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04/2020 journal articles

VASTUS LATERALIS MOTOR UNIT RECRUITMENT THRESHOLDS ARE COMPRESSED TOWARDS LOWER FORCES IN OLDER MEN

R.M. Girts, J.A. Mota, K.K. Harmon, R.J. MacLennan, M.S. Stock

J Frailty Aging 2020;9(4)191-196

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Background: Aging results in adaptations which may affect the control of motor units. Objective: We sought to determine if younger and older men recruit motor units at similar force levels. Design: Cross-sectional, between-subjects design. Setting: Controlled laboratory setting. Participants: Twelve younger (age = 25 ± 3 years) and twelve older (age = 75 ± 8 years) men. Measurements: Participants performed isometric contractions of the dominant knee extensors at a force level corresponding to 50% maximal voluntary contraction (MVC). Bipolar surface electromyographic (EMG) signals were detected from the vastus lateralis. A surface EMG signal decomposition algorithm was used to quantify the recruitment threshold of each motor unit, which was defined as the force level corresponding to the first firing. Recruitment thresholds were expressed in both relative (% MVC) and absolute (N) terms. To further understand age-related differences in motor unit control, we examined the mean firing rate versus recruitment threshold relationship at steady force. Results: MVC force was greater in younger men (p = 0.010, d = 1.15). Older men had lower median recruitment thresholds in both absolute (p = 0.005, d = 1.29) and relative (p = 0.001, d = 1.53) terms. The absolute recruitment threshold range was larger for younger men (p = 0.020; d = 1.02), though a smaller difference was noted in relative terms (p = 0.235, d = 0.50). These findings were complimented by a generally flatter slope (p = 0.070; d = 0.78) and lower y-intercept (p = 0.009; d = 1.17) of the mean firing rate versus recruitment threshold relationship in older men. Conclusion: Older men tend to recruit more motor units at lower force levels. We speculate that recruitment threshold compression may be a neural adaptation serving to compensate for lower motor unit firing rates and/or denervation and subsequent re-innervation in aged muscle.

CITATION:
R.M. Girts ; J.A. Mota ; K.K. Harmon ; R.J. MacLennan ; M.S. Stock (2020): VASTUS LATERALIS MOTOR UNIT RECRUITMENT THRESHOLDS ARE COMPRESSED TOWARDS LOWER FORCES IN OLDER MEN. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.19

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PREVALENCE OF PREFRAILTY AND FRAILTY IN SOUTH AMERICA: A SYSTEMATIC REVIEW OF OBSERVATIONAL STUDIES

H.J. Coelho-Junior, E. Marzetti, A. Picca, R. Calvani, M. Cesari, M.C. Uchida

J Frailty Aging 2020;9(4)197-213

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Objectives: The present study aimed at investigating the prevalence of prefrailty and frailty in South American older adults according to the setting and region. Design: A literature search combining the terms “frailty”, “South America” or a specific country name was performed on PubMed, EMBASE, Lilacs, and Scielo to retrieve articles published in English, Portuguese or Spanish on or before August 2019. Participants: Older adults aged 60+ years from any setting classified as frail according to a validated scale were included in the study. Measurements: Frailty assessment by a validated scale. Results: One-hundred eighteen reports (98 performed from Brazil, seven from Chile, five from Peru, four from Colombia, two from Ecuador, one from Argentina, and one from Venezuela) were included in the study. The mean prevalence of prefrailty in South America was 46.8% (50.7% in older in-patients, 47.6% in the community, and 29.8% in nursing-home residents). The mean prevalence of frailty in South America was 21.7% (55.8% in nursing-home residents, 39.1% in hospitalized older adults, and 23.0% in the community). Conclusions: Prefrailty and frailty are highly prevalent in South American older adults, with rates higher than those reported in Europe and Asia. In the community, almost one-in-two is prefrail and one-in-five is frail, while hospitalized persons and nursing-home residents are more frequently affected. These findings indicate the need for immediate attention to avoid frailty progression toward negative health outcomes. Our findings also highlight the need for specific guidelines for the management of frailty in South America.

