Ahead of print articles
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.
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
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.
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.
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
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.
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
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
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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.
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
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.
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
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.
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
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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%).
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
RESILIENCE IN A GREEK SAMPLE OF INFORMAL DEMENTIA CAREGIVERS: FAMILISM AS A CULTURE-SPECIFIC FACTOR
A. Kalaitzaki, S. Koukouli, S. Panagiotakis, C. Tziraki
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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.
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
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.
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
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.
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
FRAILTY AND PERSISTENT PAIN IN ONCOLOGICAL PATIENTS UNDERGOING REHABILITATION
S. Crosignani, L. Orlandini, S. Baruffi, M. Froldi, M. Cesari
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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.
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
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.
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
JFA N°02 - 2022
THE MANAGEMENT OF FRAILTY: BARKING UP THE WRONG TREE
M. Cesari, M. Canevelli, R. Calvani, I. Aprahamian, M. Inzitari, E. Marzetti
J Frailty Aging 2022;11(2)127-128Show summaryHide summary
No summary available.OPEN ACCESS
APPETITE LOSS AND ANOREXIA OF AGING IN CLINICAL CARE: AN ICFSR TASK FORCE REPORT
P. de Souto Barreto, M. Cesari, J.E. Morley, S. Roberts, F. Landi, T. Cederholm, Y. Rolland, B. Vellas, R. Fielding
J Frailty Aging 2022;11(2)129-134Show summaryHide summary
Appetite loss/anorexia of aging is a highly prevalent and burdensome geriatric syndrome that strongly impairs the quality of life of older adults. Loss of appetite is associated with several clinical conditions, including comorbidities and other geriatric syndromes, such as frailty. Despite its importance, appetite loss has been under-evaluated and, consequently, under-diagnosed and under-treated in routine clinical care. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force met virtually on September 27th 2021 to debate issues related to appetite loss/anorexia of aging. In particular, topics related to the implementation and management of appetite loss in at-risk older adult populations, energy balance during aging, and the design of future clinical trials on this topic were discussed. Future actions in this field should focus on the systematic assessment of appetite in the care pathway of older people, such as the Integrated Care for Older People (ICOPE) program recommended by the World Health Organization. Moreover, clinical care should move from the assessment to the treatment of appetite loss/anorexia. Researchers continue to pursue their efforts to find out effective pharmacologic and non-pharmacologic interventions with a favorable risk/benefit ratio.
P. de Souto Barreto ; M. Cesari ; J.E. Morley ; S. Roberts ; F. Landi ; T. Cederholm ; Y. Rolland ; B. Vellas ; R. Fielding (2022): Appetite Loss and Anorexia of Aging in Clinical Care: An ICFSR Task Force Report. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.14
CHALLENGES IN THE DEVELOPMENT OF DRUGS FOR SARCOPENIA AND FRAILTY - REPORT FROM THE INTERNATIONAL CONFERENCE ON FRAILTY AND SARCOPENIA RESEARCH (ICFSR) TASK FORCE
M. Cesari, R. Bernabei, B. Vellas, R.A. Fielding, D. Rooks, D. Azzolino, J. Mariani, A.A. Oliva, S. Bhasin, Y. Rolland
J Frailty Aging 2022;11(2)135-142Show summaryHide summary
Sarcopenia and frailty represent two burdensome conditions, contributing to a broad spectrum of adverse outcomes. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force met virtually in September 2021 to discuss the challenges in the development of drugs for sarcopenia and frailty. Lifestyle interventions are the current mainstay of treatment options in the prevention and management of both conditions. However, pharmacological agents are needed for people who do not respond to lifestyle modifications, for those who are unable to adhere, or for whom such interventions are inaccessible/unfeasible. Preliminary results of ongoing trials were presented and discussed. Several pharmacological candidates are currently under clinical evaluation with promising early results, but none have been approved for either frailty or sarcopenia. The COVID-19 pandemic has reshaped how clinical trials are conducted, in particular by enhancing the usefulness of remote technologies and assessments/interventions.
