Ahead of print articles
ASSOCIATIONS BETWEEN FRAILTY, BIOMARKERS OF CEREBRAL PATHOLOGY, COGNITIVE AND NEUROPSYCHIATRIC SYMPTOMS: A MEMORY CLINIC STUDY
Victor Gilles, Anthime Flaus, Achille Teillac, Marc Verny, Frédéric Blanc, Marc Paccalin, Thomas Desmidt, Sandrine Louchart de la Chapelle, Constance Dumay, Mathilde Sauvée, Sylvain Lehmann, Christophe Hirtz, François Cotton, Anthony Bathsavanis, Frédéric Gervais, Teddy Novais, Virginie Desestret, Nawele Boublay, Pierre Krolak-Salmon, Sophie Dautricourt, Antoine Garnier-Crussard
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BACKGROUND: Frailty is a prevalent condition among older adults with neurocognitive disorders.
OBJECTIVES: To ascertain whether frailty contributes to the severity of cognitive impairment and neuropsychiatric symptoms, and its association with cerebral pathology measured in vivo by fluid and imaging biomarkers.
DESIGN: We conducted cross-sectional and longitudinal analyses based on CLEM Study, a multicentre memory-clinic cohort that recruited participants between 2014 and 2018.
SETTING: CLEM Study occurred in eight memory centres in France (Lyon, Paris, Strasbourg, Poitiers, Tours, Grenoble) and Monaco.
PARTICIPANTS: A total of 168 participants (mean age 80.5 ± 4.8 years) with mild to moderate dementia due to at least one aetiological diagnosis between Alzheimer's disease, dementia with Lewy bodies or vascular dementia were included in the study.
MEASUREMENTS: The participants were evaluated at baseline and followed up for two years. The concept of frailty was operationalised using a 45-item Frailty Index. Cognition was assessed using the ADAS-cog scale, while neuropsychiatric symptoms were evaluated with the Neuropsychiatric Inventory. The cerebral pathological score, a proxy for brain pathologies, was a composite score based on the presence of several in vivo biomarkers: presynaptic dopaminergic denervation on 123I-FP-CIT SPECT (DaTscan®), vascular lesions on MRI, elevated blood-based pTau181, neurofilaments light-chain or glial fibrillary acid protein. Linear and mixed regression analyses were conducted to model the relationships between cognitive or neuropsychiatric symptoms, frailty and cerebral pathologic score, adjusted for age, sex and education.
RESULTS: The findings indicate an impact of both frailty (β = 0.28, 95 % CI [0.14–0.43], p < 0.001) and cerebral pathological score (β = 0.30, 95 % CI [0.13–0.47], p = 0.002) on cognitive impairment. However, only frailty was associated with neuropsychiatric symptoms (β = 0.28, 95 % CI [0.14–0.43], p < 0.001), particularly with apathy (β = 0.40, 95 % CI [0.26–0.53], p < 0.001). We found an association between cerebral pathological score and longitudinal cognitive decline (β = 0.36, 95 % CI [0.19–0.53], p < 0.001) in exploratory analyses with available longitudinal data at 24 months (n = 74).
CONCLUSIONS: Neurocognitive disorders are complex entities, where cognitive and neuropsychiatric symptoms are not fully influenced by the same factors. When cognitive symptoms seem more driven by cerebral pathology than frailty, neuropsychiatric symptoms appear to be more influenced by general state of frailty. Measuring and treating frailty might be a key factor in dealing with neuropsychiatric symptoms and their consequences.
CITATION:
Victor Gilles ; Anthime Flaus ; Achille Teillac ; Marc Verny ; Frédéric Blanc ; Marc Paccalin ; Thomas Desmidt ; Sandrine Louchart de la Chapelle ; Constance Dumay ; Mathilde Sauvée ; Sylvain Lehmann ; Christophe Hirtz ; François Cotton ; Anthony Bathsavanis ; Frédéric Gervais ; Teddy Novais ; Virginie Desestret ; Nawele Boublay ; Pierre Krolak-Salmon ; Sophie Dautricourt ; Antoine Garnier-Crussard (2026): Associations between frailty, biomarkers of cerebral pathology, cognitive and neuropsychiatric symptoms: a memory clinic study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100148
OLD DOG - VALIDATING THE DOG AS AN ANIMAL MODEL FOR HUMAN AGING STUDIES
Polina Zemko, Federico Bonsembiante, Marco Canevelli, Simona Buscarnera, Matteo Cesari, Tommaso Banzato
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Companion dogs represent a valuable and emerging translational model for human aging, as they share the human environment, receive comparable medical care - yet have much shorter lifespans. Despite their potential, a validated set of canine biomarkers of aging has not yet been established. The OLD-DOG Project, launched in 2023 at the University of Padua’s Veterinary Teaching Hospital, is a 30-month prospective study designed to identify and validate biomarkers of aging in companion dogs and to assess their predictive value for healthspan and lifespan, thereby evaluating the suitability of dogs as models for human aging research.
A cohort of 209 privately owned dogs aged ≥ 5 years was enrolled and underwent comprehensive evaluations every six months, including clinical examinations, physical fitness testing, blood and fecal sampling, and owner questionnaires. Collected data encompass physiological, biochemical, hematological, and behavioral parameters, as well as microbiota profiles, telomere length, and DNA methylation patterns. Surplus biological material is stored to establish a long-term biobank.
Preliminary cross-sectional analyses have identified consistent age-related patterns across multiple domains, including hematological and biochemical indices, inflammatory markers, and measures of physical and cognitive performance. Ongoing longitudinal analyses aim to determine the predictive value of these candidate biomarkers for morbidity and mortality, as well as to assess the influence of environmental and lifestyle factors on aging trajectories. Ultimately, the project seeks to construct an integrative model of biological age in dogs, thereby strengthening their value as a robust translational model for human aging research.
CITATION:
Polina Zemko ; Federico Bonsembiante ; Marco Canevelli ; Simona Buscarnera ; Matteo Cesari ; Tommaso Banzato (2026): OLD DOG - Validating the dog as an animal model for human aging studies. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100145
LONGITUDINAL NORMS OF FRAILTY MEASURED BY THE FRAILTY INDEX: A CROSS-NATIONAL COMPARISON USING DATA FROM THE SURVEY OF HEALTH, AGING, AND RETIREMENT IN EUROPE (SHARE)
Alejandra Marroig, Fernando Massa, Ángela Gutiérrez, Adil Supiyev, Bar?? Sevi, Graciela Muniz-Terrera
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BACKGROUND: Frailty, a geriatric syndrome commonly used to identify vulnerable older adults, is a public health priority. However, the lack of cross-national comparisons of frailty trajectories and their distribution constrains current understanding of normative changes in frailty for residents across different countries.
OBJECTIVE: To derive longitudinal percentiles of frailty using a consistent cross-country approach.
DESIGN: Observational study using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) between 2004 and 2020.
SETTING: We fit the distribution of the FI by Generalized Additive Models for Location, Scale, and Shape (GAMLSS), assessed the role of sex (male/female), education (in years), and migration status (migrant/non-migrant), and estimated the longitudinal percentiles of frailty using a consistent cross-country approach for 16 countries.
PARTICIPANTS: Individuals aged ≥65 years (N = 42,951) at study entry.
MEASUREMENTS: Frailty index (FI) based on the accumulation of deficits in 40 items.
