02/2023 journal articles
THE PHYSICAL RESILIENCE INSTRUMENT FOR OLDER ADULTS (PRIFOR) IN SURGICAL INPATIENTS: FURTHER EVIDENCE FOR ITS FACTOR STRUCTURE AND VALIDITY
C.-Y. Lin, C.-H. Ou, C.-M. Chang, F.-W. Hu
J Frailty Aging 2023;12(2)91-96
Show summaryHide summaryBackground: The Physical Resilience Instrument for Older Adults (PRIFOR) is a questionnaire for assessing physical resilience in older adults suffering from acute health stressors. Prior psychometric evidence of the PRIFOR showed that it has good criterion-related validity, known-group validity, predictive validity, and internal consistency. However, it is unclear whether the PRIFOR can be replicated in older adults suffering after surgical treatment.
Objectives: This study aimed at evaluating whether the three-factor structure of the PRIFOR can be replicated in older adults suffering after surgical treatment. Moreover, the concurrent validity of the PRIFOR was examined using the association between the PRIFOR and measures of depression, cognition, activities of daily living, and frailty.
Design and Setting: A longitudinal study was adopted in a tertiary-care medical center in Taiwan.
Participants: A total of 207 patients aged 65 years old and older who underwent surgery and if they were able to communicate independently.
Measurements: The PRIFOR, the 5-item Geriatric Depression Scale, the Short Portable Mental Status Questionnaire, the Katz Index of Independence in Activities of Daily Living and Clinical Frailty Scale were all assessed after surgery.
Results: The three-factor structure (positive thinking, cope and adjust lifestyle, and belief and hopeful mindset) was supported by the CFA results in the present sample. In addition, the PRIFOR showed good concurrent validity with depression (r = -0.470 to -0.542), cognition (r = 0.358 to 0.409), activities of daily living (r = 0.209 to 0.310), and frailty (r =-0.161 to -0.237).
Conclusion: The PRIFOR can be recommended to measure physical resilience in older adults suffering after surgical treatment. For the adequate estimation of older adults’ level of physical resilience postoperatively and to guide the implementation of individualized interventions, it is important to provide appropriate care for older adults to recover after surgery.
CITATION:
C.-Y. Lin; C.-H. Ou; C.-M. Chang; F.-W. Hu (2023): The Physical Resilience Instrument for Older Adults (PRIFOR) in Surgical Inpatients: Further Evidence for Its Factor Structure and Validity. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.8
FRAILTY IN CHILE: DEVELOPMENT OF A FRAILTY INDEX SCORE USING THE CHILEAN NATIONAL HEALTH SURVEY 2016-2017
F. Diaz-Toro, F. Petermann-Rocha, N. Lynskey, G. Nazar, I. Cigarroa, C. Troncoso, Y. Concha-Cisternas, A.M. Leiva-Ordoñez, M.A. Martinez-Sanguinetti, S. Parra-Soto, C. Celis-Morales
J Frailty Aging 2023;12(2)97-102
Show summaryHide summaryBackground: The Frailty Index (FI) is used to quantify and summarize vulnerability status in people. In Chile, no development and assessment of a FI have been explored.
Objective: To develop and evaluate a FI using representative data from Chilean adults aged 40 years and older stratified by sex.
Design: Cross-sectional study.
Setting: National representative data from the Chilean National Health Survey 2016–2017 (CNHS 2016-2017).
Participants: 3,036 participants older than 40 years with complete data for all variables.
Measurements: A 49-item FI was developed and evaluated. This FI included deficits from comorbidities, functional limitations, mental health status, physical activity, anthropometry, medications, and falls. A score between 0 and 1 was calculated for each person. Descriptive statistics and linear regression models were employed to evaluate the FI’s performance in the population. Comparative analyses were carried out to evaluate the FI score by age (<60 and > 60 years).