M. Cesari ; R. Bernabei ; B. Vellas ; R.A. Fielding ; D. Rooks ; D. Azzolino ; J. Mariani ; A.A. Oliva ; S. Bhasin ; Y. Rolland ; on behalf of the ICFSR Task Force members ; (2022): Challenges in the Development of Drugs for Sarcopenia and Frailty - Report from the International Conference on Frailty and Sarcopenia Research (icfsr) Task Force. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.30
RECOMMENDATIONS FOR REDUCING HETEROGENEITY IN HANDGRIP STRENGTH PROTOCOLS
R. McGrath, P.M. Cawthon, B.C. Clark, R.A. Fielding, J.J. Lang, G.R. Tomkinson
J Frailty Aging 2022;11(2)143-150Show summaryHide summary
Handgrip dynamometers are widely used to measure handgrip strength (HGS). HGS is a safe and easy to obtain measure of strength capacity, and a reliable assessment of muscle function. Although HGS provides robust prognostic value and utility, several protocol variants exist for HGS in clinical settings and translational research. This lack of methodological consistency could threaten the precision of HGS measurements and limit comparisons between the growing number of studies measuring HGS. Providing awareness of the protocol variants for HGS and making suggestions to reduce the implications of these variants will help to improve methodological consistency. Moreover, leveraging recent advancements in HGS equipment may enable us to use more sophisticated HGS dynamometer technologies to better assess muscle function. This Special Article will 1) highlight differences in HGS protocols and instrumentation, 2) provide recommendations to better specify HGS procedures and equipment, and 3) present future research directions for studies that measure HGS. We also provided a minimum reporting criteria framework to help future research studies avoid underreporting of HGS procedures.
R. McGrath ; P.M. Cawthon ; B.C. Clark ; R.A. Fielding ; J.J. Lang ; G.R. Tomkinson (2022): Recommendations for Reducing Heterogeneity in Handgrip Strength Protocols. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.21
CHANGES IN BODY COMPOSITION IN OLDER ADULTS AFTER A TECHNOLOGY-BASED WEIGHT LOSS INTERVENTION
J.A. Batsis, D. Shirazi, C.L. Petersen, M.N. Roderka, D. Lynch, D. Jimenez, S.B. Cook
J Frailty Aging 2022;11(2)151-155Show summaryHide summary
We conducted a post-hoc analysis of a pre/post, single-arm, non-randomized, multicomponent weight loss intervention in older adults. Fifty-three older adults aged ≥65 with a body mass index ≥ 30 kg/m2 were recruited to participate in a six-month, remote monitoring and video-conferencing delivered, prescriptive intervention consisting of individual and group-led registered dietitian nutrition and physical therapy sessions. We assessed weight, height, and body composition using a SECA 514 bioelectrical impedance analyzer. Mean age was 72.9±3.9 years (70% female) and all had ≥2 chronic conditions. Of those with complete data (n=30), we observed a 4.6±3.5kg loss in weight, 6.1±14.3kg (1.9%) loss in fat mass, and 0.78±1.69L loss in visceral fat (all p<0.05). Fat-free mass (-3.4kg±6.8, p=0.19), appendicular lean mass (-0.25±1.83, p=0.22), and grip strength (+3.46±7.89, p=0.56) did not significantly change. These variables were preserved after stratifying by 5% weight loss. Our intervention led to significant body and visceral fat loss while maintaining fat-free and appendicular lean muscle mass.
J.A. Batsis ; D. Shirazi ; C.L. Petersen ; M.N. Roderka ; D. Lynch ; D. Jimenez ; S.B. Cook (2022): Changes in Body Composition in Older Adults after a Technology-Based Weight Loss Intervention. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.15
PERFORMANCE OF A NOVEL HANDHELD BIOELECTRICAL IMPEDANCE DEVICE FOR ASSESSING MUSCLE MASS IN OLDER INPATIENTS
A.K. Stuck, A. Weber, R. Wittwer, A. Limacher, R.W. Kressig
J Frailty Aging 2022;11(2)156-162Show summaryHide summary
Objectives: To investigate practicality and repeatability of a handheld compared to a state-of-the-art multisegmental bioelectrical impedance analysis (BIA) device to facilitate screening of sarcopenia in older inpatients.
Design and setting: Cross-sectional study in a geriatric rehabilitation hospital.
Participants: 207 inpatients aged 70+.
Measurements: In a first phase, appendicular skeletal muscle mass index (ASMI) was measured using the handheld Biody xpertZm II BIA device (n=100). In a second phase, ASMI was obtained using the multisegmental Biacorpus RX 4004M device (n=107). Repeatability of BIA devices was compared in subgroups of patients (handheld BIA device: n=36, multisegmental BIA device: n=46) by intra-class correlation (ICC) and Bland-Altman plots.
Results: Overall, measurement failure was seen in 31 patients (31%) tested with the handheld BIA device compared to one patient (0.9%) using the multisegmental BIA device (p<0.001). Main reasons for measurement failure were inability of patients to adopt the position necessary to use the handheld BIA device and device failure. The mean difference of two ASMI measurements in the same patient was 0.32 (sd 0.85) using the handheld BIA device compared to 0.02 kg/m2 (sd 0.07) using the multisegmental device (adjusted mean difference between both groups -0.35, 95% confidence interval (CI) -0.61 to -0.09 kg/m2). Congruently, Bland-Altman plots showed poor agreement with the handheld compared to the multisegmental BIA device.