RESULTS: The results show that education is protective against frailty in all countries (a decrease of 1.1 pp. in Switzerland to 5.7 pp. in Slovenia, all p < 0.001). In most countries, women are frailer than men and migrant individuals have higher levels of frailty than non-migrants. FI trajectories showed heterogeneity across countries. The quantiles for women and migrants suggest frailer trajectories than men and non-migrants respectively.
CONCLUSIONS: Findings from this cross-national comparison provide a framework within which the longitudinal norms of frailty trajectories from different countries can be interpreted.
CITATION:
Alejandra Marroig ; Fernando Massa ; Ángela Gutiérrez ; Adil Supiyev ; Barış Sevi ; Graciela Muniz-Terrera (2026): Longitudinal norms of frailty measured by the frailty index: A cross-national comparison using data from the survey of health, aging, and retirement in Europe (SHARE). The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100144
THE MEDIATING ROLE OF CHRONIC DISEASE IN SOCIOECONOMIC INEQUALITIES IN FRAILTY: A LONGITUDINAL COHORT STUDY OF OLDER ADULTS IN LAUSANNE, SWITZERLAND
Carlos de Mestral, Saman Khalatbari-Soltani, Patrick Bodenmann, Yves Henchoz, Mauricio Avendano
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BACKGROUND: Frailty is a major public health concern in aging populations. Socioeconomic disadvantage increases the risk of frailty, yet the mechanisms underlying this association remain unclear.
OBJECTIVES: To examine the mediating role of chronic diseases in the longitudinal association between socioeconomic disadvantage and frailty.
DESIGN: Population-based cohort study.
SETTING: Lausanne, Switzerland.
PARTICIPANTS: 4731 community-dwelling adults aged 65–70 years at recruitment (2004, 2010, and 2014), followed for up to 16 years, as part of the Lausanne Cohort 65+.
INTERVENTION: None.
MEASUREMENTS: Socioeconomic disadvantage was assessed using indicators of education, occupation, income, health insurance subsidy, and financial strain. Frailty was measured using the Fried phenotype (unintentional weight loss, exhaustion, low physical activity, weakness, and slow walking speed). Chronic conditions (obesity, diabetes, hypertension, cardiovascular and respiratory disease, and multimorbidity [≥2 conditions]) were assessed at baseline using standardized self-reported physician diagnoses. Counterfactual mediation using Cox proportional hazards models estimated the proportion of the socioeconomic disadvantage–frailty association mediated by each condition.
RESULTS: Socioeconomic disadvantage was associated with a 1.5–2.5-fold higher risk of incident frailty. Obesity mediated 13–55% of this association, diabetes 11–22%, and multimorbidity 21–39%, whereas hypertension, cardiovascular, and respiratory disease showed minimal or no mediation.
CONCLUSIONS: Chronic diseases—particularly obesity and diabetes—partly explain the long-term impact of socioeconomic disadvantage on frailty, underscoring stark inequities in healthy aging. Early detection and management of these conditions in socioeconomically vulnerable older adults, alongside population-level prevention and efforts to address adverse socioeconomic conditions as root causes, could help reduce these inequalities.
CITATION:
Carlos de Mestral ; Saman Khalatbari-Soltani ; Patrick Bodenmann ; Yves Henchoz ; Mauricio Avendano (2026): The mediating role of chronic disease in socioeconomic inequalities in frailty: A longitudinal cohort study of older adults in Lausanne, Switzerland. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100134
LOW RELATIVE SIT-TO-STAND POWER IN COLOMBIAN OLDER ADULTS: CUT-OFF POINTS AND ASSOCIATIONS WITH FRAILTY AND FUNCTIONAL DECLINE
Robinson Ramírez-Vélez, Miguel Germán Borda, Juan Carlos Calderón-González, Albeiro Dávila-Grisales, Gonzalo Romero-Martínez, Mikel Izquierdo, Miguel A. Pérez-Sousa
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OBJECTIVES: To examine the association between relative sit-to-stand (STS) power and age, establish sex-specific cut-off points, and evaluate their associations with adverse outcomes in Colombian older adults.
DESIGN: Cross-sectional, population-based study.
SETTING: Health, Well-being, and Aging Study (SABE-Colombia, 2014–2015).
PARTICIPANTS: 3051 community-dwelling adults aged ≥60 years (56.6 % women; mean age 68.6 ± 6.4 years).
MEASUREMENTS: Relative STS power (W·kg⁻¹) was estimated using a validated equation. Quantile regression examined age-related changes across percentiles (Q10–Q90). Receiver operating characteristic (ROC) curves with the Youden index determined cut-off points. Age-adjusted logistic regression tested associations with frailty, functionality as gait speed and handgrip strength (HGS), and depression.
RESULTS: Optimal cut-offs for low relative STS power were 2.11 W·kg⁻¹ for men and 1.63 W·kg⁻¹ for women. Prevalence of low STS power was 34.3 % in men and 34.8 % in women, increasing with age in both sexes. Quantile regression revealed steeper age-related declines at higher percentiles, particularly among men. Low relative STS power was significantly associated with frailty and low functionality.
CONCLUSION: Relative STS power is a simple, clinically feasible biomarker to identify functional impairment in older adults. The sex-specific thresholds reported for Colombian populations reflect demographic differences in muscle physiology and decline. Their integration into geriatric practice may enhance early detection, guide preventive interventions, and ultimately improve health outcomes in aging populations.
CITATION:
Robinson Ramírez-Vélez ; Miguel Germán Borda ; Juan Carlos Calderón-González ; Albeiro Dávila-Grisales ; Gonzalo Romero-Martínez ; Mikel Izquierdo ; Miguel A. Pérez-Sousa (2026): Low relative sit-to-stand power in Colombian older adults: Cut-off points and associations with frailty and functional decline. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100141
IMPLEMENTATION OF A BEST PRACTICE ADVISORY ALERT FOR INPATIENT FRAILTY SCREENING AND INTERVENTION: A PILOT QUALITY IMPROVEMENT PROGRAM
L.M. Teo, J.A. Abengana, H. Tan, Z.Y. Koh, A.P. Chew, T.L. Tan
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BACKGROUND: Frailty is highly prevalent in hospitalized older adults and predicts adverse health outcomes but remains under-recognized. Manual screening tools previously employed were challenging in high-volume settings and reliant on individuals’ knowledge on frailty. With the development of electronic health records (EHRs), there is a potential to automate screening for frailty in hospitalized older adults. We introduce a quality improvement initiative that utilizes an EHR-automated Best Practice Advisory (BPA) alert to identify inpatients who may benefit from geriatric intervention and encourage timely Geriatric referral to a Mobile Frailty Intervention Team (MFIT).
METHODS: MFIT was piloted at Woodlands Hospital, an integrated acute and community hospital in Singapore. BPA was automatically triggered to encourage referral to MFIT if any of the following criteria were met a) Clinical Frailty Scale (CFS) 7 b) CFS 5–6 with presence of either of cognitive impairment / high falls risk / high readmission risk c) Age 60 with presence of delirium, regardless of CFS status. The MFIT team conducted Comprehensive Geriatric Assessments (CGA) as part of routine review with the diagnosed geriatric syndromes and discharge dispositions recorded.
