04/2023 journal articles
EDITORIAL: FRONT-DOOR GERIATRICS: FRAILTY-READY EMERGENCY DEPARTMENT TO ACHIEVE THE QUADRUPLE AIM
E. Chong, T. Ong, W.S. Lim
J Frailty Aging 2023;12(4)254-257
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CITATION:
E. Chong ; T. Ong ; W.S. Lim ; (2023): Editorial: Front-Door Geriatrics: Frailty-Ready Emergency Department to Achieve the Quadruple Aim. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.42
STRENGTHENING MUSCLE HEALTH OF COMMUNITY-DWELLING OLDER ADULTS IN SINGAPORE: EVIDENCE TOWARDS CLINICAL IMPLEMENTATION
A.B. Maier, S.T.H. Chew, J. Goh, F.H.X. Koh, N.C. Tan
J Frailty Aging 2023;12(4)258-266
Show summaryHide summaryThe prevalence of sarcopenia will inevitably increase as the population ages in Singapore, rendering it a growing public health concern with a significant impact on healthcare resources. This article firstly summarizes the current understanding of the epidemiology, diagnosis and management of sarcopenia, focusing on community-dwelling older individuals. Early identification is key to preventing and minimizing muscle loss. Appropriate interventions, including resistance exercise training, nutritional interventions and prehabilitation program, should be tailored to each patient. We suggest several key actions to ultimately improve awareness and overcome challenges in identifying and managing sarcopenia to improve patient outcomes. A paradigm shift where muscle health is seen as an integral component to maintaining good health with longer lifespan is needed. Education – of healthcare professionals and the public – serves as the foundation to improving awareness of muscle health and sarcopenia, and to promoting physical exercise across the age spectrum for sarcopenia prevention. The use of cost-effective evidence-based modalities (e.g., calf circumference measurement, 5-times chair stand test or bioelectric impedance assessment) enable early identification of muscle loss in routine practice. Providing subsidies for nutritional interventions (e.g., oral nutritional supplements) and exercise (e.g., ActiveSG gym membership) would encourage uptake of and adherence to interventions. Further high-quality research on interventions and their outcomes is important to determine the optimal strategy in different patient populations and to demonstrate clinical significance and value of addressing sarcopenia. Having local champions within healthcare institution would facilitate the much-needed change in healthcare culture where muscle health is a part of routine clinical practice.
CITATION:
A.B. Maier ; S.T.H. Chew ; J. Goh ; F.H.X. Koh ; N.C. Tan ; (2023): Strengthening Muscle Health of Community-Dwelling Older Adults in Singapore: Evidence Towards Clinical Implementation. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.31
PREOPERATIVE REHABILITATION IS FEASIBLE IN THE WEEKS PRIOR TO SURGERY AND SIGNIFICANTLY IMPROVES FUNCTIONAL PERFORMANCE
D.E. Hall, A. Youk, K. Allsup, K. Kennedy, T.D. Byard, R. Dhupar, D. Chu, A.M. Rahman, M. Wilson, L.P. Cahalin, J. Afilalo, D. Forman
J Frailty Aging 2023;12(4)267-276
Show summaryHide summaryBackground: Frailty is a multidimensional state of increased vulnerability. Frail patients are at increased risk for poor surgical outcomes. Prior research demonstrates that rehabilitation strategies deployed after surgery improve outcomes by building strength.
Objectives: Examine the feasibility and impact of a novel, multi-faceted prehabilitation intervention for frail patients before surgery.
Design: Single arm clinical trial.
Setting: Veterans Affairs hospital.
Participants: Patients preparing for major abdominal, urological, thoracic, or cardiac surgery with frailty identified as a Risk Analysis Index≥30.
Intervention: Prehabilitation started in a supervised setting to establish safety and then transitioned to home-based exercise with weekly telephone coaching by exercise physiologists. Prehabilitation included (a)strength and coordination training; (b)respiratory muscle training (IMT); (c)aerobic conditioning; and (d)nutritional coaching and supplementation. Prehabilitation length was tailored to the 4-6 week time lag typically preceding each participant’s normally scheduled surgery.
Measurements: Functional performance and patient surveys were assessed at baseline, every other week during prehabilitation, and then 30 and 90 days after surgery. Within-person changes were estimated using linear mixed models.
