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PHYSICAL FRAILTY AND COGNITIVE FUNCTION AMONG OLDER CHINESE ADULTS: THE MEDIATING ROLES OF ACTIVITIES OF DAILY LIVING LIMITATIONS AND DEPRESSION

C. Peng, J.A. Burr, Y. Yuan, K.L. Lapane

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BACKGROUND: Physical frailty and cognitive impairment are prevalent globally, particularly in China, which is experiencing an unprecedented aging of its large population. OBJECTIVES: Examine the association between physical frailty and the level and rate of change of cognitive function, globally and by domain, among community-dwelling Chinese older adults, and quantify the mediation effects from activities of daily living (ADL) limitations and depressive symptoms. DESIGN: Longitudinal. SETTING: China Health and Retirement Longitudinal Study (2011-2018). PARTICIPANTS: 5,431 eligible adults aged ≥ 60 years with valid information on physical frailty. MEASUREMENTS: Physical frailty, cognitive function, ADL limitations, and depressive symptoms were respectively assessed by frailty phenotypes, the Telephone Interview for Cognitive Status (episodic memory, executive function, and orientation), performance in six daily tasks, and the eight-item Center for Epidemiological Studies Depression Scale. Latent growth curve models were used to address the objectives. RESULTS: Compared to adults who were non-frail, those who were pre-frail (β = −0.06) and frail (β = −0.13) reported significantly worse global cognitive function and episodic memory (pre-frail: β = −0.05; frail: β = −0.14), executive function (pre-frail: β = −0.04, frail: β = −0.10), and orientation (pre-frail: β = −0.06; frail: β = −0.07) at baseline; those who were frail were more likely to experience faster decline in global cognitive function (β = 0.12) and episodic memory (β = 0.08). ADL limitations (β = −0.07) and depressive symptoms (β = −0.14) significantly mediated the association between physical frailty and the level of cognitive function, but not its rate of decline. CONCLUSIONS: Intervention strategies that help maintain cognitive function may benefit from early screening and assessment of physical frailty. For pre-frail and frail older Chinese adults, programs designed to help improve or maintain activities of daily living and reduce number of depressive symptoms may contribute to better cognitive performance.

CITATION:
C. Peng ; J.A. Burr ; Y. Yuan ; K.L. Lapane ; (2023): Physical Frailty and Cognitive Function among Older Chinese Adults: The Mediating Roles of Activities of Daily Living Limitations and Depression. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.1

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FRAILTY IN CHILE: DEVELOPMENT OF A FRAILTY INDEX SCORE USING THE CHILEAN NATIONAL HEALTH SURVEY 2016-2017

F. Diaz-Toro, F. Petermann-Rocha, N. Lynskey, G. Nazar, I. Cigarroa, C. Troncoso, Y. Concha-Cisternas, A.M. Leiva-Ordoñez, M.A. Martinez-Sanguinetti, S. Parra-Soto, C. Celis-Morales

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Background: The Frailty Index (FI) is used to quantify and summarize vulnerability status in people. In Chile, no development and assessment of a FI have been explored. Objective: To develop and evaluate a FI using representative data from Chilean adults aged 40 years and older stratified by sex. Design: Cross-sectional study. Setting: National representative data from the Chilean National Health Survey 2016–2017 (CNHS 2016-2017). Participants: 3,036 participants older than 40 years with complete data for all variables. Measurements: A 49-item FI was developed and evaluated. This FI included deficits from comorbidities, functional limitations, mental health status, physical activity, anthropometry, medications, and falls. A score between 0 and 1 was calculated for each person. Descriptive statistics and linear regression models were employed to evaluate the FI’s performance in the population. Comparative analyses were carried out to evaluate the FI score by age (<60 and > 60 years). Results: The mean FI score was 0.15 (SD:0.09), with a 99% upper limit of 0.46. Scores were greater in women than men (0.17 [SD:0.09]) vs. 0.12 [0.08]); in people older than 80 years (0.22 [0.11]), and in people with ≤8 years of education (0.18 [0.10]) compared with those with >12 years (0.12 [0.08]). The average age-related increase in the FI was 2.3%. When a cut-off point > 0.25 was applied, the prevalence of frail individuals was 11.8% (95% CI: 10.0 to 13.8) in the general population. The prevalence was higher in women 15.9% [95% CI: 13.3 to 18.9] than men 7.4% [95% CI: 5.3 to 10.1]. In a comparative analysis by age, higher FI mean scores and prevalence of frail were observed in people > 60 than younger than 60. Conclusions: The mean FI score and frailty prevalence were higher in women than men, in people with fewer years of formal education, and incremented markedly with age. This FI can be used for early detection of frailty status focusing on women and middle-aged people as a strategy to delay or prevent frailty-related consequences.

