Ahead of print articles
REPLY TO THE LETTER TO THE EDITOR: ENHANCING PREHABILITATION PROTOCOLS IN FRAIL OLDER ADULTS UNDERGOING JOINT REPLACEMENT - METHODOLOGICAL INSIGHTS FROM A PILOT RANDOMIZED CONTROLLED TRIAL
Alexandra Papaioannou, Ashlee Azizudin, George Ioannidis, Fit-Joints study investigators
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CITATION:
Alexandra Papaioannou ; Ashlee Azizudin ; George Ioannidis ; Fit-Joints study investigators (2025): Reply to the Letter to the editor: Enhancing prehabilitation protocols in frail older adults undergoing joint replacement - methodological insights from a pilot randomized controlled trial. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100067
LETTER TO THE EDITOR: ENHANCING PREHABILITATION PROTOCOLS IN FRAIL OLDER ADULTS UNDERGOING JOINT REPLACEMENT - METHODOLOGICAL INSIGHTS FROM A PILOT RANDOMIZED CONTROLLED TRIAL
Xinrui Sun, Fei Gao
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CITATION:
Xinrui Sun ; Fei Gao (2025): Letter to the editor: Enhancing prehabilitation protocols in frail older adults undergoing joint replacement - methodological insights from a pilot randomized controlled trial. The Journal of Frailty and Aging (JFA).https://doi.org/10.1016/j.tjfa.2025.100065
LETTER TO THE EDITOR: A SIMPLE TEST OF “KAMI-TSUMAMI” (PAPER TUG) FOR PINCH STRENGTH SCREENING AMONG COMMUNITY-DWELLING OLDER ADULTS
Weida Lyu, Tomoki Tanaka, Katsuya Iijima
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CITATION:
Weida Lyu ; Tomoki Tanaka ; Katsuya Iijima (2025): Letter to the Editor: A simple test of “Kami-Tsumami” (Paper Tug) for pinch strength screening among community-dwelling older adults. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100060
ASSOCIATIONS BETWEEN INTRINSIC CAPACITY, PLASMA P-TAU181 AND COGNITIVE FUNCTION OVER A 5-YEAR FOLLOW-UP AMONG COMMUNITY-DWELLING OLDER ADULTS: A SECONDARY ANALYSIS OF THE MAPT STUDY
Kelly Virecoulon Giudici, Philipe de Souto Barreto, Christelle Cantet, Henrik Zetterberg, Kaj Blennow, Bruno Vellas, or the MAPT/DSA group
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BACKGROUND: Intrinsic capacity (IC) is a recent key concept proposed by the World Health Organization (WHO) based on aspects of functional ability (both physical and mental) rather than the presence or absence of diseases, with a potential to predict several health outcomes.
OBJECTIVE: To explore associations between IC and cognitive function (prospectively), and between IC and plasma p-tau181 (cross-sectionally and prospectively) among community-dwelling older adults.
METHODS: Observational study with 491 subjects ≥70 years (67.4 % female, mean 75.3 years, SD=4.4), participants from the Multidomain Alzheimer Preventive Trial (MAPT). IC domains (locomotion, cognition, psychological, vitality) were combined into a 0–100 score. Alternative classification was based on the number of domains’ abnormalities. Plasma p-tau181 was measured at baseline and 36 months of follow-up. A composite cognitive score (CCS) based on four tests was determined at baseline, 6, 12, 24, 36, 48 and 60 months.
RESULTS: Inverse cross-sectional associations were observed between baseline IC score and p-tau181 (unadjusted model: β=-0.08, 95 %CI -0.13 to -0.03; p = 0.0025). A significant mean difference in p-tau181 3-year changes was observed between participants with low and normal IC (based on IC score) (adjusted model: 1.71, 95 %CI 0.01 to 3.40; p = 0.0483). Prospective 5-year associations between IC and CCS were only observed in unadjusted analysis according to the alternative IC classification (-0.21, 95 %CI -0.38 to -0.04; p = 0.0156).
CONCLUSION: IC was associated with plasma p-tau181 and cognitive function, but findings varied according to the method of IC classification. Further research may help settle the role of IC as a predictor of neurodegenerative diseases such as AD. In this regard, multidomain interventions have potential to protect IC over the aging process and prevent cognitive impairment, and should also be encouraged.
CITATION:
Kelly Virecoulon Giudici ; Philipe de Souto Barreto ; Christelle Cantet ; Henrik Zetterberg ; Kaj Blennow ; Bruno Vellas ; for the MAPT/DSA group (2025): Associations between intrinsic capacity, plasma p-tau181 and cognitive function over a 5-year follow-up among community-dwelling older adults: a secondary analysis of the MAPT Study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100064
HEALTHCARE UTILIZATION, PHARMACOTHERAPY PRESCRIPTIONS, AND CLINICAL OUTCOMES ACROSS A 5-YEAR DURATION PRECEDING AND SUCCEEDING THE INITIATION OF HOME HEALTH CARE IN A NATIONWIDE POPULATION-BASED COHORT OF 187,547 OLDER ADULTS WITH DISABILITIES
Shih-Tsung Huang, Fei-Yuan Hsiao, Wei-Ju Lee, Ming-Yueh Chou, Chih-Kuang Liang, Chu-Sheng Lin, Ching-Hui Loh, Liang-Kung Chen
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BACKGROUND: Longitudinal trajectories of healthcare utilization, medication prescription, and clinical outcomes among older adults with disabilities receiving home healthcare (HHC) holds significance but remains elusive.