Results: 43 patients completed baseline assessments; 36(84%) completed a median 5(range 3-10) weeks of prehabilitation before surgery; 32(74%) were retained through 90-day follow-up. Baseline function was relatively low. Exercise logs show participants completed 94% of supervised exercise, 78% of prescribed IMT and 74% of home-based exercise. Between baseline and day of surgery, timed-up-and-go decreased 2.3 seconds, gait speed increased 0.1 meters/second, six-minute walk test increased 41.7 meters, and the time to complete 5 chair rises decreased 1.6 seconds(all P≤0.007). Maximum and mean inspiratory and expiratory pressures increased 4.5, 7.3, 14.1 and 13.5 centimeters of water, respectively(all P≤0.041).
Conclusions: Prehabilitation is feasible before major surgery and achieves clinically meaningful improvements in functional performance that may impact postoperative outcomes and recovery. These data support rationale for a larger trial powered to detect differences in postoperative outcomes.
CITATION:
D.E. Hall ; A. Youk ; K. Allsup ; K. Kennedy ; T.D. Byard ; R. Dhupar ; D. Chu ; A.M. Rahman ; M. Wilson ; L.P. Cahalin ; J. Afilalo ; D. Forman ; (2022): Preoperative Rehabilitation Is Feasible in the Weeks Prior to Surgery and Significantly Improves Functional Performance. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.42
ASSOCIATION OF ORAL HEALTH WITH FRAILTY, MALNUTRITION RISK AND FUNCTIONAL DECLINE IN HOSPITALIZED OLDER ADULTS: A CROSS-SECTIONAL STUDY
J. Chew, J.Q. Chia, K.K. Kyaw, J.K. Fu, J. Ang, Y.P. Lim, K.Y. Ang, H.N. Tan, W.S. Lim
J Frailty Aging 2023;12(4)277-283
Show summaryHide summaryBackground: Poor oral health is known to be associated with adverse outcomes, but the frequency and impact of poor oral health on older adults in the acute inpatient setting has been less well studied.
OBJECTIVES: We examined the association between oral health, frailty, nutrition and functional decline in hospitalized older adults.
DESIGN: Retrospective cross-sectional study.
SETTING AND PARTICIPANTS: We included data from 465 inpatients (mean age 79.2+8.3 years) admitted acutely to a tertiary hospital.
METHODS: We evaluated oral health using the Revised Oral Assessment Guide (ROAG), frailty using the Clinical Frailty Scale (CFS), malnutrition risk using the Nutritional Screening Tool (NST) and functional status using a modified Katz Activities of Daily Living (ADL) scale. We examined cross-sectional associations of oral health with frailty, malnutrition risk and functional decline on admission, followed by multivariate logistic regression models evaluating the association between poor oral health and the aforementioned outcomes.
RESULTS: 343 (73.8%), 100 (21.5%) and 22 (4.7%) were classified as low, moderate and high risk on the ROAG, respectively. Poorer oral health was associated with greater severity of frailty, functional decline on admission and malnutrition risk. Abnormalities in ROAG domains of voice changes, swallowing difficulty, xerostomia, lips and tongue appearance were more frequently present at greater severity of frailty. Poor oral health was associated with frailty [odds ratio (OR): 1.76, 95% confidence interval (CI) 1.05-2.97; P=0.034]; malnutrition risk [OR: 2.76, 95% CI 1.46-5.19, P=0.002] and functional decline [OR: 1.62, 95% CI 1.01-2.59, P=0.046].
CONCLUSIONS: Poor oral health is significantly associated with frailty, malnutrition risk and functional decline in older inpatients. Oral health evaluation, as part of a comprehensive geriatric assessment may be a target for interventions to improve outcomes. Further research including longitudinal outcomes and effectiveness of specific interventions targeted at oral health are warranted in older adults in the inpatient setting.
