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LETTER TO THE EDITOR: IT IS IMPORTANT TO EXAMINE PHYSICAL FUNCTIONING AND INFLAMMATORY RESPONSES DURING POST-HOSPITALIZATION COVID-19 RECOVERY

R. McGrath, P.J. Carson, D.A. Jurivich

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CITATION:
R. McGrath ; P.J. Carson ; D.A. Jurivich (2020): Letter to the editor: It is Important to Examine Physical Functioning and Inflammatory Responses During Post-Hospitalization COVID-19 Recovery . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.73

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MUSCLE LOSS IS ASSOCIATED WITH RISK OF ORTHOSTATIC HYPOTENSION IN OLDER MEN AND WOMEN

M.J. Benton, A.L. Silva-Smith, J.M. Spicher

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Background: Muscle provides a reservoir for water to maintain fluid volume and blood pressure, so older adults may be at risk for orthostatic hypotension due to muscle loss with age. Objectives: To evaluate the association between muscle loss with age and postural blood pressure. Design: Longitudinal comparison of overnight changes in hydration, postural blood pressure, and strength. Setting: Community field study. Participants: Sixty-nine men and women (76.0 ± 0.8 years) with low (Low) or normal (Normal) muscle based on the Lean Mass Index. Measurements: Body composition was measured with bioelectrical impedance analysis. Postural blood pressure was measured sequentially (lying, sitting, standing). Strength was measured with a handgrip dynamometer, Arm Curl test, and Chair Stand test. Results: On Day 1, Low had less hydration and a significant drop in postural systolic blood pressure compared to Normal (lying to standing: -11.06 ± 2.36 vs. +1.14 ± 2.20 mmHg, p < 0.001). Overnight, both groups lost significant total body water, while fluid volume was unchanged. On Day 2, both groups experienced significant drops in postural systolic blood pressure, although the drop in Low was more profound and significantly greater than Normal (lying to standing: -16.85 ± 2.50 vs. -3.89 ± 2.52 mmHg, p = 0.001). On both days, Normal compensated for postural changes with increases in postural diastolic blood pressure not observed in Low. Only Low experienced significant overnight decreases in all strength measures. Conclusions: In older men and women, muscle loss with age is accompanied by loss of hydration and less stable early morning postural systolic blood pressure that increase risk for orthostatic hypotension and can also increase risk for falls.

CITATION:
M.J. Benton ; A.L. Silva-Smith ; J.M. Spicher (2020): Muscle Loss is Associated with Risk of Orthostatic Hypotension in Older Men and Women. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.72

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SENSOR-BASED FRAILTY ASSESSMENT IN SURVIVORS OF CHILDHOOD CANCER: A PILOT STUDY

N.J. Krnavek, S. Ajasin, E.C. Arreola, M. Zahiri, M. Noun, P.J. Lupo, B. Najafi, M.M. Gramatges

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Background: Survivors of childhood cancer (CCS) are at risk for early aging and frailty. Frailty in CCS has been assessed with established clinical criteria, a time-intensive approach requiring specialized training. There is an unmet need for cost-effective, rapid methods for assessing frailty in at-risk adolescent and young adult (AYA) CCS, which are scalable to large populations. Objectives: To validate a sensor-based frailty assessment tool in AYA CCS, compare frailty status between CCS and controls, and assess the correlation between frailty and number of CCS comorbidities. Design, Setting, and Participants: Mean frailty index (MFI) was assessed by a frailty wrist sensor in 32 AYA CCS who were ≥1 year off therapy and in remission. Results were compared with 32 AYA controls without cancer or chronic disease. Measurements: Frailty assessments with and without a simultaneous cognitive task were performed to obtain MFI. Results were compared between cases and controls using a Student t test, and the number of pre-frail/frail subjects by Chi Square test. The contribution of radiation therapy (RT) exposure to MFI was assessed in a sub-analysis, and the correlation between the number of comorbidities and MFI was measured using the Pearson method. Results: MFI was strongly correlated with gait speed in AYA CCS. CCS were more likely to be pre-frail than controls without cancer history (p=0.032), and CCS treated with RT were more likely to be pre-frail than CCS not treated with RT (p<0.001). The number of comorbidities was strongly correlated with MFI (ρ=0.65), with a 0.028 increase in MFI for each added condition (p<0.001). Conclusions: Results from this study support higher risk for frailty among CCS, especially those with multiple comorbidities or who were treated with RT. A wrist-worn sensor-based method is feasible for application in AYA CCS, and provides an opportunity for cost-effective, rapid screening of at-risk AYA CCS who may benefit from early interventions.

CITATION:
N.J. Krnavek ; S. Ajasin ; E.C. Arreola ; M. Zahiri ; M. Noun ; P.J. Lupo ; B. Najafi ; M.M. Gramatges (2020): Sensor-based frailty assessment in survivors of childhood cancer: A pilot study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.71

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LETTER TO THE EDITOR: PREVALENCE OF FRAILTY IN PATIENTS WITH COVID-19: A META-ANALYSIS

C.S. Kow, S.S. Hasan

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CITATION:
C.S. Kow ; S.S. Hasan (2020): Letter to the editor: Prevalence of frailty in patients with COVID-19: a meta-analysis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.70

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LETTER TO THE EDITOR: FRAILTY PHENOTYPE OF HOMEBOUND MONTREAL OLDER COMMUNITY DWELLERS DURING THE COVID-19 PANDEMIC: RESULTS OF A CROSS-SECTIONAL POPULATION STUDY

C.P. Launay, L. Cooper-Brown, V. Ivensky, O. Beauchet

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CITATION:
C.P. Launay ; L. Cooper-Brown ; V. Ivensky ; O. Beauchet (2020): Letter to the editor: Frailty phenotype of homebound Montreal older community dwellers during the COVID-19 pandemic: Results of a cross-sectional population study . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.69

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TRENDS IN THE PREVALENCE OF FRAILTY IN JAPAN: A META-ANALYSIS FROM THE ILSA-J

H. MAKIZAKO, Y. NISHITA, S. JEONG, R. OTSUKA, H. SHIMADA, K. IIJIMA, S. OBUCHI, H. KIM, A. KITAMURA, Y. OHARA, S. AWATA, N. YOSHIMURA, M. YAMADA, K. TOBA, T. SUZUKI

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Objective: To examine whether age-specific prevalence of frailty in Japan changed between 2012 and 2017. Design: This study performed meta-analyses of data collected from 2012 to 2017 using the Integrated Longitudinal Studies on Aging in Japan (ILSA-J), a collection of representative Japanese cohort studies. Setting: The ILSA-J studies were conducted on community-living older adults. Participants: ILSA-J studies were considered eligible for analysis if they assessed physical frailty status and presence of frailty in the sample. Seven studies were analyzed for 2012 (±1 year; n = 10312) and eight studies were analyzed for 2017 (±1 year; n = 7010). Five studies were analyzed for both 2012 and 2017. Measurements: The study assessed the prevalence of frailty and frailty status according to 5 criteria: slowness, weakness, low activity, exhaustion, and weight loss.Results: The overall prevalence of physical frailty was 7.0% in 2012 and 5.3% in 2017. The prevalence of frailty, especially in people 70 years and older, tended to decrease in 2017 compared to 2012. Slight decreases were found in the prevalence of frailty subitems including weight loss, slowness, exhaustion, and low activity between 2012 and 2017, but change in the prevalence of weakness was weaker than other components. Conclusions: The prevalence of physical frailty decreased from 2012 to 2017. There are age- and gender-related variations in the decrease of each component of frailty.

CITATION:
H. MAKIZAKO ; Y. NISHITA ; S. JEONG ; R. OTSUKA ; H. SHIMADA ; K. IIJIMA ; S. OBUCHI ; H. KIM ; A. KITAMURA ; Y. OHARA ; S. AWATA ; N. YOSHIMURA ; M. YAMADA ; K. TOBA ; T. SUZUKI (2020): TRENDS IN THE PREVALENCE OF FRAILTY IN JAPAN: A META-ANALYSIS FROM THE ILSA-J. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.68

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RELATIONSHIP BETWEEN SERUM FATTY ACIDS AND COMPONENTS OF PHYSICAL FRAILTY IN COMMUNITY-DWELLING JAPANESE OLDER ADULTS

K. Kinoshita, R. Otsuka, C. Tange, Y. Nishita, M. Tomida, F. Ando, H. Shimokata, H. Arai

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Polyunsaturated fatty acids help maintain insulin sensitivity, mitochondrial function, and anti-inflammation. It is well known that deterioration in these areas can cause frailty. However, little is known about the differences in serum polyunsaturated fatty acid levels among frailty components. We investigated the cross-sectional relationship between frailty and serum fatty acids in 1,033 community-dwelling older adults aged 60–88 years. Polyunsaturated fatty acid concentrations were measured from fasting blood samples. The modified phenotype criteria defined frailty. Polyunsaturated fatty acid levels were compared among each component using general linear modeling after controlling for sex, age, body mass index, smoking status, household income, and medical history. Lower polyunsaturated fatty acid levels were associated with the modified frailty criteria, including shrinking and weakness (p < 0.05). Our findings suggest that serum polyunsaturated fatty acid levels differ depending on the frailty status of older adults.

