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ASSOCIATION OF MUSCLE STRENGTH AND GAIT SPEED WITH CROSS-SECTIONAL MUSCLE AREA DETERMINED BY MID-THIGH COMPUTED TOMOGRAPHY - A COMPARISON WITH SKELETAL MUSCLE MASS MEASURED BY DUAL-ENERGY X-RAY ABSORPTIOMETRY

K. Tsukasaki, Y. Matsui, H. Arai, A. Harada, M. Tomida, M. Takemura, R. Otsuka, F. Ando, H. Shimokata

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Background: Muscle mass is often mentioned not to reflect muscle strength. For muscle mass assessment skeletal muscle index (SMI) is often used. We have reported that dual-energy X-ray absorptiometry (DXA)-derived SMI does not change with age in women, whereas the cross-sectional muscle area (CSMA) derived from computed tomography (CT) does. Objectives: The present study aimed to compare CT and DXA for the assessment of muscle tissue. Design & Setting: Cross-sectional study in the local residents. Participants: A total of 1818 subjects (age 40-89 years) randomly selected from community dwellers underwent CT examination of the right mid-thigh to measure the cross-sectional muscle area (CSMA). Skeletal muscle mass (SMM) was measured by DXA. The subjects performed physical function tests such as grip strength, knee extension strength, leg extension strength, and gait speed. The correlation between CT-derived CSMA and DXA-derived SMM along with their association with physical function was examined. Results: After controlling for related factors, the partial correlation coefficient of muscle cross-sectional area (CSA) with physical function was larger than that of DXA-derived SMM for gait speed in men (p=0.002) and knee extension strength in women (p=0.03). The partial correlation coefficient of quadriceps (Qc) CSA with physical function was larger than that of DXA-derived SMM for leg extension power in both sexes (p=0.01), gait speed in men (p<0.001), and knee extension strength in women (p<0.001). Conclusion: Mid-thigh CT-derived CSMA, especially Qc CSA, showed significant associations with grip strength, knee extension strength, and leg extension power, which were equal to or stronger than those of DXA-derived SMM in community-dwelling middle-aged and older Japanese people. The mid-thigh CSMA may be a predictor of mobility disability, and is considered to be useful in the diagnosis of sarcopenia.

CITATION:
K. Tsukasaki ; Y. Matsui ; H. Arai ; A. Harada ; M. Tomida ; M. Takemura ; R. Otsuka ; F. Ando ; H. Shimokata (2020): Association of muscle strength and gait speed with cross-sectional muscle area determined by mid-thigh computed tomography - a comparison with skeletal muscle mass measured by dual-energy X-ray absorptiometry. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.16

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PRACTICAL IMPLICATIONS FOR STRENGTH AND CONDITIONING OF OLDER PRE-FRAIL FEMALES

N.W. Bray, G.J. Jones, K.L. Rush, C.A. Jones, J.M. Jakobi

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Approaches to and benefits from resistance training for non-compromised older adults are well known. Less is understood about resistance training with pre-frail older adults, and even less information is available on the practical approaches to delivery. Herein, we describe an approach in pre-frail females who undertook a multi-component exercise intervention, inclusive of high-intensity, free-weight, functional resistance training. Capitalizing on the principle of overload is possible and safe for pre-frail females through constant reassurance of ability and adjustments in technique. Making exercise functionally relevant, for example, a squat is the ability to get on and off a toilet, resonates meaning. Older pre-frail females are affected by outside (clinical) influences. The exercise participant, and extraneous persons need to be educated on exercise approaches, to increase awareness, debunk myths, and enhance support for participation. Identification of individuality in a group session offers ability to navigate barriers for successful implementation.

CITATION:
N.W. Bray ; G.J. Jones ; K.L. Rush ; C.A. Jones ; J.M. Jakobi (2020): Practical Implications for Strength and Conditioning of Older Pre-Frail Females. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.15

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MULTI-COMPONENT EXERCISE WITH HIGH-INTENSITY, FREE-WEIGHT, FUNCTIONAL RESISTANCE TRAINING IN PRE-FRAIL FEMALES: A QUASI-EXPERIMENTAL, PILOT STUDY

N.W. Bray, G.J. Jones, K.L. Rush, C.A. Jones, J.M. Jakobi

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Background: No study has performed an exercise intervention that included high-intensity, free-weight, functional resistance training, and assessed frailty status as an inclusion criteria and outcome measure via original, standardized tools, in pre-frail females. Objectives: Determine if the intervention strategy is not only feasible and safe, but can also improve frailty status, functional task performance, and muscle strength. Design: Pilot, quasi-experimental. Setting: Community. Participants: 20 older-adults with pre-frailty characteristics. Intervention: 12-weeks (3 days/week, 45-60 minutes/session) of multi-component exercise, inclusive of aerobic, resistance, balance and flexibility exercises. The crux of the program was balance and resistance exercises, the latter utilized high-intensity, free-weight, functional resistance training. The control group maintained their usual care. Measurements: 1) Feasibility and safety (dropout, adherence, and adverse event); 2) Frailty (Frailty Phenotype, Clinical Frailty Scale, and gait speed); 3) Functional task performance (grip strength and sit-to-stand time); and 4) Isometric and isotonic strength of the knee extensors and elbow flexors. Results: No participants dropped out of the intervention or experienced an adverse event, and adherence averaged 88.3%. The exercise group became less frail, whereas the control group became more frail. There was a significant within-group improvement in exercise participants gait speed (p ≤ 0.01, +0.24 m/sec), grip strength (p ≤ 0.01, +3.9 kg), and sit-to-stand time (p ≤ 0.01, -5.0 sec). There was a significant within-group improvement in exercise participants knee extension isometric torque (p ≤ 0.05, +7.4 Nm) and isotonic velocity (p = ≤ 0.01, +37.5 ˚/sec). Elbow flexion isotonic velocity significantly declined within the control group (p ≤ 0.01, -20.2 ˚/sec) and demonstrated a significant between-group difference (p ≤ 0.05, 40.73 ˚/sec) post-intervention. Conclusions: The intervention strategy appears to be feasible and safe, and may also improve frailty status, functional task performance, and muscle strength. These results help calculate effect size for a future randomized controlled trial.