METHODS: People aged≥65 years who newly received Taiwan’s National Health Insurance funded HHC program from January 2005 to December 2013 were identified. Healthcare utilization, life-sustaining treatment, medication prescriptions (polypharmacy, psychotropics, anticholinergic burden and antibiotics), health status (Charlson’s comorbidity index, CCI), and mortality were assessed over a 10-year period spanning 5 years before and after initiating HHC.
RESULTS: Overall, 187,547 patients (80.6 ± 7.7 years, 51.2 % females, CCI 3+: 51.2 %) with a high prevalence of dementia (34.0 %), stroke (38.7 %), and pneumonia (49.5 %), and usage of life-sustaining treatment (urinary catheters: 82.8 % and nasogastric feeding: 78.7 %) were obtained. A sudden peak of admission rate at 1 year (91.7 %) before HHC, followed by the 70 % and 60 % admission rate in the first and second year after receiving HHC were found. Quarterly changes of using life-sustaining treatment showed significant increases from as early as 1 year prior to HHC. Gradual increases of polypharmacy, use of psychotropics, and antibiotic (4.5-fold and 3-fold) after HHC further demonstrated the complex needs (both p < 0.01). The 5-year cumulative mortality rate was 81 % (40 % in the first year with an annual rate of 25 %).
INTERPRETATION: HHC recipients embody a confluence of complex care needs and high mortality risk, whereby various interventions aim to alleviate symptoms and sustain life. Engaging in proactive advanced care planning and end-of-life care should be prioritized when home healthcare is being contemplated.
CITATION:
Shih-Tsung Huang ; Fei-Yuan Hsiao ; Wei-Ju Lee ; Ming-Yueh Chou ; Chih-Kuang Liang ; Chu-Sheng Lin ; Ching-Hui Loh ; Liang-Kung Chen (2025): Healthcare utilization, pharmacotherapy prescriptions, and clinical outcomes across a 5-year duration preceding and succeeding the initiation of home health care in a nationwide population-based cohort of 187,547 older adults with disabilities. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100063
ASSOCIATION OF LIFESTYLE MODIFICATIONS WITH FRAILTY IN OLDER ADULTS: A CROSS-SECTIONAL STUDY USING NHANES
Yuanyuan Wu, Hongyan Peng, Rui Xu, Yingxue Hua, Yanan Zhang
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BACKGROUND: Frailty significantly impacts healthy aging, yet lifestyle interventions may reduce its prevalence. This study investigated the association between a comprehensive lifestyle score, comprising eight modifiable factors (diet, physical activity, smoking, sleep, body mass index [BMI], non-HDL cholesterol, blood glucose, and blood pressure), and frailty risk in older adults, identifying key components for targeted interventions.
METHODS: Using data from the National Health and Nutrition Examination Survey (NHANES, 2005–2018), we analyzed 10,065 adults aged ≥60 years (mean age: 69.61, 54.97 % female). Each lifestyle factor was scored from 0 to 100, and frailty was defined using a 49-item index (>0.21). Weighted logistic regression assessed individual associations, restricted cubic spline (RCS) analysis explored dose-response relationships, and quantile g-computation evaluated joint effects.
RESULTS: Higher scores for dietary score (OR=0.69, 95 % CI: 0.52–0.90, score 100 vs. 0), non-smoking (OR=0.62, 95 % CI: 0.51–0.75), sleep (OR=0.29, 95 % CI: 0.17–0.49), blood glucose (OR=0.27, 95 % CI: 0.17–0.44), and blood pressure (OR=0.43, 95 % CI: 0.30–0.61, score 25 vs. 0) were associated with lower frailty risk (all P < .05). Diet and non-HDL cholesterol showed no linear association; smoking, BMI, blood glucose, and blood pressure exhibited non-linear patterns (P<.05). A simultaneous one-level increase in all lifestyle factors reduced frailty risk by 94 % (95 % CI: 92–95 %), with physical activity, blood glucose, and sleep as primary contributors.
CONCLUSION: These findings highlighted the association between specific lifestyle factors and reduced frailty risk, underscoring the need for prospective studies to prioritize interventions for frailty prevention.
CITATION:
Yuanyuan Wu ; Hongyan Peng ; Rui Xu ; Yingxue Hua ; Yanan Zhang (2025): Association of lifestyle modifications with frailty in older adults: A cross-sectional study using NHANES. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100061
THE VITALITY DOMAIN OF INTRINSIC CAPACITY: A SCOPING REVIEW OF CONCEPTUAL FRAMEWORKS AND MEASUREMENTS
J. Chew, J. Lee, H.H.C. Hernandez, Y.L. Munro, C.L. Lim, W.S. Lim
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BACKGROUND: Intrinsic capacity (IC) is a composite indicator of physical and mental capacities that are critical for healthy aging. IC comprises five domains, with “vitality” gaining most attention due to its potential impact on functional and physiological reserves with increasing age. The World Health Organization 2022 framework redefined vitality as an underlying physiological determinant of IC. However, the concept and measurement of vitality and its empirical validation are not well defined.
OBJECTIVES: This scoping review aims to: (1) map the conceptual frameworks underpinning vitality within the IC domain and (2) identify existing measures used to assess vitality.
METHODS: A systematic search of MEDLINE, PubMed, Embase, Web of Science, and WHO databases (2003–2023) using Arksey and O’Malley’s framework and PRISMA-ScR guidelines. Studies involving adults ≥50 years old that addressed vitality in IC were included. We extracted data on conceptual frameworks, measurement tools, and construct validity.