CITATION:
K. Kinoshita ; R. Otsuka ; C. Tange ; Y. Nishita ; M. Tomida ; F. Ando ; H. Shimokata ; H. Arai (2020): Relationship between Serum Fatty Acids and Components of Physical Frailty in Community-Dwelling Japanese Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.67

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LETTER TO THE EDITOR: COVID-19 MORTALITY IN PERUVIAN OLDER ADULTS: A CHRONICLE OF A HEALTH CRISIS FORETOLD?

K.L. Aguirre-Amaya, M. Palomares-Custodio, C. Quispe-Vicuña, S. Abanto-Urbano, D. Urrunaga-Pastor

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CITATION:
K.L. Aguirre-Amaya ; M. Palomares-Custodio ; C. Quispe-Vicuña ; S. Abanto-Urbano ; D. Urrunaga-Pastor (2020): Letter to the editor: COVID-19 mortality in Peruvian older adults: a chronicle of a health crisis foretold? . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.66

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OBESITY MEASURES AND DEFINITIONS OF SARCOPENIC OBESITY IN SINGAPOREAN ADULTS – THE YISHUN STUDY

B.W.J. Pang, S.-L. Wee, L.K. Lau, K.A. Jabbar, W.T. Seah, D.H.M. Ng, Q.L.L. Tan, K.K. Chen, M.U. Jagadish T.P. Ng1,4

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Objectives: Due to the lack of a uniform obesity definition, there is marked variability in reported sarcopenic obesity (SO) prevalence and associated health outcomes. We compare the association of SO with physical function using current Asian Working Group for Sarcopenia (AWGS) guidelines and different obesity measures to propose the most optimal SO diagnostic formulation according to functional impairment, and describe SO prevalence among community-dwelling young and old adults. Design: Obesity was defined according to waist circumference (WC), percentage body fat (PBF), fat mass index (FMI), fat mass/fat-free mass ratio (FM/FFM), or body mass index (BMI). SO was defined as the presence of both obesity and AWGS sarcopenia. Muscle function was compared among phenotypes and obesity definitions using ANOVA. Differences across obesity measures were further ascertained using multiple linear regressions to determine their associations with the Short Physical Performance Battery (SPPB). Setting: Community-dwelling adults 21 years old and above were recruited from a large urban residential town in Singapore. Participants: 535 community-dwelling Singaporeans were recruited (21-90 years old, 57.9% women), filling quotas of 20-40 participants in each sex- and age-group. Measurements: We took measurements of height, weight, BMI, waist and hip circumferences, body fat, muscle mass, muscle strength, and functional assessments. Questionnaire-based physical and cognitive factors were also assessed. Results: Overall prevalence of SO was 7.6% (WC-based), 5.1% (PBF-based), 2.7% (FMI-based), 1.5% (FM/FFM-based), and 0.4% (BMI-based). SO was significantly associated with SPPB only in the FMI model (p<0.05), and total variance explained by the different regression models was highest for the FMI model. Conclusions: Our findings suggest FMI as the most preferred measure for obesity and support its use as a diagnostic criteria for SO.

CITATION:
B.W.J. Pang ; S.-L. Wee ; L.K. Lau ; K.A. Jabbar ; W.T. Seah ; D.H.M. Ng ; Q.L.L. Tan ; K.K. Chen ; M.U. Jagadish ; T.P. Ng (2020): Obesity Measures and Definitions of Sarcopenic Obesity in Singaporean Adults – the Yishun Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.65

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A REVIEW OF THE EVIDENCE BASE FOR NUTRITION AND NUTRITIONAL SUPPLEMENTS IN OLDER ADULTS WITH BIPOLAR DISORDER: A REPORT FROM THE OABD TASK FORCE

A.T. Olagunju, J.A. Morgan, A. Aftab, J.R. Gatchel, P. Chen, A. Dols, M. Sajatovic, W.T. Regenold

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Objectives: To better understand the role of nutrition in older adults (aged 50 years or older) with bipolar disorders (OABD), we conducted a systematic review of the literature and appraise existing evidence. Methods: Following PRISMA guidelines, we searched databases including Medline/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Register, FDA website, and clinical trial registries through 2019 for eligible reports. The search string combined MeSH terms for bipolar disorder, nutrition and older adults. This was supplemented by snowball searching of references in relevant studies and authors were contacted to request their work where necessary. All included studies were rated with the National Institutes of Health Study Quality Assessment Tools based on study designs. Results: Of 2280 papers screened, ten studies including eight observational and two interventional studies. The topic foci of the papers examined several nutrients, (including vitamin B12, vitamin D, coenzyme Q10, homocysteine, and folate), nutritional deficiencies and biochemical correlates. The prevalence rates of deficiencies varied with specific nutrients (3.7% to 71.6% for Vitamin B12 and 34.6% for Vitamin D), and between inpatient versus outpatient populations. While nutritional interventions appeared to be associated with improvement in both affective and cognitive outcomes, the sample sizes of OABD varied and were generally small. Conclusion: While there is evidence for the benefits of nutritional interventions on affective, cognitive and overall outcome in OABD, the quality of the evidence is limited. Our findings underscore the need for high quality studies to inform evidence-based guidelines for nutritional assessment and supplemention in OABD.

CITATION:
A.T. Olagunju ; J.A. Morgan ; A. Aftab ; J.R. Gatchel ; P. Chen ; A. Dols ; M. Sajatovic ; W.T. Regenold (2020): A Review of the Evidence Base for Nutrition and Nutritional Supplements in Older Adults with Bipolar Disorder: A report from the OABD task force. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.64

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SARCOPENIA IN PRIMARY CARE: SCREENING, DIAGNOSIS, MANAGEMENT

S. Crosignani, C. Sedini, R. Calvani, E. Marzetti, M. Cesari

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Detection of sarcopenia in primary care is a first and essential step in community-dwelling older adults before implementing preventive interventions against the onset of disabling conditions. In fact, leaving this condition undiagnosed and untreated can impact on the individual’s quality of life and function, as well as on healthcare costs. This article summarizes the many instruments today available for promoting an earlier and prompter detection of sarcopenia in primary care, combining insights about its clinical management. Primary care physicians may indeed play a crucial role in the identification of individuals exposed to the risk of sarcopenia or already presenting this condition. To confirm the suspected diagnosis, several possible techniques may be advocated, but it is important that strategies are specifically calibrated to the needs, priorities and resources of the setting where the evaluation is conducted. To tackle sarcopenia, nutritional counselling and physical activity programs are today the two main interventions to be proposed. Multicomponent and personalized exercise programs can (and should) be prescribed by primary care physicians, taking advantage of validated programs ad hoc designed for this purpose (e.g., the Vivifrail protocol). It is possible that, in the next future, new pharmacological treatments may become available for tackling the skeletal muscle decline. These will probably find application in those individuals non-responding to lifestyle interventions.

CITATION:
S. Crosignani ; C. Sedini ; R. Calvani ; E. Marzetti ; M. Cesari (2020): SARCOPENIA IN PRIMARY CARE: SCREENING, DIAGNOSIS, MANAGEMENT. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.63

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A LITERATURE REVIEW OF HEALTHY AGING TRAJECTORIES THROUGH QUANTITATIVE AND QUALITATIVE STUDIES: A PSYCHO-EPIDEMIOLOGICAL APPROACH ON COMMUNITY-DWELLING OLDER ADULTS

A. Zamudio-Rodríguez, J.-F. Dartigues, H. Amieva, K. Pérès

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The population of older adults over 60 years is growing faster than any other age group and will more than double between 2020 and 2050. This increase has led to clinical, public health, and policy interest in how to age “successfully”. Before the Rowe and Kahn’s model proposed thirty years ago, aging was seen as a process of losses associated with diseases and disability. However, since the emergence of this model, there has been a shift towards a more positive view, serving for promoting diverse medical or psychosocial models, and personal perspectives. Several technical terms of “success” (e.g. “successful aging”, “healthy aging”, “active aging”, “aging well”…) coexist and compete for the meaning of the concept in the absence of a consensual definition. Our literature review article aims to study discrepancies and similarities between the main technical terms through quantitative or qualitative studies. A literature review using PubMed, SCOPUS, PsycINFO, Psycarticles, Psychology, and Behavioral Sciences Collection, Cochrane database, and clinicaltrials.gov databases was conducted. A total of 1057 articles were found and finally, 43 papers were selected for full extraction. We identified several components in these definitions, which reveal considerable inconsistency. The results particularly suggest that lay personals perspectives could bridge the gap between biomedical and psychosocial models in successful aging. In conclusion, an optimal definition would be a multidimensional one that could combine functional capacities, psychosocial abilities, environmental factors and subjective assessments of one’s own criteria to discriminate older adults at potential risk of “unsuccessful” aging to healthy aging trajectories.

