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DOES ZOLEDRONIC ACID IMPROVE APPENDICULAR LEAN MASS IN OLDER WOMEN WITH OSTEOPOROSIS? A SUB-ANALYSIS OF A RANDOMIZED CLINICAL TRIAL

N.S. Haeri, S. Perera, S.L. Greenspan

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Background: Coexistence of osteoporosis and sarcopenia (osteosarcopenia), is associated with increased risk for fractures, falls, and mortality. Although there are multiple medications for management of osteoporosis, there are no approved pharmacotherapy for sarcopenia. Objectives: We examined the effect of zoledronic acid on muscle mass indices including ALM (Appendicular Lean Mass) and ALM/Height2 in a cohort of older women with osteoporosis who were residents of Long-Term Care Communities (LTCCs). Design: A secondary analysis of a 2-year double-blind, randomized, placebo-controlled clinical trial. Setting: Residents of LTCCs. Participants: Sixty-two postmenopausal women with osteoporosis. Intervention: Participants either received 5 mg infusion of zoledronic acid or placebo, once at the start of the study. Measurements: Participant’s ALM/Height2, ALM, total hip BMD (Bone Mineral Density) and spine BMD were measured in 6, 12 and 24 months. Results: On average, participants were 86.7 years old and had a BMI of 27.4 kg/m2. There was no significant difference in change from baseline (mean ± SE) between the treatment group and the placebo group in ALM/Height2: (-0.15 vs -0.02, p = 0.541) and (-0.17 vs 0.001, p = 0.315) and (-0.29 vs -0.19, p = 0.646) or ALM: (-0.38 vs -0.09, p = 0.455) and (-0.45 vs -0.005, p = 0.216) and (-0.70 vs -0.48, p = 0.553) at 6, 12, and 24 months respectively. In addition, after adjusting for a possible confounding, the ALM/Height2 or ALM did not have significant improvements from baseline at 6 months, 12 months, and 24 months either in the treatment group or in the placebo group. However, there were significant improvements in the BMD at the total hip and the spine in the treatment group compared with the placebo group at all three time points. Conclusions: Among older women residing in LTCCs, a single dose of zoledronic acid did not increase ALM/Height2 and ALM, despite improving the BMD at the total hip and the spine at the 2-year follow-up.

CITATION:
N.S. Haeri ; S. Perera ; S.L. Greenspan ; (2022): Does Zoledronic Acid Improve Appendicular Lean Mass in Older Women with Osteoporosis? A Sub-Analysis of a Randomized Clinical Trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.54

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LETTER TO THE EDITOR: DOES HIGHER PREVALENCE OF FRAILTY IN GREEK OLDER COMMUNITY-DWELLING WOMEN ALSO RELATE TO HIGHER PREVALENCE OF PERCEIVED FINANCIAL EXPLOITATION? A NEW QUESTION TO PONDER UPON

V. Giannouli

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CITATION:
V. Giannouli ; (2022): Letter to the Editor: Does Higher Prevalence of Frailty in Greek Older Community-dwelling Women also Relate to Higher Prevalence of Perceived Financial Exploitation? A New Question to Ponder Upon. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.57

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EFFECT OF A 12-WEEK MIXED TRAINING ON BODY QUALITY IN PEOPLE LIVING WITH HIV: DOES AGE AND HIV DURATION MATTER?

F. Buckinx, J. Granet, A. Bass, N. Kaur, L.K. Fellows, M.-J. Brouillette, N. Mayo, M. Aubertin-Leheudre

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Background: The impact of HIV duration on exercise adaptations has not yet been studied. Moreover, the age at which subjects living with HIV are the most responsive to exercise is not clear. Aims: Investigate the effect of a mixed exercise training program on physical performance changes in individuals living with HIV and explore if age or HIV duration influence these adaptations in men. Methods: In this feasibility study, participants followed a 12-week mixed exercise training program, three times/week, 45 min/session. Physical performance including functional capacities (normal 4-m walking test, 6min walking test), grip strength (hand dynamometer), muscle power, body composition (android and gynoid fat masses, appendicular lean mass) were evaluated pre- and post-intervention. Subgroup analysis according to the median age of the participants (age<50yrs vs. age≥50yrs) and median HIV duration (HIV<20yrs vs. HIV≥20yrs) were performed in men. Results: A total of 27 participants (age: 54.5±6.8yrs, men: 85%; HIV duration: 19.3±7.6yrs) were included. At the end of the intervention, significant increases compared to baseline were seen in grip strength (p=0.017), leg power (p<0.001), normal walking speed (p<0.001) and 6-min walking distance (p=0.003). Following the intervention, parameters improved similarly in both age groups. However improvement was greater in those with HIV>20yrs than those with a shorter infection duration, with change (%) on total (p<0.001), android (p=0.02), and gynoid (p=0.05) fat masses as well as appendicular lean mass index (p=0.03). Conclusion: Mixed exercise training seems to be an effective intervention to improve physical performance in individuals living with HIV. In addition, this study suggests that neither age nor HIV duration has influence on the effect of mixed training in this population.

CITATION:
F. Buckinx ; J. Granet ; A. Bass ; N. Kaur ; L.K. Fellows ; M.-J. Brouillette ; N. Mayo ; M. Aubertin-Leheudre ; ; (2022): Effect of a 12-Week Mixed Training on Body Quality in People Living with HIV: Does Age and HIV Duration Matter?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.56

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EFFECTS OF TRADITIONAL CHINESE EXERCISES ON FRAILTY, QUALITY OF LIFE, AND PHYSICAL FUNCTION ON FRAIL AND PRE-FRAIL OLDER PEOPLE: A SYSTEMATIC REVIEW AND META-ANALYSIS

X. Wan, J. Shen, G. He

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PURPOSE: To explore the effects of traditional Chinese exercises (TCEs) on the frailty status, quality of life, and physical function of frail and pre-frail older adults. Methods: Eight databases were searched from inception to March 28, 2022. Methodological quality and heterogeneity were assessed. Mean difference (MD) or standardized MD (SMD) were pooled using random-effects or fixed-effects meta-analysis, depending on heterogeneity. Results: A total of 12 articles were included. Results showed relieved frailty status of frail and pre-frail older adults (SMD = −1.46; 95% CI [−2.39, −0.53]; p < 0.01); quality of life improved (SMD = 0.91, 95% CI [0.19, 1.63]; p < 0.01); grip strength enhanced doing Badaunjin (MD = 2.51, 95% CI [1.09, 3.93]; p < 0.01), but no significant improvement with Taichi (MD = 0.10, 95% CI [−2.3,2.5]; p = 0.93); dynamic balance ability improved (MD = −2.57, 95% CI [−2.90, −2.25], p < 0.01); 4.5-m walking time shortened (MD = −0.95; 95% CI [−1.70, −0.20]; p < 0.001); gait speed improved (MD = 0.04; 95% CI [0.01, 0.07]; p = 0.003); lower body endurance increased (MD = 33.78; 95% CI [10.99, 56.68]; p = 0.004); Lower limb flexibility improved (SMD = −2.07; 95% CI [−2.94, −1.21]; p < 0.01). Conclusions: This study showed that TCEs may be helpful in alleviating frailty status and improving the quality of life and physical functions of frail and pre-frail older adults. Lastly, additional high-quality clinical trials are warranted despite the limited strong evidence.

CITATION:
X. Wan ; J. Shen ; G. He ; (2022): Effects of Traditional Chinese Exercises on Frailty, Quality of Life, and Physical Function on Frail and Pre-Frail Older People: A Systematic Review and Meta-Analysis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.52

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LOW INTAKE OF CHOLINE IS ASSOCIATED WITH DIMINISHED STRENGTH AND LEAN MASS GAINS IN OLDER ADULTS

C.W. Lee, E. Galvan, T.V. Lee, V.C.W. Chen, S. Bui, S.F. Crouse, J.D. Fluckey, S.B. Smith, S.E. Riechman

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Objectives: Choline is an essential micronutrient for many physiological processes related to exercise training including biosynthesis of acetylcholine. Though dietary choline intake has been studied in relation to endurance training and performance, none have studied it during resistance exercise training (RET) in older adults. The objective of the study was to examine the relationship between choline intake and muscle responses to RET in older adults. Methods: Forty-six, 60-69-year-old individuals (M=19, F=27) underwent 12 weeks of RET (3x/week, 3 sets, 8-12 reps, 75% of maximum strength [1RM], 8 exercises). Body composition (DEXA) and 1RM tests were performed before and after training. After analyzing 1,656 diet logs (3x/week, 46 participants, 12 weeks), participants’ mean choline intakes were categorized into three groups: Low (2.9-5.5 mg/kg lean/d), Med-Low (5.6-8.0 mg/kg lean/d), or Adequate (8.1-10.6 mg/kg lean/d). These correspond to <50%, ~63%, and ~85% of Adequate Intake (AI) for choline, respectively. Results: Gains in composite strength (leg press + chest press 1RM) were significantly lower in the Low group compared with the other groups (Low: 30.9 ± 15.1%, Med-Low: 70.3 ± 48.5%, Adequate: 81.9 ± 68.4%; p=0.004). ANCOVA with cholesterol, protein, or other nutrients did not alter this result. Reduced gains in lean mass were also observed in the Low group, compared with higher choline intake of 5.6-10.6 mg/kg lean/d (1.3 ± 0.6% vs. 3.2 ± 0.6%, p<0.05). Conclusion: These data suggest that this population of older adults does not consume adequate choline and lower choline intake is negatively and independently associated with muscle responses to RET.