CITATION:
N.W. Bray ; G.J. Jones ; K.L. Rush ; C.A. Jones ; J.M. Jakobi (2020): Multi-component exercise with high-intensity, free-weight, functional Resistance Training in pre-frail females: A quasi-experimental, pilot study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.13

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SELF-RATED FRAILTY AND MORTALITY IN OLD MEN: THE MANITOBA FOLLOW-UP STUDY

E. Sachs, P. St. John, A. Swift, R. Tate

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Background: While a multitude of definitions and operationalizations of frailty have been developed, rarely have these considered the perspective of the older adult themselves. This knowledge gap was addressed by examining older adults’ self-rating of frailty. Objectives: To assess the validity of self-rated frailty and to determine whether self-rated frailty relates to mortality. Design: The Manitoba Follow-up Study was initiated in 1948 as a prospective cohort study of 3,983 men. Setting: Community dwelling older adult men. Participants: Survivors of the original cohort (231 men) were sent a quality of life survey in 2015. A response was received from 186 men, including 146 surveys completed by the participant himself and thus were eligible to include (completion rate of 78.4%). Measurements: The quality of life survey is sent out annually to the study participants to ascertain information about mental, physical, and social functioning. In 2015, the Clinical Frailty Scale was adapted and added to the survey as a simple self-rating of frailty. Results: The mean age of the 146 respondents in 2015 was 93.7 years (SD 2.7) Self-ratings of “moderate-severe” frailty, received from 132 men, were associated with worse measures of physical health and functional impairment, thus supporting the significance of self-rated frailty. Adjusted for age, the Hazard Ratio for mortality over the next 3 years was 3.3 (95% CI: 1.5, 7.1) for those who rated themselves as “mildly to severely frail” vs. “very fit or well, with no disease”. Conclusion: The present study has illustrated that self-rated frailty is associated with other measures of health and that self-rated frailty predicts mortality over a three-year period. These findings support the utilization of older adult’s self-ratings of frailty for new avenues of operationalizing frailty.

CITATION:
E. Sachs ; P. St. John ; A. Swift ; R. Tate (2020): Self-rated Frailty and Mortality in Old Men: The Manitoba Follow-up Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.14

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

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

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

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

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

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

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

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

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

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

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

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

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ICSFR: 10th International Conference on Frailty, Sarcopenia Research & Geroscience. March 11-13, 2020, Toulouse – France

Symposia, Conferences, Oral Communications

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CITATION:
I. Oral Communications (2020): 10th International Conference on Frailty, Sarcopenia Research & Geroscience (ICFSR), March 11-13, 2020, Toulouse, France. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.8

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CLINICAL FRAILTY SCALE: TRANSLATION AND CULTURAL ADAPTATION INTO THE BRAZILIAN PORTUGUESE LANGUAGE

M.K. Rodrigues, I. Nunes Rodrigues, D.J. Vasconcelos Gomes da Silva, J.M. de S. Pinto, M.F. Oliveira, M.K. Rodrigues, I. Nunes Rodrigues, D.J. Vasconcelos Gomes da Silva, J.M. de S. Pinto, M.F. Oliveira

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Background: Frailty is a biological syndrome that causes adverse events in the health of older adults. However, the Clinical Frailty Scale has not yet been culturally adapted and validated into Brazilian Portuguese language. Objectives: Our aim was to translate, reproduce and validate the Clinical Frailty Scale (CFS) for the Brazilian Portuguese language. Design: An observational cross-sectional study with senior patients was conducted between Jan 2018 and Nov 2018. Setting and Participants: Volunteers aged >60 and living in Brazil. The translation and cultural adaptation of the CFS into the Portuguese language, the principles and good practices were followed. Measurements: To conduct the validation and determine the reproducibility of an inter-observer evaluation, the patients answered the scale questions in Portuguese on two occasions, delivered by two separate examiners and separated by a 10-minute interval, on their first visit; the 36-item Short Form Survey quality-of-life questionnaire (SF-36) was also applied. Seven days later, a second visit was undertaken to perform an intra-observer reproducibility assessment. Results: A total of 66 older individuals were enrolled (72 ± 8 years), the majority of which did not present frailty (63.6%) and reported a low physical limitation level in the SF-36. The CFS showed a significant correlation with the SF-36 quality-of-life questionnaire (r= −0.663; p<0.0001) and no statistical difference was observed between intra-rater (p=0.641) and inter-rater (p=0.350) applications, demonstrating the reproducibility and applicability of the instrument. The standard error estimate (SEE) was evaluated and there were no differences between the CFS and the SF-36 (SEE= 1.13 points). Conclusion: The Brazilian Portuguese language version of the CFS is a valid, reproducible and reliable instrument for evaluating the impact of frailty on the lives of senior patients.

CITATION:
M.K. Rodrigues ; I. Nunes Rodrigues ; D.J. Vasconcelos Gomes da Silva ; J.M. de S. Pinto ; M.F. Oliveira (2020): Clinical Frailty Scale: translation and cultural adaptation into the Brazilian Portuguese language. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.7

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

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

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

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

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SHOULD WE CARE MORE ABOUT FRAILTY WHEN WE TREAT DIABETES?