RESULTS: On MFIT review, 81.3 % (N = 248) of patients referred had a geriatric syndrome and 68.5 % (N = 209) had multiple syndromes. MFIT further identified syndromes which may be neglected during acute admission such as underlying dementia (87 %, N = 83), osteoporosis (13.4 %, N = 41) and urinary incontinence (9.8 %, N = 30). MFIT also provided discharge recommendations which were adhered to in 79.2 % (N = 232) of patients. 32.8 % (N = 100) were given specialized outpatient clinic follow-up with Geriatric medicine, suggesting the potential to divert patients from away from primary care services and unplanned readmissions. Further studies are needed to investigate whether this transition effectively optimizes resource allocation.
CONCLUSION: A CFS-based BPA alert may be feasible in providing an automated and scalable method to identify hospitalized older adults with frailty that would benefit from timely geriatric intervention.
CITATION:
L.M. Teo ; J.A. Abengana ; H. Tan ; Z.Y. Koh ; A.P. Chew ; T.L. Tan (2026): Implementation of a best practice advisory alert for inpatient frailty screening and intervention: A pilot quality improvement program. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100146
INSIGHTS ON GEROSCIENCE PRE-CLINICAL AND CLINICAL TRIALS TO PROMOTE HEALTHY AGING FROM THE INTRINSIC CAPACITY, FRAILTY AND SARCOPENIA RESEARCH TASK FORCE 2025
Luca Tagliafico, Marco Canevelli, Philipe De Souto Barreto, Matteo Cesari, Luigi Ferrucci, Bruno Vellas, Yves Rolland, ICFSR Task Force
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The Intrinsic Capacity, Frailty and Sarcopenia Research (ICFSR) Task Force convened in March 2025 to discuss geroscience-oriented pre-clinical and clinical trials aimed at promoting healthy aging. Key topics included the use of aging biomarkers in clinical trials, senotherapeutics, metabolism-targeting medications, and therapeutic strategies beyond pharmacological approaches. The discussions highlighted the growing interest in, and accumulating evidence for, geroscience interventions. Several future challenges were identified, including the need for a deeper understanding of the biology of aging and the validation of aging biomarkers against relevant clinical outcomes, such as frailty and intrinsic capacity. Furthermore, to accelerate innovation in the field, there is a need to enhance clinical trial methodologies and harmonization—for example, by defining a minimum common dataset of biological, physiological, and clinical factors for geroscience clinical studies—and to foster a paradigm shift, particularly among regulatory authorities.
CITATION:
Luca Tagliafico ; Marco Canevelli ; Philipe De Souto Barreto ; Matteo Cesari ; Luigi Ferrucci ; Bruno Vellas ; Yves Rolland ; ICFSR Task Force (2026): Insights on geroscience pre-clinical and clinical trials to promote healthy aging from the Intrinsic Capacity, Frailty and Sarcopenia Research Task Force 2025. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100147
IMPACT OF PHYSICAL ACTIVITY AND FRAILTY ON MORTALITY AND UTILIZATION AMONG MIDDLE-AGED AND OLDER ADULTS IN SOUTH KOREA
Ho-Jun Kim, Kyu-Ri Hong, Xiao-Lin Wen, Da-San Kim, Jung-Min Lee
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This study examined the influence of frailty status and physical activity (PA) compliance on all-cause mortality and healthcare utilization among Korean adults aged 45 years and older. Data from 2104 participants in the Korean Longitudinal Study of Aging (KLoSA; 2006 - 2022) were analyzed. Frailty was assessed using a 38-item frailty index (FI), and PA was defined according to adherence to the World Health Organization guideline of at least 150 min per week. Participants were classified as robust, pre-frail, or frail. Cox proportional hazards models and generalized linear mixed models were used to evaluate associations with mortality and healthcare utilization. Compared with robust individuals, frail participants exhibited a markedly higher risk of all-cause mortality (hazard ratio [HR] = 3.37, 95% confidence interval [CI]: 2.42–4.69), while pre-frail individuals also showed an elevated mortality risk (HR = 1.72, 95% CI: 1.43–2.07). Frailty was consistently associated with greater healthcare utilization across outpatient visits, hospital admissions, length of hospital stay, and healthcare costs. Adherence to PA guidelines was not independently associated with reduced mortality among pre-frail and frail individuals after multivariable adjustment; however, a significant interaction indicated higher healthcare costs among frail individuals who met PA guidelines. In addition, higher BMI was associated with lower mortality risk, consistent with patterns described as the obesity paradox. These findings highlight frailty as a key, independent predictor of mortality and healthcare utilization beginning in midlife. Standardized PA recommendations alone may be insufficient for physiologically vulnerable populations, underscoring the importance of early frailty screening and individualized, function-sensitive intervention strategies to promote healthy aging.
CITATION:
Ho-Jun Kim ; Kyu-Ri Hong ; Xiao-Lin Wen ; Da-San Kim ; Jung-Min Lee (2026): Impact of physical activity and frailty on mortality and utilization among middle-aged and older adults in South Korea. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100142
LETTER TO THE EDITOR: BEYOND MORTALITY PREDICTION: FRAIL-VIG AS A TRIGGER FOR PROACTIVE MULTIDOMAIN INTERVENTIONS IN NURSING HOME RESIDENTS
Jorge A. Sánchez-Duque
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CITATION:
Jorge A. Sánchez-Duque (2026): Letter to the Editor: Beyond mortality prediction: Frail-VIG as a trigger for proactive multidomain interventions in nursing home residents. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100143
ASSESSING FRAILTY WITH CLINICAL AND LABORATORY MEASURES IN HOSPITALIZED OLDER ADULTS: A COMPARISON OF ALL-CAUSE MORTALITY ACROSS TWO GERIATRIC DEPARTMENTS
Giulia Venturelli, Francesco Canepa, Luca Tagliafico, Silvia Ottaviani, Stefania Peruzzo, Alessio Nencioni, Aldo Bellora, Fiammetta Monacelli
J Frailty Aging 2026;15(1)
Show summaryHide summaryBy 2030, one in six people globally will be over 60, potentially increasing the burden of frailty, a condition characterized by reduced physiological resilience and poor clinical outcomes. Although frailty affects up to 49 % of hospitalized patients, it is frequently under-recognized. Tools like the Clinical Frailty Scale (CFS) and the FI-Lab aim to assess frailty, though each has limitations. This retrospective cohort study evaluated the predictive value of CFS and FI-Lab, separately and in combination, for in-hospital and three-month post-discharge mortality in older adults. The study included 410 hospitalized patients (median age 87) admitted to two geriatric units between 2023 and 2025. Frailty was assessed using the CFS and a 22-item FI-Lab derived from blood tests within 48 h of admission. In-hospital and post-discharge mortality rates were 12.6 % and 24.7 %, respectively. Both FI-Lab and CFS were independently associated with increased mortality risk. A weak correlation between the two tools (r = 0.19, p < 0.001) suggests they capture distinct but complementary aspects of frailty. These findings support the combined use of FI-Lab and CFS for more accurate risk stratification in acutely ill older adults. FI-Lab may reflect acute physiological stress not captured by clinical measures alone, aiding early identification of vulnerable patients. Despite limitations, including modest sample size and lack of adjustment for multimorbidity, this study highlights the potential utility of integrating lab-based frailty assessments into routine hospital care for personalized geriatric management.