Results: The mean FI score was 0.15 (SD:0.09), with a 99% upper limit of 0.46. Scores were greater in women than men (0.17 [SD:0.09]) vs. 0.12 [0.08]); in people older than 80 years (0.22 [0.11]), and in people with ≤8 years of education (0.18 [0.10]) compared with those with >12 years (0.12 [0.08]). The average age-related increase in the FI was 2.3%. When a cut-off point > 0.25 was applied, the prevalence of frail individuals was 11.8% (95% CI: 10.0 to 13.8) in the general population. The prevalence was higher in women 15.9% [95% CI: 13.3 to 18.9] than men 7.4% [95% CI: 5.3 to 10.1]. In a comparative analysis by age, higher FI mean scores and prevalence of frail were observed in people > 60 than younger than 60.
Conclusions: The mean FI score and frailty prevalence were higher in women than men, in people with fewer years of formal education, and incremented markedly with age. This FI can be used for early detection of frailty status focusing on women and middle-aged people as a strategy to delay or prevent frailty-related consequences.
CITATION:
F. Diaz-Toro ; F. Petermann-Rocha ; N. Lynskey ; G. Nazar ; I. Cigarroa ; C. Troncoso ; Y. Concha-Cisternas ; A.M. Leiva-Ordoñez ; M.A. Martinez-Sanguinetti ; S. Parra-Soto ; C. Celis-Morales (2023): Frailty in Chile: Development of a Frailty Index Score Using the Chilean National Health Survey 2016-2017. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.2
CENTRALLY ACTING ACE INHIBITOR USE AND PHYSICAL PERFORMANCE IN OLDER ADULTS
C.J. George, C.B. Hall, E.F. Weiss, J. Verghese, E. Neptune, P. Abadir
J Frailty Aging 2023;12(2)103-108
Show summaryHide summaryBackground: There is conflicting evidence regarding the role of angiotensin-converting enzyme inhibitors and physical function. While some studies show improvements in muscle strength and physical function, others show no significant difference or decreased performance. This ambiguity could be due to differential effects of angiotensin-converting enzyme inhibitor subtypes which can be categorized as centrally or peripherally-acting based upon their ability to cross the blood-brain barrier.
Objective: The objective of this study is to compare physical performance measures among angiotensin-converting enzyme inhibitor subtype users.
Methods: Design: Cross-sectional Setting: Ambulatory Participants: Performed in 364 participants in the Health and Retirement Study cohort who were ≥ 65 years (median age (IQR) 74.00 (69-80) years. Measurements: Average difference in hand grip (kg), gait speed(m/s) and peak expiratory flow (L/min).
Results: Compared to participants on a peripherally-acting angiotensin-converting enzyme inhibitor (113 (31%)), those on a centrally-acting agent (251(69%)) had stronger grip strength 28.9 ±1.0 vs 26.3±1.0, p=.011 and higher peak expiratory flow rates 316.8±130.4 vs. 280.0±118.5, p= .011 in unadjusted analysis. After multiple adjustments the difference in PEF remained statistically significant (Estimate(CI) 26.5, 95% CI 2.24, 50.5, p = 0.032).
Conclusion: Our results suggest that in older adults the use of centrally-acting angiotensin-converting enzyme inhibitors compared to a peripherally acting angiotensin-converting enzyme inhibitors was associated with better lung function in older individuals.
CITATION:
C.J. George ; C.B. Hall ; E.F. Weiss ; J. Verghese ; E. Neptune ; P. Abadir (2023): Centrally Acting ACE Inhibitor Use and Physical Performance in Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.10
LETTER TO THE EDITOR: SUBJECTIVE HAND SQUEEZE: A PRACTICAL SOLUTION TO ASSESSING HANDGRIP STRENGTH WITHOUT EQUIPMENT?