RESULTS: Eighty-one studies met the inclusion criteria. Initial frameworks of vitality focused on nutritional indicators, while recent concepts include neuromuscular function, metabolism, and immune-stress responses. However, operationalization of these concepts remains inconsistent, with most studies relying on anthropometry, appetite, weight loss, and handgrip strength, while immune and stress response-related biomarkers were rarely assessed. Only 10.5 % of studies evaluated construct validity of vitality, and limited studies validated the potential roles of vitality underpinning the other expressed capacities.
CONCLUSIONS: Currently, vitality within IC varies in definitions and measurement approaches, with a predominant focus on nutrition and muscle strength. Empirical validation of vitality’s role as a foundational IC domain remains limited. Expanding the scope of vitality to include metabolic and immune markers, and deeper examination of the interactions between vitality with other IC domains may enhance understanding and improve assessment frameworks for healthy aging.
CITATION:
J. Chew ; J. Lee ; H.H.C. Hernandez ; Y.L. Munro ; C.L. Lim ; W.S. Lim (2025): The vitality domain of intrinsic capacity: A scoping review of conceptual frameworks and measurements. The Journal of Prevention of Alzheimer’s Disease (JPAD). https://doi.org/10.1016/j.tjfa.2025.100058
BUILT-IN HEALTHCARE APPLICATIONS REVEAL STEP CHANGES ASSOCIATED WITH TEMPERATURE, TRANSPORTATION, AND MARITAL STATUS AMONG URBAN CITIES IN JAPAN
Nobuhiko Wakai, Taiga Yamada, Hiroyuki Tomoyama, Shigehiro Iida
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BACKGROUND: Walking is a fundamental daily activity representing health status and physical condition. The number of steps taken in a given time period is widely used in research areas such as aging, geriatrics, gerontology, public health, and preventive medicine. However, the underlying mechanisms of step counts are not well understood.
OBJECTIVES: To investigate daily step counts associated with temperature, transportation, and marital status.
DESIGN: Time series analysis of daily steps using built-in healthcare applications on smartphones.
SETTING: Government-designated, well-developed urban cities in Japan: Fukuoka, Kawasaki, Kobe, Kyoto, and Saitama.
PARTICIPANTS: Respondents totaled 622 40- to 79-year-olds, comprising 370 males and 252 females.
MEASUREMENTS: The mean period of our retrospective data was 2,344 days.
RESULTS: Seasonal-trend decomposition using loess was applied to time series steps. With the high coefficient of determination R2: 0.798, an absolute value function was fitted between temperature and the mean daily steps of the seasonal component. Furthermore, ordinary train usage in Saitama, Kawasaki, and Fukuoka was significantly greater than that in Kobe and Kyoto by 14.1 points (p=0.001). Moreover, married and divorced or bereaved males’ mean daily step counts were significantly larger than those of females’ by 1,832 (p=0.001) and 2,480 (p=0.001), respectively. By contrast, the difference in the mean daily step counts for unmarried males and females was only 100.
CONCLUSIONS: This study presents significant associations between mean daily steps and the factors of temperature, transportation, and marital status. These associations can alleviate biases in step research by area and season to facilitate better step count comparisons in many research fields.
CITATION:
Nobuhiko Wakai ; Taiga Yamada ; Hiroyuki Tomoyama ; Shigehiro Iida (2025): Built-in healthcare applications reveal step changes associated with temperature, transportation, and marital status among urban cities in Japan. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100059
A RETROSPECTIVE COHORT STUDY ON THE RELATIONSHIP BETWEEN FRAILTY AND HEALTHCARE OUTCOMES
Jinmyoung Cho, Joanne Salas, Jeffery F. Scherrer, George Grossberg
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BACKGROUND: Frailty increases vulnerability for adverse outcomes in older adults. Characterizing the prevalence and distribution of frailty can help guide healthcare service decision-making and policy.
OBJECTIVES: This study evaluated the association between frailty and healthcare utilization and interactions by demographic characteristics.
DESIGN: Using electronic health records (2018–2022), we conducted a retrospective cohort study with 355,266 patients ≥65 years of age who had ≥2 ambulatory office visits in separate years in the 4-year baseline period (2018–2021). The Gilbert Frailty Index (GFI) was calculated (low vs. intermediate vs. high) using ICD-10 codes. One-year utilization outcomes in 2022 included high outpatient clinic utilizations (OCU), inpatient (IP), emergency department (ED), and nursing home (NH) admissions. Fully adjusted log-binomial regression models were calculated overall and by race (White vs. Black), age groups, and gender.
RESULTS: The sample was 74.5(±7.5) years of age, 57.7 % female, 89.2 % White, and 13.5 % categorized as GFI high. After adjustment for covariates, GFI high had the highest risk for all outcomes (RR=3.31 for IP; 2.77 for ED; 4.26 for NH; 1.60 for high OCU). We observed significant interactions by race, gender, and age for some outcomes. Effects of GFI high vs. low were larger for White (IP, ED, & high OCU), female patients (ED & high OCU), and younger patients (IP). Conversely, the effects of GFI high vs. low were strongest in older patients for ED, IP and high OCU.
CONCLUSIONS: Monitoring frailty and paying attention to patient’s demographic characteristics is needed to best estimate associations between frailty and healthcare utilization.