Conclusion: The handheld BIA device is neither a practical nor reliable device for assessing muscle mass in older rehabilitation inpatients.
A.K. Stuck ; A. Weber ; R. Wittwer ; A. Limacher ; R.W. Kressig ; (2021): Performance of a Novel Handheld Bioelectrical Impedance Device for Assessing Muscle Mass in Older Inpatients. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2021.40
FRAILTY AMONG OLDER ADULTS AND ITS DISTRIBUTION IN ENGLAND
D.R. Sinclair, A. Maharani, T. Chandola, P. Bower, B. Hanratty, J. Nazroo, T.W. O’Neill, G. Tampubolon, C. Todd, R. Wittenberg, F.E. Matthews, N. Pendleton
J Frailty Aging 2022;11(2)163-168Show summaryHide summary
Background: Information on the spatial distribution of the frail population is crucial to inform service planning in health and social care.
Objectives: To estimate small-area frailty prevalence among older adults using survey data. To assess whether prevalence differs between urban, rural, coastal and inland areas of England.
Design: Using data from the English Longitudinal Study of Ageing (ELSA), ordinal logistic regression was used to predict the probability of frailty, according to age, sex and area deprivation. Probabilities were applied to demographic and economic information in 2020 population projections to estimate the district-level prevalence of frailty.
Results: The prevalence of frailty in adults aged 50+ (2020) in England was estimated to be 8.1 [95% CI 7.3-8.8]%. We found substantial geographic variation, with the prevalence of frailty varying by a factor of 4.0 [3.5-4.4] between the most and least frail areas. A higher prevalence of frailty was found for urban than rural areas, and coastal than inland areas. There are widespread geographic inequalities in healthy ageing in England, with older people in urban and coastal areas disproportionately frail relative to those in rural and inland areas.
Conclusions: Interventions aimed at reducing inequalities in healthy ageing should be targeted at urban and coastal areas, where the greatest benefit may be achieved.
D.R. Sinclair ; A. Maharani ; T. Chandola ; P. Bower ; B. Hanratty ; J. Nazroo ; T.W. O’Neill ; G. Tampubolon ; C. Todd ; R. Wittenberg ; F.E. Matthews ; N. Pendleton (2021): Frailty among Older Adults and Its Distribution in England. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2021.55
SARCOPENIA IN DISTAL RADIUS FRACTURES: A SCOPING REVIEW
M. Yam, H. Ng, C.L. Lim, Y.L. Munro, W.S. Lim
J Frailty Aging 2022;11(2)169-176Show summaryHide summary
Background: Sarcopenia is an emerging disease that adversely impacts outcomes of older adults across the spectrum of fragility fractures. Few studies have examined sarcopenia in upstream fragility fractures such as the distal radius. Understanding the state of current evidence is essential in defining a research agenda in this critical area of sentinel distal radius fractures and sarcopenia.
Objectives: The aim of this scoping review was to summarize existing literature on sarcopenia in distal radius fracture in older adults, and to identify research areas and gaps to guide future studies.
Methods: We utilized the 5-stage framework of Arksey and O’Malley. We searched studies from 2010 to 2020 relating to «Sarcopenia» and «Distal radius fractures» in major databases. Two reviewers independently screened articles for inclusion and conducted full text reviews of shortlisted articles. We extracted data on research areas, key findings, and study limitations.
Results: Thirteen studies met the inclusion and exclusion criteria. They covered the areas of epidemiology (N=9), risk factors (N=4), basic science (N=2), outcomes (N=1), and diagnostic modalities (N=1). There were no studies on screening/case finding, prognostic scoring, intervention, or health economics. Identified limitations included the lack of clear definition and diagnostic criteria for sarcopenia, and lack of, or inappropriate, control group. Majority of studies were retrospective or cross-sectional in study design.
Conclusions: This scoping review on sarcopenia in distal radius fractures highlighted gaps in research areas and in the rigor of studies conducted, and the need for more prospective cohort and interventional studies. Building upon current consensus criteria, we propose setting a research agenda along the timeline of sarcopenia management, from screening through to intervention and follow-up, which will inform future research in this early disease cohort of fragility fractures.