CITATION:
Giulia Venturelli ; Francesco Canepa ; Luca Tagliafico ; Silvia Ottaviani ; Stefania Peruzzo ; Alessio Nencioni ; Aldo Bellora ; Fiammetta Monacelli (2026): Assessing frailty with clinical and laboratory measures in hospitalized older adults: A comparison of all-cause mortality across two geriatric departments. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100128
IDENTIFYING SARCOPENIA AND SARCOPENIC OBESITY IN A LOWER EXTREMITY ARTHROPLASTY CLINICAL SETTING: A PRAGMATIC PILOT STUDY
K. Godziuk, I. Hollyer, G. Loughran, N.J. Giori
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Sarcopenia and sarcopenic obesity may increase surgical complications and impact recovery and function after total joint arthroplasty (TJA). We assessed the feasibility of identifying these conditions in an orthopedic practice setting using published consensus criteria. Patients in a lower extremity TJA clinic were assessed for sarcopenia and sarcopenic obesity using EWGSOP2 and ESPEN/EASO diagnostic frameworks, respectively. Low strength testing involved maximal handgrip strength (HGS) and number of chair sit-to-stands in 30 seconds (CSTS). Same day dual-energy x-ray absorptiometry (DXA) testing was used to assess for low muscle mass (i.e. appendicular lean soft tissue) in patients with low strength. One hundred-one of a possible 128 patients were assessed in clinic (93% male, mean age 69.6±8.9 years and BMI 31.7±7.9 kg/m2). HGS was completed in 99% of screened patients; only 44.5% completed CSTS due to joint pain and balance limitations. Thirty-nine patients had low strength and were recommended for DXA. In 16 patients who completed DXA, 3 had sarcopenia and 5 had sarcopenic obesity. Screening for sarcopenia and sarcopenic obesity was challenging to complete in all patients during routine clinic flow with dedicated personnel. Despite our pragmatic approach and limited screening completion in all patients, we identified sarcopenic and sarcopenic obesity in 6.25% of patients. This is likely a lower bound for the true prevalence but suggests an opportunity to assess and intervene for these conditions before surgery to improve total joint arthroplasty outcomes.
CITATION:
K. Godziuk ; I. Hollyer ; G. Loughran ; N.J. Giori (2026): Identifying sarcopenia and sarcopenic obesity in a lower extremity arthroplasty clinical setting: a pragmatic pilot study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100125
FACTORS ASSOCIATED WITH SOCIAL FRAILTY IN OLDER ADULTS IN COLOMBIA
Carmen-Lucia Curcio, Sebastian Villada, Laura Chica, Claudia Liliana Valencia
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OBJECTIVES: Social frailty (SF) has gained increasing attention in recent years. While several studies have examined SF among older adults living in the community, most have been conducted in specific countries, primarily in Asia, with limited research in Latin America. The main objective of this study was to identify the relationship between SF and demographic, health, and functional conditions among older adults in Colombia.
METHODS: This study is a secondary analysis of the SABE Colombia study. Social frailty (SF) was assessed using the adapted HALFE Social Frailty Index. The main independent variables included demographic factors and health status indicators such as self-rated health, chronic conditions, depression, ADL/IADL dependence, mobility disability, and life-space assessment. Bivariate analysis and logistic regression in multivariate models were applied.
RESULTS: The overall prevalence of SF was 66.3%, increasing with advancing age. Compared to individuals without SF, those with SF were more likely to have a low level of education (<6 years), mobility disability, dependence on IADLs, restricted life space (<55.5), be female, and report poor or very poor self-rated health. In multivariate logistic regression analyses, SF was associated with higher odds of years of education (<6), dependence for IADL, restricted life-space, being female, mobility disability, and bad and very bad self-rated health. In contrast, depressive symptoms, rural areas, and marital status lose significance.
CONCLUSION: SF is prevalent among Colombian elderly individuals, affecting nearly seven in ten community-dwelling older adults. It is also significantly associated with demographic, health, and functional conditions. Additionally, social issues such as economic status, social isolation, loneliness, and social participation are increasingly prominent among older adults. Thus, SF resulting from social issues requires greater attention, particularly in non-developed countries. Consequently, to promote healthy aging, it is imperative to implement measures aimed at preventing and mitigating SF among older adults in light of these findings.
CITATION:
Carmen-Lucia Curcio ; Sebastian Villada ; Laura Chica ; Claudia Liliana Valencia (2026): Factors associated with social frailty in older adults in Colombia. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100133
ASSOCIATION OF ALLOSTATIC LOAD WITH FRAILTY TRAJECTORIES AND THE MEDIATING ROLE OF DEPRESSIVE SYMPTOMS
Mohammad Azizzadeh, Agnes Pirker-Kees, Emiel F.M. Wouters, Emiel F.M. Wouters, Daisy J.A. Janssen, Bart Spaetgens, Robab Breyer-Kohansal, Marie-Kathrin Breyer
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BACKGROUND: Frailty is a dynamic, age-related condition marked by progressive loss of resilience. Its risk factors include socioeconomic status and physiological stress burden, such as allostatic load score (ALS), remain unclear. This study aims to examine the role of depression in the association between ALS and frailty trajectories.
METHODS: We analyzed data from 5885 LEAD cohort participants aged 25–82 years at baseline and from 3564 participants with follow-up data. Frailty status (robust, pre-frail, frail) was defined using the Fried phenotype, and transitions between visits were assessed. ALS was calculated from 14 parameters spanning cardiovascular, metabolic, and body composition measures. Associations of ALS with frailty status at baseline and with frailty transitions at follow-up were examined, and depressive symptoms were tested as a mediator.
RESULTS: At baseline, 62.3% of participants were robust, 36.2% pre-frail, and 1.5% frail. Between visits, 16.3% transitioned to a worse frailty stage, while 17.7% improved. Higher ALS was linked to increased odds of being pre-frail/frail at baseline (OR 1.11; 95% CI: 1.08–1.15), and to a higher risk of transitioning from robust to pre-frail/frail (RRR 1.06; 95% CI: 1.02–1.09). Depressive symptoms mediated 35% (95% CI: 25–47%) of the cross-sectional and 17% (95% CI: 6.6–43%) of the longitudinal association between ALS and frailty.
CONCLUSIONS: Socioeconomic factors influenced frailty onset but not its progression, whereas depressive symptoms mediated approximately 17% of the effect of ALS on frailty development over time. These findings highlight the importance of exploring the effect of interventions for depression on frailty progression.
CITATION:
Mohammad Azizzadeh ; Agnes Pirker-Kees ; Emiel F.M. Wouters ; Daisy J.A. Janssen ; Bart Spaetgens ; Robab Breyer-Kohansal ; Marie-Kathrin Breyer (2026): Association of allostatic load with frailty trajectories and the mediating role of depressive symptoms. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2026.100132
PREPARATION FOR HEALTHY AGEING: AN INTEGRATED EDUCATIONAL INTERVENTION FOR ENHANCING KNOWLEDGE AND SELF-EFFICACY IN INTRINSIC CAPACITY PRESERVATION, MIDLIFE CONDITION MANAGEMENT, AND CAREGIVING IN MIDLIFE WOMEN
Ruby Yu, Matthew Yu, Cecilia Tong, Florence Ho, Angel Hui, Emily Lui, Jean Woo
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OBJECTIVES: Midlife women often experience concurrent declines in intrinsic capacity (IC) and increasing caregiving responsibilities. This study evaluated the effectiveness of an educational intervention designed to enhance knowledge of IC preservation, self-care efficacy, and caregiving competencies among midlife women.
