Ahead of print articles
FRAILTY INDEX, NOT AGE, PREDICTS TREATMENT OUTCOMES AND ADVERSE EVENTS FOR OLDER ADULTS WITH CANCER
J. Fletcher, N. Reid, R.E. Hubbard, R. Berry, M. Weston, E. Walpole, R. Kimberley, D.A. Thaker, R. Ladwa
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BACKGROUND: Frailty is an indicator of individual vulnerability and differentiates health status among people of the same chronological age.
OBJECTIVES: This study aimed to determine whether baseline frailty index (FI) was associated with systemic anticancer therapy treatment outcomes in older adults with solid cancers.
DESIGN: Retrospective cohort study.
SETTING: Major metropolitan outpatient oncology service.
PARTICIPANTS: Adults aged over 65 years with a solid malignancy who had been referred for consideration of systemic therapy, and had completed a baseline frailty assessment between January 2019 and July 2021.
MEASUREMENTS: Frailty had been prospectively assessed with a 58-item FI derived from a geriatric oncology nurse assessment prior to initial oncologist appointments. Primary outcome was treatment completion, and secondary outcomes included incidence of high-grade treatment-related toxicity or unplanned hospital admissions, and survival outcomes. Univariate and multivariable regression analyses were conducted to test the association between treatment outcomes and baseline FI. Co-variates included age, sex, performance status, treatment intent, and stage. Kaplan-Meier and cox proportional hazard analysis were conducted for survival analysis.
RESULTS: The median FI (IQR) was 0.24 (0.15-0.31) and 43% were frail (FI>0.25). FI was positively correlated with ECOG, however 28% of ECOG 0-1 were frail. In multivariable regression analyses, each 0.10 increase in FI was associated with an increased likelihood of not completing or not receiving treatment (OR 1.37, 95% CI 1.02-1.84; p=.04), treatment-related toxicity (OR 1.60, 95% CI 1.14-2.23; p<.01) and unplanned hospital admissions (OR 1.61; 95% CI 1.16-2.25; p<.01). Frail patients had increased mortality (adjusted HR 2.81, 95% CI 1.42-5.56; p<.01). Age did not predict treatment completion, toxicities, or survival.
CONCLUSION: Baseline FI is a granular measure that can help to identify frailer older patients who are more likely to require tailored therapy and support, and less frail older patients who are more likely to tolerate treatment.
CITATION:
J. Fletcher ; N. Reid ; R.E. Hubbard ; R. Berry ; M. Weston ; E. Walpole ; R. Kimberley ; D.A. Thaker ; R. Ladwa (2024): Frailty Index, Not Age, Predicts Treatment Outcomes and Adverse Events for Older Adults with Cancer. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.22
THE INTERPLAY AMONG RESPIRATORY FAILURE, DELIRIUM, FRAILTY AND SEVERITY OF ILLNESS IN HOSPITALIZED OLDER MEDICAL PATIENTS: A NATIONWIDE MULTICENTER OBSERVATIONAL STUDY
F.L. Fimognari, E. Tassistro, E. Rossi, V. Bambara, M.G. Valsecchi, A. Cherubini, A. Marengoni, E. Mossello, M. Inzitari, A. Morandi, G. Bellelli, on behalf of the Italo-Catalan Study Group on Delirium (ICSGoD)
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BACKGROUND: Prevalence, correlates and outcomes of respiratory failure (RF) were never studied in large populations of older patients hospitalized in acute care medical settings. Little is known about the possible association between RF and delirium, and whether these two syndromes, alone or in combination, may affect short-term mortality.
OBJECTIVES: To investigate prevalence and features of RF, the association between delirium and RF, and their effect on short-term mortality.
DESIGN:Prospective cross-sectional study with data collection on an index day and 30-day follow up.
SETTING AND PARTICIPANTS: 1493 patients aged ≥ 65 years hospitalized in Italian acute medical wards from the 2017 Delirium Day database.
METHODS: RF was identified according to the detection of peripheral oxygen saturation ≤ 91% on the index day, or to ongoing oxygen therapy or non-invasive ventilation on the index day or the day before. A modified National Early Warning Score (NEWS), obtained removing the “Oxygen Saturations” and “Any Supplemental Oxygen” items, measured non-hypoxemic severity of acute illness.
RESULTS: 300 patients (20.1%) had RF. Mortality was 16.6% in the RF group and 8.2% in the non-RF group (p<0.001). Delirium prevalence was 31.3% in RF (94 patients, 72 of whom with hypoactive or mixed delirium) and 22% in non-RF patients (p<0.001). Age, frailty, modified NEWS, steroids use, presence of urinary catheters or other major devices, but not delirium, were independent RF correlates. RF alone (OR [odds ratio]: 1.83; 95% CI [confidence interval]: 1.02-3.29) predicted 30-day mortality after adjustment for confounders, including modified NEWS. Without adjustment for modified NEWS, the combination of delirium and RF also significantly predicted 30-day mortality (OR: 2.26; 95% CI 1.08-4.72).
CONCLUSIONS: In hospitalized older medical patients, RF was a prevalent syndrome which was frequently complicated by delirium. RF was featured by older age, frailty and severe illness, and independently predicted short-term mortality.
CITATION:
F.L. Fimognari ; E. Tassistro ; E. Rossi ; V. Bambara ; M.G. Valsecchi ; A. Cherubini ; A. Marengoni ; E. Mossello ; M. Inzitari ; A. Morandi ; G. Bellelli ; on behalf of the Italo-Catalan Study Group on Delirium (ICSGoD) ; (2024): The Interplay among Respiratory Failure, Delirium, Frailty and Severity of Illness in Hospitalized Older Medical Patients: A Nationwide Multicenter Observational Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.12
THE PREDICTION OF HEALTHCARE UTILIZATION BY FRAILTY AND DISABILITY AMONG DUTCH COMMUNITY-DWELLING PEOPLE AGED 75 YEARS OR OLDER
T. van der Ploeg, R.J.J. Gobbens
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BACKGROUND: Population aging is occurring worldwide. As a result, frailty and disability are in the full interest of practice, policy, and science. An increase in healthcare utilization is an adverse outcome of frailty and disability.