M. Yam ; H. Ng ; C.L. Lim ; Y.L. Munro ; W.S. Lim ; (2022): Sarcopenia in Distal Radius Fractures: A Scoping Review. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.6
APPENDICULAR LEAN MASS AND FRAILTY AMONG GERIATRIC OUTPATIENTS
Tam N. Nguyen, Tu N. Nguyen, Anh T. Nguyen, Hoa L. Nguyen, Robert J. Goldberg, Huong T.T. Nguyen, Thu T.H. Nguyen, Thanh X. Nguyen, Huyen T.T. Vu
J Frailty Aging 2022;11(2)177-181Show summaryHide summary
The objective of this observational study was to examine the association between appendicular lean mass and frailty in adults aged 60 years and older. This study was conducted in the Outpatient Department of the National Geriatric Hospital in Hanoi, Vietnam. Appendicular lean mass (kg) was assessed by using Dual energy X-ray absorptiometry scans. Frailty was defined according to Fried’s frailty criteria. A total of 560 outpatients were included in the study, with a mean age of 70 years. The prevalence of frailty was 12.0%. Frail patients had significantly lower appendicular lean mass compared with non-frail outpatients (9.6 ± 2.0 kg vs. 11.7 ± 3.1 kg, p<0.001). On multivariable logistic regression models, higher appendicular lean mass was associated with significantly reduced odds for frailty (adjusted OR = 0.74, 95%CI 0.59 – 0.93). These findings suggest that the assessment of appendicular lean mass should be considered in older patients attending outpatient geriatric clinics.
Tam N. Nguyen ; Tu N. Nguyen ; Anh T. Nguyen ; Hoa L. Nguyen ; Robert J. Goldberg ; Huong T.T. Nguyen ; Thu T.H. Nguyen ; Thanh X. Nguyen ; Huyen T.T. Vu (2022): Appendicular Lean Mass and Frailty among Geriatric Outpatients. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.9
CROSS-SECTIONAL ASSOCIATIONS OF SARCOPENIA AND ITS COMPONENTS WITH NEUROPSYCHOLOGICAL PERFORMANCE AMONG MEMORY CLINIC PATIENTS WITH MILD COGNITIVE IMPAIRMENT AND ALZHEIMER’S DISEASE
T. Sugimoto, Y. Kuroda, N. Matsumoto, K. Uchida, Y. Kishino, N. Saji, S. Niida, T. Sakurai
J Frailty Aging 2022;11(2)182-189Show summaryHide summary
Background: The association of sarcopenia with cognitive function in its specific domains remains poorly understood.
Objectives: To investigate the association of sarcopenia and its components with neuropsychological performance among patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD).
Design: Cross-sectional design.
Setting: A memory clinic in Japan.
Participants: The study included 497 MCI/684 AD patients aged 65-89 years.
Measurements: Patients were assessed for muscle mass by bioelectrical impedance analysis, muscle strength by hand grip strength (HGS), and physical performance by timed up and go test (TUG). Sarcopenia was defined as presence of both low muscle strength and low muscle mass. The patients underwent neuropsychological tests, including logical memory, frontal lobe assessment battery, word fluency test, Raven’s colored progressive matrices, digit span, and the Alzheimer’s disease assessment scale-cognitive subscale (ADAS-cog).
Results: The prevalence of sarcopenia in men and women was 24.1% and 19.5%, respectively. In multiple regression analyses adjusting for confounders, unlike in men, sarcopenia was associated with memory function in women (ADAS-cog, memory domain, coefficient = 1.08, standard error (SE) = 0.36), which was thought likely due to the relationship between HGS and memory function (immediate recall of logical memory, coefficient = 0.07, SE = 0.03; ADAS-cog, memory domain, coefficient = -0.10, SE = 0.03). Of the components of sarcopenia in both sexes, HGS and TUG were associated with visuospatial function and frontal lobe function, respectively.
Conclusions: The specific association of sarcopenia and its components with cognitive domains may provide the key to elucidating the muscle-brain interactions in AD.
T. Sugimoto ; Y. Kuroda ; N. Matsumoto ; K. Uchida ; Y. Kishino ; N. Saji ; S. Niida ; T. Sakurai ; (2022): Cross-Sectional Associations of Sarcopenia and Its Components with Neuropsychological Performance among Memory Clinic Patients with Mild Cognitive Impairment and Alzheimer’s Disease. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.3
SIGNIFICANT PSYCHOSOCIAL INFLUENCE IN FRAIL PEOPLE LIVING WITH HIV INDEPENDENT OF FRAILTY INSTRUMENT USED
S.A. Abdul-Aziz, M.L. Chong, M. McStea, P.L. Wong, S. Ponnampalavanar, I. Azwa, A. Kamarulzaman, S.B. Kamaruzzaman, R. Rajasuriar
J Frailty Aging 2022;11(2)190-198Show summaryHide summary
Background: Antiretroviral therapy (ART) usage among people living with HIV (PLWH) has led to significant mortality declines and increasing lifespan. However, high incidence and early onset of aging-related conditions such as frailty, pose as a new threat to this population.
Objectives: We aimed to characterize frailty by comparing health domains consisting of psychosocial, functional and physical deficits between frail PLWH and matched uninfected controls; identify associated risk factors and the impact on negative health outcomes including mortality risk score, quality of life, healthcare utilization, functional disability and history of falls among virally suppressed PLWH.