CITATION:
J. Chew ; J.Q. Chia ; K.K. Kyaw ; J.K. Fu ; J. Ang ; Y.P. Lim ; K.Y. Ang ; H.N. Tan ; W.S. Lim (2023): Association of Oral Health with Frailty, Malnutrition Risk and Functional Decline in Hospitalized Older Adults: A Cross-Sectional Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.33
THE ASSOCIATION OF BONE TURNOVER MARKERS WITH MUSCLE FUNCTION, FALLS, AND FRAILTY IN OLDER WOMEN IN LONGTERM CARE
N.S. Haeri, S. Perera, S.L. Greenspan
J Frailty Aging 2023;12(4)284-290
Show summaryHide summaryBackground: Osteoporosis and sarcopenia commonly coexist in older adults. There is strong evidence that bone and muscle impact each other through mechanical and biochemical cross-talk.
OBJECTIVES: We sought to investigate the relationship between the markers of bone remodeling including the C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N propeptide (P1NP) with muscle function, falls, and frailty in older women residing in long-term care (LTC) facilities.
DESIGN: A secondary analysis of a randomized controlled trial.
SETTING: Residents of LTC.
PARTICIPANTS: One hundred seventy-eight older women with osteoporosis.
MEASUREMENTS: We measured and analyzed baseline CTX, P1NP, gait speed, sit to stand time, history of falls, and frailty index.
RESULTS: Participants had a mean age of 86.7 years and BMI of 27.6 kg/m2. The correlation (r) of CTX with gait speed and sit to stand test, as indices for muscle function, were -0.193 (p=0.0163) and 0.152 (p=0.0507), respectively. Additionally, CTX level was significantly associated with history of falls (p=0.0068), recurrent falls (p=0.0260), and frail phenotype (p=0.0126). P1NP did not have a significant association with gait speed, sit to stand test, and history of falls; however, it was associated with frail phenotype (p=0.0137). Most findings persisted after adjusting for age.
CONCLUSIONS: In older women residing in LTC facilities, CTX was associated with gait speed, falls history, and frail phenotype, whereas P1NP was only associated with frail phenotype. These findings suggest a relationship between bone remodeling and muscle function.
CITATION:
N.S. Haeri ; S. Perera ; S.L. Greenspan ; (2023): The Association of Bone Turnover Markers with Muscle Function, Falls, and Frailty in Older Women in Long-Term Care. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.38
RELIABILITY OF SELF-SCREENING FOR INTRINSIC CAPACITY IMPAIRMENTS USING THE ICOPE MONITOR APP
E. Gonzalez-Bautista, P. de Souto Barreto, N. Tavassoli, C. Ranarijhon, J.S. Pons, Y. Rolland, S. Andrieu, J. Delrieu
J Frailty Aging 2023;12(4)291-297
Show summaryHide summaryAIM: To verify the inter-rater agreement of the Integrated Care for Older People (ICOPE) STEP 1 screening tool using the ICOPE Monitor app, comparing self-assessment to a screening performed by a health professional.
METHODS: We compared the results of the ICOPE Step 1 obtained by self-screening with those obtained by a professional screening using Gwet’s agreement coefficient in two studies. Study 1 tested inter-rater reliability in participants to the INSPIRE-T cohort who agreed to undergo the self-and the professional screening on the same day. Study 2 used data from the INSPIRE-ICOPE care cohort. We included real-life users of the French health system whose first ICOPE Step 1 was a self-assessment followed by a professional Step 1within 130 days (mean=76 days, SD=60).
RESULTS: Study 1 included 79 participants (45 aged less than 60, 34 aged 60 and over, 60% female, mean (SD) age of 54.5 (18.5) years). Of the 207 participants in Study 2, 49 were less than 60, and 158 were 60 and over (54% female, mean (SD) age 67 (16.1) years). Agreement coefficients in Study 1 ranged from 0.49 (CI95% 0.24; 0.66) in the cognition domain – moderate agreement) to 0.99 (CI95% 0.96;1.00) in the nutrition domain – very good agreement); and in Study 2 from 0.36 (CI95% 0.23;0.49) in the cognition domain to 0.97 (95% 0.95;1.00) in the nutrition domain. The agreement coefficients for the cognition and hearing domains were higher for the participants aged <60 than those aged 60 and over. The time orientation items (cognition) showed high reliability.
CONCLUSION: Our study supports using ICOPE Step 1 as a self-assessment screening tool. High reliability was found for intrinsic capacity’s nutrition, psychological, and locomotion domains, regardless of age. We discuss aspects of the self-assessment of cognition, vision, and hearing domains when using the ICOPE monitor app in older adults.