OBJECTIVE: The aim of the present study was the prediction of six indicators of healthcare utilization by frailty and disability measures. The six indicators of healthcare utilization of interest were: use of informal care, number of visits to a general practitioner, hospital admission, receiving nursing care, receiving personal care, and contacts with (health)care professionals.
METHODS: We used a sample of 484 people that was randomly drawn from the municipality of Roosendaal (the Netherlands), a municipality with 78,000 inhabitants. A subset of people who completed the Tilburg Frailty Indicator (TFI) at baseline and the Groningen Activity Restriction Scale (GARS) questionnaires was used with a nine-year followup. We used generalized estimation equations (GEE) to predict the six indicators with the frailty measures (physical, psychological, and social scores) and disability measures (ADL and IADL scores). We also performed GEE analyses adjusted for age, gender, and multimorbidity from part A of the TFI at baseline.
RESULTS: The significant predictors were different for each indicator. However, the physical frailty score, the ADL score, and the IADL score often emerged as significant predictors. These three variables predicted several indicators of healthcare utilization: use of informal care, number of visits to a general practitioner, hospital admission, receiving nursing care, receiving personal care, and contacts with (health)care professionals. The social score was found to be significant for the indicator use of disciplines.
CONCLUSIONS: In conclusion, our study showed that in particular physical frailty, and ADL and IADL disability predicted healthcare utilization in community-dwelling people aged 75 years or older. It is important that care and welfare professionals pay attention to physical frailty and both ADL and IADL disability aiming to diminish frailty and disability and preventing intensive healthcare utilization and related costs. Future research will have to focus on more representative Dutch municipalities in order to get a more reliable and accurate picture of the disciplines used by people with frailty and disability.
CITATION:
T. van der Ploeg ; R.J.J. Gobbens (2024): The Prediction of Healthcare Utilization by Frailty and Disability among Dutch Community-Dwelling People Aged 75 Years or Older. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.14
SELF-REPORTED ORAL DISEASES AND THEIR ASSOCIATION WITH THE FRAILTY INDEX AMONG OLDER JAPANESE PEOPLE: FOURYEAR FOLLOW-UP
R.C. Castrejón-Pérez, S.A. Borges-Yáñez, R. Ramírez-Aldana, I. Nasu, Y. Saito
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BACKGROUND: Oral health is a relevant component for overall health. Oral disease onset at an early age and may harm several health dimensions, especially among older people, and has been associated with frailty.
OBJECTIVE: To evaluate associations between the Frailty Index (FI) and self-reported oral diseases among older, community-dwelling Japanese people.
DESIGN: Cross-sectional and prospective analyses were performed.
SETTING AND PARTICIPANTS: We analyzed data from 2,529 participants at the baseline and four-year follow-up of the Nihon University Japanese Longitudinal Study of Aging, which had a four-year follow-up.
MEASUREMENTS: We used the self-reported number of teeth, self-reported satisfaction with dentures, and self-reported ability to chew hard food as independent variables. We computed an FI that included 40 deficits as the dependent variable. The FI score ranged from 0 to 1, with a higher score associated with adverse health outcomes and mortality. Considering a gamma distribution and controlling for age, gender, marital status, education, working status, and residence area, we fitted generalized linear models.
RESULTS: We found that dissatisfied denture users had a 2.1% (95% CI 1.006–3.279) higher frailty score than non-denture users at the baseline and a 2.1% (95% CI 0.629–3.690) higher frailty score than non-denture users at the four-year follow-up. In the cross-sectional analysis, with each additional reported tooth at the baseline, the FI score was lower by 1.5% (95% CI -2.878 to -0.208) at the four-year follow-up. In both the cross-sectional and the prospective analyses, the FI scores increased as the ability to chew hard food decreased.
CONCLUSIONS: Self-reported oral diseases are associated with the FI score cross-sectionally and prospectively. Identifying factors prospectively associated with frailty may improve strategies for the next generation of older people. Considering oral diseases may help clinicians personalize treatment plans for older people.
CITATION:
R.C. Castrejón-Pérez ; S.A. Borges-Yáñez ; R. Ramírez-Aldana ; I. Nasu ; Y. Saito (2024): Self-Reported Oral Diseases and Their Association with the Frailty index among Older Japanese People: Four-Year Follow-Up. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.10
JFA N°02 - 2024
ASSOCIATIONS BETWEEN HYPERTENSION, ANGIOTENSINCONVERTING ENZYME INHIBITORS, AND PHYSICAL PERFORMANCE IN VERY OLD ADULTS: RESULTS FROM THE ILSIRENTE STUDY
H.J. Coelho-Junior, R. Calvani, M. Tosato, A. Álvarez-Bustos, F. Landi, A. Picca, E. Marzetti
J Frailty Aging 2024;13(2)74-81
Show summaryHide summaryBACKGROUND: Results regarding the associations between hypertension-related parameters and physical performance in older adults are conflicting. A possible explanation for these divergent results is that investigations may not have adjusted their analyses according to the use of angiotensin-converting enzyme inhibitors (ACEIs).
OBJECTIVES: To examine the associations between hypertension-related parameters, ACEI use, and a set of physical performance tests in very old adults.
DESIGN: Cross-sectional study from the ilSIRENTE database.
SETTING: Mountain community of the Sirente geographic area (L’Aquila, Abruzzo, Italy).
PARTICIPANTS: All persons born in the Sirente area (13 municipalities) before 1 January 1924 and living in that region at the time of study were identified and invited to participate. The final sample included 364 older adults (mean age: 85.8 ± standard deviation [SD] 4.8).
MEASUREMENTS: Physical performance was assessed using isometric handgrip strength (IHG), walking speed (WS) at normal and fast pace, 5-time sit-to-stand test (5STS), and muscle power measures. Blood pressure (BP) was measured after 20 to 40 min of rest, while participants sat in an upright position. Drugs were coded according to the Anatomical Therapeutic and Chemical codes. ACEIs were categorized in centrally (ACEI-c) and peripherally (ACEI-p) acting. Blood inflammatory markers, free insulin-like growth factor 1 (IGF-1), and IGF-binding protein 3 (IGFBP-3) were assayed.