Design: Cross-sectional study
Setting: Infectious disease clinic in a tertiary institution
Participants: Individuals aged >25 years, on ART > 12 months, not pregnant and without acute illness; multi-ethnic, Asian
Measurements: Frailty instruments included Frailty phenotype (FP), FRAIL scale (FS) and Frailty index (FI). FI health deficits were categorized into health domains (psychosocial, functional and physical) and used as standard comparator to characterize frailty. Health domains of frail PLWH were compared with frail matched, uninfected controls. Regression analyses were applied to explore associated risk factors and health-related frailty outcomes.
Results: We recruited 336 PLWH. Majority were male (83%), Chinese (71%) with CD4+ count 561 (397-738) cells/µl. Frailty prevalence among PLWH were 7% (FP); 16% (FS) and 22% (FI). Proportions of psychosocial, functional, and physical domains were similarly distributed among frail PLWH measured by different frailty instruments. When compared with matched controls, psychosocial dominance was significant among the PLWH, but not in functional and physical domains. Identified frailty risk factors included poor nutritional status, higher CD4+ count nadir, depression, metabolic syndrome, higher highly sensitive C-reactive protein (hsCRP) and history of AIDS-defining illness (ADI). Frailty influenced the risk for negative health outcomes including increased mortality risk scores, poor quality of life (QOL), frequent healthcare utilization and increased functional disability (p<0.05).
Conclusions: This study highlighted the importance of psychosocial influence in the development of frailty among treated PLWH in a multi-ethnic, Asian setting.
S.A. Abdul-Aziz ; M.L. Chong ; M. McStea ; P.L. Wong ; S. Ponnampalavanar ; I. Azwa ; A. Kamarulzaman ; S.B. Kamaruzzaman ; R. Rajasuriar ; (2021): Significant Psychosocial Influence in Frail People Living with HIV Independent of Frailty Instrument Used. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2021.48
SOCIAL PARTICIPATION’S ASSOCIATION WITH FALLS AND FRAILTY IN MALAYSIA: A CROSS-SECTIONAL STUDY
S. Risbridger, R. Walker, W.K. Gray, S.B Kamaruzzaman, C. Ai-Vyrn, N.N. Hairi, P.L. Khoo, T.M.Pin
J Frailty Aging 2022;11(2)199-205Show summaryHide summary
Background: The global population is ageing rapidly, with the most dramatic increases in developing countries like Malaysia. Older people are at increased risk of multimorbidity, frailty and falls.
Objectives: In this study we aimed to determine the relationship between social participation, frailty and falls in Malaysia.
Design, Setting, and Participants: This was a cross-sectional study of individuals aged 55 years and above selected from the electoral rolls of three Klang Valley parliamentary constituencies through stratified random sampling. They were invited to take part in a questionnaire and physical assessment as part of the Malaysian Elders Longitudinal Research (MELoR) study.
Measurements: Fallers were individuals who had fallen in the previous year. Frailty was defined as meeting ≥3 of: low body mass index, reduced cognition, low physical activity, low hand-grip strength, and slow walking speed. Social participation was determined from employment status, social network, and community activity. Binomial logistic regression multivariant analysis was performed to identify links between the measures of social participation and falls and frailty.
Results: The mean age of the 1383 participants was 68.5 years, with 57.1% female. Within the population, 22.9% were fallers and 9.3% were frail. Social isolation (OR= 2.119; 95% CI=1.351-3.324), and non-engagement in community activities (OR=2.548; 95% CI=1.107-5.865) were associated with increased frailty. Falls increased with social isolation (OR=1.327; 95% CI=1.004-1.754).
Conclusions: Previous studies have shown social participation to be linked to frailty and falls risk, and social isolation to be a predictor of falls. In this study frailty was associated with all three social participation measures and history of falls was associated with social isolation.
S. Risbridger ; R. Walker ; W.K. Gray ; S.B. Kamaruzzaman ; C. Ai-Vyrn ; N.N. Hairi ; P.L. Khoo ; T.M. Pin ; (2021): Social Participation’s Association with Falls and Frailty in Malaysia: A Cross-Sectional Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2021.31
SOCIAL FRAILTY AND EXECUTIVE FUNCTION: ASSOCIATION WITH GERIATRIC SYNDROMES, LIFE SPACE AND QUALITY OF LIFE IN HEALTHY COMMUNITY-DWELLING OLDER ADULTS
M. Ong, K. Pek, C.N. Tan, J. Chew, J.P. Lim, S. Yew, A. Yeo, W.S. Lim
J Frailty Aging 2022;11(2)206-213Show summaryHide summary
Background: Despite emerging evidence about the association between social frailty and cognitive impairment, little is known about the role of executive function in this interplay, and whether the co-existence of social frailty and cognitive impairment predisposes to adverse health outcomes in healthy community-dwelling older adults.