L. Orlandini, M. Cesari

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CITATION:
L. Orlandini ; M. Cesari (2020): Should we care more about frailty when we treat diabetes?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.5

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

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

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

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

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LETTER TO THE EDITOR: USE OF A HIGH-INTENSITY RESISTANCE EXERCISE PROGRAM TO IMPROVE LOWER EXTREMITY STRENGTH AND MOBILITY IN A 105-YEAR OLDER WOMAN: A CASE REPORT

M.D. Basco

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CITATION:
M.D. Basco (2020): Letter to the editor: Use of a high-intensity resistance exercise program to improve lower extremity strength and mobility in a 105-year older woman: a case report. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.3

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CLINICAL CHARACTERISTICS OF FRAILTY IN JAPANESE RHEUMATOID ARTHRITIS PATIENTS

I. Yoshii, M. Kondo

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

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

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

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

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

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

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REPORTED WEIGHT CHANGE IN OLDER ADULTS AND PRESENCE OF FRAILTY

R.S. Crow, C.L. Petersen, S.B. Cook, C.J. Stevens, A.J. Titus, T.A. Mackenzie, J.A. Batsis

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ported weight change over the lifespan impacts rates of frailty in older adults. Methods: We identified 4,984 subjects ≥60 years with body composition measures from the National Health and Nutrition Examination Survey. An adapted version of Fried’s frailty criteria was used as the primary outcome. Self-reported weight was assessed at time current,1 and 10 years earlier and at age 25. Weight changes between each time point were categorized as ≥ 5%, ≤5% or neutral. Logistic regression assessed the impact of weight change on the outcome of frailty. Results: Among 4,984 participants, 56.5% were female, mean age was 71.1 years, and mean BMI was 28.2kg/m2. A weight loss of ≥ 5% had a higher association with frailty compared to current weight, age 25 (OR 2.94 [1.72,5.02]), 10 years ago (OR 1.68 [1.05,2.69]), and 1 year ago (OR 1.55 [1.02,2.36]). Weight gain in the last year was associated with increased rate of frailty (1.59 [1.09,2.32]). Conclusion: There is an association between frailty and reported weight loss over time while only weight gain in the last year has an association with frailty.

CITATION:
R.S. Crow ; C.L. Petersen ; S.B. Cook ; C.J. Stevens ; A.J. Titus ; T.A. Mackenzie ; J.A. Batsis (2019): Reported Weight Change in Older Adults and Presence of Frailty. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.44

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A NOVEL TOOL FOR THE EARLY IDENTIFICATION OF FRAILTY IN ELDERLY PEOPLE: THE APPLICATION IN PRIMARY CARE SETTINGS

M. Maggio, M. Barbolini, Y. Longobucco , L. Barbieri, C. Benedetti, F. Bono, I. Cacciapuoti, A. Donatini, E. Lezzi, D. Papini, P.M. Rodelli , S. Tagliaferri, M.L. Moro

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Objectives: Frailty is a pre-disability condition in older persons providing a challenge to Health-Care Systems. Systematic reviews highlight the absence of a gold-standard for its identification. However, an approach based on initial screening by the General Practitioner (GP) seems particularly useful. On these premises, a 9-item Sunfrail Checklist (SC), was developed by a multidisciplinary group, in the context of European Sunfrail Project, and tested in the Community. Objectives: - to measure the concordance between the judgments of frailty (criterion-validity): the one formulated by the GP, using the SC, and the one subsequently expressed by a Comprehensive Geriatric Assessment Team (CGA-Team); - to determine the construct-validity through the correspondence between some checklist items related to the 3 domains (physical, cognitive and social) and the three tools used by the CGA-Team; - to measure the instrument’s performance in terms of positive predictive value (PPV) and negative predictive value (NPV). Design: Cross-sectional study, with a final sample-size of 95 subjects. Setting: Two Community-Health Centers of Parma, Italy. Participants: Subjects aged 75 years old or more, with no disability and living in the community. Measurements: We compared the screening capacity of the GP using the SC to that one of CGA-Team based on three tests: 4-meter Gait-Speed, Mini-Mental State Examination and Loneliness Scale. Results: 95 subjects (51 women), with a mean age of 81±4 years were enrolled. According to GPs 34 subjects were frail; the CGA-Team expressed a frailty judgment on 26 subjects. The criterion-validity presented a Cohen’s k of 0.353. Construct-validity was also low, with a maximum contingency-coefficient of 0.19. The analysis showed a PPV of 58.1% and a NPV equal to 84.6%. Conclusions: Our data showed a low agreement between the judgements of GP performed by SC and CGA-Team. However, the good NPV suggests the applicability of SC for screening activities in primary-care.

CITATION:
M. Maggio ; M. Barbolini ; Y. Longobucco ; L. Barbieri ; C. Benedetti ; F. Bono ; I. Cacciapuoti ; A. Donatini ; E. Iezzi ; D. Papini ; P.M. Rodelli ; S. Tagliaferri ; M.L. Moro (2019): A novel tool for the early identification of frailty in elderly people: the application in Primary Care Settings. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.41

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

A.D. Jadczak, R. Visvanathan

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

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

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ASSOCIATION BETWEEN THE USE OF ANGIOTENSIN-BLOCKING MEDICATIONS WITH HIP FRACTURE AND DEATH IN OLDER PEOPLE

C. Shea, M.D. Witham

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ASSOCIATION BETWEEN THE USE OF ANGIOTENSIN-BLOCKING MEDICATIONS WITH HIP FRACTURE AND DEATH IN OLDER PEOPLE

C. Shea, M.D. Witham

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It is unclear if angiotensin blocking drugs (angiotensin converting enzyme inhibitors and angiotensin receptor blockers) reduce or increase the risk of falls and fractures. We retrospectively analysed routinely-collected, linked health and social care data for patients aged 65 and over from Tayside, Scotland, including hospital discharge diagnoses, biochemistry, deaths, care package provision and community prescribing. We conducted unadjusted and adjusted Cox regression analyses for time to hip fracture and time to death, for any exposure to angiotensin blocking drugs and for time-dependent exposure to angiotensin blocking drugs. We analysed data on 16782 patients. Angiotensin blocking drug use was associated with an exposure-dependent lower risk of hip fracture (hazard ratio 0.988 [95%CI 0.982-0.994] per year of exposure; p<0.001) and death (hazard ratio 0.986 [95%CI 0.983-0.989] per year of exposure; p<0.001). These findings call into question the appropriateness of stopping angiotensin blocking drugs for older people at risk of falls.