RESULTS: Results indicated that 5STS test was significantly and negatively associated with diastolic BP values. However, significance was lost when results were adjusted for ACEI use. Participants on ACEIs were more likely to have greater specific muscle power and higher blood levels of IGFBP-3 than non-ACEI users. When participants were categorized according to ACEI subtypes, those on ACEI-p had higher blood IGF-1 levels compared with ACEI-c users.
CONCLUSIONS: The main findings of the present study indicate that ACEI use might influence the association between hypertension-related parameters and neuromuscular parameters in very old adults. Such results may possibly be linked to the effects of ACEI-p on the IGF-1 pathway.
CITATION:
H.J. Coelho-Junior ; R. Calvani ; M. Tosato ; A. Álvarez-Bustos ; F. Landi ; A. Picca ; E. Marzetti (2024): Associations Between Hypertension, Angiotensin-Converting Enzyme Inhibitors, and Physical Performance in Very Old Adults: Results from the ilSIRENTE Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.15
MYOKINES AND BIOMARKERS OF FRAILTY IN OLDER INPATIENTS WITH UNDERNUTRITION: A PROSPECTIVE STUDY
H. Liu, W. Li, M. Zhu, X. Wen, J. Jin, H. Wang, D. Lv, S. Zha, X. Wu, J. Jiao
J Frailty Aging 2024;13(2)82-90
Show summaryHide summaryBACKGROUND: Population aging might increase the prevalence of undernutrition in older people, which increases the risk of frailty. Numerous studies have indicated that myokines are released by skeletal myocytes in response to muscular contractions and might be associated with frailty. This study aimed to evaluate whether myokines are biomarkers of frailty in older inpatients with undernutrition.
METHODS: The frailty biomarkers were extracted from the Gene Expression Omnibus and Genecards datasets. Relevant myokines and health-related variables were assessed in 55 inpatients aged ≥ 65 years from the Peking Union Medical College Hospital prospective longitudinal frailty study. Serum was prepared for enzyme-linked immunosorbent assay using the appropriate kits. Correlations between biomarkers and frailty status were calculated by Spearman’s correlation analysis. Multiple linear regression was performed to investigate the association between factors and frailty scores.
RESULTS: The prevalence of frailty was 13.21%. The bioinformatics analysis indicated that leptin, adenosine 5‘-monophosphate-activated protein kinase (AMPK), irisin, decorin, and myostatin were potential biomarkers of frailty. The frailty group had significantly higher concentrations of leptin, AMPK, and MSTN than the robust group (p < 0.05). AMPK was significantly positively correlated with frailty (p < 0.05). The pre-frailty and frailty groups had significantly lower concentrations of irisin than the robust group (p < 0.05), whereas the DCN concentration did not differ among the groups. Multiple linear regression suggested that the 15 factors influencing the coefficients of association, the top 50% were the ADL score, MNA-SF score, serum albumin concentration, urination function, hearing function, leptin concentration, GDS-15 score, and MSTN concentration.
CONCLUSIONS: Proinflammatory myokines, particularly leptin, myostatin, and AMPK, negatively affect muscle mass and strength in older adults. ADL and nutritional status play major roles in the development of frailty. Our results confirm that identification of frailty relies upon clinical variables, myokine concentrations, and functional parameters, which might enable the identification and monitoring of frailty.
CITATION:
H. Liu ; W. Li ; M. Zhu ; X. Wen ; J. Jin ; H. Wang ; D. Lv ; S. Zhao ; X. Wu ; J. Jiao (2024): Myokines and Biomarkers of Frailty in Older Inpatients with Undernutrition: A Prospective Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.9
CO-OCCURRENCE OF SARCOPENIA AND FRAILTY IN ACUTELY ADMITTED OLDER MEDICAL PATIENTS: RESULTS FROM THE COPENHAGEN PROTECT STUDY
H. Nygaard, R.S. Kamper, A. Ekmann, S.K. Hansen, P. Hansen, M. Schultz, J. Rasmussen, E. Pressel, C. Suetta
J Frailty Aging 2024;13(2)91-97
Show summaryHide summaryBACKGROUND: Sarcopenia and frailty are often used interchangeably in clinical practice yet represent two distinct conditions and require different therapeutic approaches. The literature regarding the co-occurrence of both conditions in older patients is scarce as most studies have investigated the prevalence of sarcopenia and frailty separately.
OBJECTIVES: We aim to evaluate the prevalence and co-occurrence of sarcopenia and frailty in a large sample of acutely admitted older medical patients.
DESIGN: Secondary analyses using cross-sectional data from the Copenhagen PROTECT study.
SETTING: Patients were included from the acute medical ward at Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark, between November 2019 and November 2021. PARTICIPANTS: Acutely admitted older medical patients (≥65 years).
MEASUREMENTS: Handgrip strength (HGS) was investigated using a handheld dynamometer. Lean mass (SMI) was investigated using direct-segmental multifrequency bioelectrical impedance analyses (DSM-BIA). Low HGS, low SMI, and sarcopenia were defined according to the recent definitions from the European Working Group on Sarcopenia in Older People (EWGSOP2). The Clinical Frailty Scale (CFS) was used to evaluate frailty, with a value > 5 indicating the presence of frailty. Patients were enrolled and tested within 24 hours of admission.
RESULTS: This study included 638 patients (mean age: 78.2+7.6, 55% female) with complete records of SMI, HGS, and the CFS. The prevalence of low HGS, low SMI, sarcopenia, and frailty were 39.0%, 33.1%, 19.7%, and 39.0%, respectively. Sarcopenia and frailty co-occurred in 12.1% of the patients.
CONCLUSIONS: It is well-known that sarcopenia and frailty represent clinical manifestations of ageing and overlap in terms of the impairment in physical function observed in both conditions. Our results demonstrate that sarcopenia and frailty do not necessarily co-occur within the older acutely admitted patient, highlighting the need for separate assessments of frailty and sarcopenia to ensure the accurate characterization of the health status of older patients.