CITATION:
A. Zamudio-Rodríguez ; J.-F. Dartigues ; H. Amieva ; K. Pérès (2020): A Literature Review of Healthy Aging Trajectories through Quantitative and Qualitative Studies: A Psycho-epidemiological Approach on Community-dwelling Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.62

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PHYSICAL FUNCTIONAL ASSESSMENT IN OLDER ADULTS

E. Patrizio, R. Calvani, E. Marzetti, M. Cesari

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The evaluation of the physical domain represents a critical part of the assessment of the older person, both in the clinical as well as the research setting. To measure physical function, clinicians and researchers have traditionally relied on instruments focusing on the capacity of the individual to accomplish specific functional tasks (e.g., the Activities of Daily Living [ADL] or the Instrumental ADL scales). However, a growing number of physical performance and muscle strength tests has been developed in parallel over the past three decades. These measures are specifically designed to: 1) provide objective results (not surprisingly, they are frequently timed tests) taken in standardized conditions, whereas the traditional physical function scales are generally self- or proxy-reported measures; 2) be more sensitive to changes; 3) capture the real biology of the function through the assessment of standardized tasks mirroring specific functional subdomains; and 4) mirror the quality of specific mechanisms underlying more complex and multidomain functions. Among the most commonly used instruments, the usual gait speed test, the Short Physical Performance Battery, the handgrip strength, the Timed Up-and-Go test, the 6-minute walk test, and the 400-meter walk test are widely adopted by clinicians and researchers. The clinical and research importance of all these instruments has been demonstrated by their predictive capacity for negative health-related outcomes (i.e., hospitalization, falls, institutionalization, disability, mortality). Moreover, they have shown to be associated with subclinical and clinical conditions that are also not directly related to the physical domain (e.g., inflammation, oxidative stress, overall mortality). For this reason, they have been repeatedly indicated as markers of wellbeing linked to the burden of multiple chronic conditions rather than mere parameters of mobility or strength. In this work protocols of the main tests for the objective assessment of physical function in older adults are presented.

CITATION:
E. Patrizio ; R. Calvani ; E. Marzetti ; M. Cesari (2020): Physical Functional Assessment in Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.61

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OLDER PEOPLE FACING THE CRISIS OF COVID-19: BETWEEN FRAGILITY AND RESILIENCE

H. Amieva, J.-A. Avila-Funes, S. Caillot-Ranjeva, J.-F. Dartigues, M. Koleck, L. Letenneur, M. Pech, K. Pérès, N. Raoux, N. Rascle, C. Ouvrard, M. Tabue-Teguo, R. Villeneuve, V. Bergua

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The health crisis we are facing is challenging seniors’ resources and capacities for adaptation and resilience. The PACOVID survey, set up a few days after containment, investigates their psychological and social experiences with regard to the COVID-19 crisis and to what extent these characteristics, representations and attitudes have an impact on health and mortality. A telephone survey is being carried out on 935 people already followed up in the framework of ongoing epidemiological studies. As we are writing this article, the interviews conducted during the containment have just ended. Even though we will have to wait for the analysis of the results to draw conclusions, words collected by the psychologists during the interviews already illustrate a great heterogeneity in the way older adults lived this experience: social isolation, anxiety, the importance of family and the difficulty of being deprived of it, but also remarkable coping skills and resilience capacities.

CITATION:
H. Amieva ; J.-A. Avila-Funes ; S. Caillot-Ranjeva ; J.-F. Dartigues ; M. Koleck ; L. Letenneur ; M. Pech ; K. Pérès ; N. Raoux ; N. Rascle ; C. Ouvrard ; M. Tabue-Teguo ; R. Villeneuve ; V. Bergua (2020): Older people facing the crisis of COVID-19: between fragility and resilience. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.60

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INTEGRATED CARE AND GERIATRICS: A CALL TO RENOVATION FROM THE COVID-19 PANDEMIC

P. Astrone, M. Cesari

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CITATION:
P. Astrone ; M. Cesari (2020): Integrated Care and Geriatrics: a call to renovation from the COVID-19 pandemic. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.59

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FRAILTY IS ASSOCIATED WITH INCREASED MORTALITY IN OLDER ADULTS 12 MONTHS AFTER DISCHARGE FROM POST-ACUTE CARE IN SWISS NURSING HOMES

C. Fompeyrine, L.A. Abderhalden, N. Mantegazza, N. Hofstetter, G. Bieri-Brüning, H.A. Bischoff-Ferrari, M. Gagesch

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Frail older adults with ongoing care needs often require post-acute care (PAC) following acute hospitalization when not eligible for specific rehabilitation. Long-term outcomes of PAC in this patient group have not been reported for Switzerland so far. In the present report, we investigated 12-month mortality in regard to frailty status upon admission to PAC in a nursing home setting. In our sample of 140 patients (mean age 84 [±8.6] years) 4.3% were robust, 37.1% were pre-frail, 54.3% were frail and 4.3% were missing frailty status. Mortality at 12-months follow-up stratified by baseline frailty was 0% (robust), 11.5% (pre-frail) and 31.6% (frail). Kaplan-Meier analysis stratified by frailty status showed a decreased probability of 12-months survival for frail individuals compared to their pre-frail and robust counterparts (P = 0.0096). Being frail was associated with more than 4-fold increased odds of death at follow-up (OR 4.19; 95% CI 1.53-11.47).

CITATION:
C. Fompeyrine ; L.A. Abderhalden ; N. Mantegazza ; N. Hofstetter ; G. Bieri-Brüning ; H.A. Bischoff-Ferrari ; M. Gagesch ; (2020): Frailty is associated with increased mortality in older adults 12 months after discharge from post-acute care in Swiss nursing homes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.58

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COGNITIVE FUNCTION AND AMYLOID MARKER IN FRAIL OLDER ADULTS: THE COGFRAIL COHORT STUDY

S. Sourdet, G. Soriano, J. Delrieu, Z. Steinmeyer, S. Guyonnet, L. Saint-Aubert, P. Payoux, P.J. Ousset, A. Ghisolfi, B. Chicoulaa, S. Dardenne, T. Gemar, M. Baziard, F. Guerville, S. Andrieu, B. Vellas

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Background: Frailty and cognitive impairment are common manifestations of the ageing process and are closely related. But the mechanisms linking aging, physical frailty, and cognitive disorders, are complex and remain unclear. Objectives: We aim to explore the role of cerebral amyloid pathology, but also a range of nutritional, physical, biological or brain-aging marker in the development of cognitive frailty. Method: COGFRAIL study is a monocentric prospective study of frail older patients with an objective cognitive impairment (Clinical Dementia Rating Scale global score at 0.5 or 1). Three-hundred-and-twenty-one patients are followed up every 6 months, for 2 years. Clinical assessment at baseline and during follow-up included frailty, physical, mood, sensory, nutritional, and cognitive assessment (with a set of neuropsychological tests). Cerebral amyloid pathology is measured by amyloid Positron Emission Tomography (PET) or amyloid-β-1-42 level in cerebrospinal fluid. Brain magnetic resonance imaging, measurement of body composition using Dual X Ray Absorptiometry and blood sampling are performed. The main outcome of the study is to assess the prevalence of positive cerebral amyloid status according to amyloid PET or amyloid-β-1-42 level CSF. Secondary outcomes included biological, nutritional, MRI imaging, cognitive, clinical, physical and body composition markers to better understand the mechanisms of cognitive frailty. Perspective: COGFRAIL study will give the opportunity to better understand the link between Gerosciences, frailty, cognitive impairment, and Alzheimer’s disease, and to better characterize the physical and cognitive trajectories of frail older adults according to their amyloid status. Understanding the relationship between physical frailty and cognitive impairment is a prerequisite for the development of new interventions that could prevent and treat both conditions.

CITATION:
S. Sourdet ; G. Soriano ; J. Delrieu ; Z. Steinmeyer ; S. Guyonnet ; L. Saint-Aubert ; P. Payoux ; P.J. Ousset ; A. Ghisolfi ; B. Chicoulaa ; S. Dardenne ; T. Gemar ; M. Baziard ; F. Guerville ; S. Andrieu ; B. Vellas (2020): Cognitive function and amyloid marker in frail older adults: The COGFRAIL Cohort Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.57

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EFFICACY OF A COMPREHENSIVE DYSPHAGIA INTERVENTION PROGRAM TAILORED FOR THE RESIDENTS OF NURSING HOMES

R. Fong, S.W.K. Wong, J.K.L. Chan, M.C.F. Tong, K.Y.S. Lee

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Oropharyngeal dysphagia is a widespread condition in older people and thus poses a serious health threat to the residents of nursing homes. The management of dysphagia relies mainly on compensatory strategies, such as diet and environmental modification. This study investigated the efficacy of an intervention program using a single-arm interventional study design. Twenty-two participants from nursing homes were included and had an average of 26 hours of intervention, including oromotor exercises, orosensory stimulation and exercises to target dysphagia and caregiver training. Four of the 22 participants exhibited improvement in functional oral intake scale (FOIS) but was not statistically significant as a group. All oromotor function parameters, including the range, strength, and coordination of movements, significantly improved. These results indicate that this intervention program could potentially improve the oromotor function, which were translated into functional improvements in some participants’ recommended diets. The validity of this study could be improved further by using standardized swallowing and feeding assessment methods or an instrumental swallowing assessment.

CITATION:
R. Fong ; S.W.K. Wong ; J.K.L. Chan ; M.C.F. Tong ; K.Y.S. Lee (2020): Efficacy of a comprehensive dysphagia intervention program tailored for the residents of nursing homes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.56

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INTRINSIC CAPACITIY MONITORING BY DIGITAL BIOMARKERS IN INTEGRATED CARE FOR OLDER PEOPLE (ICOPE)

A. Piau, Z. Steinmeyer, M. Cesari, J. Kornfeld, Z. Beattie, J. Kaye, B. Vellas, F. Nourhashemi

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The WHO action plan on aging expects to change current clinical practices by promoting a more personalized model of medicine. To widely promote this initiative and achieve this goal, healthcare professionals need innovative monitoring tools. Use of conventional biomarkers (clinical, biological or imaging) provides a health status assessment at a given time once a capacity has declined. As a complement, continuous monitoring thanks to digital biomarkers makes it possible to remotely collect and analyze real life, ecologically valid, and continuous health related data. A seamless assessment of the patient’s health status potentially enables early diagnosis of IC decline (e.g. sub-clinical or transient events not detectable by episodic evaluations) and investigation of its probable causes. This narrative review aims to develop the concept of digital biomarkers and its implementation in IC monitoring.