METHODS: The Pursuit of Wellness Program was developed and evaluated through a multicentre mixed methods study. This program comprised nine modules addressing IC domains (cognitive, vitality, psychological) and six modules focused on priority midlife conditions (e.g., urinary incontinence). Each module integrated health education, self care practices, and caregiving training. Program's effectiveness was assessed using a mixed methods evaluation. Outcomes included pre- and post-changes in domain- or condition-specific knowledge (summative score range: 0–3) and self-care efficacy (visual analogue scale: 0–10), post-intervention caregiving confidence (Likert scale: 1–5), and qualitative feedback from program coordinators.
RESULTS: A total of 690 women aged 50–64 years were assessed. Pre-tests revealed knowledge gaps in pain management, bladder health, and dementia care, with mean health knowledge scores ranging from 1.3–1.6. Post-intervention improvements were most significant for bladder health (+69.0%, p<0.001), followed by nutrition for muscle & bone health (+56.3%, p<0.001). Self efficacy increased significantly across all IC domains and midlife conditions (ps<0.01), while caregiving confidence reached from 68.7 to 89.3% agreement, highest for skin and bathing care (89.3%) and dementia support (86.3%). Qualitative findings from program coordinators (n=18) confirmed high participant engagement with nutrition strategies and stress management techniques, corroborating quantitative outcomes.
CONCLUSIONS: The program significantly enhanced knowledge related to IC preservation and management of midlife conditions, self-care practices, and caregiving competencies among midlife women. It addresses a critical gap by concurrently promoting IC preservation and caregiving proficiency during the midlife transition.
CITATION:
Ruby Yu ; Matthew Yu ; Cecilia Tong ; Florence Ho ; Angel Hui ; Emily Lui ; Jean Woo (2026): Preparation for healthy ageing: An integrated educational intervention for enhancing knowledge and self-efficacy in intrinsic capacity preservation, midlife condition management, and caregiving in midlife women. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100126
SCREENING AND MANAGING FRAILTY IN OLDER NURSING HOME RESIDENTS WITH FRAIL-VIG INDEX: FEASIBILITY, RELIABILITY AND PREDICTIVE VALIDITY FOR MORTALITY
Cristina Jiménez-Domínguez, Lourdes Rexach-Cano, Carlos Verdejo-Bravo, Manuel Vicente Mejía-Ramírez-Arellano, Carlota Manuela Zárate-Saez, Mª Nieves Vaquero Pinto, Cristina Roldán-Plaza, Nuria Pérez-Panizo, Mª Loreto Álvarez-Nebreda
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Frailty is prevalent among older nursing home residents, although there is limited evidence regarding frailty screening and management in this setting.
OBJECTIVE: To evaluate the measurement properties of the Frail Index based on the Comprehensive Geriatric Assessment (Frail-VIG).
DESIGN: Prospective observational longitudinal study of 571 residents from 3 nursing homes. Frail-VIG scores were calculated at baseline and at 6 and 12 months. Sociodemographic variables were studied. Feasibility was assessed based on simplicity of application and requirements for score calculation. Reliability was evaluated through inter-rater agreement and test-retest assessments. Construct and content validity were examined by comparing it with other frailty indexes. Predictive validity was evaluated using log-rank tests and AUC-ROC curves for mortality prediction.
RESULTS: Mean (SD) resident age was 88.2 (6.5) years, and 80.6 % were women. The mortality rate was 11.4 % at 6 months and 20 % at 12 months. Calculating Frail-VIG scores required 5.15 min and no additional space or equipment, and there was low risk of missing data. The inter-rater consistency and score stability over time indicate strong reliability. The Frail-VIG maintains the characteristics of other established frailty indexes and shows strong convergent validity with the FRAIL-NH and CFS scales. Baseline scores have an AUC-ROC curve (confidence interval) of 0.69 (95 % CI, 0.63–0.76) at 6 months and 0.65 (95 % CI, 0.6–0.71) at 12 months.
CONCLUSIONS: The measurement properties of the Frail-VIG in older nursing home residents validate its use in this population and setting. Its predictive ability for mortality suggests important implications for advanced care planning.
CITATION:
Cristina Jiménez-Domínguez ; Lourdes Rexach-Cano ; Carlos Verdejo-Bravo ; Manuel Vicente Mejía-Ramírez-Arellano ; Carlota Manuela Zárate-Saez ; Mª Nieves Vaquero Pinto ; Cristina Roldán-Plaza ; Nuria Pérez-Panizo ; Mª Loreto Álvarez-Nebreda (2026): Screening and managing frailty in older nursing home residents with Frail-VIG index: Feasibility, reliability and predictive validity for mortality. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100130
ASSOCIATION BETWEEN THE FRAILTY INDEX AND PSORIASIS: A CROSS-SECTIONAL STUDY OF THE U.S. NHANES 2003–2006
Xiaodan Wang, Wenjia Weng, Zhenzhen Yan, Ming Zhang, Juan Li, Bingbing Song, Yanqing Gao
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BACKGROUND: Psoriasis is a chronic inflammatory skin disease often accompanied by various comorbidities, but its relationship with frailty remains understudied. The Frailty Index (FI), calculated based on 49 health deficits across multiple systems (e.g., cognition, function, comorbidities, laboratory values) was used as a continuous measure.
OBJECTIVES: We investigated the association between psoriasis and the Frailty Index (FI), providing evidence to support the implementation of frailty screening and potential interventions in patients with psoriasis.
DESIGN AND SETTING: This cross-sectional study used data from the 2003–2006 U.S. National Health and Nutrition Examination Survey (NHANES) including 6532 participants.
MEASUREMENTS: We analyzed the psoriasis–FI relationship using weighted nested regression, supplemented by subgroup analyses and restricted cubic spline regression to test for nonlinear relationships.
RESULTS: The FI was significantly higher in patients with psoriasis (n = 162) than in those without (n = 6370; P < 0.001). Weighted nested regression analysis showed a significant positive association between FI and psoriasis (OR 2.22; 95% CI 1.14–4.35; P = 0.02). The association was stronger for male patients, those with normal body mass index, hypertension, and diabetes. Nonlinear relationships were observed between FI and psoriasis.
CONCLUSIONS: The present study validates the association between psoriasis and frailty using a nationally representative sample and provides empirical support for integrating frailty evaluations into psoriasis care. Our findings are consistent with the hypothesis that chronic inflammatory pathways may underlie the association between psoriasis and frailty.
CITATION:
Xiaodan Wang ; Wenjia Weng ; Zhenzhen Yan ; Ming Zhang ; Juan Li ; Bingbing Song ; Yanqing Gao (2025): Association between the Frailty Index and psoriasis: a cross-sectional study of the U.S. NHANES 2003–2006. The Journal of Frailty and Aging (JFA).https://doi.org/10.1016/j.tjfa.2025.100102
JFA N°01 - 2026
ASSOCIATION OF ACCELERATED BIOLOGICAL AGING AND FRAILTY WITH THE RISK OF SEVERE INFECTION: A PROSPECTIVE STUDY IN THE UK BIOBANK
Runzhi Bai, Lulu Pan, Yifang Huang, Zixuan Jiang, Jing Wang, Yahang Liu, Chen Huang, Xueying Zheng, Yongfu Yu, Qingqing Li, Guoyou Qin
J Frailty Aging 2026;15(1)
Show summaryHide summaryBACKGROUND: Infectious diseases contribute substantially to morbidity and mortality among aging populations, yet the impact of biological aging on severe infection risk remains unclear.