CITATION:
C. Shea ; M.D. Witham (2019): Association between the use of angiotensin-blocking medications with hip fracture and death in older people. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.38

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ASSOCIATION BETWEEN THE USE OF ANGIOTENSIN-BLOCKING MEDICATIONS WITH HIP FRACTURE AND DEATH IN OLDER PEOPLE

C. Shea, M.D. Witham

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ASSOCIATION BETWEEN THE USE OF ANGIOTENSIN-BLOCKING MEDICATIONS WITH HIP FRACTURE AND DEATH IN OLDER PEOPLE

C. Shea, M.D. Witham

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It is unclear if angiotensin blocking drugs (angiotensin converting enzyme inhibitors and angiotensin receptor blockers) reduce or increase the risk of falls and fractures. We retrospectively analysed routinely-collected, linked health and social care data for patients aged 65 and over from Tayside, Scotland, including hospital discharge diagnoses, biochemistry, deaths, care package provision and community prescribing. We conducted unadjusted and adjusted Cox regression analyses for time to hip fracture and time to death, for any exposure to angiotensin blocking drugs and for time-dependent exposure to angiotensin blocking drugs. We analysed data on 16782 patients. Angiotensin blocking drug use was associated with an exposure-dependent lower risk of hip fracture (hazard ratio 0.988 [95%CI 0.982-0.994] per year of exposure; p<0.001) and death (hazard ratio 0.986 [95%CI 0.983-0.989] per year of exposure; p<0.001). These findings call into question the appropriateness of stopping angiotensin blocking drugs for older people at risk of falls.

CITATION:
C. Shea ; M.D. Witham (2019): Association between the use of angiotensin-blocking medications with hip fracture and death in older people. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.38

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THE INFLUENCE OF LIFESTYLE BEHAVIORS ON THE INCIDENCE OF FRAILTY

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

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

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

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IMPACT OF FAT-FREE ADIPOSE TISSUE ON THE PREVALENCE OF LOW MUSCLE MASS ESTIMATED USING CALF CIRCUMFERENCE IN MIDDLE-AGED AND OLDER ADULTS

T. Abe, S.J. Dankel, Z.W. Bell, E. Fujita, Y. Yaginuma, T. Akamine, R.W. Spitz, V. Wong, R.B. Viana, J.P. Loenneke

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Previous studies proposed calf circumference cutoff values for predicting dual-energy X-ray absorptiometry (DXA)-derived low muscle mass. However, DXA-derived appendicular lean mass (aLM) includes non-skeletal muscle components such as the appendicular fat-free component of adipose tissue fat cells (aFFAT). The purpose of this study was to compare the calf circumference method of classification before (Model #1) and after (Model #2) eliminating the influence of FFAT in healthy Japanese adults (50 to 79 years; mean age 70 (SD 7) years). Model 1, and Model 2 for classifying low muscle mass had a sensitivity of 78% and 64%, specificity of 76% and 75%, positive predictive value of 31% and 28%, and negative predictive value of 96% and 93%, respectively. Appendicular fat-free component of adipose tissue has the potential to influence the ability of calf circumference to accurately classify individuals with low muscle mass. Consideration should be made when using this as a screening tool for low muscle mass.

CITATION:
T. Abe ; S.J. Dankel ; Z.W. Bell ; E. Fujita ; Y. Yaginuma ; T. Akamine ; R.W. Spitz ; V. Wong ; R.B. Viana ; J.P. Loenneke (2019): Impact of fat-free adipose tissue on the prevalence of low muscle mass estimated using calf circumference in middle-aged and older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.34

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THE ASSOCIATION OF FRAILTY WITH HOSPITALIZATIONS AND MORTALITY AMONG COMMUNITY DWELLING OLDER ADULTS WITH DIABETES

J. Ferri-Guerra, R. Aparicio-Ugarriza, D. Salguero, D. Baskaran, Y.N. Mohammed, H. Florez, J.G. Ruiz

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Background: Diabetes (DM) is associated with an accelerated aging that promotes frailty, a state of vulnerability to stressors, characterized by multisystem decline that results in diminished intrinsic reserve and is associated with morbidity, mortality and utilization. Research suggests a bidirectional relationship between frailty and diabetes. Frailty is associated with mortality in patients with diabetes, but its prevalence and impact on hospitalizations are not well known. Objectives: Determine the association of frailty with all-cause hospitalizations and mortality in older Veterans with diabetes. Design: Retrospective cohort. Setting: Outpatient. Participants: Veterans 65 years and older with diabetes who were identified as frail through calculation of a 44-item frailty index. Measurements: The FI was constructed as a proportion of healthcare variables (demographics, comorbidities, medications, laboratory tests, and ADLs) at the time of the screening. At the end of follow up, data was aggregated on all-cause hospitalizations and mortality and compared non-frail (robust, FI≤ .10 and prefrail FI=>.10, <.21) and frail (FI≥.21) patients. After adjusting for age, race, ethnicity, median income, history of hospitalizations, comorbidities, duration of DM and glycemic control, the association of frailty with all-cause hospitalizations was carried out according to the Andersen-Gill model, accounting for repeated hospitalizations and the association with all-cause mortality using a multivariate Cox proportional hazards regression model. Results: We identified 763 patients with diabetes, mean age 72.9 (SD=6.8) years, 50.5% were frail. After a median follow-up of 561 days (IQR=172), 37.0% they had 673 hospitalizations. After adjustment for covariates, frailty was associated with higher all-cause hospitalizations, hazard ratio (HR)=1.71 (95%CI:1.31-2.24), p<.0001, and greater mortality, HR=2.05 (95%CI:1.16-3.64), p=.014. Conclusions: Frailty was independently associated with all-cause hospitalizations and mortality in older Veterans with diabetes. Interventions to reduce the burden of frailty may be helpful to improve outcomes in older patients with diabetes.