CITATION:
C.W. Lee ; E. Galvan ; T.V. Lee ; V.C.W. Chen ; S. Bui ; S.F. Crouse ; J.D. Fluckey ; S.B. Smith ; S.E. Riechman ; (2022): Low Intake of Choline Is Associated with Diminished Strength and Lean Mass Gains in Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.50

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PHYSICAL FRAILTY AND HEMOGLOBIN-TORED CELL DISTRIBUTION WIDTH RATIO IN JAPANESE OLDER OUTPATIENTS

K. Kinoshita, S. Satake, K. Murotani, M. Takemura, Y. Matsui, H. Arai

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The Frailty screening should be widely performed; however, simple and inexpensive biomarkers are missing. Biomarkers that can be routinely assessed in many patients are desirable. Recently, the hemoglobin-to-red cell distribution width ratio (Hb/RDW, HRR) has been suggested as a new prognostic marker and has been reported to be associated with inflammation, one of the factors contributing to frailty. Therefore, we aimed to address the role of HRR in frailty among 557 older outpatients (aged 65–96 years). Frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria, and HRR was calculated from clinical records. Participants were classified into five groups based on a sex-stratified quintile of HRR (Q1–Q5). Of the participants, 20.3% were frail. Using multiple logistic regression models with the Q5 group as a reference, after adjusting for sex, age, body mass index, polypharmacy, pre-orthopedic surgery, and the use of iron medications, the multivariable-adjusted odds ratios (95% confidence intervals) of the Q4 to Q1 groups were 0.92 (0.58–1.47), 1.04 (0.67–1.61), 1.29 (0.84–1.96), and 1.85 (1.22–2.82), respectively, indicating that a lower HRR was significantly associated with frailty. The robustness of these results was also shown in the multiple imputation analysis. The results suggest that HRR measurement may be one of the indicators to identify frail older adults in routine practice.

CITATION:
K. Kinoshita ; S. Satake ; K. Murotani ; M. Takemura ; Y. Matsui ; H. Arai (2022): Physical Frailty and Hemoglobin-to-Red Cell Distribution Width Ratio in Japanese Older Outpatients. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.49

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EFFECTS OF VITAMIN D, OMEGA-3 FATTY ACIDS AND A HOME EXERCISE PROGRAM ON PREVENTION OF PRE-FRAILTY IN OLDER ADULTS: THE DO-HEALTH RANDOMIZED CLINICAL TRIAL

M. Gagesch, M. Wieczorek, B. Vellas, R.W. Kressig, R. Rizzoli, J. Kanis, W.C. Willett, A. Egli, W. Lang, E.J. Orav, H.A. Bischoff-Ferrari

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Background: The benefits of supplemental vitamin D3, marine omega-3 fatty acids, and a simple home exercise program (SHEP) on frailty prevention in generally healthy community-dwelling older adults are unclear. Objective: To test the effect of vitamin D3, omega-3s, and a SHEP, alone or in combination on incident pre-frailty and frailty in robust older adults over a follow-up of 36 months. Methods: DO-HEALTH is a multi-center, double-blind, placebo-controlled, 2x2x2 factorial randomized clinical trial among generally healthy European adults aged 70 years or older, who had no major health events in the 5 years prior to enrollment, sufficient mobility and intact cognitive function. As a secondary outcome of the DO-HEALTH trial, among the subset of participants who were robust at baseline, we tested the individual and combined benefits of supplemental 2,000 IU/day of vitamin D3, 1 g/day of marine omega-3s, and a SHEP on the odds of being pre-frail and frail over 3 years of follow-up. Results: At baseline, 1,137 out of 2,157 participants were robust (mean age 74.3 years, 56.5% women, mean gait speed 1.18 m/s). Over a median follow-up time of 2.9 years, 696 (61.2%) became pre-frail and 29 (2.6%) frail. Odds ratios for becoming pre-frail were not significantly lower for vitamin D3, or omega 3-s, or SHEP, individually, compared to control (placebo for the supplements and control exercise). However, the three treatments combined showed significantly decreased odds (OR 0.61 [95% CI 0.38-0.98; p=0.04) of becoming pre-frail compared to control. None of the individual treatments or their combination significantly reduced the odds of becoming frail. Conclusion: Robust, generally healthy and active older adults without major comorbidities, may benefit from a combination of high-dose, supplemental vitamin D3, marine omega-3s, and SHEP with regard to the risk of becoming pre-frail over 3 years.

CITATION:
M. Gagesch ; M. Wieczorek ; B. Vellas ; R.W. Kressig ; R. Rizzoli ; J. Kanis ; W.C. Willett ; A. Egli ; W. Lang ; E.J. Orav ; H.A. Bischoff-Ferrari ; (2022): Effects of Vitamin D, Omega-3 Fatty Acids and a Home Exercise Program on Prevention of Pre-Frailty in Older Adults: The DO-HEALTH Randomized Clinical Trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.48

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EFFECTS OF CURCUMIN C3 COMPLEX® ON PHYSICAL FUNCTION IN MODERATELY FUNCTIONING OLDER ADULTS WITH LOW-GRADE INFLAMMATION – A PILOT TRIAL

R.T. Mankowski, K.T. Sibille, C. Leeuwenburgh, Y. Lin, F.-C. Hsu, P. Qiu, B. Sandesara, S.D. Anton

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Background: Natural dietary compounds that can modulate the inflammation process have the potential to improve physical function through a number of biological pathways, and thus may represent an alternative approach to avert functional decline compared to more time-burdening lifestyle interventions. In this pilot trial, we tested the feasibility and explored the effect of a nutritional compound, Curcumin C3 Complex® for improving physical function and muscle strength in moderately functioning older adults with low-grade inflammation. Methods: Moderately functioning (short physical performance battery, SPPB <10) and sedentary older adults (>65 years) with low-grade systemic inflammation (c-reactive protein >1mg/dL) were randomized to receive Curcumin C3 Complex® (n=9) (1000mg/day) or placebo (n=8) groups for 12 weeks. All participants (age range: 66-94 years, 8 females and 9 males) underwent functional testing (SPPB and walking speed by the 400-meter walk test) and lower-limb strength (knee flexion and extension peak torque by the Biodex test) at baseline and 12 weeks. Venous blood was collected at baseline, 4, 8 and 12 weeks for safety blood chemistry analyses and biomarkers of inflammation. Results: A total of 17 participants were randomized and completed the study. Adherence was high (> 90%) and there were no adverse events reported or abnormal blood chemistries reported. Based on effect sizes, participants in the Curcumin C3 Complex® group demonstrated large effect sizes in the SPPB (Cohen’s effect size d=0.75) and measures of knee extension (d=0.69) and flexion peak torque (d=0.82). Effect sizes for galectin-3 (d=-0.31) (larger decrease) and interleukin-6 (d=0.38) (smaller increase) were small in the Curcumin C3 Complex® group compared to placebo. Conclusion: This pilot trial suggests that there were no difficulties with recruitment, adherence and safety specific to the study protocol. Preliminary findings warrant a Phase IIb clinical trial to test the effect of Curcumin C3 Complex® on physical function and muscle strength in older adults at risk for mobility disability.

CITATION:
R.T. Mankowski ; K.T. Sibille ; C. Leeuwenburgh ; Y. Lin ; F.-C. Hsu ; P. Qiu ; B. Sandesara ; S.D. Anton (2022): Effects of Curcumin C3 Complex® on Physical Function in Moderately Functioning Older Adults with Low-Grade Inflammation – A Pilot Trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.47

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FRAILTY AND AGING IN HIV– STATUS POST 13 YEARS OF NATIONAL AWARENESS

U.A. Eke, K. Mohanty, A.L. Gruber-Baldini, A.S. Ryan4

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The People aged 50 years and above comprise over 50% of people living with HIV (PLWH) in the US. Despite the advances made with anti-retroviral therapy in increasing their life span, PLWH are plagued with non-AIDS associated conditions which increase their risk for morbidity and mortality. Frailty, a decline in physical and functional reserve, is one of the manifestations of aging, has a prevalence of 5-30%, and occurs up to 2 decades earlier in people aging with HIV (PAWH). The majority of providers for PAWH have minimal experience with the concept of gerontology, frailty, and aging. Hence, there is a gap in clinicians’ knowledge on how to address frailty and aging in PAWH. This review will focus on the clinical interventions that mitigate frailty and aging in PAWH as well as highlight areas of investigation towards achieving these mediations. Beyond the identification of the roles of exercise and nutrition, more studies are needed on the pragmatic approach to apply these resources to routine care. There should be continued reinforcement of the proven strategy of combination antiretroviral therapy as well as treatment of co-infections and age-appropriate health and cancer screening in PAWH.