CITATION:
F. Diaz-Toro ; F. Petermann-Rocha ; N. Lynskey ; G. Nazar ; I. Cigarroa ; C. Troncoso ; Y. Concha-Cisternas ; A.M. Leiva-Ordoñez ; M.A. Martinez-Sanguinetti ; S. Parra-Soto ; C. Celis-Morales (2023): Frailty in Chile: Development of a Frailty Index Score Using the Chilean National Health Survey 2016-2017. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2023.2

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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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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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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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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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JFA N°01 - 2023

 

ASSESSMENT AND MANAGEMENT OF APPETITE LOSS IN OLDER ADULTS: AN ICFSR TASK FORCE REPORT

P. de Souto Barreto, M. Cesari, J.E. Morley, E. Gonzalez-Bautista, Y. Rolland, D. Azzolino, B. Vellas, R.A. Fielding

J Frailty Aging 2023;12(1)1-6

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The Appetite loss in older people is an important unmet clinical need in geriatrics. The International Conference on Frailty and Sarcopenia Research (ICFSR) organized a Task Force on April 20th 2022, in Boston, to discuss issues related to appetite loss in older people, in particular, the assessment tools currently available, its evaluation in the primary care setting, and considerations about its management. There is a high heterogeneity in terms of the etiology of appetite loss in older people and a gold standard assessment tool for evaluating this condition is still absent. Although this may render difficult the management of poor appetite in clinical practice, validated assessment tools are currently available to facilitate early identification of appetite loss and support care decisions. As research on biomarkers of appetite loss progresses, assessment tools will soon be used jointly with biomarkers for more accurate diagnosis and prognosis. In addition, efforts to foster the development of drugs with a favorable risk/benefit ratio to combat poor appetite should be strengthened.

CITATION:
P. de Souto Barreto ; M. Cesari ; J.E. Morley ; E. Gonzalez-Bautista ; Y. Rolland ; D. Azzolino ; B. Vellas ; R.A. Fielding ; (2022): Assessment and Management of Appetite Loss in Older Adults: An ICFSR Task Force Report . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.64

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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

J Frailty Aging 2023;12(1)7-15

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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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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

J Frailty Aging 2023;12(1)16-23

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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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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

J Frailty Aging 2023;12(1)24-29

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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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ASSOCIATIONS BETWEEN DIETARY VARIETY AND FRAILTY IN COMMUNITY-DWELLING OLDER PEOPLE WHO LIVE ALONE: GENDER DIFFERENCES

M. Yokoro, N. Otaki, M. Yano, M. Tani, N. Tanino, K. Fukuo

J Frailty Aging 2023;12(1)30-36

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Objectives: This study aimed to investigate the influences of living arrangements on the association between dietary variety and frailty by gender in community-dwelling older people. Design: A cross-sectional study. Setting: Nishinomiya city, Hyogo prefecture, Japan. Participants: A total of 4,996 randomly selected community-dwelling older people aged 65 years and older and living in Nishinomiya City. Measurements: Survey questionnaires were distributed via mail. The frailty score was evaluated by the 5-item frailty screening index. Dietary variety was assessed using the dietary variety score developed for the general older Japanese population. Results: A total of 2,764 community-dwelling participants aged ≥ 65 years responded to the questionnaires. After excluding missing data, 1,780 participants were included in the study analysis. The frailty scores in older men living alone were significantly higher than those in older men living with someone (P < 0.001). The dietary variety scores in older men living alone were significantly lower than those in older men living with someone (P < 0.001). However, differences in the frailty and dietary variety scores between living alone and living with someone were not were observed in older women (P = 0.360 and P = 0.265, respectively). In the multivariable regression analysis, the associations between dietary variety score and frailty score in living alone (β= −0. 271, P = 0.011) were stronger than those in living with someone in the case of older men (β= −0.131, P = 0.045). Similar associations between dietary variety and frailty were presented in older women living alone than in those living with someone (β −0.114, P = 0.002; β −0.088, P = 0.012, respectively). Conclusions: Older men who live alone had higher frailty score and lower dietary variety. The associations between dietary variety and frailty were different according to living arrangements in both older men and older women.

