strength, rate of torque development, movement time, pre-motor time, motor time, rate of EMG rise, and hamstrings antagonist co-activation. Additionally, the 4.44-meter gait and timed up-and-go (TUG) test were administered to assess gait performance. A frontal assessment battery was measured in this study. Results: The 8-week HSPT regimen improved the knee extensor strength from 1.13±0.08 to 1.25±0.07 (p<0.05), the 200-ms RTD from 3.01±0.3 to 3.55±0.24 (p<0.05) and the rate of EMG rise from 166.48±13.31 to 197.94±11.51 (p<0.05), whereas the movement time and motor time were statistically decreased from 921.69±40.10 to 799.51±72.84, and 271.40±19.29 to 181.15±38.08 (p<0.05), respectively. The 4.44-m gait speed and TUG significantly decreased from 6.39±0.25 to 5.5±0.24, and 11.05±0.53 to 9.17±0.43 respectively (p<0.05). Conclusion: The findings of this study suggest the favorable effects of 8-week HSPT on the neuromuscular function and the gait performance in the frail elderly with MCI without increase in the executive function.

CITATION:
D. W. Lee ; D. H. Yoon ; J.-Y. Lee ; S.B. Panday ; J. Park ; W. Song (2020): Effects of High-Speed Power Training on Neuromuscular and Gait Functions in Frail Elderly with Mild Cognitive Impairment Despite Blunted Executive Functions: A Randomized Controlled Trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.23

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LETTER TO THE EDITOR: COVID-19 AND THE CHALLENGES OF FRAILTY SCREENING IN OLDER ADULTS

R. O’Caoimh, S. Kennelly, E. Ahern, S. O’Keeffe, R.R. Ortuño

J Frailty Aging 2020;9(3)185-186

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CITATION:
R. O’Caoimh ; S. Kennelly ; E. Ahern ; S. O’Keeffe ; R.R. Ortuño (2020): Letter to the editor Covid-19 and the challenges of frailty screening in older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.30

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