CITATION:
A. Piau ; Z. Steinmeyer ; M. Cesari ; J. Kornfeld ; Z. Beattie ; J. Kaye ; B. Vellas ; F. Nourhashemi (2020): Intrinsic Capacitiy monitoring by digital biomarkers in Integrated Care for Older People (ICOPE). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.51

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LETTER TO THE EDITOR: CAREFUL HAND FEEDING PROGRAM IN A GERIATRIC STEP-DOWN HOSPITAL IN HONG KONG – IS THIS FEASIBLE?

J.K.H. Luk, T.C. Chan, F.H.W. Chan

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CITATION:
J.K.H. Luk ; T.C. Chan ; F.H.W. Chan (2020): Letter to the editor: Careful hand feeding program in a geriatric step-down hospital in Hong Kong – is this feasible? . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.50

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METHODOLOGICAL ISSUES AND THE IMPACT OF AGE STRATIFICATION ON THE PROPORTION OF PARTICIPANTS WITH LOW APPENDICULAR LEAN MASS WHEN ADJUSTING FOR HEIGHT AND FAT MASS USING LINEAR REGRESSION: RESULTS FROM THE CANADIAN LONGITUDINAL STUDY ON AGING

A.J. Mayhew, S.M. Phillips, N. Sohel, L. Thabane, P.D. McNicholas, R.J. de Souza, G. Parise, P. Raina

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Background: Using residual values calculated from models regressing appendicular lean mass on fat mass and height is one of several suggested strategies for adjusting appendicular lean mass for body size when measuring sarcopenia. However, special consideration is required when using this technique in different subgroups in order to capture the correct individuals as sarcopenic. Objectives: To provide guidance about how to conduct stratified analyses for the regression adjustment technique using age groups as an example. Design: Cross-sectional study. Setting: Data collected at baseline (2012-2015) for the Canadian Longitudinal Study on Aging. Participants: Community dwelling participants of European descent aged 45 to 85 years (n=25,399). Measurements: Appendicular lean mass, height, and weight were measured. Sex-specific residuals were calculated in participants before and after stratifying participants by age group (45-54, 55-64, 65-74, 75-85 years). Cut offs corresponding to the sex-specific 20th percentile residual values in participants ≥65 years were determined first in the residuals calculated in all participants and residuals calculated in only those aged ≥65 years. For each set of cut offs, the percentage of age and sex-stratified participants with low appendicular lean mass were compared for the residuals calculated in all participants and the residuals calculated after stratifying by age. Results: In 12,622 males and 12,737 females, regardless of the cut off used, the percentage of participants with low appendicular lean mass decreased with age when residuals were calculated after age stratification. When the residuals were calculated in all participants, the percentage of participants with sarcopenia increased from the youngest to the oldest age groups. Conclusions: Sex-specific residuals in all participants should be calculated prior to stratifying the sample by age group, or other stratification variables, for the purposes of developing appendicular lean mass cut offs or subgroup analyses.

CITATION:
A.J. Mayhew ; S.M. Phillips ; N. Sohel ; L. Thabane ; P.D. McNicholas ; R.J. de Souza ; G. Parise ; P. Raina (2020): METHODOLOGICAL ISSUES AND THE IMPACT OF AGE STRATIFICATION ON THE PROPORTION OF PARTICIPANTS WITH LOW APPENDICULAR LEAN MASS WHEN ADJUSTING FOR HEIGHT AND FAT MASS USING LINEAR REGRESSION: RESULTS FROM THE CANADIAN LONGITUDINAL STUDY ON AGING. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.48

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LETTER TO THE EDITOR: DISCRIMINATIVE POWER OF THE SARCOPENIA QUALITY OF LIFE (SARQOL®) QUESTIONNAIRE WITH THE EWGSOP2 CRITERIA

A. Geerinck , M. Locquet, J.-Y. Reginster, O. Bruyère, C. Beaudart

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CITATION:
A. Geerinck ; M. Locquet ; J.-Y. Reginster ; O. Bruyère ; C. Beaudart (2020): Letter to the editor: Discriminative power of the Sarcopenia Quality of Life (SarQoL®) questionnaire with the EWGSOP2 criteria . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.47

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TOWARDS A LARGE-SCALE ASSESSMENT OF THE RELATIONSHIP BETWEEN BIOLOGICAL AND CHRONOLOGICAL AGING: THE INSPIRE MOUSE COHORT

Y. Santin, S. Lopez, I. Ader, S. Andrieu, N. Blanchard, A. Carrière, L. Casteilla, B. Cousin, N. Davezac, P. De Souto Barreto, C. Dray, N. Fazilleau, D. Gonzalez-Dunia, P. Gourdy, S. Guyonnet, N. Jabrane-Ferrat, O. Kunduzova, F. Lezoualc’h, R. Liblau, L.O. Martinez, C. Moro, P. Payoux, L. Pénicaud, V. Planat-Bénard, C. Rampon, Y. Rolland, J.-P. Schanstra, F. Sierra, P. Valet, A. Varin, N. Vergnolle, B. Vellas, J. Viña, B.P. Guiard, A. Parini

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Aging is the major risk factor for the development of chronic diseases. After decades of research focused on extending lifespan, current efforts seek primarily to promote healthy aging. Recent advances suggest that biological processes linked to aging are more reliable than chronological age to account for an individual’s functional status, i.e. frail or robust. It is becoming increasingly apparent that biological aging may be detectable as a progressive loss of resilience much earlier than the appearance of clinical signs of frailty. In this context, the INSPIRE program was built to identify the mechanisms of accelerated aging and the early biological signs predicting frailty and pathological aging. To address this issue, we designed a cohort of outbred Swiss mice (1576 male and female mice) in which we will continuously monitor spontaneous and voluntary physical activity from 6 to 24 months of age under either normal or high fat/high sucrose diet. At different age points (6, 12, 18, 24 months), multiorgan functional phenotyping will be carried out to identify early signs of organ dysfunction and generate a large biological fluids/feces/organs biobank (100,000 samples). A comprehensive correlation between functional and biological phenotypes will be assessed to determine: 1) the early signs of biological aging and their relationship with chronological age; 2) the role of dietary and exercise interventions on accelerating or decelerating the rate of biological aging; and 3) novel targets for the promotion of healthy aging. All the functional and omics data, as well as the biobank generated in the framework of the INSPIRE cohort will be available to the aging scientific community. The present article describes the scientific background and the strategies employed for the design of the INSPIRE Mouse cohort.

CITATION:
Y. Santin ; S. Lopez ; I. Ader ; S. Andrieu ; N. Blanchard ; A. Carrière ; L. Casteilla ; B. Cousin ; N. Davezac ; P. De Souto Barreto ; C. Dray ; N. Fazilleau ; D. Gonzalez-Dunia ; P. Gourdy ; S. Guyonnet ; N. Jabrane-Ferrat ; O. Kunduzova ; F. Lezoualc’h ; R. Liblau ; L.O. Martinez ; C. Moro ; P. Payoux ; L. Pénicaud ; V. Planat-Bénard ; C. Rampon ; Y. Rolland ; J.-P. Schanstra ; F. Sierra ; P. Valet ; A. Varin ; N. Vergnolle ; B. Vellas ; J. Viña ; B.P. Guiard ; A. Parini (2020): Towards a large-scale assessment of the relationship between biological and chronological aging: The INSPIRE Mouse Cohort. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.43

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FREQUENCY OF CONDITIONS ASSOCIATED WITH DECLINES IN INTRINSIC CAPACITY ACCORDING TO A SCREENING TOOL IN THE CONTEXT OF INTEGRATED CARE FOR OLDER PEOPLE

E. González-Bautista, P. de Souto Barreto, K. Virecoulon Giudici, S. Andrieu, Y. Rolland, B. Vellas, for the MAPT/DSA group

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Background: The screening tool of the Integrated Care for Older People (ICOPE Step 1), designed to detect declines in the domains of intrinsic capacity, has been incipiently investigated in older adult populations. Objectives: To retrospectively estimate the frequency of priority conditions associated with declines in intrinsic capacity according to an adaptation of the screening tool ICOPE Step 1 among participants of the Multidomain Alzheimer Preventive Trial (MAPT). Design: A cross-sectional retrospective analysis from the baseline assessment of the MAPT. Setting: The data was gathered during a preventive consultation for cardiovascular risk factors in memory clinics in France. Participants : Seven hundred fifty-nine older adults aged 70-89 years with memory complaints, allocated to the multidomain groups of the MAPT study. Measurements: Five domains of intrinsic capacity (cognition, locomotion, nutrition, sensorial, and psychological) were assessed using a screening tool similar to the ICOPE Step 1 (MAPT Step 1). The frequency of six conditions associated with declines in intrinsic capacity (cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss, and depressive symptoms) was obtained for older adults with memory complaints participating in the MAPT study. Results: Overall, 89.3% of the participants had one or more conditions associated with declines in intrinsic capacity. The overall frequency of each condition was: 52.2% for cognitive decline, 20.2% for limited mobility, 6.6% for malnutrition, 18.1% for visual impairment, 56.2% for hearing loss, and 39% for depressive symptoms. Conclusion: After being screened with an adaptation of the ICOPE step 1 (MAPT step 1) tool, 9/10 older adults had one or more conditions associated with declines in intrinsic capacity. The relative frequency differs across conditions and could probably be lower in a population without memory complaints. The frequency of screened conditions associated with declines in IC highlights how relevant it is to develop function-centered care modalities to promote healthy aging.