CITATION:
H. Nygaard ; R.S. Kamper ; A. Ekmann ; S.K. Hansen ; P. Hanse ; M. Schultz ; J. Rasmussen ; E. Pressel ; C. Suetta (2024): Co-Occurrence of Sarcopenia and Frailty in Acutely Admitted Older Medical Patients: Results from the Copenhagen PROTECT Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.23
YUBI-WAKKA TEST FOR SARCOPENIA SCREENING IN THE COMMUNITY: COMPARATIVE AGREEMENT, DIAGNOSTIC PERFORMANCE AND VALIDITY WITH CALF CIRCUMFERENCE MEASUREMENTS
M.R.B. Piodena-Aportadera, S. Lau, C.N. Tan, J. Chew, J.P. Lim, N.H. Ismail, Y.Y. Ding, W.S. Lim
J Frailty Aging 2024;13(2)98-107
Show summaryHide summaryBACKGROUND: Screening tools such as calf circumference (CC) and Yubi-wakka (finger-ring) test have been recognized as effective tools by Asian Working Group for Sarcopenia 2019 (AWGS’19) for sarcopenia screening but their comparative agreement, diagnostic performance and validity are unclear.
OBJECTIVES: This study aims to determine: (i)agreement between calf and finger-ring circumference, (ii)diagnostic performance for low muscle mass and AWGS’19 sarcopenia diagnosis, (iii)correlation with muscle mass, strength, and physical performance, and (iv)association with frailty, life space mobility and physical activity.
METHODS: We studied 187 healthy community-dwelling older adults (mean age=66.8+7.0years) from the GERILABS-2 study. CC was measured via (i) both calves in sitting and standing positions, and (ii) Yubi-wakka test by encircling the thickest part of the non-dominant calf with index fingers and thumbs of both hands. We performed Cohen’s kappa to check for agreement, area under receiver operating characteristic curve (AUC) to compare diagnostic performance, partial correlations adjusted for age and gender to compare convergent validity, and logistic regression to determine predictive validity for outcome measures.
RESULTS: Sarcopenia prevalence was 24.0% (AWGS’19). Yubi-wakka identified 16.6% of participants as screen-positive (“smaller”), showing moderate agreement only with non-dominant sitting CC measurements (k=0.421,p<0.001) and having lower diagnostic performance in determining low muscle mass (AUC=0.591 vs 0.855-0.870,p<0.001; sensitivity=57.1% vs 75.5-90.8%; specificity=58.4% vs 70.8-80.9%) and sarcopenia diagnosis (AUC=0.581 vs 0.788-0.818,p<0.001; sensitivity=55.6% vs 57.5-71.8%; specificity=74.4% vs 75.6-88.9%) compared to CC measurements. Yubi-wakka correlated significantly with muscle mass, grip strength and knee extension but not physical performance. When adjusted for age, gender and hypertension, Yubi-wakka was significantly associated with frailty (OR=3.96,95%CI:1.09-14.38), life space mobility (OR=2.38,95%CI:1.08-5.24) and physical activity (OR=2.50,95%CI:1.07-5.86).
DISCUSSION AND CONCLUSIONS: Yubi-wakka provides a self-administered, low-cost and practicable community screening tool for sarcopenia. Our study affirmed the convergent and predictive validity of Yubi-wakka, albeit with lower sensitivity and specificity in diagnostic performance compared to CC measurements.
CITATION:
M.R.B. Piodena-Aportadera ; S. Lau ; C.N. Tan ; J. Chew ; J.P. Lim ; N.H. Ismail ; Y.Y. Ding ; W.S. Lim (2024): Yubi-Wakka Test for Sarcopenia Screening in the Community: Comparative Agreement, Diagnostic Performance and Validity with Calf Circumference Measurements. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.25
NEW PERSPECTIVES IN THE ASSOCIATION BETWEEN ANTHROPOMETRY AND MORTALITY: THE ROLE OF CALF CIRCUMFERENCE
C. Ceolin, V. Acunto, C. Simonato, S. Cazzavillan, M. Vergadoro, M.V. Papa, G.S. Trapella, R. Sermasi, M. Noale, M. De Rui, B.M. Zanforlini, C. Curreri, A. Bertocco, M. Devita, A. Coin, G. Sergi
J Frailty Aging 2024;13(2)108-115
Show summaryHide summaryAIMS: Considering the impact of sarcopenia on mortality, and the difficulty to assessment of body composition, the hypothesis of the study is that calf circumference (CC) is closely related to mortality in older patients. The aim of the study was to analyze the potential role of CC to predict mortality in old individuals at 3, 6 and 12 months after discharge from hospital.
METHODS: Patients aged >65 years were recruited for this retrospective study from September 2021 to March 2022. Their physical and body composition characteristics (including Body Mass Index-BMI and Mini Nutritional Assessment-MNA) were measured; data on mortality at 3 (T3), 6 (T6) and 12 (T12) months after discharge were recorded. Sarcopenia was diagnosed according to the 2019 European Consensus criteria.
RESULTS: Participants were 192 older adults (92 women), with a mean age of 82.8±7.0 years. Sarcopenic people were 41. The mortality rate was higher in sarcopenic people only at T3 and T6. CC had comparable validity in predicting mortality to that of MNA and ASMMI (Appendicular Skeletal Muscle Mass), and was better than BMI and serum albumin at each time point. Youden’s index showed that the best cut-off for CC for predicting mortality was 30.6 cm both at T3 (sensitivity: 74%; specificity: 75%) and T6 (sensitivity: 75%; specificity: 67%). At the Cox regression model for mortality, high values of CC (HR 0.73, CI95% 0.60-0.89/p<0.001) and ADL scores (HR 0.72, CI95% 0.54-0.96/p=0.04) were protective factors at T6 and T12 respectively; at T12 high comorbidity rate was a risk factor (HR 1.28, IC95% 1.02-1.62/p=0.04).
CONCLUSIONS: CC has a validity comparable to MNA and ASMMI in predicting mortality at 3, 6 and 12 months after hospital discharge. Moreover, it can be considered an independent predictor of medium-term mortality in the hospitalized older population. CC can be an effective method for the prognostic stratification of these patients, due to its simplicity and immediacy.