CITATION:
M. Yokoro ; N. Otaki ; M. Yano ; M. Tani ; N. Tanino ; K. Fukuo ; (2022): Associations between Dietary Variety and Frailty in Community-Dwelling Older People Who Live Alone: Gender Differences. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.49

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DYNAPENIC ABDOMINAL OBESITY AS A RISK FACTOR FOR FALLS

L. Dowling, E. McCloskey, D.J. Cuthbertson, J.S. Walsh

J Frailty Aging 2023;12(1)37-42

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Background: Obesity and low muscle strength (dynapenia) are independently associated with greater falls risk. It remains unclear whether dynapenia and obesity have an additive effect on falls risk, greater than either phenotype alone. Objectives: To determine whether a combination of abdominal obesity with dynapenia, dynapenic abdominal obesity (DAO), confers a greater risk of falls than either obesity or dynapenia alone in both men and women. Design: An observational cohort study was conducted. Setting and Participants: Data from English adults (n=4239, 60-87 years) who took part in the English Longitudinal Study of Ageing were included. Measurements: Dynapenia, was defined as hand-grip strength <20kg (female), <30kg (male). Abdominal obesity was defined as waist circumference >88cm (female), >102cm (male). Data on falls and fall-related injuries over a 2-year follow-up were collected. Multiple logistic regression analyses were performed adjusting for age and sex, with results expressed as odds ratios (OR) and areas under the receiver operating characteristic curve (AUC). Results: Falls occurred in 1049 participants, with 284 reporting a related injury during follow-up. DAO was associated with greater OR of falls in men (OR 2.1, 95% Confidence Intervals (CI) 1.3–3.2). Dynapenia rather than obesity was associated with falls in women, with greatest OR observed in those with low hand-grip strength (OR 1.4, 95% CI 1.1–1.7). Individual discrimination was low for measures of obesity or dynapenia either alone or in combination (AUC 0.51–0.58). There was no relationship between fall-related injuries and obesity or dynapenia. Conclusion: Our findings suggest a synergistic effect of obesity with dynapenia on falls risk in men but not women.

CITATION:
L. Dowling ; E. McCloskey ; D.J. Cuthbertson ; J.S. Walsh ; (2022): Dynapenic Abdominal Obesity as a Risk Factor for Falls. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.18

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THE RELATIONSHIP BETWEEN PSYCHOLOGICAL DISTRESS AND PHYSICAL FRAILTY IN JAPANESE COMMUNITY-DWELLING OLDER ADULTS: A CROSSSECTIONAL STUDY

X. Liu, T. Chen, S. Chen, H. Yatsugi, T. Chu, H. Kishimoto

J Frailty Aging 2023;12(1)43-48

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Background: Older adults’ mental health and physical frailty have been a frequent research focus, but few studies have investigated the relationship between them. Objectives: To investigate the association between mental health and physical frailty in community-dwelling older Japanese people. Design: Cross-sectional study from the Itoshima Frail Study. Setting: Itoshima City, Fukuoka, Japan. Participants: A total of 919 community-dwelling older individuals aged 65–75 years. Measurements: Physical frailty was measured based on five criteria proposed by the Fried scale, and the subjects were classified into three groups: robust, pre-frailty, and frailty. Psychological distress was used to assess the subjects’ mental health, with the Kessler 6-Item Psychological Distress Scale (K6) score; the subjects were divided into three groups based on their K6 score: 0–1, 2–4, and ≥5. Psychological distress was defined by K6 score ≥5. Ordinal logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CIs) between the psychological distress and physical frailty status. Results: Psychological distress was identified in 190 subjects (20.7%). Forty-six subjects (5.0%) presented with physical frailty, and 24 subjects (2.6%) had both psychological distress and physical frailty. With the increase in the K6 score, more subjects had pre-frailty and physical frailty (p<0.001). Significant positive associations were observed between psychological distress and the risks of pre-frailty (OR 2.94, 95%CI: 1.95–4.43) and frailty (OR 10.71, 95%CI: 4.68–24.51), even in a multivariable-adjusted analysis. In a subgroup analysis of components of frailty, one-point increment in K6 score was associated with higher odds of shrinking and fatigue. Conclusion: A severe psychological distress was associated with increased risks of physical frailty and the frailty sub-items of shrinking and fatigue in community-dwelling older Japanese adults.