CITATION:
E. González-Bautista ; P. de Souto Barreto ; K. Virecoulon Giudici ; S. Andrieu ; Y. Rolland ; B. Vellas ; for the MAPT/DSA group (2020): Frequency of conditions associated with declines in intrinsic capacity according to a screening tool in the context of Integrated care for older people. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.42

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INTEGRATED CARE FOR OLDER PEOPLE (ICOPE): FROM GUIDELINES TO DEMONSTRATING FEASIBILITY

A. Banerjee, R. Sadana

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CITATION:
A. Banerjee ; R. Sadana (2020): Integrated care for older people (ICOPE): from guidelines to demonstrating feasibility . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.40

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THE INSPIRE BIO-RESOURCE RESEARCH PLATFORM FOR HEALTHY AGING AND GEROSCIENCE: FOCUS ON THE HUMAN TRANSLATIONAL RESEARCH COHORT (THE INSPIRE-T COHORT)

S. Guyonnet, Y. Rolland, C. Takeda, P.-J. Ousset, I. Ader, N. Davezac, C. Dray, N. Fazilleau, P. Gourdy, R. Liblau, A. Parini, P. Payoux, L. Pénicaud, C. Rampon, P. Valet, N. Vergnolle, S. Andrieu, P. de Souto Barreto, L. Casteilla, B. Vellas, for the INSPIRE Platform group

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Background: The Geroscience field focuses on the core biological mechanisms of aging, which are involved in the onset of age-related diseases, as well as declines in intrinsic capacity (IC) (body functions) leading to dependency. A better understanding on how to measure the true age of an individual or biological aging is an essential step that may lead to the definition of putative markers capable of predicting healthy aging. Objectives: The main objective of the INStitute for Prevention healthy agIng and medicine Rejuvenative (INSPIRE) Platform initiative is to build a program for Geroscience and healthy aging research going from animal models to humans and the health care system. The specific aim of the INSPIRE human translational cohort (INSPIRE-T cohort) is to gather clinical, digital and imaging data, and perform relevant and extensive biobanking to allow basic and translational research on humans. Methods: The INSPIRE-T cohort consists in a population study comprising 1000 individuals in Toulouse and surrounding areas (France) of different ages (20 years or over - no upper limit for age) and functional capacity levels (from robustness to frailty, and even dependency) with follow-up over 10 years. Diversified data are collected annually in research facilities or at home according to standardized procedures. Between two annual visits, IC domains are monitored every 4-month by using the ICOPE Monitor app developed in collaboration with WHO. Once IC decline is confirmed, participants will have a clinical assessment and blood sampling to investigate markers of aging at the time IC declines are detected. Biospecimens include blood, urine, saliva, and dental plaque that are collected from all subjects at baseline and then, annually. Nasopharyngeal swabs and cutaneous surface samples are collected in a large subgroup of subjects every two years. Feces, hair bulb and skin biopsy are collected optionally at the baseline visit and will be performed again during the longitudinal follow up. Expected Results: Recruitment started on October 2019 and is expected to last for two years. Bio-resources collected and explored in the INSPIRE-T cohort will be available for academic and industry partners aiming to identify robust (set of) markers of aging, age-related diseases and IC evolution that could be pharmacologically or non-pharmacologically targetable. The INSPIRE-T will also aim to develop an integrative approach to explore the use of innovative technologies and a new, function and person-centered health care pathway that will promote a healthy aging.

CITATION:
S. Guyonnet ; Y. Rolland ; C. Takeda ; P.-J. Ousset ; I. Ader ; N. Davezac ; C. Dray ; N. Fazilleau ; P. Gourdy ; R. Liblau ; A. Parini ; P. Payoux ; L. Pénicaud ; C. Rampon ; P. Valet ; N. Vergnolle ; S. Andrieu ; P. de Souto Barreto ; L. Casteilla ; B. Vellas ; for the INSPIRE Platform group (2020): The INSPIRE Bio-resource Research Platform for Healthy Aging and Geroscience: Focus on the Human Translational Research Cohort (The INSPIRE-T Cohort). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.38

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SARCOPENIA, FRAILTY, AND GERO-SCIENCE: A DECADE OF PROGRESS AND A BRIGHT FUTURE OF DISCOVERY

R.A. Fielding

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CITATION:
R.A. Fielding (2020): Sarcopenia, Frailty, and Gero-science: a decade of progress and a bright future of discovery. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.37

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FRAMEWORK IMPLEMENTATION OF THE INSPIRE ICOPE-CARE PROGRAM IN COLLABORATION WITH THE WORLD HEALTH ORGANIZATION (WHO) IN THE OCCITANIA REGION

N. Tavassoli, A. Piau, C. Berbon, J. De Kerimel, C. Lafont, P. De Souto Barreto, S. Guyonnet, C. Takeda, I. Carrie, D. Angioni, F. Paris, C. Mathieu, P.J. Ousset, L. Balardy, T. Voisin, S. Sourdet, J. Delrieu, V. Bezombes, V. Pons-Pretre, S. Andrieu, F. Nourhashemi, Y. Rolland, M.E. Soto, J. Beard, Y. Sumi, I. Araujo Carvalho, B. Vellas

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Introduction: Limiting the number of dependent older people in coming years will be a major economic and human challenge. In response, the World Health Organization (WHO) has developed the «Integrated Care for Older People (ICOPE)» approach. The aim of the ICOPE program is to enable as many people as possible to age in good health. To reach this objective, the WHO proposes to follow the trajectory of an individual’s intrinsic capacity, which is the composite of all their physical and mental capacities and comprised of multiple domains including mobility, cognition, vitality / nutrition, psychological state, vision, hearing. Objective: The main objective of the INSPIRE ICOPE-CARE program is to implement, in clinical practice at a large scale, the WHO ICOPE program in the Occitania region, in France, to promote healthy aging and maintain the autonomy of seniors using digital medicine. Method: The target population is independent seniors aged 60 years and over. To follow this population, the 6 domains of intrinsic capacity are systematically monitored with pre-established tools proposed by WHO especially STEP 1 which has been adapted in digital form to make remote and large-scale monitoring possible. Two tools were developed: the ICOPE MONITOR, an application, and the BOTFRAIL, a conversational robot. Both are connected to the Gerontopole frailty database. STEP 1 is performed every 4-6 months by professionals or seniors themselves. If a deterioration in one or more domains of intrinsic capacity is identified, an alert is generated by an algorithm which allows health professionals to quickly intervene. The operational implementation of the INSPIRE ICOPE-CARE program in Occitania is done by the network of Territorial Teams of Aging and Prevention of Dependency (ETVPD) which have more than 2,200 members composed of professionals in the medical, medico-social and social sectors. Targeted actions have started to deploy the use of STEP 1 by healthcare professionals (physicians, nurses, pharmacists,…) or different institutions like French National old age insurance fund (CNAV), complementary pension funds (CEDIP), Departmental Council of Haute Garonne, etc. Perspective: The INSPIRE ICOPE-CARE program draws significantly on numeric tools, e-health and digital medicine to facilitate communication and coordination between professionals and seniors. It seeks to screen and monitor 200,000 older people in Occitania region within 3 to 5 years and promote preventive actions. The French Presidential Plan Grand Age aims to largely implement the WHO ICOPE program in France following the experience of the INSPIRE ICOPE-CARE program in Occitania.