CITATION:
J. Ferri-Guerra ; R. Aparicio-Ugarriza ; D. Salguero1 ; D. Baskaran ; Y.N. Mohammed ; H. Florez ; J.G. Ruiz (2019): The Association of Frailty with Hospitalizations and Mortality among Community Dwelling Older Adults with Diabetes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.31

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

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

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

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

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JFA N°01 - 2020

 

EDITORIAL: THE NEED TO IMPLEMENT FRAILTY IN THE INTERNATIONAL CLASSIFICATION OF DISEASE (ICD)

J. Muscedere

J Frailty Aging 2020;9(1)2-3

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CITATION:
J. Muscedere (2020): Editorial: The Need to Implement Frailty in the International Classification of Disease (ICD) . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.2

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ICFSR TASK FORCE PERSPECTIVE ON BIOMARKERS FOR SARCOPENIA AND FRAILTY

L. Rodriguez-Mañas, I. Araujo de Carvalho, S. Bhasin, H.A. Bischoff-Ferrari, M. Cesari, W. Evans, J.M. Hare, M. Pahor, A. Parini, Y. Rolland, R.A. Fielding, J. Walston, B. Vellas, and the ICFSR Task Force

J Frailty Aging 2020;9(1)4-8

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Biomarkers of frailty and sarcopenia are essential to advance the understanding of these conditions of aging and develop new diagnostic tools and effective treatments. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force – a group of academic and industry scientists from around the world -- met in February 2019 to discuss the current state of biomarker development for frailty and sarcopenia. The D3Cr dilution method, which assesses creatinine excretion as a biochemical measure of muscle mass, was suggested as a more accurate measure of functional muscle mass than assessment by dual energy x-ray absorptiometry (DXA). Proposed biomarkers of frailty include markers of inflammation, the hypothalamic-pituitary-adrenal (HPA) axis response to stress, altered glucose insulin dynamics, endocrine dysregulation, aging, and others, acknowledging the complex multisystem etiology that contributes to frailty. Lack of clarity regarding a regulatory pathway for biomarker development has hindered progress; however, there are currently several international efforts to develop such biomarkers as tools to improve the treatment of individuals presenting these conditions.

CITATION:
L. Rodriguez-Mañas ; I. Araujo de Carvalho ; S. Bhasin ; H.A. Bischoff-Ferrari ; M. Cesari ; W. Evans ; J.M. Hare ; M. Pahor ; A. Parini ; Y. Rolland ; R.A. Fielding ; J. Walston ; B. Vellas ; and the ICFSR Task Force (2019): ICFSR Task Force Perspective on Biomarkers for Sarcopenia and Frailty. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.32

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CLINICALLY MEANINGFUL CHANGE FOR PHYSICAL PERFORMANCE: PERSPECTIVES OF THE ICFSR TASK FORCE

J. Guralnik, K. Bandeen-Roche, S.A.R. Bhasin, S. Eremenco, F. Landi, J. Muscedere, S. Perera, J.-Y. Reginster, L. Woodhouse, B. Vellas, and the ICFSR Task Force

J Frailty Aging 2020;9(1)9-13

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For clinical studies of sarcopenia and frailty, clinically meaningful outcome measures are needed to monitor disease progression, evaluate efficacy of interventions, and plan clinical trials. Physical performance measures including measures of gait speed and other aspects of mobility and strength have been used in many studies, although a definition of clinically meaningful change in performance has remained unclear. The International Conference on Frailty and Sarcopenia Research Task Force (ICFSR-TF), a group of academic and industry scientists investigating frailty and sarcopenia, met in Miami Beach, Florida, USA in February 2019 to explore approaches for establishing clinical meaningfulness in a manner aligned with regulatory authorities. They concluded that clinical meaningful change is contextually dependent, and that both anchor- based and distribution-based methods of quantifying physical function are informative and should be evaluated relative to patient-reported outcomes. In addition, they identified additional research needed to enable setting criteria for clinical meaningful change in trials.

CITATION:
J. Guralnik ; K. Bandeen-Roche ; S.A.R. Bhasin ; S. Eremenco ; F. Landi ; J. Muscedere ; S. Perera ; J.-Y. Reginster ; L. Woodhouse ; B. Vellas ; and the ICFSR Task Force (2019): Clinically Meaningful Change for Physical Performance: Perspectives of the ICFSR Task Force. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.33

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MOVING TOWARDS COMMON DATA ELEMENTS AND CORE OUTCOME MEASURES IN FRAILTY RESEARCH

J. Muscedere, J. Afilalo, I. Araujo de Carvalho, M. Cesari, A. Clegg, H.E. Eriksen, K.R. Evans, G. Heckman, J.P. Hirdes, P.M. Kim, B. Laffon, J. Lynn, F. Martin, J.C. Prorok, K. Rockwood, L. Rodrigues Mañas, D. Rolfson, G. Shaw, B. Shea, S. Sinha, O. Theou, P. Tugwell, V. Valdiglesias, B. Vellas, N. Veronese, L.M.K. Wallace, P.R. Williamson, For the Canadian Frailty Network