CITATION:
E. Gonzalez-Bautista ; P. de Souto Barreto ; N. Tavassoli ; C. Ranarijhon ; J.S. Pons ; Y. Rolland ; S. Andrieu ; J. Delrieu ; (2023): Reliability of Self-Screening for Intrinsic Capacity Impairments Using the ICOPE Monitor App. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.34
THE IMPACT OF FRAILTY AND DEPRIVATION ON THE LIKELIHOOD OF RECEIVING PRIMARY TOTAL HIP AND KNEE ARTHROPLASTY AMONG PEOPLE WITH HIP AND KNEE OSTEOARTHRITIS
M.J. Cook, M. Lunt, D.M. Ashcroft, T. Board, T.W. O’Neill
J Frailty Aging 2023;12(4)298-304
Show summaryHide summaryBackground: Among people with hip and knee osteoarthritis (OA), increasing deprivation is associated with reduced likelihood of receiving hip and knee arthroplasty (THA, TKA).
Objectives: To assess whether higher levels of frailty in the most deprived neighbourhoods explains the association between greater neighbourhood deprivation and reduced likelihood of receiving THA and TKA among people with hip and knee OA.
Design: Longitudinal cohort study.
Setting: Linked primary and secondary care electronic medical records and national mortality data.
Participants: 104,913 individuals with incident hip OA and 216,420 with incident knee OA.
Measurements: Frailty was assessed using a frailty index and categorised as fit, mild, moderate, and severe frailty. Neighbourhood deprivation was assessed using the index of multiple deprivation (IMD).
Results: Compared to those in neighbourhoods in the least deprived quintile of IMD, those in neighbourhoods in the fourth and fifth quintile of IMD (most deprived), respectively, were less likely to receive THA, adjusted subhazard ratio (95% CI), 0.90 (0.87, 0.93) and 0.77 (0.74, 0.80), over a mean follow up of 4.4 years, with similar results for TKA. Higher levels of frailty at OA diagnosis were associated also with reduced likelihood of receiving THA and TKA. The association, however, between deprivation and likelihood of receiving THA and TKA could not be explained by increased levels of frailty among those living in the most deprived areas.
Conclusions: Further work is needed to understand why those in the most deprived areas are less likely to receive THA and TKA.
CITATION:
M.J. Cook ; M. Lunt ; D.M. Ashcroft ; T. Board ; T.W. O’Neill ; (2023): The Impact of Frailty and Deprivation on the Likelihood of Receiving Primary Total Hip and Knee Arthroplasty among People with Hip and Knee Osteoarthritis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.36
THE EFFECT OF SARCOPENIA ON POSTOPERATIVE OUTCOMES FOLLOWING EMERGENCY LAPAROTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS
N. Humphry, M. Jones, S. Goodison, B. Carter, J. Hewitt
J Frailty Aging 2023;12(4)305-310
Show summaryHide summaryEmergency laparotomy procedures have high rates of postoperative mortality and morbidity in older patient. Sarcopenia is associated with poor postoperative outcomes in elective surgeries and there is growing evidence for its use as a risk predictor in the emergency setting. The study aimed to evaluate the effect of sarcopenia on postoperative mortality and morbidity following emergency laparotomy. Five electronic databases were systematically searched (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Web of Science) from conception until the 14th February 2022. All prospective cohort studies were included. Risk of bias was assessed with the Newcastle-Ottawa score. Pooled meta-analyses were estimated using the Mantel-Haenszel and inverse-generic variance method for mortality and morbidity outcomes. Eleven retrospective cohort studies were included, of which ten were included in the meta-analysis comprising of 3492 patients (1027 sarcopenic, 2465 non-sarcopenic). The study level incidence of sarcopenia ranged from 24.6 to 50.3% with a median rate of 25.1%. Sarcopenia was associated with increased 30-day mortality (OR 2.36, 95% CI, 1.66, 3.37, I2 = 43%), 90-day mortality (OR 2.51, 95% CI, 1.79, 3.52, I2 = 0%), and length of hospital stay (in days) (MD 1.18, 95% CI, 0.42, 1.94, I2 = 0%, P=0.002), but not incidence of postoperative major complications (OR 1.49, 95% CI, 0.86, 2.56, I2 = 70%, P = 0.15). Sarcopenia predicts poor outcomes following emergency laparotomy. We suggest assessment of sarcopenia should be incorporated into acute surgical assessment to identify high risk patients and inform clinical decision-making prior to an emergency laparotomy.