METHODS: Cox proportional hazards models estimated hazard ratios (HRs) and 95 % confidence intervals (CIs) for associations of accelerated biological aging (measured by KDM-BA and PhenoAge) and frailty index (FI) with overall and type-specific severe infections. Life expectancy differences by biological aging status were assessed. Bivariate response surface models evaluated combined effects of FI and two biological age acceleration indicators on severe infections.
RESULTS: KDM-BA acceleration (HR: 1.18; 95 % CI: 1.16 to 1.19) and PhenoAge acceleration (HR: 1.27; 95 % CI: 1.25 to 1.29) were associated with increased severe infection risk. Higher FI levels showed progressively greater risk, with HRs (95 % CIs) of 1.40 (1.38 to 1.43), 2.01 (1.96 to 2.06), 2.64 (2.53 to 2.76) and 3.37 (2.96 to 3.83) for FI categories 0.1 -< 0.2, 0.2 -< 0.3, 0.3 -< 0.4, and ≥ 0.4 versus FI < 0.1. Associations varied by infection type: KDM-BA acceleration and PhenoAge acceleration showed the strongest associations with respiratory infections, whereas the frailty index was most associated with digestive infections. Significant combined effects of FI and biological age accelerations further increased risk. Biologically younger individuals had longer life expectancy: +1.59 years (95 % CI: 1.40 to 1.77) for KDM-BA acceleration and +2.2 years (95 % CI: 2.00 to 2.40) for PhenoAge acceleration.
CONCLUSION: Accelerated biological aging and frailty were significantly associated with increased risks of overall and type-specific severe infections. These findings suggest that integrating biological aging assessments into routine healthcare could improve infection risk stratification and guide targeted prevention strategies.
CITATION:
Runzhi Bai ; Lulu Pan ; Yifang Huang ; Zixuan Jiang ; Jing Wang ; Yahang Liu ; Chen Huang ; Xueying Zheng ; Yongfu Yu ; Qingqing Li ; Guoyou Qin (2025): Association of accelerated biological aging and frailty with the risk of severe infection: a prospective study in the UK Biobank. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100118
A MULTICOMPONENT INTERVENTION CONSISTING OF EXERCISE, PROTEINS AND OMEGA-3 SUPPLEMENTATION TO IMPROVE SARCOPENIA IN COMMUNITY-DWELLING OLDER ADULTS: LESSONS LEARNED FROM A 5-ARMED RANDOMIZED CONTROLLED FEASIBILITY TRIAL
Nadjia Amini, Jolan Dupont, Laurence Lapauw, Laura Vercauteren, Lisa Peeters, Lenore Dedeyne, Sabine Verschueren, Jos Tournoy, Evelien Gielen
J Frailty Aging 2026;15(1)
Show summaryHide summaryBACKGROUND: Anabolic interventions, including physical exercise, proteins and omega-3 polyunsaturated fatty acids (PUFAs) supplementation, have shown effectiveness in improving sarcopenia outcomes. However, data on their combined effects in older adults with sarcopenia remain limited.
OBJECTIVES: To assess feasibility, acceptability, and preliminary effects of a multicomponent intervention combining individualized home-based exercise, proteins, and/or omega-3 supplementation.
DESIGN: Parallel five-armed randomized assessor-blinded controlled feasibility trial with triple-blinded supplementation.
PARTICIPANTS AND SETTING: Community-dwelling older adults (≥65 years) diagnosed with sarcopenia (EWGSOP2-criteria) from the Exercise and Nutrition for Healthy Ageing (ENHANce) study. The ENHANce study was registered on ClinicalTrials.gov (NCT03649698).
INTERVENTION: Participants were randomized into 5 groups: 1) Exercise, 2) Proteins, 3) Exercise+Protein, 4) Exercise+Protein+Omega-3, and 5) Control group.
MEASUREMENTS: Feasibility was assessed via eligibility, recruitment, retention, and data completion rates. Acceptability was evaluated through participants’ feedback, adherence, and safety. Effects were measured by changes in sarcopenia outcomes after 12 weeks.
RESULTS: Fifty-eight participants (76.2±6.6years,♀:65.5%) were included (Exercise,n=9;Protein,n=12; Exercise+Protein,n=13;Exercise+Protein+Omega-3;n=12;Control,n=12). Feasibility was low, with a recruitment rate of 2%. Acceptability was moderate, with most participants completing the planned assessments and reporting positive experiences such as feeling stronger and more aware of the importance of physical activity and nutrition. However, many found the study procedures demanding, and many experienced difficulties with the protein supplements. Adherence varied widely across interventions. Safety was high, with no significant adverse effects reported. The interventions showed potential to improve chair stand test (CST), Short Physical Performance Battery (SPPB), muscle mass and quadriceps strength.
CONCLUSION: A multicomponent intervention to treat sarcopenia showed low feasibility, moderate acceptability, and high safety. Preliminary efficacy results showed that exercise with protein supplementation may improve physical function. Adding omega-3 PUFA might offer further benefits for muscle strength and mass, but should be confirmed in larger studies. The insights and the practical challenges in the ENHANce study inform future sarcopenia intervention designs.
CITATION:
Nadjia Amini ; Jolan Dupont ; Laurence Lapauw ; Laura Vercauteren ; Lisa Peeters ; Lenore Dedeyne ; Sabine Verschueren ; Jos Tournoy ; Evelien Gielen (2025): A multicomponent intervention consisting of exercise, proteins and omega-3 supplementation to improve sarcopenia in community-dwelling older adults: Lessons learned from a 5-armed randomized controlled feasibility trial. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100129
COMPREHENSIVE GERIATRIC AS-SESSMENT AND PRIMARY CARE BA-SED INTERVENTIONS FOR MANAGING FRAILTY IN OLDER ADULTS: AN EVI-DENCE MAP
Smiteerekha Sahoo, Tanveer Rehman, Md Shaney Ali, Haimanti Bhattacharya, AK Kavitha , Rasmiranjan Nayak, Ashok Kumar Mahakuda, Sanghamitra Pati, Jaya Singh Kshatri
J Frailty Aging 2026;15(1)
Show summaryHide summaryBACKGROUND: Frailty is a geriatric syndrome leading to adverse health outcomes, but can be managed through targeted interventions and potentially reversed. Primary care settings play a pivotal role in identifying and addressing frailty. This review aims to assess the effective primary care interventions and strategies to manage frailty.
METHODS: This review mapped evidence to evaluate systematic reviews of randomized controlled trials in older adults (≥60 years) on primary care-based interventions for managing frailty. Data were extracted from databases including MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane CENTRAL, covering publications up to September 11, 2024. Interventions in primary care, community-based, or home-based settings were included, excluding hospitalized or bedridden individuals. The AMSTAR 2 tool assessed review quality, and interventions were categorized by type, setting, and effectiveness.