J Frailty Aging 2020;9(1)14-22

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With aging populations around the world, frailty is becoming more prevalent increasing the need for health systems and social systems to deliver optimal evidence based care. However, in spite of the growing number of frailty publications, high-quality evidence for decision making is often lacking. Inadequate descriptions of the populations enrolled including frailty severity and frailty conceptualization, lack of use of validated frailty assessment tools, utilization of different frailty instruments between studies, and variation in reported outcomes impairs the ability to interpret, generalize and implement the research findings. The utilization of common data elements (CDEs) and core outcome measures (COMs) in clinical trials is increasingly being adopted to address such concerns. To catalyze the development and use of CDEs and COMs for future frailty studies, the Canadian Frailty Network (www.cfn-nce.ca; CFN), a not-for-profit pan-Canadian nationally-funded research network, convened an international group of experts to examine the issue and plan the path forward. The meeting was structured to allow for an examination of current frailty evidence, ability to learn from other COMs and CDEs initiatives, discussions about specific considerations for frailty COMs and CDEs and finally the identification of the necessary steps for a COMs and CDEs consensus initiative going forward. It was agreed at the onset of the meeting that a statement based on the meeting would be published and herein we report the statement.

CITATION:
J. Muscedere ; J. Afilalo ; I. Araujo de Carvalho ; M. Cesari ; A. Clegg ; H.E. Eriksen ; K.R. Evans ; G. Heckman ; J.P. Hirdes ; P.M. Kim ; B. Laffon ; J. Lynn ; F. Martin ; J.C. Prorok ; K. Rockwood ; L. Rodrigues Mañas ; D. Rolfson ; G. Shaw ; B. Shea ; S. Sinha ; O. Theou ; P. Tugwell ; V. Valdiglesias ; B. Vellas ; N. Veronese ; L.M.K. Wallace ; P.R. Williamson ; For the Canadian Frailty Network (2019): Moving towards common data elements and core outcome measures in frailty research. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.43

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MUSCLE STRENGTH AS A PREDICTOR OF GAIT VARIABILITY AFTER TWO YEARS IN COMMUNITY-LIVING OLDER ADULTS

B. Bogen, R. Moe-Nilssen, M.K. Aaslund, A.H. Ranhoff

J Frailty Aging 2020;9(1)23-29

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Background: Stride-to-stride fluctuations, or gait variability, can be captured easily using body worn inertial sensors. Previously, sensor-measured gait variability has been found to be associated with fall risk and central nervous changes. However, further research is needed to clarify the clinical relevance of this method. Objectives: In this study, we look at how gait variability is associated with muscle strength, measured two years earlier. Design, setting and participants: This is study of longitudinal associations. Participants were community-dwelling volunteers between 70-81 years. Measurements: Participants were tested while walking with a single sensor at their lower back, and they walked back and forth over a distance of 6.5 meters under four conditions: at preferred speed, at fast speed, with an added cognitive task, and while walking across an uneven surface. Gait variability in the anteroposterior (AP), mediolateral (ML) and vertical (V) directions was identified. A muscle strength score was composed by transforming hand grip strength, isometric knee extension strength and the 30 second chair rise-test to z-scores and adding them. Results: 56 individuals were analysed (mean age at baseline 75.8 (SD 3.43), 60 percent women). In a backwards regression method using age, gender and baseline walking speed as covariates, muscle strength predicted gait variability after two years for AP variability during preferred speed (Beta= .314, p=.025) and uneven surface walking (Beta=.326, p=.018). Further, muscle strength was associated with ML variability during preferred speed (Beta=.364, p=.048) and fast speed (Beta=.419, p=.042), and V variability during preferred speed (Beta=.402, p=.002), fast speed (Beta=.394, p=.004) and uneven surface walking (Beta=.369, p=.004). Conclusions: Sensor-measured gait variability tended to be associated with muscle strength measured two years earlier. This finding could emphasize the relevance of this relatively novel measure of gait in older adults for both research and clinical practice.

CITATION:
B. Bogen ; R. Moe-Nilssen ; M.K. Aaslund ; A.H. Ranhoff (2019): Muscle strength as a predictor of gait variability after two years in community-living older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.24

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NEUROMUSCULAR ATTRIBUTES ARE ASSOCIATED WITH POOR MOBILITY IN OLDER ADULTS WITH VASCULAR RISK CONDITIONS

A.J. Jor’dan, M.E. Jacob, E. Leritz, J.F. Bean

J Frailty Aging 2020;9(1)30-36

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Background: The mobility of older adults is limited by the compounding effects of vascular health conditions, or vascular risk burden. However, little is known about the role of neuromuscular attributes among those in which vascular risk burden contributes to mobility limitations. Objective: We investigated (1) the relationship between the absence/presence of type 2 diabetes, hypertension, and/or obesity and mobility measures and neuromuscular attributes, and (2) whether the association between vascular risk burden and mobility is mediated by lower limb neuromuscular attributes. Design: Cross-sectional analysis of baseline data from 430 older adults within the Boston RISE Study. Measurements: Measures of mobility were the Short Physical Performance Battery, habitual gait speed, and functional mobility as measured by the Late Life Function Instrument. We also evaluated lower limb neuromuscular attributes, namely leg strength, leg velocity, trunk extensor muscle endurance, knee and ankle range of motion, and sensory loss. Results: Participants self-reported the presence of None (n=93), One (n=179), Two (n=114), or Three (n=44) of the following conditions: diabetes, hypertension, and obesity. Multivariable regression models indicated that those with a greater vascular risk burden had worse performance on the Short Physical Performance Battery (p=0.01), slower gait speed (p=0.0003) and lower Basic and Advanced Late Life Function Instrument scores (p<0.003). These associations were independent of multiple covariates. Vascular risk burden was also found to be negatively associated with leg strength (p=0.0002) and knee flexion range of motion (p<0.0001) and an associated non-significant trend was observed with leg velocity (p=0.06). In addition, the association between vascular risk burden and mobility outcomes were found to be partially mediated by leg strength, leg velocity, and knee flexion range of motion. Conclusions: Among older adults with vascular risk burden and mobility problems, neuromuscular impairments in attributes such as leg strength, leg velocity, and knee range of motion may need to be treatment priorities.