CITATION:
U.A. Eke ; K. Mohanty ; A.L. Gruber-Baldini ; A.S. Ryan ; ; (2022): Frailty and Aging in HIV– Status Post 13 Years of National Awareness. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.45

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LETTER TO THE EDITOR: A FRAILTY FRAMEWORK FOR DEMENTIA

T. Daly

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CITATION:
T. Daly ; (2022): A Frailty Framework for Dementia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.46

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EVALUATING QUALITY-OF-LIFE, LENGTH OF STAY AND COSTEFFECTIVENESS OF A FRONT-DOOR GERIATRICS PROGRAM: AN EXPLORATORY PROOF-OF-CONCEPT STUDY

M.J. Pereira, E. Chong, J.A.D. Molina, S.H.X. Ng, E.F. Goh, B. Zhu, M. Chan, W.S. Lim

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Background: The Emergency Department Interventions for Frailty (EDIFY) program was developed to deliver early geriatric specialist interventions at the Emergency Department (ED). EDIFY has been successful in reducing acute admissions among older adults. Objectives: We aimed to examine the effectiveness of EDIFY in improving health-related quality-of-life (HRQOL) and length of stay (LOS), and evaluate EDIFY’s cost-effectiveness. Design: A quasi-experiment study. Setting: The ED of a 1700-bed tertiary hospital. Participants: Patients (≥85 years) pending acute hospital admission and screened by the EDIFY team to be potentially suitable for discharge or transfer to low-acuity care areas. Intervention: EDIFY versus standard-care. Measurements: Data on demographics, comorbidities, premorbid function, and frailty status were gathered. HRQOL was measured using EQ-5D-5L over 6 months. We used a crosswalk methodology to compute Singapore-specific index scores from EQ-5D-5L responses and calculated quality-adjusted life-years (QALYs) gained. LOS and bills in Singapore-dollars (SGD) before subsidy from ED attendances (including admissions, if applicable) were obtained. We estimated average programmatic EDIFY cost and performed multiple imputation (MI) for missing data. QALYs gained, LOS and cost were compared. Potential uncertainties were also examined. Results: Among 100 participants (EDIFY=43; standard-care=57), 61 provided complete data. For complete cases, there were significant QALYs gained at 3-month (coefficient=0.032, p=0.004) and overall (coefficient=0.096, p=0.002) for EDIFY, whilst treatment cost was similar between-groups. For MI, we observed only overall QALYs gained for EDIFY (coefficient=0.102, p=0.001). EDIFY reduced LOS by 17% (Incident risk ratio=0.83, p=0.015). In a deterministic sensitivity analysis, EDIFY’s cost-threshold was SGD$2,500, and main conclusions were consistent in other uncertainty scenarios. Mean bills were: EDIFY=SGD$4562.70; standard-care=SGD$5530.90. EDIFY’s average programmatic cost approximated SGD$469.30. Conclusions: This exploratory proof-of-concept study found that EDIFY benefits QALYs and LOS, with equivalent cost, and is potentially cost-effective. The program has now been established as standard-care for older adults attending the ED at our center.

CITATION:
M.J. Pereira ; E. Chong ; J.A.D. Molina ; S.H.X. Ng ; E.F. Goh ; B. Zhu ; M. Chan ; W.S. Lim (2022): Evaluating Quality-of-Life, Length of Stay and Cost-Effectiveness of a Front-Door Geriatrics Program: An Exploratory Proof-of-Concept Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.40

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PREDICTIVE ABILITIES OF THE FRAILTY PHENOTYPE AND THE SWISS FRAILTY NETWORK AND REPOSITORY FRAILTY INDEX FOR NON-HOME DISCHARGE AND FUNCTIONAL DECLINE IN HOSPITALIZED GERIATRIC PATIENTS

A.K. Stuck, N. Schilling, D. Bertschi, A. Limacher, M. Gagesch, H.A. Bischoff-Ferrari

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Background: Frailty is increasingly applied as a measure to predict clinical outcomes, but data on the predictive abilities of frailty measures for non-home discharge and functional decline in acutely hospitalized geriatric patients are scarce. Objectives: The aim of this study was to investigate the predictive ability of the frailty phenotype and a frailty index currently validated as part of the ongoing Swiss Frailty Network and Repository Study based on clinical admission data for non-home discharge and functional decline in acutely hospitalized older patients. Design: Prospective cohort study. Setting and Participants: Data were analyzed from 334 consecutive hospitalized patients of a tertiary acute care geriatric inpatient clinic admitted between August 2020 and March 2021. Measurements: We assessed frailty using 1) the frailty phenotype and 2) the Swiss Frailty Network and Repository Study (SFNR) frailty index based on routinely available clinical admission data. Predictive abilities of both frailty measures were analyzed for the clinical outcomes of non-home discharge and functional decline using multivariate logistic regression models and receiver operating characteristic curves (ROC). Results: Mean age was 82.8 (SD 7.2) years and 55.4% were women. Overall, 170 (53.1%) were frail based on the frailty phenotype and 220 (65.9%) based on the frailty index. Frail patients based on the frailty phenotype were more likely to be discharged non-home (55 (32.4%) vs. 26 (17.3%); adjusted OR 2.4 (95% CI, 1.4, 5.1)). Similarly, frail patients based on the frailty index were more likely to be discharged non-home compared to non-frail patients (76 (34.6%) vs. 9 (7.9%); adjusted OR, 5.5 (95% CI, 2.6, 11.5)). Both, the frailty phenotype and the frailty index were similarly associated with functional decline (adjusted OR 2.7 (95% CI, 1.5, 4.9); adjusted OR 2.8 (95% CI 1.4, 5.5)). ROC analyses showed best discriminatory accuracy for the frailty index for non-home discharge (area under the curve 0.76). Conclusions: Frailty using the SFNR-frailty index and the frailty phenotype is a promising measure for prediction of non-home discharge and functional decline in acutely hospitalized geriatric patients. Further study is needed to define the most valid frailty measure.

CITATION:
A.K. Stuck ; N. Schilling ; D. Bertschi ; A. Limacher ; M. Gagesch ; H.A. Bischoff-Ferrari (2022): Predictive Abilities of the Frailty Phenotype and the Swiss Frailty Network and Repository Frailty Index for Non-Home Discharge and Functional Decline in Hospitalized Geriatric Patients. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.44

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PREOPERATIVE REHABILITATION IS FEASIBLE IN THE WEEKS PRIOR TO SURGERY AND SIGNIFICANTLY IMPROVES FUNCTIONAL PERFORMANCE

D.E. Hall, A. Youk, K. Allsup, K. Kennedy, T.D. Byard, R. Dhupar, D. Chu, A.M. Rahman, M. Wilson, L.P. Cahalin, J. Afilalo, D. Forman

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Background: Frailty is a multidimensional state of increased vulnerability. Frail patients are at increased risk for poor surgical outcomes. Prior research demonstrates that rehabilitation strategies deployed after surgery improve outcomes by building strength. Objectives: Examine the feasibility and impact of a novel, multi-faceted prehabilitation intervention for frail patients before surgery. Design: Single arm clinical trial. Setting: Veterans Affairs hospital. Participants: Patients preparing for major abdominal, urological, thoracic, or cardiac surgery with frailty identified as a Risk Analysis Index≥30. Intervention: Prehabilitation started in a supervised setting to establish safety and then transitioned to home-based exercise with weekly telephone coaching by exercise physiologists. Prehabilitation included (a)strength and coordination training; (b)respiratory muscle training (IMT); (c)aerobic conditioning; and (d)nutritional coaching and supplementation. Prehabilitation length was tailored to the 4-6 week time lag typically preceding each participant’s normally scheduled surgery. Measurements: Functional performance and patient surveys were assessed at baseline, every other week during prehabilitation, and then 30 and 90 days after surgery. Within-person changes were estimated using linear mixed models. Results: 43 patients completed baseline assessments; 36(84%) completed a median 5(range 3-10) weeks of prehabilitation before surgery; 32(74%) were retained through 90-day follow-up. Baseline function was relatively low. Exercise logs show participants completed 94% of supervised exercise, 78% of prescribed IMT and 74% of home-based exercise. Between baseline and day of surgery, timed-up-and-go decreased 2.3 seconds, gait speed increased 0.1 meters/second, six-minute walk test increased 41.7 meters, and the time to complete 5 chair rises decreased 1.6 seconds(all P≤0.007). Maximum and mean inspiratory and expiratory pressures increased 4.5, 7.3, 14.1 and 13.5 centimeters of water, respectively(all P≤0.041). Conclusions: Prehabilitation is feasible before major surgery and achieves clinically meaningful improvements in functional performance that may impact postoperative outcomes and recovery. These data support rationale for a larger trial powered to detect differences in postoperative outcomes.