CITATION:
N. Tavassoli ; A. Piau ; C. Berbon ; J. De Kerimel ; C. Lafont ; P. De Souto Barreto ; S. Guyonnet ; C. Takeda ; I. Carrie ; D. Angioni ; F. Paris ; C. Mathieu ; P.J. Ousset ; L. Balardy ; T. Voisin ; S. Sourdet ; J. Delrieu ; V. Bezombes ; V. Pons-Pretre ; S. Andrieu ; F. Nourhashemi ; Y. Rolland ; M.E. Soto ; J. Beard ; Y. Sumi ; I. Araujo Carvalho ; B. Vellas ; (2020): Framework Implementation of the INSPIRE ICOPE-CARE program in collaboration with the World Health Organization (WHO) in the Occitania region. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.26

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IMPLEMENTATION OF THE INTEGRATED CARE OF OLDER PEOPLE (ICOPE) APP IN PRIMARY CARE: NEW TECHNOLOGIES IN GERIATRIC CARE DURING QUARANTINE OF COVID-19 AND BEYOND

D. Sanchez-Rodriguez, C. Annweiler, S. Gillain, B. Vellas

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CITATION:
D. Sanchez-Rodriguez ; C. Annweiler ; S. Gillain ; B. Vellas (2020): Implementation of the Integrated Care of Older People (ICOPE) App in Primary Care: New technologies in geriatric care during quarantine of COVID-19 and beyond. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.24

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THE INSPIRE RESEARCH INITIATIVE: A PROGRAM FOR GEROSCIENCE AND HEALTHY AGING RESEARCH GOING FROM ANIMAL MODELS TO HUMANS AND THE HEALTHCARE SYSTEM

P. de Souto Barreto, S. Guyonnet, I. Ader, S. Andrieu, L. Casteilla, N. Davezac, C. Dray, N. Fazilleau, P. Gourdy, R. Liblau, A. Parini, P. Payoux, L. Pénicaud, C. Rampon, Y. Rolland, P. Valet, N. Vergnolle, B. Vellas, for the INSPIRE Program Group

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Aging is the most important risk factor for the onset of several chronic diseases and functional decline. Understanding the interplays between biological aging and the biology of diseases and functional loss as well as integrating a function-centered approach to the care pathway of older adults are crucial steps towards the elaboration of preventive strategies (both pharmacological and non-pharmacological) against the onset and severity of burdensome chronic conditions during aging. In order to tackle these two crucial challenges, ie, how both the manipulation of biological aging and the implementation of a function-centered care pathway (the Integrated Care for Older People (ICOPE) model of the World Health Organization) may contribute to the trajectories of healthy aging, a new initiative on Gerosciences was built: the INSPIRE research program. The present article describes the scientific background on which the foundations of the INSPIRE program have been constructed and provides the general lines of this initiative that involves researchers from basic and translational science, clinical gerontology, geriatrics and primary care, and public health.

CITATION:
P. de Souto Barreto ; S. Guyonnet, ; I. Ader ; S. Andrieu ; L. Casteilla ; N. Davezac ; C. Dray ; N. Fazilleau ; P. Gourdy ; R. Liblau ; A. Parini ; P. Payoux ; L. Pénicaud ; C. Rampon ; Y. Rolland ; P. Valet ; N. Vergnolle ; B. Vellas ; for the INSPIRE Program Group (2020): The INSPIRE research initiative: a program for GeroScience and healthy aging research going from animal models to humans and the healthcare system. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.18

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ICSFR: 10th International Conference on Frailty, Sarcopenia Research & Geroscience. March 11-13, 2020, Toulouse – France

Symposia, Conferences, Oral Communications

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CITATION:
I. Oral Communications (2020): 10th International Conference on Frailty, Sarcopenia Research & Geroscience (ICFSR), March 11-13, 2020, Toulouse, France. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.8

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JFA N°01 - 2021

 

THE RELATIONSHIP BETWEEN VITAMIN D AND TELOMERE/TELOMERASE: A COMPREHENSIVE REVIEW

M. Zarei, M. Zarezadeh, F. Hamedi Kalajahi, M.H. Javanbakht

J Frailty Aging 2021;10(1)2-9

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Telomeres are repetitive nucleotide sequences that together with the associated sheltrin complex protect the ends of chromosomes and maintain genomic stability. Evidences from various organisms suggests that several factors influence telomere length regulation, such as telomere binding proteins, telomere capping proteins, telomerase, and DNA replication enzymes. Recent studies suggest that micronutrients, such as vitamin D, folate and vitamin B12, are involved in telomere biology and cellular aging. In particular, vitamin D is important for a range of vital cellular processes including cellular differentiation, proliferation and apoptosis. As a result of the multiple functions of vitamin D it has been speculated that vitamin D might play a role in telomere biology and genomic stability. In this study, our main goal is investigating the relationship between telomerase enzyme and vitamin D. Findings of this study suggest that higher vitamin D concentrations, which are easily modifiable through nutritional supplementation, are associated with longer LTL, which underscores the potentially beneficial effects of this hormone on aging and age-related diseases. Vitamin D may reduce telomere shortening through anti-inflammatory and anti-cell proliferation mechanisms. Significant Low levels of telomerase activity create short telomeres, which in turn signal exit from the cell cycle resulting in cell senescence and apoptosis. In follow-up examination, the patients who remained vitamin D deficient tended to have shorter telomeres than those patients whose 25-hydroxyvitamin D levels were depleted. Increasing 25-hydroxyvitamin D levels in patients with SLE may be beneficial in maintaining telomere length and preventing cellular aging. Moreover, anti-telomere antibody levels may be a promising biomarker of SLE status and disease activity.

CITATION:
M. Zarei ; M. Zarezadeh ; F. Hamedi Kalajahi ; M.H. Javanbakht (2020): The Relationship Between Vitamin D and Telomere/Telomerase: a comprehensive review. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.33

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PREVALENCE OF FALL AND ASSOCIATED FACTORS AMONG COMMUNITYDWELLING EUROPEAN OLDER ADULTS: A CROSS-SECTIONAL STUDY

M. Almada, P. Brochado, D. Portela, L. Midão, E. Costa

J Frailty Aging 2021;10(1)10-16

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im: As a person ages, the risk of fall increases, which affects quality of life and represents a financial burden to health- and social-systems, and a greater morbidity and mortality risk. Fall leads to decreased social contact, anxiety, long-term physical disability, severe dependency and hospitalizations. Currently, few studies address this phenomenon using a uniform methodology; therefore, this study aims to explore the prevalence of fall and associated-variables in older adults across Europe. Methods: In this cross-sectional analysis, we used data from Wave 6 of SHARE. The prevalence of fall was assessed through the answer “falling down” to the question “For the past six months at least, have you been bothered by any of the health conditions on this card?”. Multilevel logistic regression was used, using fall as a dependent variable. Multilevel univariable logistic regression models were made to identify potential associated factors. Results: From the 41,098 participants, 56.3% were female, and the average age was of 70.0 ± 8.9 years. The prevalence of fall was 8.2% (CI 8.0% to 8.4%), being higher in women (10.1% vs. 5.8%) and increasing with age. Age, female gender, being frail or pre-frail, higher scores on the EURO-D scale, polypharmacy and fear of falling were found to be significantly associated with fall. Conclusions: We found that fall is prevalent in the European community-dwelling population, with variations between countries. As a public health priority, identification of the variables associated with fall is important in order to identify/monitor the risk in older groups and develop tailored and cost-effective interventions for fall prevention.

CITATION:
M. Almada ; P. Brochado ; D. Portela ; L. Midão ; E. Costa (2020): Prevalence of fall and associated factors among community-dwelling European older adults: a cross-sectional study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.44

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DO MALNUTRITION, SARCOPENIA AND FRAILTY OVERLAP IN NURSING-HOME RESIDENTS?

G. Faxén-Irving, Y. Luiking, H. Grönstedt, E. Franzén, Å. Seiger, S. Vikström, A. Wimo, A.-M. Boström, T. Cederholm

J Frailty Aging 2021;10(1)17-21

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Objectives: To study the prevalence and overlap between malnutrition, sarcopenia and frailty in a selected group of nursing home (NH) residents. Design: Cross-sectional descriptive study. Setting: Nursing homes (NH). Participants: 92 residents taking part in an exercise and oral nutritional supplementation study; >75 years old, able to rise from a seated position, body mass index ≤30 kg/m2 and not receiving protein-rich oral nutritional supplements. Measurements: The MNA-SF and Global Leadership Initiative on Malnutrition (GLIM) criteria were used for screening and diagnosis of malnutrition (moderate or severe), respectively. Sarcopenia risk was assessed by the SARC-F Questionnaire (0-10p; ≥4=increased risk), and for diagnosis the European Working Group of Sarcopenia in Older People (EWGSOP2) criteria was used. To screen for frailty the FRAIL Questionnaire (0-5p; 1-2p indicating pre-frailty, and >3p indicating frailty), was employed. Results: Average age was 86 years; 62% were women. MNA-SF showed that 30 (33%) people were at risk or malnourished. The GLIM criteria verified malnutrition in 16 (17%) subjects. One third (n=33) was at risk for sarcopenia by SARC-F. Twenty-seven (29%) subjects displayed confirmed sarcopenic according to EWGSOP2. Around 50% (n=47) was assessed as pre-frail or frail. Six people (7%) suffered from all three conditions. Another five (5%) of the residents were simultaneously malnourished and sarcopenic, but not frail, while frailty coexisted with sarcopenia in 10% (n=9) of non-malnourished residents. Twenty-nine (32%) residents were neither malnourished, sarcopenic nor frail. Conclusions: In a group of selected NH residents a majority was either (pre)frail (51%), sarcopenic (29%) or malnourished (17%). There were considerable overlaps between the three conditions.