CITATION:
X. Liu ; T. Chen ; S. Chen ; H. Yatsugi ; T. Chu ; H. Kishimoto ; (2022): The Relationship between Psychological Distress and Physical Frailty in Japanese Community-Dwelling Older Adults: A Cross-Sectional Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.63

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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

J Frailty Aging 2023;12(1)49-58

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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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RISK OF FOUR GERIATRIC SYNDROMES: A COMPARISON OF MENTAL HEALTH CARE AND GENERAL HOSPITAL INPATIENTS

J. Douairi, E.G.T. Bos, B.C. van Munster, K. Boudestein, C. Benraad, L. Disselhorst, R.C. Oude Voshaar, F.M.M. Oud, R.M. Kok

J Frailty Aging 2023;12(1)59-62

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An observational, cross-sectional study is conducted to compare elevated risk scores of four geriatric syndromes (falls, malnutrition, physical impairment, delirium) in older hospitalized psychiatric patients (n=178) with patients hospitalized in a general hospital (n=687). The median age of all patients was 78 years (IQR 73.3-83.3), 53% were female. After correction for age and gender, we found significantly more often an elevated risk in the mental health care group, compared to the general hospital group of falls (Odds Ratio (OR) = 1.75; 95% Confidence Interval (CI) 1.18-2.57), malnutrition (OR = 4.12; 95% CI 2.67-6.36) and delirium (OR = 6.45; 95% CI 4.23-9.85). The risk on physical impairment was not statistically significantly different in both groups (OR = 1.36; 95% CI .90-2.07). Older mental health care patients have a higher risk to develop geriatric syndromes compared to general hospital patients with the same age and gender, which might be explained by a higher level of frailty.

CITATION:
J. Douairi ; E.G.T. Bos ; B.C. van Munster ; K. Boudestein ; C. Benraad ; L. Disselhorst ; R.C. Oude Voshaar ; F.M.M. Oud ; R.M. Kok (2022): Risk of Four Geriatric Syndromes: A Comparison of Mental Health Care and General Hospital Inpatients. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.8

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STOP AND GO: BARRIERS AND FACILITATORS TO CARE HOME RESEARCH

L.A. Ritchie, A.L. Gordon, P.E. Penson, D.A. Lane, A. Akpan

J Frailty Aging 2023;12(1)63-66

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Barriers to care home research have always existed, but have been thrown into sharp relief by the COVID-19 pandemic. Existing infrastructure failed to deliver the research, or outcomes, which care home residents deserved and we need to look, again, at how these barriers can be taken down. Barriers can be categorised as procedural (encountered before research starts), system (encountered during research) or resident-specific. To tackle these, research regulatory bodies need to adopt a standardised approach to how care home research is developed and designed, reviewed and regulated, and how such approaches can enable recruitment of as wide a range of residents and their representatives as possible, including those without the mental capacity to consent for research. Establishment of local, inter-disciplinary collaborations between universities, general practices, health and social care providers and care homes is another priority. This should be based on pre-existing models such as the ‘Living lab’ model developed in The Netherlands and now being implemented in the UK and Austria. These changes are critical to develop a sustainable research model. If well designed this will deliver better outcomes for residents and align with the individual and organisational priorities of those who care for them.

CITATION:
L.A. Ritchie ; A.L. Gordon ; P.E. Penson ; D.A. Lane ; A. Akpan ; (2022): Stop and Go: Barriers and Facilitators to Care Home Research. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.51

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FOOD ASSISTANCE PROGRAMS AND REDUCED HOSPITALIZATIONS FOR OLDER ADULTS WITH DIABETES

M.L. Johnson, S.E. Walsh

J Frailty Aging 2023;12(1)67-70

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Diabetes is an increasingly common and costly condition for older adults. Each year, as many as 1 in 3 Medicare dollars is spent to treat and manage diabetes and associated comorbidities for people with diabetes. To control health care spending in the US, it is imperative that we identify factors for reducing hospitalizations for these individuals. The purpose of this cross-sectional study was to identify predictors of hospitalization in the past 12 months for community-dwelling older adults with diabetes. Data from round five of the National Health and Aging Trends Study were analyzed to assess the impact of food assistance programs on the risk of hospitalization in the past 12 months for 1094 Medicare recipients ages 65 and older with diabetes. Previous research on the social determinants of health has demonstrated that social stressors like poverty and exposure to racism are associated with poorer health outcomes overall, but we did not find a statistically-significant association between race, gender, age or Medicare/ Medicaid dual-eligibility and hospitalization for our study population. Notably, receipt of Supplemental Nutrition Assistance Program (SNAP) benefits, Meals on Wheels services or other food assistance was associated with a 43% reduction in the risk of hospitalization in the past 12 months. Food assistance programs appear to be a promising strategy for reducing hospitalizations associated with diabetes and its comorbidities. Primary care providers, diabetes educators and other health professionals should be more proactive in their referrals to food assistance programs and other community supports.