CITATION:
D.E. Hall ; A. Youk ; K. Allsup ; K. Kennedy ; T.D. Byard ; R. Dhupar ; D. Chu ; A.M. Rahman ; M. Wilson ; L.P. Cahalin ; J. Afilalo ; D. Forman ; (2022): Preoperative Rehabilitation Is Feasible in the Weeks Prior to Surgery and Significantly Improves Functional Performance. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.42

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CLINICAL CHARACTERISTICS AND MORTALITY OF OLD AND VERY OLD PATIENTS HOSPITALIZED FOR HIP FRACTURE OR ACUTE MEDICAL CONDITIONS

D. Fluck, C.H. Fry, R. Lisk, K. Yeong, J. Robin, T.S. Han

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Background: There is increasing interest in healthcare quality and economic implications for hip fracture patients of very old age. However, results are limited by access to comparable control groups. Objectives: We examined healthcare quality measures including mortality and length of stay (LOS) in hospital of adults aged 60-107 years undergoing hip operations, compared to an age-matched group admitted for acute general medical conditions. Design: Monocentric cross-sectional study. Setting: Ashford and St Peter’s Hospitals NHS Foundation Trust, Surrey, United Kingdom. Participants: A total of 3972 consecutive admissions for hip operation from 1st April 2009 to 30th June 2019 (dataset-1) and 6979 for acute general medical conditions from 1st April 2019 to 29th February 2020 (dataset-2). Respective ages, mean (±standard deviation), were 83.5 years (±9.1) and 79.8 years (±9.8). Measurements: Mortality and LOS were assessed with each group divided into five- year age bands and those ≥95 years. Results: There were proportionally more (P <0.001) females admitted for hip operations (72.8%) than for acute general medical conditions (53.8%). Amongst patients admitted with general medical conditions, the frequency of the most serious recorded conditions - including congestive heart failure, stroke, and pneumonia - increased with age. Amongst patients undergoing hip operations, 5.7% died in hospital and 29.3% had a LOS ≥3 weeks. Corresponding values for acute general medical conditions were 10.4% and 11.8%. For those undergoing hip operations in all age categories, the risk of death was lower than for acute general medical group: sex-adjusted odds ratios ranged between 0.27 and 0.67, but the risk of LOS ≥3 weeks was greater: odds ratios ranged between 2.46 and 2.95. Conclusions: Compared to those admitted with acute general medical conditions, patients admitted for hip operations had a lower risk of death, but a longer hospital LOS.

CITATION:
D. Fluck ; C.H. Fry ; R. Lisk ; K. Yeong ; J. Robin ; T.S. Han (2022): Clinical Characteristics and Mortality of Old and Very Old Patients Hospitalized for Hip Fracture or Acute Medical Conditions. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.34

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LONGITUDINAL ASSOCIATIONS BETWEEN CONCURRENT CHANGES IN PHENOTYPIC FRAILTY AND LOWER URINARY TRACT SYMPTOMS AMONG OLDER MEN

S.R. Bauer, C.E. McCulloch, P.M. Cawthon, K.E. Ensrud, A.M. Suskind, J.C. Newman, S.L. Harrison, A. Senders, K. Covinsky, L.M. Marshall, for the Osteoporotic Fractures in Men (MrOS) Research Group

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Background: Lower urinary tract symptoms (LUTS) are associated with prevalent frailty and functional impairment, but longitudinal associations remain unexplored. Objectives: To assess the association of change in phenotypic frailty with concurrent worsening LUTS severity among older men without clinically significant LUTS at baseline. Design: Multicenter, prospective cohort study. Setting: Population-based. Participants: Participants included community-dwelling men age ≥65 years at enrollment in the Osteoporotic Fractures in Men study. Measurements: Data were collected at 4 visits over 7 years. Phenotypic frailty score (range: 0-5) was defined at each visit using adapted Fried criterion and men were categorized at baseline as robust (0), pre-frail (1-2), or frail (3-5). Within-person change in frailty was calculated at each visit as the absolute difference in number of criteria met compared to baseline. LUTS severity was defined using the American Urologic Association Symptom Index (AUASI; range: 0-35) and men with AUASI ≥8 at baseline were excluded. Linear mixed effects models were adjusted for demographics, health-behaviors, and comorbidities to quantify the association between within-person change in frailty and AUASI. Results: Among 3235 men included in analysis, 48% were robust, 45% were pre-frail, and 7% were frail. Whereas baseline frailty status was not associated with change in LUTS severity, within-person increases in frailty were associated with greater LUTS severity (quadratic P<0.001). Among robust men at baseline, mean predicted AUASI during follow-up was 4.2 (95% CI 3.9, 4.5) among those meeting 0 frailty criteria, 4.6 (95% CI 4.3, 4.9) among those meeting 1 criterion increasing non-linearly to 11.2 (95% CI 9.8, 12.6) among those meeting 5 criteria. Conclusions: Greater phenotypic frailty was associated with non-linear increases in LUTS severity in older men over time, independent of age and comorbidities. Results suggest LUTS and frailty share an underlying mechanism that is not targeted by existing LUTS interventions.

CITATION:
S.R. Bauer ; C.E. McCulloch ; P.M. Cawthon ; K.E. Ensrud ; A.M. Suskind ; J.C. Newman ; S.L. Harrison ; A. Senders ; K. Covinsky ; L.M. Marshall ; for the Osteoporotic Fractures in Men (MrOS) Research Group ; (2022): Longitudinal Associations between Concurrent Changes in Phenotypic Frailty and Lower Urinary Tract Symptoms among Older Men. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.33

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SOCIOECONOMIC DISADVANTAGE IS ASSOCIATED WITH PROBABLE SARCOPENIA IN COMMUNITY-DWELLING OLDER ADULTS: FINDINGS FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING

L. Swan, A. Warters, M. O’Sullivan

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Background: Sarcopenia is characterized by the accelerated loss of muscle strength, mass, and function in aging. The disease is a major public health issue with emerging evidence of a disproportionate burden in areas of socioeconomic disadvantage. Objectives: To estimate the prevalence of probable sarcopenia overall, and according to Socioeconomic Position (SEP). To explore the association between markers of SEP and probable sarcopenia. Design: Cross-sectional analysis of the English Longitudinal Study of Ageing data. Setting: England, United Kingdom (UK). Participants: This study comprised 6,052 older adult participants from Wave 6 of the English Longitudinal Study of Ageing (ELSA) aged 60 years and older. Measurements: Probable sarcopenia was identified by the EWGSOP2 guidelines as low hand grip strength (females <16kg and males <27kg) or poor chair rise test performance (completion of 5 chair rises >15 seconds). Socioeconomic position was defined by educational attainment and subjective social status (SSS). Weighted multivariable regression analysis was employed to identify determinants of probable sarcopenia. Results: Over one-third of older adults met the criteria for probable sarcopenia (33.7%; weighted, 36.1%) in the study population of mean age 70.7 (SD 7.7) years. When examined by SEP, the prevalence of probable sarcopenia was over 2-fold higher in adults in the most vs the least disadvantaged SEP groups (47.0% vs 20.6%, respectively, p<0.001). Multivariable regression analysis identified disadvantaged SEP, as measured by educational attainment and SSS, as independent predictors of probable sarcopenia, along with older age, physical inactivity, underweight BMI, chronic conditions, osteoarthritis, and minority group ethnicity. Conclusions: Disadvantaged SEP was associated with an increased likelihood of probable sarcopenia when controlled for other known risk factors. The findings suggest a need and opportunity for sarcopenia prevention and treatment strategies to address socioeconomic disadvantage in policies and practice.

CITATION:
L. Swan ; A. Warters ; M. O’Sullivan ; (2022): Socioeconomic Disadvantage is Associated with Probable Sarcopenia in Community-Dwelling Older Adults: Findings from the English Longitudinal Study of Ageing. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.32

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SLEEP QUALITY AND DURATION AS DETERMINANTS OF HEALTHY AGING TRAJECTORIES: THE HELIAD STUDY

V. Gkotzamanis, D.B. Panagiotakos, M. Yannakoulia, M. Kosmidis, E. Dardiotis, G. Hadjigeorgiou, P. Sakka, N. Scarmeas6

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Background: The aging of global population has increased the scientific interest in the concept of healthy aging and its determinants. Aim: The aim of this study was to investigate the association of sleep characteristics with trajectories of healthy aging. Design and Setting: Prospective observational study conducted in two cities, Maroussi and Larissa. Participants: A total of 1226 older adults (≥65 years, 704 women) were selected through random sampling. Measurements: Sleep quality was assessed with the Sleep Index II, and sleep duration was self-reported. A healthy aging metric was introduced using an Item Response Theory approach based on validated questionnaires that assessed functionality. Four healthy aging trajectories were developed based on whether the healthy aging status of the participants was above (High) or below (Low) the median at baseline and follow-up, i.e., High-High, High-Low, Low-High, and Low-Low. The association of sleep characteristics with the trajectories was investigated using a multinomial logistic regression with the Low-Low group as reference, adjusting for potential confounders. Results: 34.3% participants classified to the High-High group, 15.7% to the High-Low, 18.6% to the Low-High, and 31.4% to the Low-Low group. Better sleep quality was associated with the probability of belonging to the High-High group (p-value<0.001); while, long sleep duration was inversely associated with likelihood of being classified in the High-High group (p-value < 0.05). Conclusion: Poor sleep quality and long sleep duration seem to have a significant negative association with healthy aging. Public health policies are needed to raise awareness about the importance of sleep characteristics on human health.