CITATION:
H.J. Coelho-Junior ; E. Marzetti ; A. Picca ; R. Calvani ; M. Cesari ; M.C. Uchida (2020): Prevalence of prefrailty and frailty in South America: a systematic review of observational studies. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.22

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FAT MASS IS NEGATIVELY ASSOCIATED WITH MUSCLE STRENGTH AND JUMP TEST PERFORMANCE

B.A. Moore, D.A. Bemben, D.H. Lein, M.G. Bemben, H. Singh

J Frailty Aging 2020;9(4)214-218

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Background: It is known that maintenance of muscle mass cannot prevent loss of muscle strength in older adults. Recent evidence suggests that fat mass can weaken the relationship between muscle mass and functional performance. No information exists if fat mass can independently affect muscle strength and jump test performance in middle-aged and older adults. Objective: To assess the independent relationships between fat mass, leg muscle mass, lower extremity muscle strength, and jump test performance in adults, 55-75 years of age. Design: Cross-sectional. Setting: University laboratory. Participants: Fifty-nine older adults (men, n = 27, age = 64.8 + 6.5 years; women, n = 32, age = 62.5 + 5.1 years) participated in this study. Measurements: Dual energy X-ray absorptiometry was used to measure fat mass and leg muscle mass. An average of 3 maximal countermovement jumps was used to calculate jump power and jump height. Two leg press and hip abduction strength were assessed by 1-repetition maximum testing. Results: Stepwise sequential regression analysis of fat mass and leg muscle mass versus jump test performance and measures of muscle strength after adjusting for age, height, and physical activity revealed that fat mass was negatively associated with jump height (p = 0.047, rpartial = -0.410) in men. In women, fat mass was negatively associated with jump height (p = 0.003, rpartial = -0.538), leg press (p = 0.002, rpartial = -0.544), and hip abduction strength (p < 0.001, rpartial = -0.661). Leg muscle mass was positively associated with jump power in women (p = 0.047, rpartial = 0.372) only. Conclusions: Fat mass has an independent negative relationship with jump test performance in middle-aged and older men and women. This has clinical implications for rehabilitating neuromuscular performance in middle-aged and older adults.

CITATION:
B.A. Moore ; D.A. Bemben ; D.H. Lein ; M.G. Bemben ; H. Singh (2020): Fat Mass is Negatively Associated with Muscle Strength and Jump Test Performance. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.11

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THE VALIDITY OF THE SUNFRAIL TOOL: A CROSS-SECTIONAL STUDY AMONG DUTCH COMMUNITY-DWELLING OLDER PEOPLE

R.J.J. Gobbens, M. Maggio, Y. Longobucco, M. Barbolini

J Frailty Aging 2020;9(4)219-225

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Background: Early detection of frail older people is important. Timely intervention may allow health care professionals to prevent or delay the occurrence of adverse outcomes such as disability, increases in health care utilization, and premature death. Objectives: We assessed the construct and criterion validity of the SUNFRAIL tool, a questionnaire for measuring frailty among older people. Design, Setting and Participants: This cross-sectional study was carried out in a sample of Dutch citizens. A total of 195 community-dwelling persons aged 71 years and older completed the questionnaire. Measurements: Construct validity was examined by determining the correlation between the SUNFRAIL tool and the Tilburg Frailty Indicator (TFI). Criterion validity for the SUNFRAIL tool was determined by establishing the correlations with chronic diseases and adverse outcomes of frailty (disability, falls, indicators of health care utilization). Disability was measured using the Groningen Activity Restriction Scale. Participants also answered questions regarding falls and health care utilization. Results: The construct validity of this tool was good and showed significant correlations with the TFI. The correlation between SUNFRAIL total and TFI total was 0.624. The criterion validity of the SUNFRAIL tool was good for chronic diseases and good-to-excellent for adverse outcomes disability, receiving nursing care, and falls. The area under the curve for these outcomes was 0.840 (95% CI 0.781–0.899), 0.782 (95% CI 0.696–0.868), and 0.769 (95% CI 0.686–0.859), respectively. Conclusions: The results of our study suggest that the SUNFRAIL tool is a valid instrument for assessing frailty in community-dwelling older people. It is an attractive instrument for use in practice because it takes little time for health care professionals and older people to complete the questionnaire, and it expresses the integral functioning of human beings.