R. McGrath, G.R. Tomkinson, J. Kieser, K. Kisner, K.J. Hackney
J Frailty Aging 2023;12(2)109-110
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CITATION:
R. McGrath ; G.R. Tomkinson ; J. Kieser ; K. Kisner ; K.J. Hackney ; (2023): Letter to the Editor: Subjective Hand Squeeze: A Practical Solution to Assessing Handgrip Strength Without Equipment?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.9
OPTIMIZING THE AGING BRAIN: THE BEAD STUDY ON THE ETHICS OF DEMENTIA PREVENTION
M. Andreoletti, C. Lazzaroni, N. Petersen, S. Segawa, A. Leibing, S. Schicktanz, A. Blasimme
J Frailty Aging 2023;12(2)111-116
Show summaryHide summaryDementia has lately undergone a profound reconceptualization. Long conceived of as an unpreventable process of mental deterioration, current evidence shows that it can be prevented in at least one in three cases intervening on a specified set of factors. Issues of justice and equity loom large on the implementation of dementia prevention, from a global health perspective. Our project thus embraces emerging evidence about dementia risk factors and their uneven distribution nationally and globally by specifically focusing on the situated aspects of dementia prevention.
The aim of the BEAD study (Optimizing the Aging Brain? Situating Ethical Aspects in Dementia Prevention) is to dissect the ethical and clinical assumptions of this novel understanding of dementia, and to analyze how such new discourse on dementia prevention plays out in three countries: Canada, Germany and Switzerland.
This study adopts a multi-perspective, comparative, qualitative approach, combining stakeholder interviews with different kinds of focused ethnographies, elaborating on conceptual, ethical, and social aspects of what we would like to call the “new dementia”.
By situating the paradigmatic shifts in Alzheimer’s and dementia research within current aging cultures and contemporary social policies, we aim to initiate a debate about the often implicit unresolved social, ethical, and political implications and preconditions of the medical understanding and handling of cognitive disorders.
CITATION:
M. Andreoletti ; C. Lazzaroni ; N. Petersen ; S. Segawa ; A. Leibing ; S. Schicktanz ; A. Blasimme (2023): Optimizing the Aging Brain: The BEAD Study on the Ethics of Dementia Prevention. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.6
LONGITUDINAL ASSOCIATIONS BETWEEN CONCURRENT CHANGES IN PHENOTYPIC FRAILTY AND LOWER URINARY TRACT SYMPTOMS AMONG OLDER MEN
S.R. Bauer, C.E. McCulloch, P.M. Cawthon, K.E. Ensrud, A.M. Suskind, J.C. Newman, S.L. Harrison, A. Senders, K. Covinsky, L.M. Marshall, for the Osteoporotic Fractures in Men (MrOS) Research Group
J Frailty Aging 2023;12(2)117-125
Show summaryHide summaryBackground: Lower urinary tract symptoms (LUTS) are associated with prevalent frailty and functional impairment, but longitudinal associations remain unexplored.
Objectives: To assess the association of change in phenotypic frailty with concurrent worsening LUTS severity among older men without clinically significant LUTS at baseline.
Design: Multicenter, prospective cohort study.
Setting: Population-based.
Participants: Participants included community-dwelling men age ≥65 years at enrollment in the Osteoporotic Fractures in Men study.
Measurements: Data were collected at 4 visits over 7 years. Phenotypic frailty score (range: 0-5) was defined at each visit using adapted Fried criterion and men were categorized at baseline as robust (0), pre-frail (1-2), or frail (3-5). Within-person change in frailty was calculated at each visit as the absolute difference in number of criteria met compared to baseline. LUTS severity was defined using the American Urologic Association Symptom Index (AUASI; range: 0-35) and men with AUASI ≥8 at baseline were excluded. Linear mixed effects models were adjusted for demographics, health-behaviors, and comorbidities to quantify the association between within-person change in frailty and AUASI.