Objectives: We aim to examine independent associations between social frailty with the MMSE and FAB, and to determine if having both social frailty and cognitive impairment is associated with worse health outcomes than either or neither condition.
Methods: We studied 229 cognitively intact and functionally independent community-dwelling older adults (mean age= 67.2±7.43). Outcome measures comprise physical activity; physical performance and frailty; geriatric syndromes; life space and quality of life. We compared Chinese Mini Mental State Examination (CMMSE) and Chinese Frontal Assessment Battery (FAB) scores across the socially non-frail, socially pre-frail and socially frail. Participants were further recategorized into three subgroups (neither, either or both) based on presence of social frailty and cognitive impairment. Cognitive impairment was defined as a score below the educational adjusted cut-offs in either CMMSE or FAB. We performed logistic regression adjusted for significant covariates and mood to examine association with outcomes across the three subgroups.
Results: Compared with CMMSE, Chinese FAB scores significantly decreased across the social frailty spectrum (p<0.001), suggesting strong association between executive function with social frailty. We derived three subgroups relative to relationship with socially frailty and executive dysfunction: (i) Neither, N=140(61.1%), (ii) Either, N=79(34.5%), and (iii) Both, N=10(4.4%). Compared with neither or either subgroups, having both social frailty and executive dysfunction was associated with anorexia (OR=4.79, 95% CI= 1.04-22.02), near falls and falls (OR= 5.23, 95% CI= 1.10-24.90), lower life-space mobility (odds ratio, OR=9.80, 95% CI=2.07-46.31) and poorer quality of life (OR= 13.2, 95% CI= 2.38-73.4).
Conclusion: Our results explicated the association of executive dysfunction with social frailty, and their synergistic relationship independent of mood with geriatric syndromes, decreased life space and poorer quality of life. In light of the current COVID-19 pandemic, the association between social frailty and executive dysfunction merits further study as a possible target for early intervention in relatively healthy older adults.
M. Ong ; K. Pek ; C.N. Tan ; J. Chew ; J.P. Lim ; S. Yew ; A. Yeo ; W.S. Lim (2021): Social Frailty and Executive Function: Association with Geriatric Syndromes, Life Space and Quality of Life in Healthy Community-Dwelling Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2021.43
THE DESIGN AND RATIONALE OF A PHASE 2B, RANDOMIZED, DOUBLE-BLINDED, AND PLACEBO-CONTROLLED TRIAL TO EVALUATE THE SAFETY AND EFFICACY OF LOMECEL-B IN OLDER ADULTS WITH FRAILTY
K. Yousefi, K.N. Ramdas, J.G. Ruiz, J. Walston, H. Arai, E. Volpi, A.B. Newman, C. Wang, B. Hitchinson, L. McClain-Moss, L. Diaz, G.A. Green, J.M. Hare, A.A. Oliva
J Frailty Aging 2022;11(2)214-223Show summaryHide summary
BACKGROUND: Frailty in older adults is a rapidly growing unmet medical need. It is an aging-related syndrome characterized by physical decline leading to higher risk of adverse health outcomes.
OBJECTIVES: To evaluate the efficacy of Lomecel-B, an allogeneic medicinal signaling cell (MSC) formulation, in older adults with frailty.
DESIGN: This multicenter, randomized, parallel-arm, double-blinded, and placebo-controlled phase 2b trial is designed to evaluate dose-range effects of Lomecel-B for frailty on physical functioning, patient-reported outcomes (PROs), frailty status, and biomarkers.
SETTING: Eight enrolling clinical research centers, including the Miami Veterans Affairs Medical Center.
PARTICIPANTS: Target enrollment is 150 subjects aged 70-85 years of any race, ethnicity, or gender. Enrollment criteria include a Clinical Frailty Score of 5 (“mild”) or 6 (“moderate”), a 6MWT of 200-400 m, and serum tumor necrosis factor-alpha (TNF-α) ≥2.5 pg/mL.
INTERVENTION: A single intravenous infusion of Lomecel-B (25, 50, 100, or 200 million cells) or placebo (N=30/arm). Patients are followed for 365 days for safety, and the efficacy assessments performed at 90, 180, and 270 days.
MEASUREMENTS: The primary endpoint is change in 6MWT in the Lomecel-B-treated arms versus placebo at 180 days post-infusion. Secondary and exploratory endpoints include change in: 6MWT and other physical function measures at all time points; PROs; frailty status; cognitive status; and an inflammatory biomarkers panel. A pre-specified sub-study examines vascular/endothelial biomarkers. Safety is evaluated throughout the trial.