CITATION:
A.J. Jor’dan ; M.E. Jacob ; E. Leritz ; J.F. Bean (2019): Neuromuscular Attributes are Associated with Poor Mobility in Older Adults with Vascular Risk Conditions . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.42

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OBESITY DEFINITIONS IN SARCOPENIC OBESITY: DIFFERENCES IN PREVALENCE, AGREEMENT AND ASSOCIATION WITH MUSCLE FUNCTION

E.Q. Khor, J.P. Lim, L. Tay, A. Yeo, S. Yew, Y.Y. Ding, W.S. Lim

J Frailty Aging 2020;9(1)37-43

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Background: Sarcopenic obesity (SO) is associated with poorer physical performance in the elderly and will increase in relevance with population ageing and the obesity epidemic. The lack of a consensus definition for SO has resulted in variability in its reported prevalence, poor inter-definitional agreement, and disagreement on its impact on physical performance, impeding further development in the field. While sarcopenia definitions have been compared, the impact of obesity definitions in SO has been less well-studied. Objectives: To compare 3 widely-adopted definitions of obesity in terms of SO prevalence, inter-definitional agreement, and association with muscle function. Design: Cross-sectional. Setting: GERILABS study, Singapore Participants: 200 community-dwelling, functionally-independent older adults. Measurements: We utilized three commonly-used definitions of obesity: body mass index (BMI), waist circumference (WC) and DXA-derived fat mass percentage (FM%). Sarcopenia was defined using Asian Working Group for Sarcopenia criteria. For muscle function, we assessed handgrip strength, gait speed and Short Physical Performance Battery (SPPB). Subjects were classified into 4 body composition phenotypes (normal, obese, sarcopenic and SO), and outcomes were compared between groups. Results: The prevalence rate for SO was lowest for BMI (0.5%) compared to FM% (10.0%) and WC (10.5%). Inter-definitional agreement was lowest between BMI and WC (κ=0.364), and at best moderate between FM% and WC (κ=0.583). SO performed the worst amongst body composition phenotypes in handgrip strength, gait speed and SPPB (all p<0.01) only when defined using WC. In regression analyses, SO was associated with decreased SPPB scores (β=-0.261, p=0.001) only for the WC definition. Conclusion: There is large variation in the prevalence of SO across different obesity definitions, with low-to-moderate agreement between them. Our results corroborate recent evidence that WC, and thus central obesity, is best associated with poorer muscle function in SO. Thus, WC should be further explored in defining obesity for accurate and early characterization of SO among older adults in Asian populations.

CITATION:
E.Q. Khor ; J.P. Lim ; L. Tay ; A. Yeo ; S. Yew ; Y.Y. Ding ; W.S. Lim (2019): Obesity definitions in sarcopenic obesity: Differences in prevalence, agreement and association with muscle function. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.28

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THE USE OF POSTUROGRAPHY IN INVESTIGATING THE RISK OF FALLING IN FRAIL OR PREFRAIL OLDER PEOPLE WITH DIABETES

H. Domergue, L. Rodríguez-Mañas, O. Laosa Zafra, K. Hood, D. Gasq, S. Regueme, A.J. Sinclair, I. Bourdel-Marchasson

J Frailty Aging 2020;9(1)44-50

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Background: In older people, diabetes is associated with an increased risk of falls and frailty. The value of using posturography for evaluating the risk of falling is unclear. In theory, a time-scale analysis should increase the metrological properties of the posturography assessment. Objectives: This study aimed to determine which posturographic parameters can be used to identify fall-risk patients in a frail diabetic older population and to assess their interest in comparison to usual clinical trials for gait and balance. Design: This is a prospective observational cohort. Settings: frail or pre-frail diabetic patients, in Bordeaux, France. Participants: 84 patients were included in the study (mean age 80.09 years, 64.5% of men).Criteria for inclusion were: age over 70 years, diabetes mellitus for over 2 years, and at least one of the Fried’s frailty criteria. Measurements: Gait and balance assessments were undertaken at baseline: Static posturography, the timed up and go test, short physical performance battery, and (gait) walking speed. Raw data from posturography were used for wavelet analysis. Data on self reported new falls were collected prospectively during 6 months. Results: The posturography parameter most useful was area of 90% confidence ellipse of statokinesigram (COP90area): area under the ROC curve AUC = 0.617 (95% CI, 0.445-0.789) and OR=1.003 (95%CI 1.000-1.005) p =0.05. The optimum clinical test was the time to walk over 4m AUC=0.735 (95%CI, 0.587-0.882) and OR=1.42 (95%CI 1.08-1.87) p= 0.013. Conclusion: Posturography has limited utility for assessment of falls risk in frail older people with diabetes. Gait and balance clinical assessments such as walking speed continue to retain their value.