Results: Among 3235 men included in analysis, 48% were robust, 45% were pre-frail, and 7% were frail. Whereas baseline frailty status was not associated with change in LUTS severity, within-person increases in frailty were associated with greater LUTS severity (quadratic P<0.001). Among robust men at baseline, mean predicted AUASI during follow-up was 4.2 (95% CI 3.9, 4.5) among those meeting 0 frailty criteria, 4.6 (95% CI 4.3, 4.9) among those meeting 1 criterion increasing non-linearly to 11.2 (95% CI 9.8, 12.6) among those meeting 5 criteria.
Conclusions: Greater phenotypic frailty was associated with non-linear increases in LUTS severity in older men over time, independent of age and comorbidities. Results suggest LUTS and frailty share an underlying mechanism that is not targeted by existing LUTS interventions.
CITATION:
S.R. Bauer ; C.E. McCulloch ; P.M. Cawthon ; K.E. Ensrud ; A.M. Suskind ; J.C. Newman ; S.L. Harrison ; A. Senders ; K. Covinsky ; L.M. Marshall ; for the Osteoporotic Fractures in Men (MrOS) Research Group ; (2022): Longitudinal Associations between Concurrent Changes in Phenotypic Frailty and Lower Urinary Tract Symptoms among Older Men. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.33
ASSESSING THE READINESS FOR IMPLEMENTING THE WORLD HEALTH ORGANIZATION’S ICOPE APPROACH IN HONG KONG: PERSPECTIVES FROM SOCIAL CARE AND POLICY STAKEHOLDERS
R. Yu, G. Leung, D. Lai, C. Tong, L.Y. Tam, C. Cheng, S. Kong, J. Woo
J Frailty Aging 2023;12(2)126-133
Show summaryHide summaryhealth systems around the world, it seems hard to realise in practice, particularly in the part of medical social integration. Worse still, little is known about the capacity of social care professionals who implement it, or their perceived roles and responsibilities, as well as the barriers and facilitators that stakeholders from the health and social sectors identify as factors affecting the ICOPE implementation process. Therefore, the present study was performed to probe into these issues. Data were collected from an online survey based on the WHO ICOPE scorecard (N = 34), and focus groups with policy makers, managers, health and social care professionals (N = 47). Inductive analyses were performed in accordance with the service and system levels within the WHO ICOPE implementation framework. While the findings from the scorecard survey highlight the gap in actualizing the ICOPE approach within the existing social services and care structures, we found support for a model of integrated care underpinned by the WHO ICOPE approach. Factors that may hinder and facilitate ICOPE implementation include workforce capacity-building, coordinated networks and partnerships, and financial mechanisms. This finding can help inform subsequent actions that further support health and social care advancement and collaboration, and the implementation of the ICOPE approach.
CITATION:
R. Yu ; G. Leung ; D. Lai ; C. Tong ; L.Y. Tam ; C. Cheng ; S. Kong ; J. Woo ; (2023): Assessing the Readiness for Implementing the World Health Organization’s ICOPE Approach in Hong Kong: Perspectives from Social Care and Policy Stakeholders. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.3
EXPLORING THE CHALLENGES OF FRAILTY IN MEDICAL EDUCATION
R. Winter, G.M.E. Pearson
J Frailty Aging 2023;12(2)134-138
Show summaryHide summaryFrailty is common, and medical students and doctors across all specialties will look after patients with frailty. The General Medical Council requires UK medical schools to teach and assess on frailty, and national geriatric societies across the globe include frailty in their recommended undergraduate curricula. However, frailty in medical education is challenging; there is uncertainty around what frailty is in medical education, including how and when to teach it; controversies in mapping teaching and assessments to recommended curricula; patients with frailty can be challenging to include in teaching and assessments due to functional, sensory, and/or cognitive impairments; an individual with frailty is likely to present atypically, with less predictable recovery, introducing complexities into clinical reasoning that can be challenging for students; the term frailty is often negatively perceived, used colloquially and avoided in educational interactions. This commentary discusses these challenges around frailty in undergraduate medical education and serves to provoke discussion about why frailty is so challenging to teach and learn about, including recommendations for how frailty education could be improved.