CITATION:
Jinmyoung Cho ; Joanne Salas ; Jeffery F. Scherrer ; George Grossberg (2025): A retrospective cohort study on the relationship between frailty and healthcare outcomes. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100053
CHRONIC PAIN AS A MEDIATOR IN THE FALLS-FRAILTY ASSOCIATION: EVIDENCE FROM MIDDLE-AGED AND OLDER ETHNIC MINORITIES IN YUNNAN, CHINA
Xuan Wen, Rui Deng, Xinping Wang, Chunyan Deng, Xiaoju Li, Yafang Zhang, Ying Chen, Yuan Huang
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BACKGROUND: Falls are associated with an increased risk of frailty in middle-aged and older adults; however, the mediating role between falls and frailty remains underexplored, particularly among ethnic minority groups with distinct sociocultural and environmental exposures. Ethnic minority populations exhibit significant disparities in the prevalence of falls, frailty, and chronic pain compared to the majority. The primary objective of this study is to examine the relationship between falls and frailty in middle-aged and elderly individuals residing in Yunnan Province, China, with a specific emphasis on exploring the potential mediating effect of chronic pain across different ethnic groups.
METHODS: Employing a cross-sectional design, data were collected from July to December 2022 from adults aged ≥45 years in five ethnically diverse counties of Yunnan Province, China. Structured face-to-face interviews and stratified multistage cluster sampling were used for data collection. Baron and Kenny’s causal steps method was used to explore the mediating effect of chronic pain on the relationship between falls and frailty. Spearman correlation analysis, multiple linear regression models, and bootstrap method were used for data analysis.
RESULTS: A total of 2710 respondents participated in this study. The age distribution was as follows: 1161 (42.84 %) aged 45–59 years, 863 (31.85 %) aged 60–69 years, and 686 (25.31 %) aged 70 years or older. The sample comprised 1218 males (44.94 %) and 1492 females (55.06 %). The prevalence of falls among middle-aged and older individuals was 12.77 %, while the prevalence of frailty in the same population was observed to be 21.62 %. Spearman correlation analysis revealed significant positive association between chronic pain and both falls (r = 0.135, P < 0.05) as well as frailty (r = 0.383, P < 0.05). Frailty also exhibited a significant positive correlation with falls (r = 0.162, P < 0.05). After adjusting for all covariates, the total effect of falls on frailty was estimated to be 1.065 (95 % bootstrap CI: 0.804∼1.326), with a direct effect estimate of 0.797 (95 % bootstrap CI: 0.511∼1.083). The indirect effect of chronic pain on this association was found to be approximately one-quarter at 0.268 (95 % bootstrap CI: 0.170∼0.366). The subgroup analysis discovered differences in the mediating effects across different ethnic groups; specifically, the proportions mediated by chronic pain were found to be 28.2 %, 18.4 %, and 21.5 % for Han majority group, Zhiguo ethnic minorities, and other ethnic minority groups, respectively.
CONCLUSION: This study provides valuable insights into the intricate association between frailty, falls, and chronic pain among middle-aged and older adults from diverse ethnic backgrounds in a western province of China. Effective management strategies targeting chronic pain and falls prevention could serve as crucial interventions to address frailty.
CITATION:
Xuan Wen ; Rui Deng ; Xinping Wang ; Chunyan Deng ; Xiaoju Li ; Yafang Zhang ; Ying Chen ; Yuan Huang (2025): Chronic pain as a mediator in the falls-frailty association: Evidence from middle-aged and older ethnic minorities in Yunnan, China. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100050
THE RELATIONSHIP BETWEEN GLAUCOMA AND AN ELECTRONIC FRAILTY INDEX WITH THE CUMULATIVE INCIDENCE OF HEALTHCARE ENCOUNTERS FOR FALLS AND FRACTURES IN OLDER ADULTS
Walter D. Duy, Nicholas M. Pajewski, Jeff D. Williamson, Atalie C. Thompson
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OBJECTIVE: To compare the association of glaucoma and glaucoma suspect diagnoses with frailty, quantified via an electronic frailty index (eFI), and to evaluate whether a glaucoma diagnosis moderates the association between frailty and the cumulative risk of acute healthcare encounters for incident falls or fractures.
DESIGN: Retrospective study of electronic health record (EHR) data.
SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Adults ≥65 years old with an ICD-10 diagnosis code for glaucoma or glaucoma suspect who had a calculable eFI score as of 10/1/2017.
METHODS: Ordinal logistic regression was used to examine the cross-sectional association between glaucoma (predictor) and frailty status (outcome) based on the eFI. The relationship of glaucoma and frailty with the cumulative incidence of hospital or emergency room visits for injurious falls or fractures over time was modeled using cause-specific recurrent event survival models that account for censoring and the competing risk of death.
MAIN OUTCOME MEASURES: Frailty status based on the eFI and cumulative incidence of falls or fractures. RESULTS: Glaucoma patients were significantly more likely to be frail compared to glaucoma suspects (adjusted odds ratio=1.36, 95 % CI(1.16, 1.60)). Both pre-frailty and frailty were associated with an increased risk of incident falls/fractures in older adults: prefrail (hazard ratio=2.07, 95 % CI (1.40, 3.06)), frail (hazard ratio=3.35, 95 % CI (2.24, 5.03)), but there was no interaction of frailty with glaucoma status on falls/fractures risk. Also, the risk of incident falls/fractures did not significantly differ between glaucoma versus glaucoma suspects.
CONCLUSIONS: Glaucoma patients were more likely to be frail or pre-frail based on an EHR-derived index than glaucoma suspects. Both pre-frailty and frailty were associated with increased cumulative risk of injurious falls or fractures but there was no interaction of frailty with glaucoma. Frailty based on the eFI was better at discriminating who is at risk of acute healthcare utilization for falls/fractures than a glaucoma diagnosis.