CITATION:
G. Faxén-Irving ; Y. Luiking ; H. Grönstedt ; E. Franzén ; Å. Seiger ; S. Vikström ; A. Wimo ; A.-M. Boström ; T. Cederholm (2020): Do malnutrition, sarcopenia and frailty overlap in nursing-home residents?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.45

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ONGOING RESEARCH PROTOCOLS FOR THE PHARMACOLOGICAL TREATMENT OF NEUROPSYCHIATRIC SYMPTOMS IN DEMENTIA

M. Canevelli, G. Remoli, M. Toccaceli Blasi, L. Tariciotti, G. Sarli, M. Valletta, F. D’Antonio, N. Vanacore, M. Cesari, G. Bruno

J Frailty Aging 2021;10(1)22-30

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The implementation of effective interventions for neuropsychiatric symptoms (NPS) is perceived as one of the most pressing research priorities in the field of dementia and one of the main unmet needs from the perspective of affected individuals and their caregivers and relatives. Nevertheless, to date, only a relatively marginal part of dementia research has focused on NPS. This study aimed to describe and discuss the state of the art concerning the identification and development of new pharmacological treatments for NPS in dementia. A review of 320 ongoing phase 1, 2, 3, and 4 protocols registered in the clinicaltrials.gov database was performed. All the trials enrolling patients with dementia were selected. Only studies adopting clinical measures of NPS frequency and/or severity as primary outcome were retained and analyzed. Overall, only a minority of ongoing phase 1, 2, 3 and 4 protocols on dementia (i.e., 9.0%) is primarily targeting NPS. Most of these studies are adopting a placebo-controlled parallel assignment design, testing oral compounds, and targeting specific NPS (mostly agitation and/or aggression). A total of 3,445 subjects with dementia will tentatively be recruited in these trials. The methodologies adopted in these studies, the characteristics of the tested interventions, the eligibility criteria, and the operational definitions of NPS are presented and discussed. The relevance of NPS is not yet matched by an adequate research effort. The current tendency at privileging disease-modifying approaches and other symptoms of dementia and the methodological complexity of studying NPS are still substantially contributing to the gap between research activities and clinical needs.

CITATION:
M. Canevelli ; G. Remoli ; M. Toccaceli Blasi ; L. Tariciotti ; G. Sarli ; M. Valletta ; F. D’Antonio ; N. Vanacore ; M. Cesari ; G. Bruno (2020): Ongoing research protocols for the pharmacological treatment of neuropsychiatric symptoms in dementia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.36

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PREDICTION OF COGNITIVE STATUS AND 5-YEAR SURVIVAL RATE FOR ELDERLY WITH CARDIOVASCULAR DISEASES: A CANADIAN STUDY OF HEALTH AND AGING SECONDARY DATA ANALYSIS

S. Pakzad, P. Bourque, N. Fallah

J Frailty Aging 2021;10(1)31-37

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Background: Given the important association between cardiovascular disease and cognitive decline, and their significant implications on frailty status, the contribution of neurocognitive frailty measure helping with the assessment of patient outcomes is dearly needed. Objectives: The present study examines the prognostic value of the Neurocognitive Frailty Index (NFI) in the elderly with cardiovascular disease. Design: Secondary analysis of the Canadian Study of Health and Aging (CSHA) dataset was used for prediction of 5-year cognitive changes. Setting: Community and institutional sample. Participants: Canadians aged 65 and over [Mean age: 80.4 years (SD=6.9; Range of 66-100)]. Measurement: Neurocognitive Frailty Index (NFI) and Modified Mini-Mental State (3MS) scores for cognitive functioning of all subjects at follow-up and mortality rate were measured. Results: The NFI mean score was 9.63 (SD = 6.04) and ranged from 0 to 33. This study demonstrated that the NFI was significantly associated with cognitive changes for subjects with heart disease and this correlation was a stronger predictor than age. Conclusion: The clinical relevance of this study is that our result supports the prognostic utility of the NFI tool in treatment planning for those with modifiable cardiovascular disease risk factors in the development of dementia.

CITATION:
S. Pakzad ; P. Bourque ; N. Fallah (2020): Prediction of Cognitive Status and 5-year Survival rate for Elderly with Cardiovascular Diseases: A Canadian Study of Health and Aging Secondary Data Analysis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.21

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CLINICAL FRAILTY SCALE: TRANSLATION AND CULTURAL ADAPTATION INTO THE BRAZILIAN PORTUGUESE LANGUAGE

M.K. Rodrigues, I. Nunes Rodrigues, D.J. Vasconcelos Gomes da Silva, J.M. de S. Pinto, M.F. Oliveira, M.K. Rodrigues, I. Nunes Rodrigues, D.J. Vasconcelos Gomes da Silva, J.M. de S. Pinto, M.F. Oliveira

J Frailty Aging 2021;10(1)38-43

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Background: Frailty is a biological syndrome that causes adverse events in the health of older adults. However, the Clinical Frailty Scale has not yet been culturally adapted and validated into Brazilian Portuguese language. Objectives: Our aim was to translate, reproduce and validate the Clinical Frailty Scale (CFS) for the Brazilian Portuguese language. Design: An observational cross-sectional study with senior patients was conducted between Jan 2018 and Nov 2018. Setting and Participants: Volunteers aged >60 and living in Brazil. The translation and cultural adaptation of the CFS into the Portuguese language, the principles and good practices were followed. Measurements: To conduct the validation and determine the reproducibility of an inter-observer evaluation, the patients answered the scale questions in Portuguese on two occasions, delivered by two separate examiners and separated by a 10-minute interval, on their first visit; the 36-item Short Form Survey quality-of-life questionnaire (SF-36) was also applied. Seven days later, a second visit was undertaken to perform an intra-observer reproducibility assessment. Results: A total of 66 older individuals were enrolled (72 ± 8 years), the majority of which did not present frailty (63.6%) and reported a low physical limitation level in the SF-36. The CFS showed a significant correlation with the SF-36 quality-of-life questionnaire (r= −0.663; p<0.0001) and no statistical difference was observed between intra-rater (p=0.641) and inter-rater (p=0.350) applications, demonstrating the reproducibility and applicability of the instrument. The standard error estimate (SEE) was evaluated and there were no differences between the CFS and the SF-36 (SEE= 1.13 points). Conclusion: The Brazilian Portuguese language version of the CFS is a valid, reproducible and reliable instrument for evaluating the impact of frailty on the lives of senior patients.

CITATION:
M.K. Rodrigues ; I. Nunes Rodrigues ; D.J. Vasconcelos Gomes da Silva ; J.M. de S. Pinto ; M.F. Oliveira (2020): Clinical Frailty Scale: translation and cultural adaptation into the Brazilian Portuguese language. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.7

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SELF-RATED FRAILTY AND MORTALITY IN OLD MEN: THE MANITOBA FOLLOW-UP STUDY

E. Sachs, P. St. John, A. Swift, R. Tate

J Frailty Aging 2021;10(1)44-48

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Background: While a multitude of definitions and operationalizations of frailty have been developed, rarely have these considered the perspective of the older adult themselves. This knowledge gap was addressed by examining older adults’ self-rating of frailty. Objectives: To assess the validity of self-rated frailty and to determine whether self-rated frailty relates to mortality. Design: The Manitoba Follow-up Study was initiated in 1948 as a prospective cohort study of 3,983 men. Setting: Community dwelling older adult men. Participants: Survivors of the original cohort (231 men) were sent a quality of life survey in 2015. A response was received from 186 men, including 146 surveys completed by the participant himself and thus were eligible to include (completion rate of 78.4%). Measurements: The quality of life survey is sent out annually to the study participants to ascertain information about mental, physical, and social functioning. In 2015, the Clinical Frailty Scale was adapted and added to the survey as a simple self-rating of frailty. Results: The mean age of the 146 respondents in 2015 was 93.7 years (SD 2.7) Self-ratings of “moderate-severe” frailty, received from 132 men, were associated with worse measures of physical health and functional impairment, thus supporting the significance of self-rated frailty. Adjusted for age, the Hazard Ratio for mortality over the next 3 years was 3.3 (95% CI: 1.5, 7.1) for those who rated themselves as “mildly to severely frail” vs. “very fit or well, with no disease”. Conclusion: The present study has illustrated that self-rated frailty is associated with other measures of health and that self-rated frailty predicts mortality over a three-year period. These findings support the utilization of older adult’s self-ratings of frailty for new avenues of operationalizing frailty.

CITATION:
E. Sachs ; P. St. John ; A. Swift ; R. Tate (2020): Self-rated Frailty and Mortality in Old Men: The Manitoba Follow-up Study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.14

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THE ASSOCIATION BETWEEN FRAILTY AND SHORT-TERM OUTCOMES IN AN INTENSIVE CARE UNIT REHABILITATION TRIAL: AN EXPLORATORY ANALYSIS

A. Takaoka, D. Heels-Ansdell, D.J. Cook, M.E. Kho

J Frailty Aging 2021;10(1)49-55

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Background: Physical therapy initiated early in an ICU stay may reduce functional deficits in critically ill patients; however, the association of frailty with outcomes in those receiving early in-ICU rehabilitation is unknown. Objective: To estimate the association between frailty and 3 outcomes in patients enrolled in an ICU randomized clinical trial (RCT). Design: Exploratory secondary analyses of the CYCLE pilot RCT (NCT02377830). Setting: 7 Canadian ICUs. Participants: Previously ambulatory critically ill adults. Intervention: Participants were randomized to early in-bed cycling plus routine physiotherapy versus early routine physiotherapy alone. Measurements: Using regression analyses, we modelled the association between pre-hospital Clinical Frailty Scale (CFS) scores, Physical Function in ICU Test-scored (PFIT-s), muscle strength, and mortality at hospital discharge, adjusting for illness severity (APACHE II) and the randomized intervention. We explored the influence of imputing mean PFIT-s and strength scores for decedents, and with listwise deletion of decedents in a sensitivity analysis. Results: Of 66 patients, 2 had missing data, 2 had incomplete data, and 21 died by hospital discharge. At hospital discharge for 66 patients, frailty was not associated with PFIT-s (mean difference (MD) [95% CI]=0.20, [-2.08, 2.74]) or muscle strength (1.96, [-12.6, 16.6]). A sensitivity analysis yielded consistent results. Frailty was also not associated with hospital mortality (odds ratio 0.91, [0.28 to 2.93]). Conclusion: We found no association between pre-hospital frailty, physical function, strength, or mortality at hospital discharge in critically ill patients enrolled in an early rehabilitation trial. Larger sample sizes are needed to further explore the association of frailty with these outcomes at hospital discharge.