RESULTS: From the 3152 studies extracted, 17 systematic reviews met the inclusion criteria. Interventions were classified into physical, nutritional, pharmacological, e-health/telemedicine, and multicomponent approaches. Multicomponent interventions, combining physical, nutritional, and cognitive strategies, demonstrated effectiveness, with significant benefits reported in 15 reviews. Community and home-based settings dominated, emphasizing accessibility. However, the quality of evidence varied, with seven reviews rated as critically low and six as high. Most studies were conducted in high-income countries, limiting their generalizability to LMICs.
CONCLUSION: Multicomponent interventions delivered in community settings show significant promise for managing frailty in older adults. However, evidence gaps suggest the need for context-specific research to adapt these interventions into primary care, which can improve the health status and quality of life for ageing populations globally.
CITATION:
Smiteerekha Sahoo ; Tanveer Rehman ; Md Shaney Ali ; Haimanti Bhattacharya ; AK Kavitha ; Rasmiranjan Nayak ; Ashok Kumar Mahakuda ; Sanghamitra Pati ; Jaya Singh Kshatri (2025): Comprehensive geriatric assessment and primary care based interventions for managing frailty in older adults: An evidence map. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100104
PREVALENCE OF INTRINSIC CAPACITY DECLINE AND ITS ASSOCIATION WITH ACTIVITIES OF DAILY LIVING AMONG PRE-FRAIL AND FRAIL OLDER ADULTS IN A COMMUNITY-BASED GERIATRIC SERVICES HUB MODEL
Lydia Au, Izza Elyana Bte Azhar, Jer En Lee, Jasmine Shimin Lim, Alexa Lai, Bernice MH Chua, Yu Ann Tan, Reshma A. Merchant
J Frailty Aging 2026;15(1)
Show summaryHide summaryINTRODUCTION: As Singapore’s population rapidly ages, there is a growing need to proactively address frailty and intrinsic capacity (IC) decline to delay disability and preserve independence. This study aims to a) determine prevalence of IC decline in frail older patients referred to the geriatric service hub (GSH), stratified by age and frailty status and b) determine its association with activity of daily living (ADL).
METHODOLOGY: A cross-sectional study was conducted from July 2019 to March 2022. Community-dwelling older adults (≥65 years) identified as pre-frail or frail in selected primary care clinics and eldercare centers were referred to the GSH for further evaluation. All participants received a comprehensive geriatric assessment, which included Clinical Frailty Scale (CFS) scoring and evaluation of six IC domains: locomotion, vitality, cognition, sensory (vision and hearing), psychological, and continence. Functional status was assessed using the Modified Barthel Index and self-reported ADL and instrumental ADL (IADL).
RESULTS: Among 372 participants, 52.2 % were aged 65–79 (old) and 47.8 % were ≥ 80 years (old-old). Approximately two-thirds were classified as CFS 4 or 5. IC decline was significantly more prevalent in the “old-old” group, especially in locomotion (94.4 %), vitality (94.5 %), cognition (68.4 %), vision (78.7 %), and hearing (33.1 %). Despite IC decline, up to two-thirds of participants remained independent or only mildly dependent in ADL. IC impairment increased progressively with advancing frailty and age. In multivariate logistic regression, moderate to severe ADL dependency was independently associated with impaired locomotion (aOR 5.105; 95 % CI 1.023–25.477) and vision impairment (aOR 2.607; 95 % CI 1.234–5.508).
CONCLUSION: IC screening in primary care is a feasible and effective approach that may contribute to detection of early functional decline. The high burden of multidomain IC impairment, particularly among the oldest and most frail, supports the need for upstream, integrated, and age-inclusive screening and intervention strategies in community settings.
CITATION:
Lydia Au ; Izza Elyana Bte Azhar ; Jer En Lee ; Jasmine Shimin Lim ; Alexa Lai ; Bernice MH Chua ; Yu Ann Tan ; Reshma A. Merchant (2025): Prevalence of intrinsic capacity decline and its association with activities of daily living among pre-frail and frail older adults in a community-based geriatric services hub model. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100105
TRANSITIONS IN FRAILTY STATES AND ASSOCIATED FACTORS: A MULTISTATE ANALYSIS OF THE ITALIAN LONGITUDINAL STUDY ON AGING POPULATION-BASED COHORT
Lucia Galluzzo, Marianna Noale, Stefania Maggi, Marzia Baldereschi, Antonio Di Carlo, Nicola Veronese, Marco Silano, the ILSA Working Group
J Frailty Aging 2026;15(1)
Show summaryHide summaryBACKGROUND: Frailty is recognized as a dynamic and potentially reversible process, but comprehensive studies on its progression/regression are rare.
OBJECTIVE: To investigate the frequency and characteristics of frailty transitions over time in a representative sample of older Italians.
DESIGN AND PARTICIPANTS: As secondary analysis of the Italian Longitudinal Study on Aging (ILSA) population-based cohort, we studied all participants (n = 1339; women 47.5 %, age 72.7 ± 5.1) with complete information on changes in frailty status (or death) between consecutive ILSA surveys (T0, T1, T2).
MEASUREMENTS: Frailty was operationalized according to Fried phenotype, analysing transitions between frailty, or death, during T0-T1, T1-T2 (4-, 5-year length). Transition probability at 1, 3, 5 years was estimated through non-hidden continuous-time Markov models, with death as absorbing state. Factors influencing transitions were evaluated with Cox proportional Hazard Ratios (HR).
RESULTS: We observed 1931 transitions between frailty states and 241 to death. The estimated probability of: maintaining a stable frailty status (∼80 % within 1 year) halved at 5 years; worsening increased steeply over time and was always greater among women; improvement/remission was twice higher at medium (about 20 % among Frail->preFrail women, preFrail->nonFrail men) than short term. Depressive symptoms were the strongest predictor of worsening [nonFrail->Frail: women HR 3.63 (95 %CI 1.45–9.10), men HR 3.78 (95 %CI 2.0–7.13)]. Not having a spouse/partner was associated with a 30 % reduced probability of pre-frailty remission in both sexes.
CONCLUSIONS: Our findings confirm the fluctuating nature of frailty with an ample chance of remission/improvement, highlighting the importance of a prompt, multidimensional preventive approach, including psycho-social dimensions.
CITATION:
Lucia Galluzzo ; Marianna Noale ; Stefania Maggi ; Marzia Baldereschi ; Antonio Di Carlo ; Nicola Veronese ; Marco Silano ; the ILSA Working Group (2025): Transitions in frailty states and associated factors: a multistate analysis of the Italian Longitudinal Study on Aging population-based cohort. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100117
IMPACTS OF ESOGER HOME-BASED CARE AND HEALTH SERVICES ON SPOUSAL CAREGIVERS\' ANXIETY, QUALITY OF LIFE AND BURDEN: FINDINGS FROM A PILOT RANDOMIZED CONTROLLED TRIAL
Olivier Beauchet, Camille Normandin, Pascal Mathieu, Kevin Galéry
J Frailty Aging 2026;15(1)
Show summaryHide summaryBACKGROUND: Spousal caregivers of ill older adults face increasing risks of deteriorating mental health and burden. “Socio-Geriatric Evaluation” (ESOGER) is home-based care and health services for ill older adults. This study aimed to examine changes in anxiety, quality of life and burden over a 3-month period in spousal caregivers of ill older adults who benefits from ESOGER home health care and support services.