CITATION:
V. Gkotzamanis ; D.B. Panagiotakos ; M. Yannakoulia ; M. Kosmidis ; E. Dardiotis ; G. Hadjigeorgiou ; P. Sakka ; N. Scarmeas ; (2022): Sleep Quality and Duration as Determinants of Healthy Aging Trajectories: The HELIAD Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.37

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PREDICTING THE READMISSION AND MORTALITY IN OLDER PATIENTS HOSPITALIZED WITH PNEUMONIA WITH PREADMISSION FRAILTY

K. Yamada, K. Iwata, Y. Yoshimura, H. Ota, Y. Oki, Y. Mitani, Y. Oki, Y. Yamada, A. Yamamoto, K. Ono, A. Honda, T. Kitai, R. Tachikawa, N. Kohara, K. Tomii, A. Ishikawa

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Background: In older people, frailty has been recognized as an important prognostic factor. However, only a few studies have focused on multidimensional frailty as a predictor of mortality and readmission among inpatients with pneumonia. Objective: The present study aimed to assess the association between preadmission frailty and clinical outcomes after the hospitalization of older patients with pneumonia. Design: Single-center, retrospective case-control study. Setting: Acute phase hospital at Kobe, Japan. Participants: The present study included 654 consecutive older inpatients with pneumonia. Measurements: Frailty status before admission was assessed using total Kihon Checklist (KCL) score, which has been used as a self-administered questionnaire to assess comprehensive frailty, including physical, social, and cognitive status. The primary outcome was a composited 6-month mortality and readmission after discharge. Results: In total, 330 patients were analyzed (median age: 79 years, male: 70.4%, median total KCL score: 10 points), of which 68 were readmitted and 10 died within 6 months. After multivariate analysis, total KCL score was associated with a composited 6-month mortality and readmission (adjusted hazard ratio, 1.07; 95% confidence interval, 1.02–1.12; p = 0.006). The cutoff value for total KCL score determined by receiver operating characteristic curve analysis was 15 points (area under the curve = 0.610). The group with a total KCL score ≥ 15 points had significantly higher readmission or mortality rates than the groups with a total KCL score < 15 points (p < 0.001). Conclusions: Preadmission frailty status in older patients with pneumonia was an independent risk factor for readmission and survival after hospitalization.

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FRAILTY, QUALITY OF LIFE, AND LONELINESS OF AGING IN NATIVE AND DIASPORIC CHINESE ADULTS

S.L. Cheung, W.P. Krijnen, C.P. van der Schans, J.S.M. Hobbelen

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Background: Global migration has increased in the past century, and aging in a foreign country is relevant to the Chinese diaspora. Objective: With regard to migration, this study focuses on the places of aging as the context of older Chinese adults. This study aimed to describe the general health and wellbeing of this population with respect to their location. Design: This study has a cross sectional design. Setting and participants: Participants were recruited who were “aging in place” from Tianjin, China (199 participants), and “aging out of place” from the Netherlands (134 participants). Data from April to May 2019 in China and November 2018 to March 2019 in the Netherlands were aggregated. Measurements: frailty, QoL and loneliness were used in both samples. Results: T-tests and regression analyses demonstrated that social domains of frailty and QoL, as well as loneliness and frailty prevalence characterized the major differences between both places of aging. A correlation analysis and visual correlation network revealed that frailty, quality of life (QoL), and loneliness were more closely related in the aging out of place sample. Social domains of frailty and QoL, as well as the prevalence of loneliness and frailty, characterized the major differences between both places of aging. Conclusions: The findings indicate that frailty, QoL, and loneliness have a complex relationship, confirming that loneliness is a major detriment to the general wellbeing of older Chinese adults aging out of place. This study examined the places of aging of the larger Chinese population and allows a comprehensive understanding of health and wellbeing. The social components, especially loneliness, among the aging out of place Chinese community should receive more attention practice and clinical wise. On the other hand, frailty as well as its prevention is of more importance for the Chinese community aging in place.

CITATION:
S.L. Cheung ; W.P. Krijnen ; C.P. van der Schans ; J.S.M. Hobbelen ; (2022): Frailty, Quality of Life, and Loneliness of Aging in Native and Diasporic Chinese Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.27

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ASSOCIATION OF INTRINSIC CAPACITY WITH FRAILTY, PHYSICAL FITNESS AND ADVERSE HEALTH OUTCOMES IN COMMUNITYDWELLING OLDER ADULTS

L. Tay, E.-L. Tay, S.M. Mah, A. Latib, C. Koh, Y.-S. Ng

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Background: Intrinsic capacity (IC) and frailty are complementary in advancing disability prevention through maintaining functionality. Objectives: We examined the relationship between IC and frailty status at baseline and 1-year, and evaluated if IC decline predicts frailty onset among robust older adults. The secondary objectives investigated associations between IC, physical fitness and health-related outcomes. Design: Prospective cohort study. Setting: Community-based assessments. Participants: Older adults aged>55 years, who were independent in ambulation (walking aids permitted). Measurements: 5 domains of IC were assessed at baseline: locomotion (Short Physical Performance Battery, 6-minute walk test), vitality (nutritional status, muscle mass), sensory (self-reported hearing and vision), cognition (self-reported memory, age- and education adjusted cognitive performance), psychological (Geriatric Depression Scale-15, self-reported anxiety/ depression). Composite IC (0-10) was calculated, with higher scores representing greater IC. Frailty status was based on modified Fried criteria, with frailty progression defined as incremental Fried score at 1-year. Results: 809 participants (67.6+6.8 years) had complete data for all 5 IC domains. 489 (60.4%) participants were robust but only 213 (26.3%) had no decline in any IC domain. Pre-frail and frail participants were more likely to exhibit decline in all 5 IC domains (p<0.05), with decremental composite IC [9 (8-9), 8 (6-9), 5.5 (4-7.5), p<0.001] across robust, prefrail and frail. IC was significantly associated with fitness performance, independent of age and gender. Higher composite IC reduced risk for frailty progression (OR=0.62, 95% CI 0.48-0.80), and reduced frailty onset among robust older adults (OR=0.53, 95% CI 0.37-0.77), independent of age, comorbidities and social vulnerability. Participants with higher IC were less likely to experience health deterioration (OR=0.70, 95% CI 0.58-0.83), falls (OR=0.76, 95% CI 0.65-0.90) and functional decline (OR=0.64, 95% CI 0.50-0.83) at 1-year. Conclusion: Declining IC may present before frailty becomes clinically manifest, increasing risk for poor outcomes. Monitoring of IC domains potentially facilitates personalized interventions to avoid progressive frailty.

CITATION:
L. Tay ; E.-L. Tay ; S.M. Mah ; A. Latib ; C. Koh ; Y.-S. Ng (2022): Association of Intrinsic Capacity with Frailty, Physical Fitness and Adverse Health Outcomes in Community-Dwelling Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.28

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RISK OF FRAILTY ACCORDING TO THE VALUES OF THE ANKLEBRACHIAL INDEX IN THE TOLEDO STUDY FOR HEALTHY AGING

F. Quiñónez-Bareiro, J.A. Carnicero, A. Alfaro-Acha, C.Rosado-Artalejo, M.C. Grau-Jimenez, L. Rodriguez-Mañas, F.J. García-Garcia

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Background: Vascular function (VF) is a general term used to describe the regulation of blood flow, arterial pressure, capillary recruitment, filtration and central venous pressure, it´s well known that age has direct effects on the VF, and this may affect the frailty status. Objectives: To analyse the association between Frailty Trait Scale 5 (FTS 5) with VF and its changes at values below and above a nadir. Design: Prospective population-based cohort study. Setting and Participants: Data from 1.230 patients were taken from the first wave (2006-2009) of the Toledo Study for Healthy Aging. Measurements: Frailty was evaluated using FTS 5, which evaluates 5 items: Body mass index, progressive Romberg, physical activity, usual gait speed and hand grip strength. VF was assessed using the ankle-brachial index (ABI) as an indirect measure of VF. Screening for cardiovascular and cerebrovascular disease was also performed by self-reporting and by searching medical records, and was used as exclusion criteria Results: The optimal ABI cut-off point that maximized the adjusted R2 was 1.071. We observed a statistically significant association for FTS 5 score above and below the ABI cut-off points. For every tenth that the ABI decreased below the cut-off point the patient had an increase in the FTS 5 score of 0.47 points and in every tenth that increased above the cut-off point the increase in the FTS 5 score was 0.41 points. Of all FTS 5 items, the gait speed was the only item that showed a significant association with an ABI changes 0.28 and 0.21 points for every tenth below and above the cut-off point, respectively. Conclusions: Frailty is highly associated with VF. In addition, FTS 5 and its gait speed criteria are useful to detect VF impairments, via changes in ABI.

CITATION:
F. Quiñónez-Bareiro ; J.A. Carnicero ; A. Alfaro-Acha ; C.Rosado-Artalejo ; M.C. Grau-Jimenez ; L. Rodriguez-Mañas ; F.J. García-Garcia (2022): Risk of Frailty According to the Values of the Ankle-Brachial Index in the Toledo Study for Healthy Aging. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.25

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JFA N°03 - 2022

 

COULD THERE BE FRAILTY IN THE DISCREPANCY BETWEEN LESIONS AND SYMPTOMS OF ALZHEIMER’S DISEASE?