RESULTS: The trial is conducted under a Food and Drug Administration Investigational New Drug (IND), with Institutional Review Board approval, and monitoring by an NIH-appointed independent Data Safety Monitoring Board.
CONCLUSION: This clinical trial investigates the use of a regenerative medicine strategy for frailty in older adults. The results will further the understanding of the potential for Lomecel-B in the geriatric condition of frailty.
K. Yousefi ; K.N. Ramdas ; J.G. Ruiz ; J. Walston ; H. Arai ; E. Volpi ; A.B. Newman ; C. Wang ; B. Hitchinson ; L. McClain-Moss ; L. Diaz ; G.A. Green ; J.M. Hare ; A.A. Oliva (2022): The Design and Rationale of a Phase 2b, Randomized, Double-Blinded, and Placebo-Controlled Trial to Evaluate the Safety and Efficacy of Lomecel-B in Older Adults with Frailty. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.2
VITAMIN D SUPPLEMENTATION IS ASSOCIATED WITH A REDUCTION IN SELF-REPORTED FALLS AMONG OLDER ADULTS WITH PREVIOUS FALL HISTORY – FEASIBILITY STUDY
S.D. Anton, R.T. Mankowski, P. Qiu, L. You, B.A. Bensadon, E.J. Audino, C. Custodero, J.H. Lee, J. Hincapie, C. McLaren, C. Leeuwenburgh, S.P. Ganesh
J Frailty Aging 2022;11(2)224-230Show summaryHide summary
Background: Vitamin D insufficiency contributes to muscle weakness and a higher risk of falls in older adults.
Objectives: This study explored the impact of vitamin D supplementation on self-reported falls and physical function in older adults with low vitamin D levels and a recent fall history.
Materials and Methods: Twenty-five older adults ≥ 70 years with two or more falls during the past year, low vitamin D blood levels (≥10 ng/ml and < 30 ng/mL), and slow gait speed (1.2 m/s) participated in a 6-month vitamin D supplementation (800 IU/day) study. A modified version of the Morse Fall Scale questionnaire was used to assess frequency of falls over one-year prior to study enrollment. Functional outcomes (short physical performance battery, handgrip strength, gait Timed Up and Go, and six-minute walk), and vitamin D levels were assessed at baseline and 6-month follow-up.
Results: Based on diaries and pill counts, participants were generally adherent to the intervention (6 of 7 days per week). Supplementation with 800 IU/day of vitamin D for 6 months increased blood vitamin D levels from 23.25±4.8 ng/ml to 29.13±6.9 ng/ml (p<0.001). Self-reported number of falls decreased from an average of 3.76 ± 2.2 falls in one-year to 0.76 ± 1.4 falls (p <0.0001) over the 6-month intervention. No changes in functional outcome measures were observed.
Conclusions: Vitamin D supplementation at the currently recommended dose of 800 IU/day increased blood vitamin D levels and reduced frequency of falls in older adults with low vitamin D levels and a recent fall history.
S.D. Anton ; R.T. Mankowski ; P. Qiu ; L. You ; B.A. Bensadon ; E.J. Audino ; C. Custodero ; J.H. Lee ; J. Hincapie ; C. McLaren ; C. Leeuwenburgh ; S.P. Ganesh ; (2021): Vitamin D Supplementation Is Associated with a Reduction in Self-Reported Falls among Older Adults with Previous Fall History – Feasibility Study . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2021.46
SOCIAL DETACHMENT INFLUENCED MUSCLE MASS AND STRENGTH DURING THE COVID-19 PANDEMIC IN JAPANESE COMMUNITYDWELLING OLDER WOMEN
B.K. Son, T. Imoto, T. Inoue, T. Nishimura, T. Tanaka, K. Iijima
J Frailty Aging 2022;11(2)231-235Show summaryHide summary
Social detachment due to coronavirus disease (COVID-19) has caused a decline in physical activity, leading to sarcopenia and frailty in older adults. This study aimed to compare muscle mass, strength, and function values in older women before and after the first wave of the COVID-19 pandemic (April−May 2020). Furthermore, changes in muscle measures across women who experienced different levels of impact on their social participation due to the COVID-19 pandemic were examined. Muscle mass (total, trunk, and appendicular muscle), grip strength, oral motor skills, social interactions (social network and participation), and social support were assessed in 46 Japanese community-dwelling older women (mean, 77.5 y; range 66−93 y) before and after the first wave of the COVID-19 pandemic. Trunk muscle mass significantly decreased after the first wave of the pandemic. When comparing changed values between the enhanced/maintained and reduced group during the pandemic, significant group difference was observed in trunk muscular mass, grip strength, and oral motor skills. Intriguingly, those who enhanced social participation had a positive change of grip strength values, showing that social participation might influence muscle function during the COVID-19 pandemic.