CITATION:
M.L. Johnson ; S.E. Walsh (2022): Food Assistance Programs and Reduced Hospitalizations for Older Adults with Diabetes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.13

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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

J Frailty Aging 2023;12(1)71-77

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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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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

J Frailty Aging 2023;12(1)78-83

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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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COULD A TAILORED EXERCISE INTERVENTION FOR HOSPITALISED OLDER ADULTS HAVE A ROLE IN THE RESOLUTION OF DELIRIUM? SECONDARY ANALYSIS OF A RANDOMISED CLINICAL TRIAL

N. Martinez Velilla, L. Lozano-Vicario, M.L. Sáez de Asteasu, F. Zambom-Ferraresi, A. Galbete, M. Sanchez-Latorre

J Frailty Aging 2023;12(1)84-85

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Delirium is a transient neurocognitive disorder. Nonpharmacological measures can be efficient in reducing the incidence and intensity of delirium, but there is a paucity of evidence when using a physical exercise program exclusively. This was a secondary analysis of a randomised clinical trial that provided evidence on the functional and cognitive benefits of an individualised exercise intervention in hospitalised older adults. Of the 370 patients who participated in the trial, 17.1% in the intervention group had delirium and 12.1% in the control group. After the exercise intervention, 84.6% of the patients in the intervention group showed improvement in delirium compared to 68.4% of patients in the control group. Despite the fluctuating nature of delirium,we show that it is feasible to establish individualised exercise interventions in hospitalised geriatric patients in the periods when patients are able to cooperate. Baseline functional status, measured by the Barthel Index, is a clinical marker that could help to identify those who will benefit most.

CITATION:
N. Martinez Velilla ; L. Lozano-Vicario ; M.L. Sáez de Asteasu ; F. Zambom-Ferraresi ; A. Galbete ; M. Sanchez-Latorre ; M. Izquierdo ; (2022): Could a Tailored Exercise Intervention for Hospitalised Older Adults Have a Role in the Resolution of Delirium? Secondary Analysis of a Randomised Clinical Trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.60

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POOR HEALTH BEHAVIORS AMONG HOUSEBOUND JAPANESE COMMUNITY-DWELLING OLDER ADULTS DUE TO PROLONGED SELF-RESTRAINT DURING THE FIRST COVID-19 PANDEMIC: A CROSS-SECTIONAL SURVEY

T. Tanaka, B.-K. Son, K. Iijima

J Frailty Aging 2023;12(1)86-90

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Background: Prolonged self-restraining behaviors induced by the coronavirus disease 2019 (COVID-19) pandemic’s containment measures can limit various positive health behaviors. Objective: We examined the decline in going-out and certain other positive health behaviors and investigated the relationship between excessive decreases in going-out frequency and declining engagement in positive health behaviors among community-dwelling older adults during the self-restraint period. Design: This study employed a cross-sectional survey design. Setting: This study was conducted in Nishi Tokyo City, Tokyo, Japan. Participants: The participants were 294 respondents (150 women) aged 50 years and older who lived in public housing that were permitted to be surveyed during the self-restraint period. Measurements: Their pre-pandemic going-out frequency around February 2020 and going-out frequency during the self-restraint period starting in April 2020 were reported. We mainly assessed the existence of home health behaviors (i.e., exercise, in-person and phone conversations, and healthy diet). A self-report questionnaire was used to obtain data. Results: Going-out frequency decreased in 41.2% of the 294 respondents owing to the government’s request for self-restraint. In total, 13 individuals had been going out less than one time per week (housebound) before the request. Of the 281 people who were not housebound before the government’s self-restraint request, 13.9% were newly housebound. Newly housebound individuals were 5.3 times less likely to exercise, had 2.1 times fewer social contacts, and 2.6 times less balanced or healthy diets than those who maintained their frequency of going out. Conclusions: Prolonged self-restraint due to the COVID-19 pandemic may lead to housebound status and poor health behaviors. Public health intervention is needed to prevent excessive self-restraint, along with new measures integrating information and communication technologies to enable older adults to live active lives.

CITATION:
T. Tanaka ; B.-K. Son ; K. Iijima (2022): Poor Health Behaviors among Housebound Japanese Community-Dwelling Older Adults Due to Prolonged Self-Restraint during the First COVID-19 Pandemic: A Cross-Sectional Survey. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2022.20

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