CITATION:
Walter D. Duy ; Nicholas M. Pajewski ; Jeff D. Williamson ; Atalie C. Thompson (2025): The relationship between glaucoma and an electronic frailty index with the cumulative incidence of healthcare encounters for falls and fractures in older adults. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100051
PATIENT-OUTCOMES OF A FRAILTY MANAGEMENT PROGRAM FOR COMMUNITY-DWELLING OLDER ADULTS IN SINGAPORE: A COHORT EVALUATION
Ze Ling Nai, Robin Choo, Grace Sum, Siew Fong Goh, Yew Yoong Ding, Wee Shiong Lim, Woan Shin Tan, Geriatric Service Hub Programme Group
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BACKGROUND: There is urgency to manage frailty due to its increasing prevalence. The Geriatric Service Hub (GSH) is a novel programme in Singapore, which aims to manage frailty amongst community-dwelling older adults.
OBJECTIVES: We aimed to (1) assess the effectiveness of the GSH through patient-outcomes including patient activation, functional status, and quality-of-life (QoL), and (2) assess impact on patient-outcomes through different levels of frailty using the Clinical Frailty Scale (CFS) scores.
DESIGN: Single-arm pre-post design.
SETTING: Community-based health and social care provider.
PARTICIPANTS: 218 GSH patients, aged≥65, with CFS4 to CFS7.
INTERVENTION: Patients received comprehensive geriatric assessments in community-based settings and had individualised care plans formed by a multi-disciplinary care team. Patients were then referred to health and social services located in the community based on identified needs.
MEASUREMENTS: Functional status (Barthel Index), Patient activation (Patient Activation Measure), health-related QoL (EuroQoL 5-dimension 5-level tool) and the emotional-related QoL (Control, Autonomy, Self-realisation, and Pleasure tool). Measurements administered at baseline, 3- and 6-months post-enrolment. Analysis included unadjusted t-tests and multi-level mixed-effects linear regression.
RESULTS: We studied 191 (87.6 %) participants who completed all 3-timepoints. Compared to baseline, functional status was maintained at 3-months (Mdiff=-0.2, 95 % CI [-1.8;1.3]) and 6-months (Mdiff=-0.5, 95 % CI[-2.2;1.2]). Patient activation increased slightly at 3-months (Mdiff=3.0, 95 % CI [0.1;5.9]) but not at 6-months (Mdiff=1.5, 95 % CI [-1.2;4.1]). There were significant increases for health-related QoL a t 3-months (Mdiff=0.068, 95 %CI [0.041;0.095]) and 6-months (Mdiff=0.045, 95 % CI [0.016;0.074]), and for emotional-related QoL at 3-months (Mdiff=2.3, 95 % CI [1.2;3.3]) and 6-months (Mdiff=1.5, 95 % CI [0.4;2.7]). For sub-group analyses, there were significant increases for patient activation and both QoL measurements for patients categorised as CFS4 and CFS5, and no significant changes for patient-outcomes for CFS6–7.
CONCLUSIONS: Overall, results suggest maintenance in patient activation and functional status, with improvements in QoL. Sub-group analyses suggest that GSH is beneficial for patients categorised as CFS4 and CFS5, but the programme played a largely maintenance role for patients with CFS6–7.
CITATION:
Ze Ling Nai ; Robin Choo ; Grace Sum ; Siew Fong Goh ; Yew Yoong Ding ; Wee Shiong Lim ; Woan Shin Tan ; Geriatric Service Hub Programme Group (2025): Patient-outcomes of a frailty management program for community-dwelling older adults in Singapore: A cohort evaluation. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100048
JFA N°03 - 2025
EDITORIAL: REFLECTION POINTS ON HOW FRAILTY CONCEPTS HAVE CHANGED CLINICAL PRACTICE
Cornel Christian Sieber
J Frailty Aging 2025;14(3)
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CITATION:
Cornel Christian Sieber (2025): Editorial: Reflection points on how frailty concepts have changed clinical practice. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100046
PSOAS MUSCLE DENSITY PREDICTS ELECTIVE COLORECTAL SURGICAL OUTCOMES MORE ACCURATELY THAN PSOAS MUSCLE AREA OR INDEXED AREA
Louis Scarrold, Douglas Stupart, David Watters
J Frailty Aging 2025;14(3)
Show summaryHide summaryBACKGROUND: CT measurements of psoas muscle density (PMD) and area (PMA) (with or without indexing to height-squared or body-surface-area) are used interchangeably as sarcopenia measures - it is unknown which best correlates with surgical risk.
OBJECTIVES: 1.Determine the correlation between psoas muscle density, area, and indexed area;
2.Identify which psoas measures most strongly associated with surgical outcomes
DESIGN: The University Hospital Geelong Colorectal database included all patients who underwent elective colorectal surgery from 2007 to 2014 (minimum five-years follow-up). Pre-operative CT scans were reviewed, psoas measures correlated with each other and with outcomes.
SETTING: University Hospital Geelong is a regional referral hospital in Victoria, Australia.
PARTICIPANTS: This database listed 552 patients, 120 were excluded as pre-operative CT-films were not accessible, leaving 432 patients included.
EXPOSURE: Psoas muscle density, area, and area indexed by height-squared and body-surface-area.
MEASUREMENTS: Pearson correlations investigated correlations between psoas muscle measures. Logistic regression and ROC-analysis investigated each psoas measures association with peri‑operative morbidity. Kaplan-Meier survival-analysis investigated the association of each psoas measure with long-term survival.
RESULTS: Mean age was 70.4 years, 41 % were female.
Psoas muscle density correlated poorly with area (R2=0.15). Unindexed psoas muscle area correlated well with area indexed by height-squared (R2=0.950) and body-surface-area (R2=0.938).