M. Canevelli, G. Bruno, M. Valletta, M. Cesari

J Frailty Aging 2022;11(3)248-249

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CITATION:
M. Canevelli ; G. Bruno ; M. Valletta ; M. Cesari ; (2022): Could there Be Frailty in the Discrepancy between Lesions and Symptoms of Alzheimer’s Disease?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.43

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SEX DIFFERENCES IN FRAILTY INCIDENCE IN GREEK COMMUNITYDWELLING OLDER PEOPLE: THE HELIAD STUDY

N. Geronikola, I. Zalonis, E. Ntanasi, S. Charisis, M.H. Kosmidis, C.A. Anastasiou, E. Dardiotis, G. Hadjigeorgiou, M. Megalou, G. Velonakis, E. Karavasilis, A.N. Gargalionis, K. Patas, A. Piperidi, S. Chatzipanagiotou, P. Sakka, G. Paraskevas, M. Yannakoulia, N. Scarmeas

J Frailty Aging 2022;11(3)250-255

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Background: Previous frailty studies found higher prevalence of frailty in female than in male participants. This was mainly attributed to the fact that compared to men, women show increased longevity. Recent studies have reported that the observed difference between sexes applies irrespectively of the age of older people. Objectives: To provide data on sex differences in incident frailty by applying both phenotypic and multi-domain frailty measures in the same population of Greek community-dwelling older people. Design: Longitudinal study. Setting: Data were drawn from the Hellenic longitudinal Investigation of Aging and Diet (HELIAD), a population-based, multidisciplinary study designed to estimate the prevalence and incidence of dementia in the Greek population. Participants: 1104 participants aged 65 year and above were included in this longitudinal study. This incidence cohort was re-evaluated after a mean follow-up period of 3.04±0.90 years. Measurements: Frailty was operationalized using 5 different definitions in the same population: the Fried Frailty Phenotype (FFP) definition, the FRAIL Scale, the Frailty Index (FI), the Tilburg Frailty Indicator (TFI) and the Groningen Frailty Index (GFI). Frailty incidence was calculated a) for the whole sample, b) separately for men and women and c) after both age and sex stratification. Results: Age and sex stratification revealed that irrespective of age and frailty measurement, women showed higher incidence rates of frailty than men. Specifically, frailty seems to be a condition concerning women >65 years old, but when it comes to men, it is more frequent in those aged more than 75 years old. Finally, in relation to overall frailty incidence and comparing our results to previous studies, we detected a lower frailty incidence in the Greek population. Conclusions: Differences between the two sexes indicate that when exploring the factors that are related to frailty, studies should provide data disaggregated for men and women.

CITATION:
N. Geronikola ; I. Zalonis ; E. Ntanasi ; S. Charisis ; M.H. Kosmidis ; C.A. Anastasiou ; E. Dardiotis ; G. Hadjigeorgiou ; M. Megalou ; G. Velonakis ; E. Karavasilis ; A.N. Gargalionis ; K. Patas ; A. Piperidi ; S. Chatzipanagiotou ; P. Sakka ; G. Paraskevas ; M. Yannakoulia ; N. Scarmeas ; (2022): Sex Differences in Frailty Incidence in Greek Community-Dwelling Older People: The HELIAD Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.39

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PROTEIN INTAKE AND THE RISK OF PRE-FRAILTY AND FRAILTY IN NORWEGIAN OLDER ADULTS. THE TROMS  STUDY 1994–2016

D.M. Konglevoll, A. Hjartåker, L.A. Hopstock, B.H. Strand, M. Thoresen, L.F. Andersen, M.H. Carlsen

J Frailty Aging 2022;11(3)256-266

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Background: Protein intake is suggested as an important dietary factor in the prevention of frailty, however, the influence of lifelong intake remains unclear. Objectives: The present study investigated the relationship between daily protein intake and patterns of protein intake over 21 years and the risk of pre-frailty/frailty. Design: Prospective cohort study. Setting: The population-based Tromsø Study in Tromsø municipality, Norway. Participants: In total, 1,906 women and 1,820 men aged >45 years in 1994 who participated in both Tromsø4 (1994–95) and Tromsø7 (2015–16). Measurements: Frailty status in Tromsø7 was measured according to Fried’s phenotype, classifying participants as “robust” (frailty components present: 0), “pre-frail” (1–2) or “frail” (>3). Daily intake of protein was estimated from self-reported habitual dietary intake using food frequency questionnaires and assessed as grams per kilogram bodyweight (g/kg BW) and per megajoule energy intake (g/MJ). The protein–frailty association was assessed via longitudinal and cross-sectional multivariable logistic regression analyses. Results: The prevalence of pre-frailty and frailty in this study was 27% and 1.0%, respectively. Longitudinal analysis showed that the odds of pre-frailty/frailty decreased by 57% (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.31;0.58, p<0.001) with the increase in intake of one additional gram of dietary protein per kg BW. The results obtained from cross-sectional analysis were similar. Tracking analysis showed that, compared to a stable high intake of protein in g/kg BW over time, other patterns of protein intake increased the risk of pre-frailty/frailty. No associations were found between intake of protein in g/MJ and pre-frailty/frailty. Conclusions: Intake of protein in g/kg BW both in mid-life and later in life was inversely associated with pre-frailty/frailty in older adults. This emphasizes the importance of an adequate protein intake to facilitate healthy ageing in Norwegian older adults.

CITATION:
D.M. Konglevoll ; A. Hjartåker ; L.A. Hopstock ; B.H. Strand ; M. Thoresen ; L.F. Andersen ; M.H. Carlsen (2022): Protein Intake and the Risk of Pre-Frailty and Frailty in Norwegian Older Adults. The Tromsø Study 1994–2016. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.16

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VALIDATION OF THE HUNGARIAN VERSION OF THE SARQOL  QUESTIONNAIRE AND ITS ASSOCIATION WITH THE SARC-F SCREENING TOOL

A. Geerinck, M.-B. Demián, C. Beaudart, A.-I. Gasparik

J Frailty Aging 2022;11(3)267-273

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Background: Following the publication of a culturally adapted version of the original SarQoL® questionnaire in Hungarian language, we aimed to test its psychometric properties and its association with the SARC-F screening instrument. DESIGN: This cross-sectional validation study recruited elderly people from 2 nursing homes and an endocrinology clinic. All participants were screened for sarcopenia with the SARC-F tool, had their muscle mass measured with bioelectrical impedance analysis, as well as grip strength and gait speed. Sarcopenia was diagnosed with the EWGSOP2 criteria. Participants completed the SarQoL questionnaire, the SF-36, the EQ-5D and the EQ-VAS. Validation consisted of analyzing discriminative power, internal consistency, construct validity and floor- and ceiling effects. A multivariate regression model was used to evaluate the association between QoL, the SARC-F questionnaire, and a number of demographic and clinical variables. RESULTS: A total of 70 participants, aged 80.00 (68.50 – 82.50) years, were included. Discriminative power between sarcopenic and nonsarcopenic subjects was found for all domains, except domain 7 (Fears) when dividing study population based on the SARC-F score. We also found significantly lower QoL for domains 4 (Functionality) and 5 (Activities of daily living) when splitting participants based on muscle strength (Probable sarcopenia - EWGSOP2 definition). All domains showed a strong or moderate correlation with the total SarQoL score. Conceptually similar domains of other generic QoL questionnaires significantly correlated with the total SarQol score, confirming its convergent validity. Low correlations were found with different domains (divergent validity). No floor or ceiling effects were observed. Using a regression model, the components “strength” and “stair climbing” of the SARC-F questionnaire were significantly associated with the QoL of our patients assessed with the SarQoL instrument. CONCLUSION: Sarcopenia risk assessed with the Sarc-F instrument was significantly associated with QoL measured with the SarQol questionnaire. High internal consistency, convergent and divergent validity and no floor and ceiling effects characterised the Hungarian language SarQoL® questionnaire. Due to some limitations, further multi-center designed studies are needed to verify the validity of the SarQol questionnaire.

CITATION:
A. Geerinck ; M.-B. Demián ; C. Beaudart ; A.-I. Gasparik ; (2021): Validation of the Hungarian Version of the SarQoL® Questionnaire and Its Association with the SARC-F Screening Tool. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2021.53

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THE AWARENESS AND KNOWLEDGE REGARDING SARCOPENIA AMONG HEALTHCARE PROFESSIONALS: A SCOPING REVIEW

X.M. Yao, B.B. Liu, W.Y. Deng, X.H. Wang

J Frailty Aging 2022;11(3)274-280

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Background: Sarcopenia is a prevalent and costly disease associated with serious negative health outcomes, and its prevalence will further grow as the percentage of elderly rises. Healthcare professionals play a crucial role in the prevention, identification and management of sarcopenia and in promoting the well-being of elders. Awareness and knowledge are the prerequisite and basis for these actions. Objective: The objective of the review was to summarize available publications to identify the healthcare professionals’ awareness and knowledge about sarcopenia, and to identify knowledge gaps that interventions could address. Design: The scoping review will be performed based on the Scoping Review guidelines published by JBI in Australia. Methods: Six electronic databases, including PubMed, Embase, CINAHL, Web of Science, Cochrane Library and CNKI were searched systematically. Two researchers independently screened the retrieved articles and extracted the information. Results: A total of 6 studies were identified, including 5 quantitative studies and 1 qualitative study. These studies mainly were conducted in Australia, Netherlands and Brazil, and none from Asia. The awareness and knowledge of healthcare professionals about sarcopenia varied in different studies. With exception of one study conducted in oncology clinicians, other studies suggested that awareness and knowledge among healthcare professionals was incomplete and limited. Conclusion: The relatively few studies indicated that healthcare professionals had low awareness and limited knowledge of sarcopenia, which could influence and hinder the diagnosis and treatment of sarcopenia in practice. Future researches should develop a rigorously tested and valid sarcopenia knowledge assessment tool and researches conducted in larger samples are needed.