CITATION:
N. Humphry ; M. Jones ; S. Goodison ; B. Carter ; J. Hewitt (2023): The Effect of Sarcopenia on Postoperative Outcomes Following Emergency Laparotomy: A Systematic Review and Meta-Analysis . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.30
LIFE EXPECTANCY IN PRE-FRAIL AND FRAIL STATES WITH AND WITHOUT DISABILITY: 18-YEARS OF FOLLOW-UP DATA FROM THE HEPESE STUDY USING THE MARKOV CHAIN METHOD
S. Al Snih, N.-W. Chen, L.-N. Chou, K.S. Markides, K.J. Ottenbacher
J Frailty Aging 2023;12(4)311-315
Show summaryHide summaryWe estimated the total life expectancy (TLE), frailty-free life expectancy (FFLE), frail life expectancy (FLE), pre-frail life expectancy (PFLE), and FLE with and without disability among 2,000 Mexican Americans aged ≥67 years over an 18-year period. Frailty was defined as the presence of ≥2 criteria (weight loss, weakness, self-reported exhaustion, slowness). We used the Markov chain method to estimate the TLE, FFLE, FLE, PFLE, and FLE with and without disability by age and gender. TLE at age 67 was 17.49 years (women) and 15.54 years (men); FFLE was 6.50 years (women) and 6.45 years (men); PFLE was 6.48 years (women) and 5.42 years (men); FLE was 4.51 years (women) and 3.67 years (men); and FLE with disability was 2.13 years (women) and 1.13 years (men). In conclusion, Mexican American older women had fewer years of non-frail LE, more pre-frail or frail years, and more years with disability than men.
CITATION:
S. Al Snih ; N.-W. Chen ; L.-N. Chou ; K.S. Markides ; K.J. Ottenbacher ; (2023): Life Expectancy in Pre-Frail and Frail States with and without Disability: 18-Years of Follow-Up Data from the HEPESE Study Using the Markov Chain Method. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.37
GERIATRIC SERVICES HUB – A COLLABORATIVE FRAILTY MANAGEMENT MODEL BETWEEN THE HOSPITAL AND COMMUNITY PROVIDERS
L.F. Tan, J. Teng, Z.J. Chew, A. Choong, L. Hong, R. Aroos, P.V. Menon, J. Sumner, K.C. Goh, S.K. Seetharaman
J Frailty Aging 2023;12(4)316-321
Show summaryHide summaryBackground: Frailty is an important geriatric syndrome especially with ageing populations. Frailty can be managed or even reversed with community-based interventions delivered by a multi-disciplinary team. Innovation is required to find community frailty models that can deliver cost-effective and feasible care to each local context.
Objectives: We share pilot data from our Geriatric Service Hub (GSH) which is a novel frailty care model in Singapore that identifies and manages frailty in the community, supported by a hospital-based multi-disciplinary team.
Methods: We describe in detail our GSH model and its implementation. We performed a retrospective data analysis on patient characteristics, uptake, prevalence of frailty and sarcopenia and referral rates for multi-component interventions.
Results: A total of 152 persons attended between January 2020 to May 2021. Majority (59.9%) were female and mean age was 81.0 ± 7.1 years old. One-fifth (21.1%) of persons live alone. Mean Charlson Co-morbidity Index was 5.2 ± 1.8. Based on the clinical frailty risk scale (CFS), 31.6% were vulnerable, 51.3% were mildly frail and 12.5% were moderately frail. Based on SARC-F screening, 45.3% were identified to be sarcopenic whilst 56.9% had a high concern about falling using the Falls-Efficacy Scale-International. BMD scans were done for 41.4% of participants, of which 58.7% were started on osteoporosis treatment. In terms of referrals to allied health professionals, 87.5% were referred for physiotherapy, 71.1% for occupational therapy and 50.7% to dieticians.
Conclusion: The GSH programme demonstrates a new local model of partnering with community service providers to bring comprehensive population level frailty screening and interventions to pre-frail and frail older adults. Our study found high rates of frailty, sarcopenia and fear of falling in community-dwelling older adults who were not presently known to geriatric care services.