Long-term survival was associated with psoas muscle density (HR1.515(95 %CI 1.062–2.161)) and area (HR1.886(95 %CI 1.322–2.692)).
Increasing psoas muscle density (reduced sarcopenia) was associated with decreased major-complications (OR0.963(95 %CI 0.938–0.989)) and peri‑operative mortality (OR0.903(95 %CI 0.847–0.962)), with ROC-curve AUC=0.829 indicating an accurate test. There was no association between psoas muscle area and major-complications (OR1.000(95 %CI 1.000–1.000)), nor peri‑operative mortality (OR1.000(95 %CI 0.999–1.001)), with ROC-curves AUC=0.507–0.521.
Indexed area measures were not associated with outcomes.
CONCLUSIONS: Psoas muscle density and area did not correlate. Both were associated with long-term survival, but only density was associated major-complications and mortality. Indexing removed the correlation of area with long-term survival.
CITATION:
Louis Scarrold ; Douglas Stupart ; David Watters (2025): Psoas muscle density predicts elective colorectal surgical outcomes more accurately than psoas muscle area or indexed area. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100037
FRAMEWORK FOR A SHORT MUSCLE FUNCTION BATTERY USING ELECTRONIC HANDGRIP DYNAMOMETRY AND ACCELEROMETRY IN OLDER ADULTS
Ryan McGrath, Grant R. Tomkinson, Sarah Andrew, Joshua Batesole, Chloe Carling, Bryan K. Christensen, Samantha FitzSimmons, Halli Heimbuch, Tyler Hoang, Donald Jurivich, Jacob Kieser, Kelly Knoll, Peyton Lahr, Matthew Langford, Michaela Mastrud, Megan Orr, Yeong Rhee, Kyle J. Hackney
J Frailty Aging 2025;14(3)
Show summaryHide summaryBACKGROUND: Electronic handgrip dynamometry and accelerometry enables novel opportunities to collect additional attributes of muscle function beyond just maximal strength, but some muscle function attributes may already be related, which may warrant discerning these attributes into a short muscle function battery (SMFB).
OBJECTIVES: We sought to determine the multivariate relationships between maximal strength, asymmetry, submaximal control, rate of force development, bimanual coordination, fatigability, and contractile steadiness in older adults.
DESIGN: A cross-sectional design was used for this investigation.
SETTING: Laboratory.
PARTICIPANTS: The analytic sample included 121 generally healthy older adults aged 70.7 ± 4.7 years.
MEASUREMENTS: Electronic handgrip dynamometry and accelerometry measured strength, asymmetry, submaximal control, rate of force development, bimanual coordination, fatigability, and contractile steadiness. The handgrip variables were standardized before they were included in a factor analysis. Factors with eigenvalues >1.0 were kept. Items within a factor with a loading |>0.30| were similarly retained.
RESULTS: There were 3 factors retained with eigenvalues of 1.88, 1.56, and 1.10. The first factor (functional strength), which explained 39.9 % of the variance, included strength, submaximal control, and rate of force development. Factor 2 (lateral function), which explained 35.8 % of the variance, included asymmetry and bimanual coordination. The third factor (muscle endurance), which explained 24.3 % of the variance, included fatigability and contractile steadiness.
CONCLUSIONS: Our findings suggest the surfacing of themes in the additional muscle function measures, thereby providing framework for a SMFB. More research is needed for electronic handgrip dynamometry and accelerometry derived muscle function on health before consideration of implementation in clinical practice.
CITATION:
Ryan McGrath ; Grant R. Tomkinson ; Sarah Andrew ; Joshua Batesole ; Chloe Carling ; Bryan K. Christensen ; Samantha FitzSimmons ; Halli Heimbuch ; Tyler Hoang ; Donald Jurivich ; Jacob Kieser ; Kelly Knoll ; Peyton Lahr ; Matthew Langford ; Michaela Mastrud ; Megan Orr ; Yeong Rhee ; Kyle J. Hackney ; (2025): Framework for a short muscle function battery using electronic handgrip dynamometry and accelerometry in older adults. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100045
SARCOPENIA IS ASSOCIATED WITH LOWER QUALITY OF LIFE SCORES AMONG COMMUNITY-DWELLING OLDER FILIPINOS: FINDINGS FROM A CROSS-SECTIONAL STUDY
Robby Carlo Tan, Kyler Kenn Castilla, Michael Serafico, Marco Mensink, Lisette de Groot
J Frailty Aging 2025;14(3)
Show summaryHide summaryBACKGROUND AND OBJECTIVES: Sarcopenia, characterized by a progressive decline in muscle mass and strength, is a significant concern among older individuals, impacting their functionality and overall quality of life (QOL). The relationship between sarcopenia and QOL among Filipino older adults remains underexplored. Thus, the study aims to determine the prevalence of sarcopenia and its association with the QOL of community-dwelling older adults in selected Philippine cities.
DESIGN: This cross-sectional study used convenience sampling in the selection of the cities. Participants were randomly selected from the list provided by each local city government.
SETTING AND PARTICIPANTS: 536 apparently healthy community-dwelling Filipino older adults from three major islands in the Philippines.
METHODS: Sarcopenia was determined using the 2019 Asian Working Group for Sarcopenia criteria which is the presence of low muscle mass, plus low muscle strength, and/or low physical performance. Quality of life was assessed using the culturally-validated WHO-QOL short form questionnaire. Mixed Model logistic regression adjusted for covariates was performed to study the association of sarcopenia indicators to quality of life.