CITATION:
X.M. Yao ; B.B. Liu ; W.Y. Deng ; X.H. Wang ; (2022): The Awareness and Knowledge Regarding Sarcopenia among Healthcare Professionals: A Scoping Review. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.7

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A SIMPLIFIED APPROACH FOR CLASSIFYING PHYSICAL RESILIENCE AMONG COMMUNITY-DWELLING OLDER ADULTS: THE HEALTH, AGING, AND BODY COMPOSITION STUDY

C. Wu, T.-Z. Lin, J.L. Sanders

J Frailty Aging 2022;11(3)281-285

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Background: Physical resilience is an emerging concept within the context of aging and geriatric medicine, and we previously developed and validated one such indicator based on the mismatch between persons’ frailty level and multimorbidity burden. We sought to develop a simplified version for classifying physical resilience. We also examined the agreement between the simplified version and the original approach and evaluated its predictive validity. Methods: Participants were 2,457 older adults from the Health, Aging, and Body Composition Study. We constructed a simplified version for quantifying physical resilience based on the multimorbidity burden and level of frailty (score: 0-10). Participants were grouped by the number of diseases and classified into three groups—adapters, expected agers, and premature frailers—based on the mean and SD of frailty score (less than, within, or above one standard deviation of the mean). Results: The Cohen’s kappa between the novel resilience classification and the original approach was 0.70, and the percentage of absolute agreement was 85.4%. We observed a steep increase in years of healthy and able life from premature frailers to adapters in the simplified resilience classifications. Conclusions: We developed a simplified version for quantifying physical resilience in a cohort of initially well-functioning older Black and White adults. The agreement between the simplified version and the original approach is high. Adapters had a longer healthy lifespan than expected agers and premature frailers. This user-friendly indicator could help assess patients’ physical resilience in clinical settings.

CITATION:
C. Wu ; T.-Z. Lin ; J.L. Sanders ; (2022): A Simplified Approach for Classifying Physical Resilience among Community-Dwelling Older Adults: The Health, Aging, and Body Composition Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.38

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FRAILTY AND PERSISTENT PAIN IN ONCOLOGICAL PATIENTS UNDERGOING REHABILITATION

S. Crosignani, L. Orlandini, S. Baruffi, M. Froldi, M. Cesari

J Frailty Aging 2022;11(3)286-290

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Objectives: Pain is one of the most common symptoms among oncological patients and has a strong negative impact on quality of life. The aim of this study is to assess if frailty and polypharmacy are associated with persistent pain in oncological patients undergoing rehabilitation. Design: Observational, prospective, longitudinal study. Setting and Participants: Data are from oncological patients admitted to the Oncological Rehabilitation Unit. Methods: Presence of pain, its intensity and characteristics were evaluated at the admission and after 7 days. A Frailty Index (FI) was computed from Comprehensive Geriatric Assessment (CGA) data. Results: Among the 45 consecutively recruited patients (mean age 72 years, woman 44%), pain was present in 20 (44%) patients at the admission and 9 (20%) after 7 days of stay. Forty-one patients (92%) were taking more than 5 drugs at the admission (mean 9 drugs). The FI was normally distributed and descriptive statistics define our population as frail (mean 0.44; range 0.23-0.64). The FI was significantly associated with the presence of pain (OR 2.66; 95%CI 1.13-6.27, p=0.03) and its intensity after 7 days from the admission (β 4.24 95% CI 1.28 – 7.19, p=0.006), even after adjustment for potential confounders. Conclusions and Implications: Investigating frailty in cancer patients to implement multidisciplinary strategies could play an important role in improving persistent pain.

CITATION:
S. Crosignani ; L. Orlandini ; S. Baruffi ; M. Froldi ; M. Cesari (2022): Frailty and Persistent Pain in Oncological Patients Undergoing Rehabilitation . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.26

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GRIP STRENGTH, GAIT SPEED AND PLASMA MARKERS OF NEURODEGENERATION IN ASYMPTOMATIC MIDDLE-AGED AND OLDER ADULTS

M.E. Jacob, A. O’Donnell, J. Samra, M.M. Gonzales, C. Satizabal, M.P. Pase, J.M. Murabito, A. Beiser, S. Seshadri

J Frailty Aging 2022;11(3)291-298

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Background: Pragmatic biomarkers of preclinical dementia would allow for easy and large-scale screening of risk in populations. Physical function measures like grip strength and gait speed are potential predictive biomarkers but their relationship with plasma markers of Alzheimer’s Disease and neurodegeneration have not been elucidated. Objectives: To examine association between physical function measures and plasma markers of Alzheimer’s Disease (AD) and neurodegeneration. Design: Cross-sectional and longitudinal analyses. Setting: Community-based cohort in the city of Framingham, Massachusetts. Participants: 2336 participants of the Framingham Heart Study Offspring cohort with an average age of 61. Measurements: Plasma Aβ40 and Aβ42 were measured in 1998-2001 (Exam-7) and plasma total tau measured 5 years later (Exam-8). Grip strength, fast walk speed and chair stand speed were measured at both exams. Quantification of Aβ isoforms in plasma was performed using INNO-BIA assays and plasma total-tau was measured using Quanterix Simoa HD-1 assay. Confounder-adjusted linear regression models examined associations between physical function and plasma markers, Results: Grip strength at Exam-7 was associated with plasma Aβ40 (β -0.006, p-value 0.032) at Exam-7 and plasma total-tau (β -0.010, p-value 0.001) at Exam-8. Grip strength and fast walk speed at Exam-8 were associated with plasma total-tau at Exam-8 (GS: β -0.009, p 0.0005; FWS: β -0.226, p-value <0.0001). Chair stand speed was not associated with plasma markers; Aβ42 was not associated with function. Conclusion: Grip strength and fast walk speed are associated with plasma markers of neurodegeneration in dementia-free middle aged and older individuals. Both these measures could be used as potential screening tools for identifying individuals at a higher risk for AD and related dementias alongside other validated markers.

CITATION:
M.E. Jacob ; A. O’Donnell ; J. Samra ; M.M. Gonzales ; C. Satizabal ; M.P. Pase ; J.M. Murabito ; A. Beiser ; S. Seshadri (2022): Grip Strength, Gait Speed and Plasma Markers of Neurodegeneration in Asymptomatic Middle-aged and Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.17

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RESILIENCE IN A GREEK SAMPLE OF INFORMAL DEMENTIA CAREGIVERS: FAMILISM AS A CULTURE-SPECIFIC FACTOR

A. Kalaitzaki, S. Koukouli, S. Panagiotakis, C. Tziraki

J Frailty Aging 2022;11(3)299-301

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The aim of this study was to examine the prevalence and the factors associated with resilience among a sample of 118 Greek informal caregivers (78.8% females, mean age=58.9, SD=11.6) of people with dementia. Face-to-face interviews assessed caregivers’ socio-demographics, resilience, quality of life, burden, familism, and perception of services and their proxy assessments of the cognitive functioning, functional activity, and behavioral problems of people with dementia. Moderate levels of resilience were reported by 58.6% of the caregivers. Dementia-related knowledge and higher levels of familism were associated with higher levels of resilience, whereas higher frequency of dealing with behavioral problems was associated with lower resilience. Effective interventions to strengthen Greek dementia caregivers’ resilience should be culture-specific, targeting both behavioral problems and caregivers’ intrapersonal facilitators (i.e, dementia-related knowledge) and interpersonal interactions (i.e., familism). Healthcare professionals may have a key role in building caregivers’ resilience and contribute to implications for policy and practice.

CITATION:
A. Kalaitzaki ; S. Koukouli ; S. Panagiotakis ; C. Tziraki ; (2022): Resilience in a Greek Sample of Informal Dementia Caregivers: Familism as a Culture-Specific Factor. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.31

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PREVALENCE AND DISTRIBUTION OF INTRINSIC CAPACITY AND ITS ASSOCIATIONS WITH HEALTH OUTCOMES IN OLDER PEOPLE: THE JOCKEY CLUB COMMUNITY EHEALTH CARE PROJECT IN HONG KONG

R. Yu, G. Leung, J. Leung, C. Cheng, S. Kong, L.Y. Tam, J. Woo

J Frailty Aging 2022;11(3)302-308

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Objective: To determine the prevalence and distribution of intrinsic capacity (IC) impairments and examine their associations with health outcomes. Methods: Community-dwelling people aged 60 years and older were interviewed at baseline and followed up for one to three years. IC domains including cognitive, locomotor, vitality, sensory (vision, hearing), and psychological capacities were assessed at baseline. Incident polypharmacy, incontinence, poor/fair self-rated health, and instrumental activities of daily living (IADL) difficulty were ascertained at each follow-up. Findings: 10,007 participants were interviewed at baseline. Overall mean age was 75.7±7.9 years. At baseline, 85.3% had impairments in one or more IC domains, where cognitive capacity was the domain that was most frequently affected (71.3%). The prevalence of impairments in one or more domains increased with age (p<0.001) and was higher among women than men (p<0.001). Among the 1,601 participants who were interviewed at each follow-up, those with impairments in three or more domains had the greatest risk for the incidence of polypharmacy (adjusted OR 2.2, 95%CI 1.1-4.2), incontinence (adjusted OR 3.0, 95%CI 1.8-5.0), poor/fair self-rated health (adjusted OR 3.7, 95%CI 1.9-7.2), and IADL difficulty (adjusted OR 3.3, 95%CI 1.8-6.1) compared with those without IC impairments. Conclusion: IC impairments are highly prevalent and those with IC impairments had increased risks of polypharmacy, incontinence, poor/fair self-rated health, and IADL difficulty. The findings could potentially lead to a refinement and the adoption of IC as a screening measure which could be served as a target of intervention in the care for older people.