CITATION:
C. Ceolin ; V. Acunto ; C. Simonato ; S. Cazzavillan ; M. Vergadoro ; M.V. Papa ; G.S. Trapella ; R. Sermasi ; M. Noale ; M. De Rui ; B.M. Zanforlini ; C. Curreri ; A. Bertocco ; M. Devita ; A. Coin ; G. Sergi (2024): New Perspectives in the Association between Anthropometry and Mortality: The Role of Calf Circumference. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.4
SERUM CREATININE–CYSTATIN C BASED SCREENING OF SARCOPENIA IN COMMUNITY DWELLING OLDER ADULTS: A CROSS-SECTIONAL ANALYSIS
R. Matsuzawa, K. Nagai, K. Takahashi, T. Mori, M. Onishi, S. Tsuji, K. Hashimoto, K. Tamaki, Y. Wada, H. Kusunoki, Y. Nagasawa, K. Shinmura
J Frailty Aging 2024;13(2)116-124
Show summaryHide summaryOBJECTIVES: To compare the discriminative capabilities for the manifestation of sarcopenia or physical frailty between serum creatinine- and cystatin C-derived indices among community-dwelling older adults.
DESIGN: Cross-sectional study.
SETTING: Primary Care and Community.
PARTICIPANTS: We utilized a subset of data from the Frail Elderly in the Sasayama-Tamba Area (FESTA) study, which was initiated in 2015 to gather comprehensive information on various health-related parameters among community-dwelling older individuals (age ≥65 years).
MEASUREMENTS: Five serum creatinine–cystatin C based indices including the Sarcopenia Index, the serum creatinine/cystatin C ratio, the disparity between serum cystatin-C-based and creatinine-based estimated GFR, the total body muscle mass index (TBMM), and the prediction equation for skeletal muscle mass index (pSMI) were employed. Sarcopenia and physical frailty were identified based on the Asian Working Group for Sarcopenia criteria and the revised Japanese version of the Cardiovascular Health Study criteria, respectively. The receiver operating characteristic (ROC) and logistic regression analyses were performed to assess the discriminative abilities of these tools.
RESULTS: In the analysis of 954 participants, 52 (5.5%) were identified with sarcopenia and 35 (3.7%) with physical frailty. Regarding sarcopenia discrimination, TBMM and pSMI both exhibited area under the curve (AUC) values exceeding 0.8 for both men and women. Concerning the identification of physical frailty, AUC values ranged from 0.61 to 0.77 for males and 0.50 to 0.69 for females. In the multivariate logistic regression analyses, only TBMM and pSMI consistently displayed associations with sarcopenia, irrespective of sex (P<0.001, respectively). On the other hand, no consistent associations were observed between the indices and physical frailty.
CONCLUSIONS: This study provides a robust association of a serum creatinine- and cystatin C-derived indices, especially TBMM and pSMI, with sarcopenia among community-dwelling older adults. Conversely, the application of these indices for the screening of physical frailty has its constraints, necessitating further investigation.
CITATION:
R. Matsuzawa ; K. Nagai ; K. Takahashi ; T. Mori ; M. Onishi ; S. Tsuji ; K. Hashimoto ; K. Tamaki ; Y. Wada ; H. Kusunoki ; Y. Nagasawa ; K. Shinmura (2024): Serum Creatinine–Cystatin C Based Screening of Sarcopenia in Community Dwelling Older Adults: A Cross-Sectional Analysis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.13
DEVELOPMENT OF THE CLINICAL PHYSICAL RESILIENCE ASSESSMENT SCALE (CHEES) IN CHINESE OLDER ADULTS
J. Li, P. Liu, Y. Zhang, G. Wang, Y. Zhou, Y. Xing, L. Zhang, Y. Li, L. Ma
J Frailty Aging 2024;13(2)125-130
Show summaryHide summaryBACKGROUND: Physical resilience is an emerging concept that describes an individual’s capacity to recover from stressors. However, few instruments are currently available for assessing physical resilience.
OBJECTIVE: To develop a scale to assess physical resilience in older adults.
DESIGN: Development of a clinical scale.
SETTING AND PARTICIPANTS: A total of 172 hospitalized older adults were recruited.
MEASUREMENTS: This study comprised two stages. First, a pool of physical resilience scale items was created through a literature review, and the Delphi method was used to establish an initial scale. Second, the initial physical resilience scale was tested on hospitalized older adults.
RESULTS: Five primary and 19 secondary items were identified after reviewing the literature. After two rounds of expert consultations, three primary and 16 secondary items were determined. The overall Cronbach’s alpha for the scale was 0.760. Except for items N2, N4, N5, N8, and N14, Pearson’s correlation between the scores of the remaining items and the total score ranged from 0.407 to 0.672. Except for items N2, N4, and N5, the corrected item-total correlation results ranged from 0.301 to 0.580, indicating good consistency between each item and the overall scale. Factor analysis showed that except for N7, the factor loadings of the remaining items were between 0.584 and 0.844. After expert discussions, items N2, N4, N7, and N14 were included in the scale, and items N5 and N8 were removed.
CONCLUSION: A 14-item physical resilience scale, CHEES, was developed to assess physical resilience levels in older adults.