RESULTS: 24.3 % of older Filipinos were found to have sarcopenia. Sarcopenic community-dwelling older adults had significantly decreased odds of attaining higher score in the physical domain (OR 0.63; 0.40–0.98), psychological domain (OR 0.55; CI 0.35–0.84), and overall quality of life (OR 0.57; CI 0.37–0.89) than the non-sarcopenic group.
CONCLUSION: One in four community-dwelling Filipino older adults met the sarcopenia criteria. Sarcopenia is associated with decreased QOL scores, particularly in the physical health and psychological health domains. Sarcopenia needs to be considered in the context of public health to come up with targeted nutrition and health interventions for improved QOL.
CITATION:
Robby Carlo Tan ; Kyler Kenn Castilla ; Michael Serafico ; Marco Mensink ; Lisette de Groot (2025): Sarcopenia is associated with lower quality of life scores among community-dwelling older Filipinos: Findings from a cross-sectional study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100044
ASSOCIATION BETWEEN FRAILTY AND PHYSICAL FUNCTION RECOVERY OF PEOPLE WHO RECEIVED PHYSIOTHERAPY EARLY REHABILITATION DURING ACUTE HOSPITALISATION: AN OBSERVATIONAL COHORT STUDY
Jennifer R A Jones, Sue Berney, Chris Michael, Tessa O’Dea, Joleen W Rose, Talia Clohessy, Stacey Haughton, Rebekah McGaw, Cameron Patrick, Mark Hindson, Sharae Theisinger, Elena Gerstman, Rebecca Morris, Lucy Gao, David J Berlowitz
J Frailty Aging 2025;14(3)
Show summaryHide summaryOBJECTIVES: Examine the effect of frailty on physical function recovery in people admitted to hospital who received a physiotherapy Early Rehabilitation program.
METHODS: Observational cohort (1 January 2021 to 31 December 2021). Patients admitted to the acute site at Austin Health, Australia who received an Early Rehabilitation program (targeted physical rehabilitation to address goals aligned to physiotherapy intervention in parallel with acute medical treatment) were eligible. Frailty was measured with the Clinical Frailty Scale (CFS). The primary outcome was, across the CFS, magnitude of change from admission to discharge in physical function assessed with the modified Iowa Level of Assistance Scale (mILOA). Secondary outcomes were length of stay and discharge destination. Generalised additive models were used.
RESULTS: There were 674 patients included in the study. Irrespective of frailty status, mean improvement in physical function from admission to discharge exceeded the minimal datable change of 5.8 points for the mILOA. Larger average improvements in mILOA were observed in patients with lower degrees of frailty (p < 0.001 overall effect), where a portion of patients with severe frailty did not make clinically meaningful gains in physical function following Early Rehabilitation. Mean improvement in physical function and predicted probabilities for discharge home were similar; where greater frailty severity was associated with a lesser chance of going home at acute hospital discharge (p = 0.002 overall effect).
CONCLUSIONS: Validating the link between predictions for change in physical function and discharge home in people receiving early rehabilitation during acute hospitalisation would be of great clinical utility.
CITATION:
Jennifer R A Jones ; Sue Berney ; Chris Michael ; Tessa O’Dea ; Joleen W Rose ; Talia Clohessy ; Stacey Haughton ; Rebekah McGaw ; Cameron Patrick ; Mark Hindson ; Sharae Theisinger ; Elena Gerstman ; Rebecca Morris ; Lucy Gao ; David J Berlowitz (2025): Association between frailty and physical function recovery of people who received physiotherapy early rehabilitation during acute hospitalisation: An observational cohort study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100052
IMMEDIATE ADMISSION TO THE SURGERY HOSPITAL SIGNIFICANTLY OPTIMISES QUALITY INDICATORS IN OLDER PATIENTS WITH HIP FRACTURES: A BEFORE-AND-AFTER STUDY
José Luis Dinamarca-Montecinos, Alejandra Leiva Vásquez, Carmelinda Ruggiero, Yasna Barrera Fernández, Rayén Delgado Gac, Ada Carrillo, Gedeón Lazcano Améstica, Daniel Ulloa Vásquez, Fernando Aranda, Andrés Canales Pizarro, Graciela Mardones, Constanza Morales Gherardelli, Victoria Assael Novik, Osvaldo Sepúlveda, Jossie Acuña, Carola Arancibia Aravena, Julio Ibarra, Jack Bell, Emma Sutton
J Frailty Aging 2025;14(3)
Show summaryHide summaryBACKGROUND: Hip fractures generate high biomedical, social, functional, organisational, and economic costs. There are various quality indicators to guide its management. One of them is surgery within 48–72 h. In Chilean public health system, this indicator has out-of-standard results. This situation could have organizational causes: after hip fracture diagnosis, many older patients are first referred to general hospitals, whilst waiting an orthopedic surgical bed.
OBJECTIVE: To evaluate the effects of a protocol of immediate-admission to the surgery hospital on organisational and economic indicators of hip-fractured older patients.
DESIGN: Before-and-after study, between 01/01/2017–09/30/2019; 12 months before and 21 months after implementation.
SETTING: Regional surgical hospital responsible for 87 % of the older population in its assigned territory, in the more aged region of Chile.
PARTICIPANTS: Anonymised data of 902 hip-fractured older adults (≥ 60 years).
INTERVENTION: Implementation of a protocol that requires immediate admission to the surgical hospital of all older hip-fractured patients at the time of diagnosis.
MEASUREMENTS: Number of hip-fractured patients with no immediate admission, time to surgery, total in-hospital time, and economic costs. Normality tests (Kolmogorov-Smirnov), non-parametric tests (Chi-squared), Mann-Whitney and Kruskal-Wallis tests were performed. Measures of central tendency (medians and percentiles) were used.
