Ahead of print articles
MAXIMISING INCLUSIVITY IN CARE HOME RESEARCH: LESSONS LEARNED FROM THE AFRI-C RANDOMISED CONTROLLED TRIAL
Laurel Campbell-Smith, Sophie Rees, Jane Sprackman, Karen Sargent, Alastair D Hay, Rachel CM Brierley
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Ethical and procedural requirements make research in care homes challenging. With people living longer globally, it is essential that older people are included in research, including within the care home setting. We conducted a randomised controlled trial (AFRI-c) in 91 care homes across England, aiming to make the study available to every eligible resident. Facilitators included flexible models for receiving consent; commitment from care home staff, residents and families; tailored and specific training for care home staff; and support from national research infrastructure to engage care homes in research. To facilitate inclusive care home research, we recommend consulting with care homes about their research priorities; continuing investment in national research infrastructure for care homes; using advance directives for research planning for care home residents; embedding research nurses in care home environments; and more guidance for researchers and ethics committees on applying legal frameworks regarding capacity to research settings.
CITATION:
Laurel Campbell-Smith ; Sophie Rees ; Jane Sprackman ; Karen Sargent ; Alastair D Hay ; Rachel CM Brierley (2025): Maximising inclusivity in care home research: Lessons learned from the AFRI-c randomised controlled trial. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100038
IMMEDIATE ADMISSION TO THE SURGERY HOSPITAL SIGNIFICANTLY OPTIMISES QUALITY INDICATORS IN OLDER PATIENTS WITH HIP FRACTURES: A BEFORE-AND-AFTER STUDY
José Luis Dinamarca-Montecinos, Alejandra Leiva Vásquez, Carmelinda Ruggiero, Yasna Barrera Fernández, Rayén Delgado Gac, Ada Carrillo, Gedeón Lazcano Améstica, Daniel Ulloa Vásquez, Fernando Aranda, Andrés Canales Pizarro, Graciela Mardones, Constanza Morales Gherardelli, Victoria Assael Novik, Osvaldo Sepúlveda, Jossie Acuña, Carola Arancibia Aravena, Julio Ibarra, Jack Bell, Emma Sutton
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BACKGROUND: Hip fractures generate high biomedical, social, functional, organisational, and economic costs. There are various quality indicators to guide its management. One of them is surgery within 48–72 h. In Chilean public health system, this indicator has out-of-standard results. This situation could have organizational causes: after hip fracture diagnosis, many older patients are first referred to general hospitals, whilst waiting an orthopedic surgical bed.
OBJECTIVE: To evaluate the effects of a protocol of immediate-admission to the surgery hospital on organisational and economic indicators of hip-fractured older patients.
DESIGN: Before-and-after study, between 01/01/2017–09/30/2019; 12 months before and 21 months after implementation.
SETTING: Regional surgical hospital responsible for 87 % of the older population in its assigned territory, in the more aged region of Chile.
PARTICIPANTS: Anonymised data of 902 hip-fractured older adults (≥ 60 years).
INTERVENTION: Implementation of a protocol that requires immediate admission to the surgical hospital of all older hip-fractured patients at the time of diagnosis.
MEASUREMENTS: Number of hip-fractured patients with no immediate admission, time to surgery, total in-hospital time, and economic costs. Normality tests (Kolmogorov-Smirnov), non-parametric tests (Chi-squared), Mann-Whitney and Kruskal-Wallis tests were performed. Measures of central tendency (medians and percentiles) were used.
RESULTS: After protocol there was a significant reduction in the proportion of patients referred to general hospitals in both, first and second year (pre=37,8 %; post 1 = 27,3 %; post 2 = 23,3 %, p = 0,000). Time to surgery was also significantly reduced (medians bed days pre=15, post 1 = 11, post 2 = 10, p = 0,000). Total in-hospital time decreased 21 % (3395 bed days), and there was also a significant decrease in costs from USD130,000 to USD35,000 (p = 0,000).
CONCLUSION: Immediate admission to orthopedic surgical hospital of older adults with hip fractures significantly decreases inter-hospital transfers, time to surgery, total in-hospital time, and direct hospital costs.
CITATION:
José Luis Dinamarca-Montecinos ; Alejandra Leiva Vásquez ; Carmelinda Ruggiero ; Yasna Barrera Fernández ; Rayén Delgado Gac ; Ada Carrillo ; Gedeón Lazcano Améstica ; Daniel Ulloa Vásquez ; Fernando Aranda ; Andrés Canales Pizarro ; Graciela Mardones ; Constanza Morales Gherardelli ; Victoria Assael Novik ; Osvaldo Sepúlveda ; Jossie Acuña ; Carola Arancibia Aravena ; Julio Ibarra ; Jack Bell ; Emma Sutton (2025): Immediate admission to the surgery hospital significantly optimises quality indicators in older patients with hip fractures: A before-and-after study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100014
PSOAS MUSCLE DENSITY PREDICTS ELECTIVE COLORECTAL SURGICAL OUTCOMES MORE ACCURATELY THAN PSOAS MUSCLE AREA OR INDEXED AREA
Louis Scarrold, Douglas Stupart, David Watters
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BACKGROUND: CT measurements of psoas muscle density (PMD) and area (PMA) (with or without indexing to height-squared or body-surface-area) are used interchangeably as sarcopenia measures - it is unknown which best correlates with surgical risk.