CITATION:
J. Li ; P. Liu ; Y. Zhang ; G. Wang ; Y. Zhou ; Y. Xing ; L. Zhang ; Y. Li ; L. Ma ; (2024): Development of the Clinical pHysical rEsilience assEssment Scale (CHEES) in Chinese Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.24
THE IMPACT OF EXERCISE AND COGNITIVE STIMULATION THERAPY ON INTRINSIC CAPACITY COMPOSITE SCORE IN PREFRAIL OLDER ADULTS: A PRE-POST INTERVENTION STUDY
R.A. Merchant, Y.H. Chan, D. Anbarasan, J. Woo
J Frailty Aging 2024;13(2)131-138
Show summaryHide summaryIntrinsic capacity(IC) is a measure of physical, cognitive, vitality, psychological, and sensory abilities which determines functional ability. Decline in IC has been shown to accelerate the trajectory of frailty. We aim to show the impact of exercise (Ex) and cognitive stimulation therapy (CST) on (i) IC domains and composite score (ii) frailty and functional ability in pre-frail older adults. Secondary analysis of data from a pre-post intervention study of pre-frail older adults ≥ 65 years attending primary care clinic. Control (CON) and 2 intervention groups ((i) Ex 6 months (ii) CST 3 months with Ex 6 months (Ex+CST)) were recruited. Pre-frailty was determined using the FRAIL scale. Questionnaires (on demographics, functional ability, and depression) were administered and physical function assessment (gait speed (GS), short physical performance battery (SPPB) test, handgrip strength, five times sit-to-stand (5x-STS)) was conducted at 0, 3, 6 and 12 months. Four domains of IC were evaluated: locomotion (GS and 5x-STS), vitality (nutrition and muscle mass), cognition (MoCA and subjective cognitive decline) and psychological (depression and anxiety). Each domain was scored from 0 to 2 (no decline) with total IC score ranging from 0 to 8. 187 participants completed baseline and 3 months assessments, 109 (58.3%) were allocated to CON, 37 (19.8%) to Ex and 41 (21.9%) to Ex + CST groups. At 3 months, both Ex and Ex +CST showed improvement in IC composite scores, locomotion, and psychological domain scores but improvement in cognition domain only in Ex + CST group. At 6 months, there were improvements in total IC score, locomotion, vitality, and psychological domain in both Ex and Ex + CST groups. At 12 months, significant improvement was evident in total IC score for Ex and Ex+CST groups, vitality when fatigue (in addition to muscle mass and nutrition) was added and instrumental activities of daily living. Multidomain intervention incorporating exercise and CST resulted in significant improvement in IC composite scores, locomotion, vitality, cognition, and psychological domains.
CITATION:
R.A. Merchant ; Y.H. Chan ; D. Anbarasan ; J. Woo (2024): The Impact of Exercise and Cognitive Stimulation Therapy on Intrinsic Capacity Composite Score in Pre-Frail Older Adults: A Pre-Post Intervention Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.16
DOSE-RESPONSIVE IMPACTS OF SOCIAL FRAILTY ON INTRINSIC CAPACITY AND HEALTHY AGING AMONG COMMUNITY-DWELLING MIDDLE-AGED AND OLDER ADULTS: STRONGER ROLES OF SOCIAL DETERMINANTS OVER BIOMARKERS
S.-T. Huang, W.-H. Lu, W.-J. Lee, L.-N. Peng, L.-K. Chen, F.-Y. Hsiao
J Frailty Aging 2024;13(2)139-148
Show summaryHide summaryOBJECTIVE: The intricate relationship between social determinants, e.g., social frailty, biomarkers and healthy aging remains largely unexplored, despite the potential for social frailty to impact both intrinsic capacity (IC) and functional ability in the aging process.
DESIGN: Retrospective longitudinal cohort study.
SETTING AND PARTICIPANTS: Participants aged 50+ years from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan, stratified into three age groups: 50-64, 65-74 and 75+.
MEASUREMENTS: Social frailty was defined based on a score derived from four domains: exclusion from general resources, social resources, social activity, and fulfillment of basic social needs. The scores were categorized as score=0 (no social frailty), 1 (social pre-frailty), and 2+ (social frailty). Multivariable logistic regression and Cox proportional hazard models were employed to examine the dose-responsive relationship between social frailty, low IC, functional and psychological health, and mortality.
RESULTS: Of 1015 study participants, 24.9% and 7.9% were classified as social pre-frailty and social frailty, respectively. No significant differences were observed in most biomarkers between those with social frailty and those without. A dose-responsive relationship was found between social frailty and increased risk of low IC (social pre-frailty: aOR 2.20 [95% CI 1.59-3.04]; social frailty: 5.73 [3.39-9.69]). Similar results were found for functional and psychological health. However, no significant association between social frailty and all-cause mortality was found at the 4-year follow-up (social pre-frailty: aHR 1.52 [95% CI 0.94-2.43]; social frailty: 1.59 [0.81-3.09]).
CONCLUSIONS: The significant association between social frailty and low IC, functional limitations, cognitive declines, and depressive symptoms underscores the pressing need for research on intervention strategies to enhance healthy aging in the lifespan course.
CITATION:
S.-T. Huang ; W.-H. Lu ; W.-J. Lee ; L.-N. Peng ; L.-K. Chen ; F.-Y. Hsiao (2024): Dose-Responsive Impacts of Social Frailty on Intrinsic Capacity and Healthy Aging among Community-Dwelling Middle-aged and Older Adults: Stronger Roles of Social Determinants over Biomarkers. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.8
WEARABLE TECHNOLOGIES FOR HEALTHY AGEING: PROSPECTS, CHALLENGES, AND ETHICAL CONSIDERATIONS
S. Canali, A. Ferretti, V. Schiaffonati, A. Blasimme
J Frailty Aging 2024;13(2)149-156
Show summaryHide summaryDigital technologies hold promise to modernize healthcare. Such opportunity should be leveraged also to address the needs of rapidly ageing populations. Against this backdrop, this paper examines the use of wearable devices for promoting healthy ageing. Previous work has assessed the prospects of digital technologies for health promotion and disease prevention in older adults. However, to our knowledge, ours is one of the first attempts to specifically address the use of wearables for healthy ageing, and to offer ethical insights for assessing the prospects of leveraging wearable devices in this context. We provide an analysis of the considerable opportunities associated with the use of wearables for healthy ageing, with a focus on the five domains of intrinsic capacity: locomotion, sensory functions, psychological aspects, cognition, and vitality. We then highlight current limitations and ethical challenges of such approach to healthy ageing, including issues related to access, inclusion, privacy, surveillance, autonomy, and regulation. We conclude by discussing the implications of our analysis in light of current debates on the ethics of digital health, and suggest measures to address the identified challenges.
10.14283/jfa.2024.19
CITATION:
S. Canali ; A. Ferretti ; V. Schiaffonati ; A. Blasimme (2024): Wearable Technologies for Healthy Ageing: Prospects, Challenges, and Ethical Considerations. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.19
AWARENESS AND SELF-REPORTED KNOWLEDGE AND TRAINING ON NUTRITION IN OLDER PEOPLE AMONG PRIMARY CARE PRACTITIONERS
L. Rodríguez-Mañas, J.M. Moreno-Villares, J. Álvarez Hernández, A.A. Romero Secín, M.L. López Díaz-Ufano, F. Suárez Gonzále, A. Costa-Grille, J. López-Miranda, J.M. Fernández-Garcia, on behalf of the Working Group on Nutrition in Older People-DANONE Institute
J Frailty Aging 2024;13(2)157-162
Show summaryHide summaryOBJECTIVES: To assess the awareness and training of primary care physicians on nutrition in older patients.