CITATION:
R. Winter ; G.M.E. Pearson ; (2023): Exploring the Challenges of Frailty in Medical Education. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.12
THE LIMITATIONS OF FRAILTY ASSESSMENT TOOLS IN ANCAASSOCIATED VASCULITIS
L. Floyd, L. Byrne, A.D. Morris, A.C. Nixon, A. Dhaygude
J Frailty Aging 2023;12(2)139-142
Show summaryHide summaryAnti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) can be associated with a high burden of morbidity and mortality in an ageing population. It is increasingly recognised that individualised management is needed. Few studies have looked specifically at frailty related outcomes in AAV and a gap remains in understanding the application of frailty assessment tools in these patients. We carried out a single centre, cohort study between 2017 to 2022. Forty-one patients who had newly diagnosed or relapsing AAV and aged ≥65 years were included. The Clinical Frailty Scale (CFS) score at presentation was assessed by health care practitioners and interval CFS scores were carried out a minimum of 6 weeks from diagnosis. The aim was to determine if patients living with frailty had worse outcomes or if their perceived frailty improved with immunosuppressive treatment. The median CFS at diagnosis was 4 (vulnerable) and this remained at follow up. There was no significant interval change in CFS (P=0.16) suggesting that the patients did not become frailer and instead there was a tendency towards improved frailty scores at re-assessment. There was no significant difference in end stage kidney disease between those with higher (>5) or lower (≤5) CFS (P=1.0), although crude mortality was higher among those with an initial CFS >5 (P=0.03). Overall, we demonstrated that CFS has limitations in determining patients that may be frail as a result of disease burden with the potential to improve with treatment and clinicians should be mindful of this when making decisions relating to management.
CITATION:
L. Floyd ; L. Byrne ; A.D. Morris ; A.C. Nixon ; A. Dhaygude ; (2023): The Limitations of Frailty Assessment Tools in ANCA-Associated Vasculitis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.14
EFFECTS OF CURCUMIN C3 COMPLEX® ON PHYSICAL FUNCTION IN MODERATELY FUNCTIONING OLDER ADULTS WITH LOW-GRADE INFLAMMATION – A PILOT TRIAL
R.T. Mankowski, K.T. Sibille, C. Leeuwenburgh, Y. Lin, F.-C. Hsu, P. Qiu, B. Sandesara, S.D. Anton
J Frailty Aging 2023;12(2)143-149
Show summaryHide summaryBackground: Natural dietary compounds that can modulate the inflammation process have the potential to improve physical function through a number of biological pathways, and thus may represent an alternative approach to avert functional decline compared to more time-burdening lifestyle interventions. In this pilot trial, we tested the feasibility and explored the effect of a nutritional compound, Curcumin C3 Complex® for improving physical function and muscle strength in moderately functioning older adults with low-grade inflammation.
Methods: Moderately functioning (short physical performance battery, SPPB <10) and sedentary older adults (>65 years) with low-grade systemic inflammation (c-reactive protein >1mg/dL) were randomized to receive Curcumin C3 Complex® (n=9) (1000mg/day) or placebo (n=8) groups for 12 weeks. All participants (age range: 66-94 years, 8 females and 9 males) underwent functional testing (SPPB and walking speed by the 400-meter walk test) and lower-limb strength (knee flexion and extension peak torque by the Biodex test) at baseline and 12 weeks. Venous blood was collected at baseline, 4, 8 and 12 weeks for safety blood chemistry analyses and biomarkers of inflammation.
Results: A total of 17 participants were randomized and completed the study. Adherence was high (> 90%) and there were no adverse events reported or abnormal blood chemistries reported. Based on effect sizes, participants in the Curcumin C3 Complex® group demonstrated large effect sizes in the SPPB (Cohen’s effect size d=0.75) and measures of knee extension (d=0.69) and flexion peak torque (d=0.82). Effect sizes for galectin-3 (d=-0.31) (larger decrease) and interleukin-6 (d=0.38) (smaller increase) were small in the Curcumin C3 Complex® group compared to placebo.