OBJECTIVES: 1.Determine the correlation between psoas muscle density, area, and indexed area;
2.Identify which psoas measures most strongly associated with surgical outcomes
DESIGN: The University Hospital Geelong Colorectal database included all patients who underwent elective colorectal surgery from 2007 to 2014 (minimum five-years follow-up). Pre-operative CT scans were reviewed, psoas measures correlated with each other and with outcomes.
SETTING: University Hospital Geelong is a regional referral hospital in Victoria, Australia.
PARTICIPANTS: This database listed 552 patients, 120 were excluded as pre-operative CT-films were not accessible, leaving 432 patients included.
EXPOSURE: Psoas muscle density, area, and area indexed by height-squared and body-surface-area.
MEASUREMENTS: Pearson correlations investigated correlations between psoas muscle measures. Logistic regression and ROC-analysis investigated each psoas measures association with peri‑operative morbidity. Kaplan-Meier survival-analysis investigated the association of each psoas measure with long-term survival.
RESULTS: Mean age was 70.4 years, 41 % were female.
Psoas muscle density correlated poorly with area (R2=0.15). Unindexed psoas muscle area correlated well with area indexed by height-squared (R2=0.950) and body-surface-area (R2=0.938).
Long-term survival was associated with psoas muscle density (HR1.515(95 %CI 1.062–2.161)) and area (HR1.886(95 %CI 1.322–2.692)).
Increasing psoas muscle density (reduced sarcopenia) was associated with decreased major-complications (OR0.963(95 %CI 0.938–0.989)) and peri‑operative mortality (OR0.903(95 %CI 0.847–0.962)), with ROC-curve AUC=0.829 indicating an accurate test. There was no association between psoas muscle area and major-complications (OR1.000(95 %CI 1.000–1.000)), nor peri‑operative mortality (OR1.000(95 %CI 0.999–1.001)), with ROC-curves AUC=0.507–0.521.
Indexed area measures were not associated with outcomes.
CONCLUSIONS: Psoas muscle density and area did not correlate. Both were associated with long-term survival, but only density was associated major-complications and mortality. Indexing removed the correlation of area with long-term survival.
CITATION:
Louis Scarrold ; Douglas Stupart ; David Watters (2025): Psoas muscle density predicts elective colorectal surgical outcomes more accurately than psoas muscle area or indexed area. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100037
JFA N°02 - 2025
GENETIC DETERMINANTS OF MUSCLE HEALTH: A POPULATION-BASED STUDY
Sylvia Maria Affonso da Silva, Priscila Farias Tempaku, Ronaldo D Piovezan, Monica Levy Andersen, Sergio Tufik, Vânia D\'Almeida
J Frailty Aging 2025;14(2)
Show summaryHide summaryBACKGROUND: Muscle mass is associated with physical and functional performance across adulthood. Its reduction plays a crucial role in the development of age-related conditions such as frailty and sarcopenia. Genetic variations potentially impact muscle health, particularly in an aged population.
OBJECTIVES: For this reason, we aimed to evaluate the association between genetic biomarkers and appendicular lean mass index (ALMI), a marker of muscle health, to identify possible risk factors for age-related sarcopenia in a population-based study.
MATERIALS AND METHODS: We cross-sectionally analyzed data collected in 2015 from the São Paulo Epidemiologic Sleep Study (EPISONO). Participants underwent bioelectrical impedance and genetic evaluations.
RESULTS: After adjusting the data for age and sex, 12 single nucleotide polymorphisms (SNP) were significantly associated with ALMI. Among them, rs9928094 (beta = −0.031 p = 0.029) and rs9930333 (beta = −0.030 p = 0.035) are located in the FTO gene, which is related to obesity and fat gain and, rs16839632 (beta = 0.038 p = 0.029) located in the FMN2 gene, responsible for actin cytoskeleton and cell polarity.
CONCLUSIONS: Poor muscle health is a multifactorial condition and genetic biomarkers can support the stratification of the risk for adverse body composition states affecting muscle and physical performance across adulthood.
CITATION:
Sylvia Maria Affonso da Silva ; Priscila Farias Tempaku ; Ronaldo D Piovezan ; Monica Levy Andersen ; Sergio Tufik ; Vânia D'Almeida (2025): Genetic determinants of muscle health: A population-based study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100013
DEVELOPING AN ELECTRONIC FRAILTY INDEX (EFI) AND A BIOLOGICAL AGE TRAJECTORY WITH A COHORT OF OVER ONE MILLION OLDER ADULTS IN HONG KONG
Tung Wai Auyeung, Carolyn Poey Lyn Kng, Tak Yeung Chan, Elsie Hui, Chi Shing Leung, James Ka Hay Luk, Kwok Yiu Sha, Teresa Kim Kum Yu
J Frailty Aging 2025;14(2)
Show summaryHide summaryBACKGROUND: Electronic health record (EHR) has been in place in many parts of the world. This fits in very well to the frailty index calculation proposed by Rockwood and thus a frailty index can potentially be generated automatically from an EHR database. Therefore, the Hong Kong Hospital Authority (HA) attempted to develop an electronic frailty index (HK eFI), by employing thirty-eight health variables from her own EHR database.