DESIGN: Observational, real-world data survey.
SETTING: Primary Care.
PARTICIPANTS: One hundred sixty-two physicians, generalists and specialists, working in primary care.
MEASUREMENTS: Participants received an online questionnaire with 18 questions concerning the importance of nutrition, degree of knowledge, needs, and training in nutrition. The results were evaluated using univariate descriptive analysis, with a percentage for each chosen answer. Logistic regression models were used to evaluate if answers were related to training in nutrition and professional experience.
RESULTS: 43.2% of participants reported that nutrition is very important in individuals over 65 years old, and 90% were aware of the importance of nutrition in healthy aging. Nutritional problems affect 30 to 50% of patients, according to 44.7% of participants. 89.2% agree about the need for nutritional assessment in older patients; however, the professionals believe they should be better prepared. Two out of three respondents consider the training received in nutrition during their undergraduate course or continuing medical education as deficient. Time of professional practice was mainly associated with conceptual facts, while continuing medical education did with practical issues, mainly the use of screening and diagnostic tools [FRAIL (OR: 3.16; 95%IC: 1.55-6.46), MNA-SF (OR: 6.455; 95%IC: 2.980-13.981) and SARC-F (OR: 3.063; 95%IC: 1.284-7.309)].
CONCLUSION: Although primary care professionals are aware of the importance of nutrition in older patients, there are still gaps in daily practice that could be improved by developing educational strategies.
CITATION:
L. Rodríguez-Mañas ; J.M. Moreno-Villares ; J. Álvarez Hernández ; A.A. Romero Secín ; M.L. López Díaz-Ufano ; F. Suárez González ; A. Costa-Grille ; J. López-Miranda ; J.M. Fernández-Garcia ; on behalf of the Working Group on Nutrition in Older People-DANONE Institute ; (2024): Awareness and Self-Reported Knowledge and Training on Nutrition in Older People among Primary Care Practitioners. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.11
LONELINESS PREDICTS PROGRESSION OF FRAILTY IN MARRIED AND WIDOWED, BUT NOT UNMARRIED COMMUNITY DWELLING OLDER ADULTS
C. Pollak, J. Verghese, A.S. Buchman, Y. Jin, H.M. Blumen
J Frailty Aging 2024;13(2)163-171
Show summaryHide summaryBackground: Loneliness is highly prevalent among older adults and is associated with frailty. Most studies consider loneliness in isolation without consideration for structural and functional measures of social relationships – and longitudinal studies are scarce.
OBJECTIVES: This study examined longitudinal associations between loneliness and frailty and analyzed how structural and functional social measures influence these associations.
DESIGN: Linear mixed effects models examined longitudinal associations between loneliness and frailty assessed with the frailty index (scale 0-100). Models were adjusted for baseline age, gender, education, depressive symptoms, global cognition, and structural (e.g., social network, marital status), and functional social measures (e.g., social, cognitive, and physical activity, and social support).
PARTICIPANTS: Loneliness and frailty data from 1,931 older adults without dementia at baseline from the Rush Memory and Aging Project were examined (mean age 79.6 ± 7.7 years, 74.9% female).
MEASUREMENTS: Baseline loneliness assessed by the de Jong Gierveld Loneliness Scale was the predictor of interest.
RESULTS: Frailty increased significantly over a mean follow-up period of 4.6 years. Effects of loneliness on frailty were modified by marital status. Loneliness predicted an additional accumulation of 0.37 and 0.34 deficits on the frailty index per year in married and widowed individuals respectively, compared to those who were not lonely (married: p=0.009, CI 0.09, 0.64; widowed: p=0.005, CI 0.1, 0.58). Loneliness did not predict frailty progression in unmarried individuals.
CONCLUSIONS: Loneliness predicts frailty progression, highlighting the importance of social determinants on physical health in aging.
CITATION:
C. Pollak ; J. Verghese ; A.S. Buchman ; Y. Jin ; H.M. Blumen (2024): Loneliness Predicts Progression of Frailty in Married and Widowed, but Not Unmarried Community Dwelling Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.27
POOR NUTRITIONAL STATUS IS ASSOCIATED WITH DEATH IN A POPULATION OF DIALYZED OLDER PERSONS
D. Azzolino, S. Vettoretti, M.M. Poggi, A. Soldati, L. Caldiroli, L.A. Dalla Vecchia, M. Cesari
J Frailty Aging 2024;13(2)172-178
Show summaryHide summaryBACKGROUND: Older patients in hemodialysis have high prevalence of malnutrition that is often associated with rapid weight loss till cachexia.
OBJECTIVESs: We aimed to investigate whether in older patients undergoing hemodialysis the association between poor nutritional status and mortality may be independent of comorbidities and other risk factors.
DESIGN: Retrospective longitudinal study.
SETTING: Unit of Nephrology, Dialysis and Kidney Transplantation of the Policlinic Hospital of Milan, Milan, Italy.
PARTICIPANTS: A total of 107 prevalent patients undergoing hemodialysis for at least three months.
MEASUREMENTS: Sociodemographic, clinical, and biological data were recorded. Unintentional weight loss (UWL) was defined as loss of body weight > 5% in 3 months or > 10% in 6 months. We computed a 21-item Frailty Index that included clinical conditions associated with malnutrition and mortality in this population. Unadjusted and adjusted Cox proportional hazard models were performed to test the association of UWL, albumin and transferrin levels with death. Survival analyses based on Kaplan-Meier estimates were performed.
RESULTS: Patients’ age was 79 (±7.7) years; 38 (35%) were women. Thirty-one patients (29%) died during follow-up. Eighteen (16.8%) patients experienced UWL during the follow-up period. UWL was positively associated with death in the unadjusted model and even after the progressive inclusion of potential confounders. Low albumin levels were positively associated with death only in the unadjusted and partially adjusted models while low transferrin levels were not associated with death in none of the models. Mortality was significantly higher in those patients experiencing both UWL and albumin levels below 3.5 mg/dL.