CITATION:
A. Takaoka ; D. Heels-Ansdell ; D.J. Cook ; M.E. Kho (2020): The Association between Frailty and Short-Term Outcomes in an Intensive Care Unit Rehabilitation Trial: An Exploratory Analysis. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.52

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EXPLORING ASSOCIATIONS BETWEEN ORAL HEALTH AND FRAILTY IN COMMUNITY-DWELLING OLDER PEOPLE

B. Everaars , K. Jerkovi? – ?osi?, N. Bleijenberg, N. J. de Wit, G.J.M.G. van der Heijden

J Frailty Aging 2021;10(1)56-62

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Background: In frail older people with natural teeth factors like polypharmacy, reduced salivary flow, a decrease of oral self-care, general healthcare issues, and a decrease in dental care utilization contribute to an increased risk for oral complications. On the other hand, oral morbidity may have a negative impact on frailty. Objective: This study explored associations between oral health and two frailty measures in community-dwelling older people. Design: A cross-sectional study. Setting: The study was carried out in a Primary Healthcare Center (PHC) in The Netherlands. Participants: Of the 5,816 persons registered in the PHC, 1,814 persons were eligible for participation at the start of the study. Measurements: Two frailty measures were used: 1. Being at risk for frailty, using Electronical Medical Record (EMR) data, and: 2. Survey-based frailty using ‘The Groningen Frailty Indicator’ (GFI). For oral health measures, dental-record data (dental care utilization, dental status, and oral health information) and self-reported oral problems were recorded. Univariate regression analyses were applied to determine the association between oral health and frailty, followed by age- and sex-adjusted multivariate logistic regressions. Results: In total 1,202 community-dwelling older people were included in the study, 45% were male and the mean age was 73 years (SD=8). Of all participants, 53% was at risk for frailty (638/1,202), and 19% was frail based on the GFI (222/1,202). A dental emergency visit (Odds Ratio (OR)= 2.0, 95% Confidence Interval (CI)=1.33;3.02 and OR=1.58, 95% CI=1.00;2.49), experiencing oral problems (OR=2.07, 95% CI=1.52;2.81 and OR=2.87, 95% CI= 2.07;3.99), and making dietary adaptations (OR=2.66, 95% CI=1.31;5.41 and OR=5.49, 95% CI= 3.01;10.01) were associated with being at risk for frailty and survey-based frailty respectively. Conclusions: A dental emergency visit and self-reported oral health problems are associated with frailty irrespective of the approach to its measurement. Healthcare professionals should be aware of the associations of oral health and frailty in daily practice.

CITATION:
B. Everaars ; K. Jerković – Ćosić ; N. Bleijenberg ; N. J. de Wit ; G.J.M.G. van der Heijden (2020): Exploring associations between oral health and frailty in community-dwelling older people. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.55

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SARCOPENIA AND ADVERSE POST-SURGICAL OUTCOMES IN GERIATRIC PATIENTS: A SCOPING REVIEW

M. Hossain, D. Yu, B. Bikdeli, S. Yu

J Frailty Aging 2021;10(1)63-69

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Background: Sarcopenia is associated with adverse outcomes in cancer, chemotherapy, solid organ transplants, intensive care and medical patients. It has also been proven to increase perioperative mortality, hospital length of stay and complications in patients of various age groups. However, a limited number of studies have examined the association of post-surgical outcomes and sarcopenia inclusively in patients aged 65 years and older. Objective: This scoping review aimed to examine the relationship between adverse post-surgical outcomes and sarcopenia in patients aged 65 years and older. Methodology: EMBASE and Medline databases were searched for sarcopenia, perioperative period and post-surgical outcomes. The articles were screened based on exclusion and inclusion criteria and were reviewed systematically as per the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. Results: After duplicates removal and application of the inclusion and exclusion criteria, eight articles were included for this study from a total of nine hundred initially identified articles. All studies defined sarcopenia as low muscle mass but did not include physical function or muscle strength as the parameter of sarcopenia. Low muscle mass was associated with higher mortality in emergency surgeries, reduced long term survival in open elective surgeries, and increased length of hospital stay in endoscopic surgeries. Conclusion: The current review suggests that low muscle mass is associated with higher mortality and various adverse post-surgical outcomes in the elderly. It remains to be determined if applying the definition of sarcopenia as per the international consensus/guidelines will affect the association of adverse post-surgical outcomes and sarcopenia.

CITATION:
M. Hossain ; D. Yu ; B. Bikdeli ; S. Yu (2020): Sarcopenia and adverse post-surgical outcomes in geriatric patients: a scoping review. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.27

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“SAY NINETYNINE”: IT’S NEVER TOO LATE TO RECOVER FROM COVID-19

M. Tosato, F. Varone, A. Ciccullo, R. Calvani, D. Moschese, A. Potenza, M. Siciliano, M. Fantoni

J Frailty Aging 2021;10(1)70-71

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COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, showed higher severity and lethality in male older adults . There are currently no specific treatments. Studies are evaluating the efficacy of monoclonal antibodies against interleukin-6 receptor. Here we present the case of a 98-years old man admitted to our COVID-Hospital with acute respiratory failure. Comprehensive geriatric assessment showed no signs of frailty. First-line therapy with hydroxychloroquine and anticoagulants was not effective. Patient was administered intravenous monoclonal antibodies, and he showed remarkable clinical improvement. This case suggests that age alone should not preclude access to new therapeutic approaches. Comprehensive, multisciplinary, multidomain approaches are needed to develop patient-tailored treatments against COVID-19.

CITATION:
M. Tosato ; F. Varone ; A. Ciccullo ; R. Calvani ; D. Moschese ; A. Potenza ; M. Siciliano ; M. Fantoni (2020): “Say ninetynine”: It’s never too late to recover from COVID-19. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.41

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LETTER TO THE EDITOR: HEALTHY FOR LIFE: AN INNOVATIVE AND COLLABORATIVE APPROACH TO COVID 19 LOCKDOWN IN NEW ZEALAND

J. Parsons, D.L. Waters, E. Binns, V. Burholt, G. Cheung , S. Clare, R. Duncan, C. Fox, R. Gibson, A. Grant, G. Guy, T. Jackson, N. Kerse, R. Logan, K. Peri, C. Petagna, F. Stephens, D. Taylor, R. Teh, C. Wall

J Frailty Aging 2021;10(1)72

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CITATION:
J. Parsons ; D.L. Waters ; E. Binns ; V. Burholt ; G. Cheung ; S. Clare ; R. Duncan ; C. Fox ; R. Gibson ; A. Grant ; G. Guy ; T. Jackson ; N. Kerse ; R. Logan ; K. Peri ; C. Petagna ; F. Stephens ; D. Taylor ; R. Teh ; C. Wall (2020): Letter to the editor: Healthy for Life: an innovative and collaborative approach to COVID 19 lockdown in New Zealand . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.49

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LETTER TO THE EDITOR: COVID-19 AND PERSONS WITH DEMENTIA IN ACUTE CARE SETTINGS: HOW TO “EVADE” CHALLENGING BEHAVIORS

H. Tan , A.X. How, X.X. Wang, J.E. Lee, W.S. Lim

J Frailty Aging 2021;10(1)73-74

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CITATION:
H. Tan ; A.X. How ; X.X. Wang ; J.E. Lee ; W.S. Lim (2020): Letter to the editor: COVID-19 and Persons with Dementia in Acute Care Settings: How to “EVADE” Challenging Behaviors . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.53

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LETTER TO THE EDITOR: EFFECTS OF THE COVID-19 PANDEMIC ON COVID-19 NEGATIVE GERIATRIC PATIENTS WITH HIP FRACTURES

S.M. Lim, M. Tan , Y.L. Sze, L. Au

J Frailty Aging 2021;10(1)75-76

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CITATION:
S.M. Lim ; M. Tan ; Y.L. Sze ; L. Au (2020): Letter to the editor: Effects of the COVID-19 Pandemic on COVID-19 Negative Geriatric Patients with Hip Fractures . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.54

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LETTER TO THE EDITOR: IMPLEMENTING HOME-BASED EXERCISE TECHNOLOGY IN A NURSING HOME: DOES MCI STATUS MATTER?

F. Buckinx, D.L. Waters, M. Aubertin-Leheudre

J Frailty Aging 2021;10(1)77-78

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CITATION:
F. Buckinx ; D.L. Waters ; M. Aubertin-Leheudre (2020): Letter to the editor: Implementing home-based exercise technology in a nursing home: does MCI status matter?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.34

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LETTER TO THE EDITOR: ADJUSTING ANTERIOR THIGH MUSCLE MEASUREMENTS USING ULTRASOUND IN SARCOPENIA

A.M. Ata, M. Kara, L. Özçakar

J Frailty Aging 2021;10(1)79-80

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CITATION:
A.M. Ata ; M. Kara ; L. Özçakar (2020): Letter to the editor: Adjusting Anterior Thigh Muscle Measurements Using Ultrasound in Sarcopenia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.32

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