CITATION:
L.F. Tan ; J. Teng ; Z.J. Chew ; A. Choong ; L. Hong ; R. Aroos ; P.V. Menon ; J. Sumner ; K.C. Goh ; S.K. Seetharaman (2023): Geriatric Services Hub – A Collaborative Frailty Management Model between The Hospital and Community Providers. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.23
ARE GENERAL PRACTITIONERS MORE RELUCTANT TO GIVE ADVICE FOR EXERCISE TO OLDER WOMEN? A CROSS-SECTIONAL SURVEY OF EUROPEAN ADULTS
K. Christopoulos
J Frailty Aging 2023;12(4)322-325
Show summaryHide summaryDespite the importance of physical exercise for older people, only a fraction of them receive advice to do so by primary care physicians. This study aims to examine whether gender disparities exist in primary care regarding General Practitioners’ (GPs’) advice for exercise in older European adults. A total of N=21,703 participants from 14 countries were employed from the Survey of Health, Ageing, and Retirement in Europe and analysed with the use of multivariate ordered logistic regressions. Being female reduced the odds of receiving advice from a primary care physician (OR=0.83; 95% CI: 0.78–0.88) irrespective of health, behavioural, demographic, and socioeconomic factors. In conclusion, older European women may have reduced odds of receiving advice for exercise because of their gender, which in turn may affect their frailty.
CITATION:
K. Christopoulos ; (2023): Are General Practitioners More Reluctant to Give Advice for Exercise to Older Women? A Cross-Sectional Survey of European Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.40
RELATIONSHIP AMONG AGE, EDUCATION AND FRAILTY IN OLDER PERSONS
F. Bellelli, E. Consorti, T.M.K. Hettiarachchige, P. Rossi, T. Lucchi, M. Froldi, M. Cesari
J Frailty Aging 2023;12(4)326-328
Show summaryHide summaryPreliminary data suggest that frailty tend to increase with age and is associated with fewer years of formal education. However, it is still unclear whether age and education synergistically act in the definition of frailty. Aim of the study is to evaluate the interaction between age and education in defining frailty in community-dwelling older persons. We considered 911 community-dwelling older adults (mean age 79.5 years) who underwent a comprehensive geriatric assessment. Our results showed that education and age interact in the definition of frailty following an exponential-type relationship. Whereas age is a non-modifiable risk factor, much can be done to address the social component of frailty here represented by education. The reported interaction suggests that social interventions might be particularly effective at an older age, paving the way for multidisciplinary interventions beyond the clinical field.
CITATION:
F. Bellelli ; E. Consorti ; T.M.K. Hettiarachchige ; P. Rossi ; T. Lucchi ; M. Froldi ; M. Cesari ; (2023): Relationship among Age, Education and Frailty in Older Persons. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.39
LETTER TO THE EDITOR: UTILITY OF SERIAL PATIENT REPORTED OUTCOMES MEASUREMENT INFORMATION SYSTEM (PROMIS®) PHYSICAL FUNCTION ASSESSMENT IN A GERIATRICS OUTPATIENT CLINIC
N. Newmeyer, L. Zhong, M. Cheslock, S.D.M. Sison, V. Raman, .D. Whyman, D.H. Kim
J Frailty Aging 2023;12(4)329-330
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CITATION:
N. Newmeyer ; L. Zhong ; M. Cheslock ; S.D.M. Sison ; V. Raman ; J.D. Whyman ; D.H. Kim (2023): Letter to the Editor: Utility of Serial Patient Reported Outcomes Measurement Information System (PROMIS®) Physical Function Assessment in a Geriatrics Outpatient Clinic. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.32
LETTER TO THE EDITOR: INTERGENERATIONAL CONFLICTS BETWEEN YOUNG AND OLDER ADULTS: MAY THE CINEMA OF PASOLINI HELP US?
H.J. Coelho-Júnior, E. Marzetti
J Frailty Aging 2023;12(4)331-332
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CITATION:
H.J. Coelho-Júnior ; E. Marzetti ; (2023): Letter to the Editor: Intergenerational Conflicts between Young and Older Adults: May the Cinema of Pasolini Help Us?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.19