CONCLUSIONS: In older patients undergoing chronic hemodialysis UWL is associated with mortality independently of comorbidities and other risk factors. Patients presenting both UWL and low albumin levels were those experiencing the worst outcomes in terms of mortality.
CITATION:
D. Azzolino ; S. Vettoretti ; M.M. Poggi ; A. Soldati ; L. Caldiroli ; L.A. Dalla Vecchia ; M. Cesari (2024): Poor Nutritional Status Is Associated with Death in a Population of Dialyzed Older Persons. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.2
IDENTIFYING FRAILTY IN ADMINISTRATIVE DATABASES: A NARRATIVE REVIEW
A. Campeau Calfat, C. Sirois
J Frailty Aging 2024;13(2)179-183
Show summaryHide summaryFrailty is a state of increased vulnerability that can lead to premature death. While various clinical tools effectively measure frailty in individual care, their applicability at the population-level is limited. However, in the era of big-data, administrative databases serve as valuable sources for medication-based research and population surveillance. This narrative scoping review synthesizes the literature on tools used within administrative databases to detect frailty in community-dwelling older adults. The 17 identified publications explore four tools that meet the criteria of the Rockwood & Mitnitski frailty index model. Despite variations in the deficits they incorporate, all tools appear to be valuable for identifying frailty and predicting the risk of adverse events. Using those tools within administrative databases can be useful for research and surveillance purposes.
CITATION:
A. Campeau Calfat ; C. Sirois (2024): Identifying Frailty in Administrative Databases: A Narrative Review. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.18
COMBINED SOCIAL FRAILTY AND LIFE-SPACE ACTIVITIES ASSOCIATED WITH RISK OF DISABILITY: A PROSPECTIVE COHORT STUDY
T. Doi, K. Tsutsumimoto, K. Makino, S. Nakakubo, F. Sakimoto, S. Matsuda, H. Shimada
J Frailty Aging 2024;13(2)184-188
Show summaryHide summaryOBJECTIVES: To examine the association between social frailty and life-space activities, and determine whether a combined status of life-space activities and social frailty is associated with risk of disability among older adults.
DESIGN: A prospective cohort study.
SETTING AND PARTICIPANTS: The participants were 8,301 older adults (mean age 72.9 ± 5.6 years, women [53.3%]) from a community setting.
METHODS: Life-space activities were evaluated using the Active Mobility Index (AMI) to assess activities in each life-space (distance from the respondent’s home: up to 1 km, 1–10 km, or greater than 10 km) during the past 1 month. Activities were also assessed according to physical or social activity. Social frailty and characteristics were measured at the baseline. Incident disability was assessed according to long term care insurance.
RESULTS: The lowest scoring group was based on the quartile in each of the AMI scores (Q1), with reference to the highest scoring group, which had a higher odds ratios for social frailty (AMI total score Q1: OR 4.32, 95% CI 3.43–5.45, AMI physical score Q1: 2.19, 95% CI 1.79–2.69, AMI social score Q1: 5.04, 95% CI 3.94–6.44). During the follow-up (mean 23.5 months), 330 participants had incident disability. Incident disability was associated with social frailty. Combined status of social frailty and low AMI increased the risk of disability (HR 2.15, 95% CI 1.52-3.03), with reference to non-frailty and higher AMI scores.
CONCLUSIONS AND IMPLICATIONS: Social frailty or reduced activity in life-space assessment were identified as risk factors for incident disability. To decrease the risk of disability, the development of an intervention program to enhance activities and cope with social frailty is required.
CITATION:
T. Doi ; K. Tsutsumimoto ; K. Makino ; S. Nakakubo ; F. Sakimoto ; S. Matsuda ; H. Shimada (2024): Combined Social Frailty and Life-Space Activities Associated with Risk of Disability: A Prospective Cohort Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.17
TEACHING FRAILTY TO MEDICAL RESIDENTS: A NEEDS ASSESSMENT AMONG GERIATRICS FACULTY
M. Cheslock, A. Nahas, A.R. Orkaby, A.W. Schwartz
J Frailty Aging 2024;13(2)189-192
Show summaryHide summaryBACKGROUND: Knowledge of frailty is essential for meeting the Accreditation Council for Graduate Medical Education core competencies for US trainees. The UK General Medical Council requires that frailty be included in undergraduate and graduate medical education curricula. Trainees are expected to appropriately modify care plans and help make patient-centered decisions, while incorporating diagnostic uncertainty, such as frailty, in older adults. Little is known about current needs for frailty instruction in graduate medical education in the US and beyond.
OBJECTIVE: We sought to capture faculty perceptions on how frailty should be defined and identified, and what aspects and level of detail should be taught to residents.
DESIGN: The authors developed a 4-item short response questionnaire, and faculty had the option to respond via electronic survey or via semi-structured interviews.
SETTING AND SUBJECTS: Respondents included 24 fellowship-trained geriatricians based at 6 different academic medical centers in a single urban metropolitan area.
METHODS: An invitation to participate in either an electronic survey or semi-structured virtual interview was e-mailed to 30 geriatricians affiliated with an academic multi-campus Geriatric Medicine fellowship. Responses were transcribed and coded independently by two authors.
RESULTS: Responses were received from 24 geriatricians via a combination of digital questionnaires (n=18) and semi-structured online interviews (n=6), for a response rate of 80%. Responses revealed significant diversity of opinion on how to define and identify frailty and how these concepts should be taught.
CONCLUSIONS: As frailty is increasingly incorporated into clinical practice, consensus is needed on how to define and teach frailty to residents.
CITATION:
M. Cheslock ; A. Nahas ; A.R. Orkaby ; A.W. Schwartz (2024): Teaching Frailty to Medical Residents: A Needs Assessment Among Geriatrics Faculty. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2024.26
14th International Conference on Frailty & Sarcopenia Research (ICFSR) March 20-22, 2024, Albuquerque, NM, USA
Symposia - Conferences - Oral Communications
J Frailty Aging 2024;13(S1):S2-S42
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