Conclusion: This pilot trial suggests that there were no difficulties with recruitment, adherence and safety specific to the study protocol. Preliminary findings warrant a Phase IIb clinical trial to test the effect of Curcumin C3 Complex® on physical function and muscle strength in older adults at risk for mobility disability.
CITATION:
R.T. Mankowski ; K.T. Sibille ; C. Leeuwenburgh ; Y. Lin ; F.-C. Hsu ; P. Qiu ; B. Sandesara ; S.D. Anton (2022): Effects of Curcumin C3 Complex® on Physical Function in Moderately Functioning Older Adults with Low-Grade Inflammation – A Pilot Trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.47
USING A CLAIMS-BASED FRAILTY INDEX TO INVESTIGATE FRAILTY, SURVIVAL, AND HEALTHCARE EXPENDITURES AMONG OLDER ADULTS HOSPITALIZED FOR COVID-19 AT AN ACADEMIC MEDICAL CENTER
T. Keeney, M. Flom, J. Ding, M. Sy, K. Leung, D.H. Kim, J. Orav, C. Vogeli, C.S. Ritchie
J Frailty Aging 2023;12(2)150-154
Show summaryHide summaryBackground: Frailty is associated with mortality in older adults hospitalized with COVID-19, yet few studies have quantified healthcare utilization and spending following COVID-19 hospitalization.
Objective: To evaluate whether survival and follow-up healthcare utilization and expenditures varied as a function of claims-based frailty status for older adults hospitalized with COVID-19.
Design: Retrospective cohort study.
Participants: 136 patients aged 65 and older enrolled in an Accountable Care Organization (ACO) risk contract at an academic medical center and hospitalized for COVID-19 between March 11, 2020 – June 3, 2020.
Measurements: We linked a COVID-19 Registry with administrative claims data to quantify a frailty index and its relationship to mortality, healthcare utilization, and expenditures over 6 months following hospital discharge. Kaplan Meier curves and Cox Proportional Hazards models were used to evaluate survival by frailty. Kruskal-Wallis tests were used to compare utilization. A generalized linear model with a gamma distribution was used to evaluate differences in monthly Medicare expenditures.
Results: Much of the cohort was classified as moderate to severely frail (65.4%), 24.3% mildly frail, and 10.3% robust or pre-frail. Overall, 27.2% (n=37) of the cohort died (n=26 during hospitalization, n=11 after discharge) and survival did not significantly differ by frailty. Among survivors, inpatient hospitalizations during the 6-month follow-up period varied significantly by frailty (p=0.02). Mean cost over follow-up was $856.37 for the mild and $4914.16 for the moderate to severe frailty group, and monthly expenditures increased with higher frailty classification (p <.001).
Conclusions: In this cohort, claims-based frailty was not significantly associated with survival but was associated with follow-up hospitalizations and Medicare expenditures.
CITATION:
T. Keeney ; M. Flom ; J. Ding ; M. Sy ; K. Leung ; D.H. Kim ; J. Orav ; C. Vogeli ; C.S. Ritchie (2023): Using a Claims-Based Frailty Index to Investigate Frailty, Survival, and Healthcare Expenditures among Older Adults Hospitalized for COVID-19 at an Academic Medical Center. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.15
LETTER TO THE EDITOR: DIETARY INTAKE WITH THE TRANSITIONS OF FRAILTY AMONG JAPANESE COMMUNITY-DWELLING OLDER ADULTS
L. Gao
J Frailty Aging 2023;12(2)155
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CITATION:
L. Gao (2023): Letter to the Editor: Dietary Intake with the Transitions of Frailty among Japanese Community-Dwelling Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.7
13th International Conference on Frailty & Sarcopenia Research (ICFSR) March 22-24, 2023 Toulouse, France
Symposia - Conferences - Oral Communications
J Frailty Aging 2023;12(S1):S2-S32
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