CITATION:
R.J.J. Gobbens ; M. Maggio ; Y. Longobucco ; M. Barbolini (2020): The validity of the SUNFRAIL tool: A cross-sectional study among Dutch community-dwelling older people. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.4

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PREDICTOR BIOMARKERS OF NONELECTIVE HOSPITAL READMISSION AND MORTALITY IN MALNOURISHED HOSPITALIZED OLDER ADULTS

K.M. Pencina, S. Bhasin, M. Luo, G.E. Baggs, S.L. Pereira, G.J. Davis, N.E. Deutz, T.G. Travison

J Frailty Aging 2020;9(4)226-231

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Background: 90-day mortality and rehospitalizations are important hospital quality metrics. Biomarkers that predict these outcomes among malnourished hospitalized patients could identify those at risk and help direct care plans. Objectives: To identify biomarkers that predict 90-day (primary) and 30-day (secondary) mortality or nonelective rehospitalization. Design and Participants: An analysis of the ability of biomarkers to predict 90- and 30-day mortality and rehospitalization among malnourished hospitalized patients. Setting: 52 blood biomarkers were measured in 193 participants in NOURISH, a randomized trial that determined the effects of a nutritional supplement on 90-day readmission and death in patients >65 years. Composite outcomes were defined as readmission or death over 90-days or 30-days. Univariate Cox Proportional Hazards models were used to select best predictors of outcomes. Markers with the strongest association were included in multivariate stepwise regression. Final model of hospital readmission or death was derived using stepwise selection. Measurements: Nutritional, inflammatory, hormonal and muscle biomarkers. Results: Mean age was 76 years, 51% were men. In univariate models, 10 biomarkers were significantly associated with 90-day outcomes and 4 biomarkers with 30-day outcomes. In multivariate stepwise selection, glutamate, hydroxyproline, tau-methylhistidine levels, and sex were associated with death and readmission within 90-days. In stepwise selection, age-adjusted model that included sex and these 3 amino-acids demonstrated moderate discriminating ability over 90-days (C-statistic 0.68 (95%CI 0.61, 0.75); age-adjusted model that included sex, hydroxyproline and Charlson Comorbidity Index was predictive of 30-day outcomes (C-statistic 0.76 (95%CI 0.68, 0.85). Conclusions: Baseline glutamate, hydroxyproline, and tau-methylhistidine levels, along with sex and age, predict risk of 90-day mortality and nonelective readmission in malnourished hospitalized older patients. This biomarker set should be further validated in prospective studies and could be useful in prognostication of malnourished hospitalized patients and guiding in-hospital care.

CITATION:
K.M. Pencina ; S. Bhasin ; M. Luo ; G.E. Baggs ; S.L. Pereira ; G.J. Davis ; N.E. Deutz ; T.G. Travison (2020): Predictor Biomarkers of Nonelective Hospital Readmission and Mortality in Malnourished Hospitalized Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.10

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PREDICTIVE FACTORS OF IN-HOSPITAL MORTALITY IN OLDER ADULTS WITH COMMUNITY-ACQUIRED BLOODSTREAM INFECTION

D. Angioni, M. Hites, F. Jacobs, S. De Breucker

J Frailty Aging 2020;9(4)232-237

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Objectives: To assess the prevalence of intra-hospital mortality and associated risk factors in older people aged 75+, admitted with blood stream infections (BSI). Design: Single center retrospective study performed in an 850-bed of the academic hospital of the Université Libre de Bruxelles. Setting and Participants: From January 2015 to December 2017, all inpatients over 75 years old admitted with BSI were included. Measures: Demographical, clinical and microbiological data were collected. Results: 212 patients were included: median age was 82 [79-85] years and 60 % were female. The in-hospital mortality rate was 19%. The majority of microorganisms were Gram-negative strains, of which Escherichia coli was the most common, and urinary tract infection was the most common origin of BSI. Compared to patients who survived, the non-survivor group had a higher SOFA score (6 versus 3, p<0.0001), a higher comorbidity score (5 versus 4, p<0.0001), more respiratory tract infections (28 vs 6 %, p < 0.0001) and fungal infections (5 vs 1 %, p = 0.033), bedridden status (60 vs 25 %, p < 0.0001), and healthcare related infections (60 vs 40 %, p = 0.019). Using Cox multivariable regression analysis, only SOFA score was independently associated with mortality (HR 1.75 [95%IC 1.52-2.03], p<0.0001).Conclusions and Implications: BSI in older people are severe infections associated with a significant in-hospital mortality. Severity of clinical presentation at onset remains the most important predictor of mortality for BSI in older people. BSI originating from respiratory source and bedridden patients are at greater risk of intra-hospital mortality. Further prospective studies are needed to confirm these results.