B.K. Son ; T. Imoto ; T. Inoue ; T. Nishimura ; T. Tanaka ; K. Iijima (2022): Social Detachment Influenced Muscle Mass and Strength during the COVID-19 Pandemic in Japanese Community-Dwelling Older Women. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.4
COVID-19 VACCINATION FOR FRAIL OLDER ADULTS IN SINGAPORE - RAPID EVIDENCE SUMMARY AND DELPHI CONSENSUS STATEMENTS
J. Gao, P. Lun, Y.Y. Ding, P.P. George
J Frailty Aging 2022;11(2)236-241Show summaryHide summary
Objective: This study aimed to synthesize available evidence on the effectiveness and safety of COVID-19 vaccines for frail older adults through a rapid review, supplemented with geriatricians’ consensus statements.
Methods: References were identified through MEDLINE and Web of Science on 1st February 2021 using relevant terms related to COVID-19, vaccine, and older adults. Searches were also conducted on reference lists of review articles and Google Scholar. The content was updated on 8th April via hand searching. We included studies on Phase III randomized controlled trials, and data from real world administration of vaccines. A two-round Delphi study was conducted with 15 geriatricians to elicit their thoughts and recommendations regarding COVID-19 vaccination for frail older adults.
Results: Five Phase III randomized controlled efficacy trials reported vaccine efficacy ranging from 66.7% to 95% among participants aged 16 to 95. The vaccine efficacy for participants aged 65 and above is 94.7% and 86.4% for Pfizer-BioNTech and Moderna respectively. Sputnik V reported a vaccine efficacy of 91.8% for participants 60 and above. Serious adverse events were reported by 0.27% to 1% of participants who received at least one dose of the four vaccines. For the Delphi study, 16 out of 24 statements achieved consensus. The Delphi panel opined that frail or very old adults, except those with limited life expectancy, should be vaccinated due to their vulnerability. They also agree that vaccination decisions should be made by patients when possible, with the involvement of next-of-kin should the frail older adult be unable to do so. Lastly, the panel thought that frail older adults should be included in future clinical trials.
Conclusion: In early clinical trials, there is paucity of evidence on efficacy and safety of current COVID-19 vaccines among frail older adults. Geriatricians’ consensus indicate that frail older adults should be vaccinated except where life expectancy is limited. Future trials assessing efficacy and safety should include frail older adults.
J. Gao ; P. Lun ; Y.Y. Ding ; P.P. George (2022): COVID-19 Vaccination for Frail Older Adults in Singapore - Rapid Evidence Summary and Delphi Consensus Statements. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.12
FRAILTY STATUS AND OUTCOMES OF COVID-19 PATIENTS ADMITTED TO AN INTENSIVE CARE UNIT
M.R. Jones, C.P. Subbe, C. Thorpe, C. Pickwick
J Frailty Aging 2022;11(2)242-243Show summaryHide summary
M.R. Jones ; C.P. Subbe ; C. Thorpe ; C. Pickwick ; (2022): Frailty Status and Outcomes of COVID-19 Patients Admitted to an Intensive Care Unit. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.5
OSTEOSARCOPENIA TO RAISE AWARENESS ON THE COMPLEXITY OF THE OLDER PERSON
J Frailty Aging 2022;11(2)244Show summaryHide summary
(2022): Osteosarcopenia to Raise Awareness on the Complexity of the Older Person. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.10
NUMBER OF CHAIR STANDS SHOULD NOT BE CONSIDERED A MUSCLE FUNCTION MEASURE, BUT A PHYSICAL PERFORMANCE MEASURE. WHAT CAN WE DO THEN?
J. Alcazar, I. Ara, F.J. García-García, L.M. Alegre
J Frailty Aging 2022;11(2)245-246Show summaryHide summary
J. Alcazar ; I. Ara ; F.J. García-García ; L.M. Alegre ; (2021): Number of Chair Stands Should Not Be Considered a Muscle Function Measure, But a Physical Performance Measure. What Can We Do Then? . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2021.50
ERRATUM TO: THE ASSOCIATION BETWEEN FRAILTY AND ALL-CAUSE MORTALITY IN COMMUNITY-DWELLING OLDER INDIVIDUALS: AN UMBRELLA REVIEW
A.R.M.S. Ekram, R.L. Woods, C. Britt, S. Espinoza, M.E. Ernst, J. Ryan
J Frailty Aging 2022;11(2)247Show summaryHide summary
A.R.M.S. Ekram ; R.L. Woods ; C. Britt ; S. Espinoza ; M.E. Ernst ; J. Ryan ; (2021): Erratum to: The Association Between Frailty and All-Cause Mortality in Community-Dwelling Older Individuals: An Umbrella Review. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.24