METHODS/DESIGN: A randomized controlled trial (RCT) with two parallel arms enrolled 42 spousal caregivers distributed equally between the intervention group and the control group. The intervention consisted of ESOGER, a telehealth-based home care program that evaluates older adults’ health and social needs and provides personalized recommendations and referrals to health and community services to ill spouses, implemented through the Canadian Red Cross. Spousal caregivers were assessed at baseline (M0) and at three months (M3). Anxiety was evaluated using a visual analogue scale (VAS) ranging from 0 (no anxiety) to 10 (severe anxiety) and the EuroQol-5D assessed quality of life using. Burden was measured using the 4-item Zarit scale.
RESULTS: Anxiety (P < 0.001) and burden (P = 0.003) increased significantly, and the quality of life decreased (P = 0.018) in the control group at M3 compared to M0. In the intervention group anxiety decreased significantly (P < 0.001) over the 3-months follow-up. Only burden was significantly lower in the intervention group compared to the control group (P = 0.022) at M3. The changes in scores of the 4-item Zarit scale between M0 and M3 (P = 0.011) and of the EQ-5D visual analogue scale (P = 0.024) were significantly different between groups, showing an improvement in the intervention group.
CONCLUSION: This study highlights the positive impact of ESOGER home-based care on spousal caregivers, showing reduced anxiety and burden while improving quality of life. These findings underscore the importance of structured home care services in supporting caregivers' well-being and sustaining home-based care for older adults.
CITATION:
Olivier Beauchet ; Camille Normandin ; Pascal Mathieu ; Kevin Galéry (2025): Impacts of ESOGER home-based care and health services on spousal caregivers' anxiety, quality of life and burden: Findings from a pilot randomized controlled trial. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100114
ASSOCIATION BETWEEN DIABETES AND FRAILTY, AND THE MODERATING ROLE OF SEX IN THAT ASSOCIATION IN OLDER ADULTS OF THE ELSA-BRASIL STUDY
Elizabeth Leite Barbosa, Rosa Weiss Telles, Maria de Jesus Mendes da Fonseca, Maria Inês Schmidt, Sandhi Maria Barreto, Bruce Duncan, Rosane Harter Griep
J Frailty Aging 2026;15(1)
Show summaryHide summaryOBJECTIVE: to investigate the association of diabetes and its duration with frailty and evaluate the moderating effect of sex on that association in older adults.
METHODS: This cross-sectional study used data from the third visit (2017–2019) of the Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil), a multicentre cohort of Brazilian civil servants. The data included were from 4886 participants aged ≥ 60 years. Diabetes was identified on the basis of self-reported diagnosis or laboratory test values. Frailty was evaluated on frailty phenotype criteria. Associations were estimated by way of multinomial regression models.
RESULTS: Adjusted final models showed that older adults classified as having diabetes were 116% more likely to show frailty, and 27% more likely to show pre-frailty, than persons without diabetes. Individuals with a diagnosis before baseline and those with that diagnosis at baseline or during follow-up until visit 3 were, respectively, 145% and 92% more likely to be classified as frail, and 35% and 21% more likely to be classified as pre-frail, than individuals without diabetes. No modification by a multiplier effect of sex was observed in the final models.
CONCLUSIONS/INTERPRETATION: Older adults with diabetes returned greater odds of pre-frailty and frailty, and the odds were even greater in those with longer times since the diagnosis of diabetes, but sex did not modify those associations. These findings endorse the need for more frequent screening of older adults with diabetes with a view to early prevention and/or intervention.
CITATION:
Elizabeth Leite Barbosa ; Rosa Weiss Telles ; Maria de Jesus Mendes da Fonseca ; Maria Inês Schmidt ; Sandhi Maria Barreto ; Bruce Duncan ; Rosane Harter Griep (2025): Association between diabetes and frailty, and the moderating role of sex in that association in older adults of the ELSA-Brasil study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100115
ASSOCIATION BETWEEN THE FRAILTY INDEX AND ALL-CAUSE AND CARDIOVASCULAR MORTALITY IN A POPULATION WITH CARDIOVASCULAR-KIDNEY-METABOLIC SYNDROME: INSIGHTS FROM THE NHANES 2011-2018
Xin Wang, Xinrui Hai, Ali Ma, Xiaolan Liang, Hua Cheng, Peng Wu, Yu Hao, Dapeng Chen, Ning Yan
J Frailty Aging 2026;15(1)
Show summaryHide summaryBACKGROUND: The Frailty Index (FI) is a well-established predictor of accelerated biological aging and a reliable tool for estimating all-cause and cardiovascular disease (CVD) mortality in older adults in the United States. However, its predictive value remains unclear in other U.S. population subgroups. This study aimed to examine the association between FI levels and both all-cause and CVD mortality among patients diagnosed with Cardiovascular-Kidney-Metabolic Syndrome (CKM syndrome).
METHODS: This study utilized the data from the National Health and Nutrition Examination Survey (NHANES 2011–2018), which included 7049 participants with complete information for CKM staging (stages 0–4). We employed multivariate Cox proportional hazards models in conjunction with restricted cubic splines (RCS) to account for potential non-linear relationships in the data. Additionally, segmented Cox proportional hazards models were used to examine the association between FI levels and both all-cause and CVD mortality in the CKM syndrome population. Subgroup analyses stratified by demographic and clinical factors, along with interaction tests, were performed to evaluate the consistency of these associations.
RESULTS: After adjusting for potential confounding variables, a nonlinear association was observed between the FI and CKM syndrome. Multivariable Cox regression analysis based on nationally representative data demonstrated that higher FI levels were significantly associated with increased risks of both all-cause and CVD mortality among patients with CKM syndrome. Multivariable analysis indicated a robust association between higher FI levels and the presence of CKM syndrome. Among patients diagnosed with CKM syndrome, each 10-unit increase in the FI was associated with a 54% higher risk of CVD mortality (HR = 1.54, 95% CI: 1.24–1.91; P < 0.001) and a 55% higher risk of all-cause mortality (HR = 1.55; 95% CI: 1.38–1.73, P < 0.0001). Stratified analyses revealed no significant interaction effects between the FI and demographic or clinical factors on mortality outcomes.
CONCLUSION: The results highlight a robust and statistically significant association between FI and increased risk of both all-cause and CVD mortality among individuals with KM syndrome. Notably, FI may serve as a valuable marker for CKM stage stratification and for identifying high-risk patients.
CITATION:
Xin Wang ; Xinrui Hai ; Ali Ma ; Xiaolan Liang ; Hua Cheng ; Peng Wu ; Yu Hao ; Dapeng Chen ; Ning Yan (2026): Association between the frailty index and all-cause and cardiovascular mortality in a population with cardiovascular-kidney-metabolic syndrome: Insights from the NHANES 2011-2018. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100131
LETTER TO THE EDITOR: “VIENI DA NONNA TUA, VIENI!” A COMMENTARY ON THE SOCIAL CONSTRUCTION OF GRANDMOTHERS AND ITS IMPACT ON OLDER WOMEN’S LIVES
Hélio José Coelho-Júnior, Riccardo Calvani, Emanuele Marzetti
J Frailty Aging 2026;15(1)
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CITATION:
Hélio José Coelho-Júnior ; Riccardo Calvani ; Emanuele Marzetti (2025): Letter to the Editor: “Vieni da Nonna Tua, Vieni!” A commentary on the social construction of grandmothers and its impact on older women’s lives. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100119