CITATION:
D. Angioni ; M. Hites ; F. Jacobs ; S. De Breucker (2019): Predictive factors of in-hospital mortality in older adults with community-acquired bloodstream infection. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.45

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FRAILTY CHECKUP SUPPORTERS’ INTENTIONS TO PARTICIPATE IN HUMAN-RESOURCE DEVELOPMENT AND TRAINING ACTIVITIES

M. Fujisaki-Sueda-Sakai, K. Takahashi, Y. Yoshizawa, K. Iijima

J Frailty Aging 2020;9(4)238-243

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Background: Frailty prevention is one of social prescriptions for an aging society. That requires community level intervention. Objectives: This study examined frailty checkup supporters’ (FCSs’) intentions to engage in human-resource development and training activities (i.e., leadership activities) and related factors. Design: Cross-sectional study. Setting: Three municipalities in suburban area, Eastern Japan. Participants: Forty-five of 59 FCSs completed anonymous self-administered questionnaires. Measurements: Questionnaire sought information regarding their sociodemographic data, their perceptions and experiences of FCS activities, and their intentions to participate in human-resource development and training activities. Participants were divided into a high intention (HI) and low intention group (LI). The two groups were compared using quantitative and qualitative data. Results: Eleven FCSs reported intending to engage in leader-related activities. Factors associated with FCSs’ intentions were finding FCS activities rewarding and the willingness to continue performing FCS activities. The participants who changed their daily activities (p = .041) and perceptions regarding contributing to the community (p = .018) showed significantly higher intention than LI participants. Free description about the changes in perceptions and lifestyles as a consequence of participating in FCS activities were analyzed qualitatively. FCSs who changed their daily activities and perspectives about contributing to the community described positive changes in both the groups. Meanwhile, FCSs who did not change their daily activities and perspectives about contributing to the community described their reason only in the LI group. Conclusions: The results might encourage FCSs to participate in training and guidance activities, as they have positive experiences and receive recognition obtained through participation in such activities.

CITATION:
M. Fujisaki-Sueda-Sakai ; K. Takahashi ; Y. Yoshizawa ; K. Iijima (2020): Frailty checkup supporters’ intentions to participate in human-resource development and training activities. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.6

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LETTER TO THE EDITOR: COVID-19 QUARANTINE IN OLDER PEOPLE: THE NEED TO THINK ABOUT SARCOPENIA-RELATED PHENOTYPES

A. Bonadias Gadelha, R.M. Lima

J Frailty Aging 2020;9(4)244-245

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CITATION:
A. Bonadias Gadelha ; R.M. Lima (2020): Letter to the editor: COVID-19 QUARANTINE IN OLDER PEOPLE: THE NEED TO THINK ABOUT SARCOPENIA-RELATED PHENOTYPES. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.31

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LETTER TO THE EDITOR: SETTING GOALS OR SHIFTING GOALPOSTS: ROLE OF FRAILTY FOR CRITICAL CARE DECISIONS DURING COVID-19

R. Hsien-Xiong Lee, E. Peiying Ho , H.-Y. Neo, A. Hum, W.-S. Lim

J Frailty Aging 2020;9(4)246-247

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CITATION:
R. Hsien-Xiong Lee ; E. Peiying Ho ; H.-Y. Neo ; A. Hum ; W.-S. Lim (2010): Letter to the editor: Setting goals or shifting goalposts: Role of frailty for critical care decisions during COVID-19 . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2010.46

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LETTER TO THE EDITOR: COVID-19: ROLE OF INTEGRATED REGIONAL HEALTH SYSTEM TOWARDS CONTROLLING PANDEMIC IN THE COMMUNITY, INTERMEDIATE AND LONG-TERM CARE

R.A. Merchant

J Frailty Aging 2020;9(4)248-249

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CITATION:
R.A. Merchant1 (2020): COVID-19: Role of Integrated Regional Health System Towards Controlling Pandemic in the Community, Intermediate and Long-term Care. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.39

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REPLY TO ATA AND COLLEAGUES’ LETTER TO THE EDITOR. Adjustments for Anterior Thigh Muscle Measuremets in Sarcopenia

Y. Matsui

J Frailty Aging 2020;9(4)250

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CITATION:
Y. Matsui (2020): Reply to Ata and colleagues’ Letter to the Editor. Adjustments for Anterior Thigh Muscle Measuremets in Sarcopenia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.35

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