RESULTS: After protocol there was a significant reduction in the proportion of patients referred to general hospitals in both, first and second year (pre=37,8 %; post 1 = 27,3 %; post 2 = 23,3 %, p = 0,000). Time to surgery was also significantly reduced (medians bed days pre=15, post 1 = 11, post 2 = 10, p = 0,000). Total in-hospital time decreased 21 % (3395 bed days), and there was also a significant decrease in costs from USD130,000 to USD35,000 (p = 0,000).
CONCLUSION: Immediate admission to orthopedic surgical hospital of older adults with hip fractures significantly decreases inter-hospital transfers, time to surgery, total in-hospital time, and direct hospital costs.
CITATION:
José Luis Dinamarca-Montecinos ; Alejandra Leiva Vásquez ; Carmelinda Ruggiero ; Yasna Barrera Fernández ; Rayén Delgado Gac ; Ada Carrillo ; Gedeón Lazcano Améstica ; Daniel Ulloa Vásquez ; Fernando Aranda ; Andrés Canales Pizarro ; Graciela Mardones ; Constanza Morales Gherardelli ; Victoria Assael Novik ; Osvaldo Sepúlveda ; Jossie Acuña ; Carola Arancibia Aravena ; Julio Ibarra ; Jack Bell ; Emma Sutton (2025): Immediate admission to the surgery hospital significantly optimises quality indicators in older patients with hip fractures: A before-and-after study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100014
FRAILTY INDICES BASED ON ROUTINELY COLLECTED DATA: A SCOPING REVIEW
Schenelle Dayna Dlima, Danielle Harris, Abodunrin Quadri Aminu, Alex Hall, Chris Todd, Emma RLC Vardy
J Frailty Aging 2025;14(3)
Show summaryHide summaryA frailty index (FI) is a frailty assessment tool calculated as the proportion of the number of health-related deficits an individual has to the total number of variables in the index. Routinely collected clinical and administrative data can be used as sources of deficits to automatically calculate FIs. This scoping review aimed to evaluate the current research landscape on routine data-based FIs. We searched seven databases to find literature published in 2013–2023. Main inclusion criteria were original research articles on FIs constructed from routine data, with deficits in at least two of the following categories: “symptoms/signs”, “laboratory values”, “diseases”, “disabilities”, and “others”. From 7526 publications screened, 218 were included. Studies were primarily from North America (47.7 %), conducted in the community (35.3 %), and used routine data-based FIs for risk stratification (51.4 %). FIs were calculated using various routine data sources; however, most were initially developed and validated using hospital records. We noted geographical differences in study settings and routine data sources. We identified 611 unique deficits comprising these FIs. Most were either “diseases” (34.4 %) or “symptoms/signs” (32.1 %). Routine data-based FIs are feasible and valid risk stratification tools, but research is confined to high-income countries, their routine adoption is slow, and deficits comprising these FIs emphasise a reactive and overtly medical approach in addressing frailty. Future directions include exploring the feasibility and applicability of using routine databases for frailty assessment in lower- and middle-income countries, and leveraging non-clinical routine data through data linkages to proactively identify and manage frailty.
CITATION:
Schenelle Dayna Dlima ; Danielle Harris ; Abodunrin Quadri Aminu ; Alex Hall ; Chris Todd ; Emma RLC Vardy (2025): Frailty indices based on routinely collected data: a scoping review. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100047
MAXIMISING INCLUSIVITY IN CARE HOME RESEARCH: LESSONS LEARNED FROM THE AFRI-C RANDOMISED CONTROLLED TRIAL
Laurel Campbell-Smith, Sophie Rees, Jane Sprackman, Karen Sargent, Alastair D Hay, Rachel CM Brierley
J Frailty Aging 2025;14(3)
Show summaryHide summaryEthical and procedural requirements make research in care homes challenging. With people living longer globally, it is essential that older people are included in research, including within the care home setting. We conducted a randomised controlled trial (AFRI-c) in 91 care homes across England, aiming to make the study available to every eligible resident. Facilitators included flexible models for receiving consent; commitment from care home staff, residents and families; tailored and specific training for care home staff; and support from national research infrastructure to engage care homes in research. To facilitate inclusive care home research, we recommend consulting with care homes about their research priorities; continuing investment in national research infrastructure for care homes; using advance directives for research planning for care home residents; embedding research nurses in care home environments; and more guidance for researchers and ethics committees on applying legal frameworks regarding capacity to research settings.
CITATION:
Laurel Campbell-Smith ; Sophie Rees ; Jane Sprackman ; Karen Sargent ; Alastair D Hay ; Rachel CM Brierley (2025): Maximising inclusivity in care home research: Lessons learned from the AFRI-c randomised controlled trial. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100038
CORRIGENDUM TO “IMPLEMENTING OCCUPATIONAL THERAPY INTO AN ACUTE GERIATRIC WARD: EFFECTS ON PATIENTS\' FUNCTIONAL STATUS AT DISCHARGE” [J FRAILTY AGING 13 (2024) 307-12]
C. Sidoli, C. Okoye, A. Staglianò, A. Zambon, C. Pozzi, M.C. Ferrara, G. Bellelli
J Frailty Aging 2025;14(3)
Show summaryHide summary
CITATION:
C. Sidoli ; C. Okoye ; A. Staglianò ; A. Zambon ; C. Pozzi ; M.C. Ferrara ; G. Bellelli (2025): Corrigendum to “Implementing Occupational Therapy into an Acute Geriatric Ward: Effects on Patients' Functional Status at Discharge” [J Frailty Aging 13 (2024) 307-12]. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100049