CITATION:
R. Yu ; G. Leung ; J. Leung ; C. Cheng ; S. Kong ; L.Y. Tam ; J. Woo (2022): Prevalence and Distribution of Intrinsic Capacity and Its Associations with Health Outcomes in Older People: The Jockey Club Community eHealth Care Project in Hong Kong. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.19

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DIFFERENCES IN MUSCLE QUANTITY AND QUALITY BY HIV SEROSTATUS AND SEX

K.M. Erlandson, S. Langan, J.E. Lake, J. Sun, A. Sharma, S. Adrian, A. Scherzinger, F. Palella, L. Kingsley, S.J. Gange, P.C. Tien, M.T. Yin, T.T. Brown

J Frailty Aging 2022;11(3)309-317

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Objective: People with HIV (PWH) experience greater declines in both muscle function and muscle mass with aging. Whether changes in muscle quality and quantity with aging differ between men and women with HIV and the implications on muscle function are not established. Design: In coordinated substudies of the Multicenter AIDS Cohort Study and Women’s Interagency HIV Study, participants completed physical function and falls assessments; total trunk/thigh density, inversely related to fatty infiltration, and area were quantified from computed tomography (CT) scans. Methods: Generalized linear models were used to explore variables affecting density/area, and associations between area/density and physical function and falls. Results: CT scans were available on 387 men (198 PWH) and 184 women (118 PWH). HIV serostatus was associated with greater lateralis, paraspinal, and hamstring area, but lower psoas area and density. Older age and female sex were associated with smaller trunk muscle area and lower density. Both lower muscle area and muscle density were associated with several measures of impaired physical function. The odds of falling were lower with greater hamstring density, but not associated with other measurers of muscle area or density. Conclusions: In summary, older adults with HIV appear to have smaller and less dense (fattier) psoas, a key component in truncal stability and hip flexion that could have implications on physical function. The longitudinal associations of muscle area and density with physical function require careful investigation, with a particular focus on characteristics and interventions that can preserve muscle area, density, and function over time.

CITATION:
K.M. Erlandson ; S. Langan ; J.E. Lake ; J. Sun ; A. Sharma ; S. Adrian ; A. Scherzinger ; F. Palella ; L. Kingsley ; S.J. Gange ; P.C. Tien ; M.T. Yin ; T.T. Brown (2022): Differences in Muscle Quantity and Quality by HIV Serostatus and Sex. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/jpad.2022.11

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SOCIAL VULNERABILITY PREDICTS FRAILTY: TOWARDS A DISTINCTION BETWEEN FRAGILITY AND FRAILTY?

H. Amieva, C. Ouvrard-Brouillou, J.-F. Dartigues, K. Pérès, M. Tabue Teguo, A. Avila-Funes

J Frailty Aging 2022;11(3)318-323

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Background: All definitions of frailty converge in two aspects: the notion of loss or decline and the ability to predict negative health outcomes. Numerous factors were reported to be associated with frailty among which biological, psychological, economic and social factors. Whether the latter contribute at the same level is a relevant question, as social vulnerability does not refer to an ongoing process of decline leading a person to become frail but rather to a relativity stable state making the person fragile. Thus, social vulnerability should increase the risk of frailty. Objectives: This study aims at assessing whether social vulnerability increases the risk of incident frailty. Methods: 1531 participants aged 65 or older from the PAQUID cohort study were included. Cox regression models tested the association between social vulnerability index (SVI, based on 28 social items) and frailty index (FI, based on 25 health-related items) over the 27 years of follow-up. Results: Adjusted for age and sex, higher SVI was associated with increased risk of incident frailty (HR=3.85, 95% CI=1.87–7.94, p<.001). After additional control for IADL disability and comorbidities, higher SVI was associated with increased risk of frailty (HR=3.40, 95% CI=1.63–7.07, p<.05). The association remained significant after controlling for MMSE (HR=2.34, 95% CI=1.08–5.07, p<.05). Discussion: Poor social status is a risk factor of frailty. From a conceptual point of view, our results claim for a distinction between the concepts of frailty and fragility, the first one being the consequence of an ongoing decline, the other one related to a relatively stable condition of fragility, mainly explained by unfavorable social conditions.

CITATION:
H. Amieva ; C. Ouvrard-Brouillou ; J.-F. Dartigues ; K. Pérès ; M. Tabue Teguo ; A. Avila-Funes (2022): Social Vulnerability Predicts Frailty: Towards a Distinction between Fragility and Frailty?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.24

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POOR ORAL HEALTH IS A FACTOR THAT ATTENUATES THE EFFECT OF REHABILITATION IN OLDER MALE PATIENTS WITH FRACTURES

T. Ogawa, M. Koike, M. Nakahama, S. Kato

J Frailty Aging 2022;11(3)324-328

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Background: Poor oral health can lead to poor general health. We hypothesized that poor oral health might be a factor that attenuates the effect of rehabilitation in older patients with fractures. Objectives: This study aimed to evaluate the relationship between oral health in elderly patients with fractures and improvement in activities of daily living (ADL) through rehabilitation. In addition, we assessed factors associated with ADL improvement among older patients with fractures. Methods: This case-control study was conducted at a rehabilitation hospital among 178 men aged ≥65 years who underwent fracture rehabilitation. Patients were divided into two groups based on the oral health assessment tool (OHAT) score on admission (≥4 and <4). Analysis of comparison between the two groups and multivariate linear regression analyses were performed, with respect to functional independence measure (FIM) gain during rehabilitation. Results: FIM gain was significantly lower in the group with OHAT score ≥4 (26.2±17.5) than that in group with OHAT score <4 (31.1±16.1, p=0.044). There were also significant differences between the two groups in body mass index values, Mini Nutritional Assessment Short Form (MNA-SF) scores, and fracture types. OHAT score on admission was significantly associated with FIM gain during hospitalization (coefficient: 6.350, 95% confidence interval: 1.043-11.658, p=0.019). FIM on admission, Mini-Mental State Examination score, and period of rehabilitation were significantly associated with FIM gain. Conclusions: We demonstrated that the group with poor oral health had lesser ADL improvement than the group with good oral health. In addition, oral health and period of rehabilitation were independent factors that significantly affected ADL improvements. Older patients with poor oral health should be encouraged to undergo further rehabilitation, and to not refrain from exercise because of old age and fractures.

CITATION:
T. Ogawa ; M. Koike ; M. Nakahama ; S. Kato ; (2021): Poor Oral Health Is a Factor that Attenuates the Effect of Rehabilitation in Older Male Patients with Fractures. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2021.54

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ADVERSE DRUG REACTIONS DUE TO OPIOID USE IN OLDEST-OLD PATIENTS VISITING THE EMERGENCY UNIT OF THE GENEVA GERIATRIC HOSPITAL

K. Ing Lorenzini, L. Wainstein, F. Curtin, V. Trombert, D. Zekry, G. Gold, V. Piguet, J. Desmeules

J Frailty Aging 2022;11(3)329-334

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Opioid use has much increased in several countries during the last two decades, accompanied by a rise in associated morbidity and mortality, especially in the United States. Data on a possible opioid crisis are scarcer in Europe. We performed a study aiming to assess the frequency of adverse drug reactions (ADR) related to opioids in patients presenting to the emergency unit (EU) of a geriatric tertiary Swiss University Hospital. This particular setting is intended for patients aged 75 and older. Our retrospective, monocentric survey of opioid use and related ADR was conducted over two months in 2018. The main and secondary outcomes were the frequency of EU visits considered due to an opioid ADR and insufficient pain relief, respectively. Current opioid use was identified in 20.3% (n=99) of the 487 included EU visits (mean age 86). An ADR was the suspected cause of the EU visit in 22 opioid users, mainly fall-related injury and gastrointestinal disorders. All these patients had at least one comorbid condition. In 19/22 cases (86%) of ADR, a drug-drug interaction might have been involved. In 12 opioid users (12%), insufficient pain relief was suspected as the cause of the EU visit. In conclusion, one-third of opioid users visiting a geriatric EU consulted for a problem related to its use mainly adverse drug-related reaction (22%) followed by insufficient pain relief (12%).

CITATION:
K. Ing Lorenzini ; L. Wainstein ; F. Curtin ; V. Trombert ; D. Zekry ; G. Gold ; V. Piguet ; J. Desmeules (2022): Adverse Drug Reactions Due to Opioid Use in Oldest-Old Patients Visiting the Emergency Unit of the Geneva Geriatric Hospital. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.35

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COVID-19 AND THE IMPACT ON CAREGIVERS

L. Orlandini

J Frailty Aging 2022;11(3)335-336

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CITATION:
L. Orlandini ; (2022): covid-19 and the Impact on Caregivers. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.41

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LETTER TO THE EDITOR: SHOULD THE 30-SECOND CHAIR STAND TEST BE CONSIDERED A MUSCLE FUNCTION ASSESSMENT?

R. McGrath

J Frailty Aging 2022;11(3)337-338

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CITATION:
R. McGrath ; (2021): Should the 30-Second Chair Stand Test Be Considered a Muscle Function Assessment?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2021.41

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