CITATION:
H. Domergue ; L. Rodríguez-Mañas ; O. Laosa Zafra ; K. Hood ; D. Gasq ; S. Regueme ; A.J. Sinclair ; I. Bourdel-Marchasson (2019): The use of posturography in investigating the risk of falling in frail or prefrail older people with diabetes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.27

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CONTRIBUTION OF PROTEIN INTAKE AND CONCURRENT EXERCISE TO SKELETAL MUSCLE QUALITY WITH AGING

N.D. Dicks, C.J. Kotarsky, K.A. Trautman, A.M. Barry, J.F. Keith, S. Mitchell, W. Byun, S.N. Stastny, K.J. Hackney

J Frailty Aging 2020;9(1)51-56

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Background: The use of magnetic resonance imaging (MRI) derived functional cross-sectional area (FCSA) and intramuscular adipose tissue (IMAT) to define skeletal muscle quality is of fundamental importance in order to understand aging and inactivity-related loss of muscle mass. Objectives: This study examined factors associated with lower-extremity skeletal muscle quality in healthy, younger, and middle-aged adults. Design: Cross-sectional study. Setting and Participants: Ninety-eight participants (53% female) were classified as younger (20-35 years, n=50) or middle-aged (50-65 years, n=48) as well as sedentary (≤1 day per week) or active (≥3 days per week) on self-reported concurrent exercise (aerobic and resistance). Measurements: All participants wore an accelerometer for seven days, recorded a three-day food diary, and participated in magnetic resonance imaging (MRI) of the lower limbs. Muscle cross-sectional area (CSA) was determined by tracing the knee extensors (KE) and plantar flexors, while muscle quality was established through the determination of FCSA and IMAT via color thresholding. Results: One-way analysis of variance and stepwise regression models were performed to predict FCSA and IMAT. KE-IMAT (cm2) was significantly higher among sedentary (3.74 ± 1.93) vs. active (1.85 ± 0.56) and middle-aged (3.14 ± 2.05) vs. younger (2.74 ± 1.25) (p < 0.05). Protein intake (g•kg•day-1) was significantly higher in active (1.63 ± 0.55) vs. sedentary (1.19 ± 0.40) (p < 0.05). Sex, age, concurrent exercise training status, and protein intake were significant predictors of KE FCSA (R2 = 0.71, p < 0.01), while concurrent exercise training status and light physical activity predicted 33% of the variance in KE IMAT (p < 0.01). Conclusion: Concurrent exercise training, dietary protein intake, and light physical activity are significant determinants of skeletal muscle health and require further investigation to mitigate aging and inactivity-related loss of muscle quality.

CITATION:
N.D. Dicks ; C.J. Kotarsky ; K.A. Trautman ; A.M. Barry ; J.F. Keith ; S. Mitchell ; W. Byun ; S.N. Stastny ; K.J. Hackney (2019): Contribution of Protein Intake and Concurrent Exercise to Skeletal Muscle Quality with Aging. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.40

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CIRCULATING INTERLEUKIN-6 IS ASSOCIATED WITH SKELETAL MUSCLE STRENGTH, QUALITY, AND FUNCTIONAL ADAPTATION WITH EXERCISE TRAINING IN MOBILITY-LIMITED OLDER ADULTS

G.J. Grosicki, B.B. Barrett, D.A. Englund, C. Liu, T.G. Travison, T. Cederholm, A. Koochek, Å. von Berens, T. Gustafsson, T. Benard, K.F. Reid, R.A. Fielding

J Frailty Aging 2020;9(1)57-63

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Background: Human aging is characterized by a chronic, low-grade inflammation suspected to contribute to reductions in skeletal muscle size, strength, and function. Inflammatory cytokines, such as interleukin-6 (IL-6), may play a role in the reduced skeletal muscle adaptive response seen in older individuals. Objectives: To investigate relationships between circulating IL-6, skeletal muscle health and exercise adaptation in mobility-limited older adults. Design: Randomized controlled trial. Setting: Exercise laboratory on the Health Sciences campus of an urban university. Participants: 99 mobility-limited (Short Physical Performance Battery (SPPB) ≤9) older adults. Intervention: 6-month structured physical activity with or without a protein and vitamin D nutritional supplement. Measurements: Circulating IL-6, skeletal muscle size, composition (percent normal density muscle tissue), strength, power, and specific force (strength/CSA) as well as physical function (gait speed, stair climb time, SPPB-score) were measured pre- and post-intervention. Results: At baseline, Spearman’s correlations demonstrated an inverse relationship (P<0.05) between circulating IL-6 and thigh muscle composition (r = -0.201), strength (r = -0.311), power (r = -0.210), and specific force (r = -0.248), and positive association between IL-6 and stair climb time (r = 0.256; P<0.05). Although the training program did not affect circulating IL-6 levels (P=0.69), reductions in IL-6 were associated with gait speed improvements (r = -0.487; P<0.05) in “higher” IL-6 individuals (>1.36 pg/ml). Moreover, baseline IL-6 was inversely associated (P<0.05) with gains in appendicular lean mass and improvements in SPPB score (r = -0.211 and -0.237, respectively). Conclusions: These findings implicate age-related increases in circulating IL-6 as an important contributor to declines in skeletal muscle strength, quality, function, and training-mediated adaptation. Given the pervasive nature of inflammation among older adults, novel therapeutic strategies to reduce IL-6 as a means of preserving skeletal muscle health are enticing.

CITATION:
G.J. Grosicki ; B.B. Barrett ; D.A. Englund ; C. Liu ; T.G. Travison ; T. Cederholm ; A. Koochek ; Å. von Berens ; T. Gustafsson ; T. Benard ; K.F. Reid ; R.A. Fielding (2019): Circulating Interleukin-6 is Associated with Skeletal Muscle Strength, Quality, and Functional Adaptation with Exercise Training in Mobility-Limited Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.30

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ICSFR: 10th International Conference on Frailty & Sarcopenia Research. March 11-13, 2020, Toulouse – France

Symposia - Conferences - Oral Communications

J Frailty Aging 2020;9(S1):S1-S45

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CITATION:
(2020): ICSFR: 10th International Conference on Frailty & Sarcopenia Research. March 11-13, 2020, Toulouse – France. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.8

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ICSFR: 10th International Conference on Frailty, Sarcopenia Research & Geroscience. March 11-13, 2020, Toulouse – France

Posters

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CITATION:
I. Posters (2020): 10th International Conference on Frailty, Sarcopenia Research & Geroscience (ICFSR), March 11-13, 2020, Toulouse, France. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.9

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