METHODS: Five cohorts of patients aged 60 years or above ever attended any services provided by the Hong Kong HA in the year 2015, 2016, 2017, 2018 and 2019, were included. The HK eFI trajectory with ageing, generated by the five cohorts, were compared to the one described by Rockwood's group. Following the UK eFI method, 4 levels of frailty were categorized, and they were examined whether they were related to mortality, readmission rate and hospitalization patient days.
RESULTS: Each successive cohort consisted of increasing number of patients aged 60 years or above. (2015, 1.14 million; 2016, 1.19 million; 2017,1.25 million; 2018, 1.31 million; 2019, 1.38 million). The gradients of the five trajectories ranged from 0.035 to 0.037, representing an increase in FI approximately 3.6 % annually. The intercept of the curves converged at 0.1, representing the FI at age 60 years was 0.1. Compared to the fit group, the adjusted hazard ratios of mortality of the mild, moderate and severe frail group were 1.77, 3.31 and 6.65 respectively and they were all statistically higher than the fit group. (p < 0.005) Likewise, there was a stepwise increase in readmission rate and hospital patient days utilization with increasing frailty levels.
CONCLUSION: It is feasible to develop an eFI and a biological age trajectory from a large EHR database with local adaptation.
CITATION:
Tung Wai Auyeung ; Carolyn Poey Lyn Kng ; Tak Yeung Chan ; Elsie Hui ; Chi Shing Leung ; James Ka Hay Luk ; Kwok Yiu Sha ; Teresa Kim Kum Yu (2025): Developing an Electronic Frailty Index (eFI) and a biological age trajectory with a cohort of over one million older adults in Hong Kong. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100021
THE DEVELOPMENT OF FRAILTY TRAJECTORIES IN WORLD TRADE CENTER GENERAL RESPONDERS AND THE ASSOCIATION WITH WORLD TRADE CENTER EXPOSURE
Hannah M. Thompson, Katherine A. Ornstein, Elena Colicino, Nicolo Foppa Pedretti, Ghalib Bello, Ahmad Sabra, Erin Thanik, Roberto G. Lucchini, Michael Crane, Susan L. Teitelbaum, William W. Hung, Fred Ko
J Frailty Aging 2025;14(2)
Show summaryHide summaryBACKGROUND: As the World Trade Center (WTC) General Responder Cohort ages, it is imperative to study their aging process and identify factors that can be targeted for interventions.
OBJECTIVES: Our goal was to utilize a previously developed WTC Clinical Frailty Index (CFI) to identify distinct frailty trajectories and associated factors in this cohort.
DESIGN: A latent class mixed model evaluated frailty trajectories using WTC CFIs. Multinomial regression models were used to assess associations between frailty trajectory and sociodemographic and WTC characteristics.
SETTING: We utilized data collected during routine WTC monitoring visits from 2004 until 2021.
PARTICIPANTS: The participants were WTC general responders.
MEASUREMENTS: Relative risk ratios (RRR) assessed associations with a 95 % confidence interval (CI).
RESULTS: Three distinct linear frailty trajectories were identified: high CFI (indicating higher frailty), low CFI, and progressively increasing CFI. Compared with the low CFI group, females were more likely to be in the high CFI and progressively increasing CFI groups (RRR 1.66, 95 %CI 1.46, 1.90; RRR 1.32, 95 %CI 1.15, 1.53, respectively). Education beyond high school and elevated income were protective against high CFI and progressively increasing CFI groups. Individuals that self-identified as Hispanic had an elevated RRR for the high CFI group (RRR 1.17, 95 %CI 1.04, 1.31). Occupation on 9/11, such as construction and maintenance and repair, as well as high/very high WTC exposure were significantly associated with both the high CFI and progressively increasing CFI groups.
CONCLUSIONS: Several sociodemographic and WTC variables were associated with more hazardous frailty trajectories in WTC general responders. This work is beneficial to informing and directing future interventions for those at higher-risk for more hazardous frailty progression.
CITATION:
Hannah M. Thompson ; Katherine A. Ornstein ; Elena Colicino ; Nicolo Foppa Pedretti ; Ghalib Bello ; Ahmad Sabra ; Erin Thanik ; Roberto G. Lucchini ; Michael Crane ; Susan L. Teitelbaum ; William W. Hung ; Fred Ko (2025): The development of frailty trajectories in world trade center general responders and the association with World Trade Center Exposure. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100027
NATIONWIDE INSIGHTS INTO FRAILTY: SYSTEMATIC REVIEW AND META-ANALYSIS OF COMMUNITY-BASED PREVALENCE STUDIES FROM INDIA
Sunanda Gupta, Aninda Debnath, Ankit Yadav, Anubhav Mondal, Shweta Charag, Jugal Kishore
J Frailty Aging 2025;14(2)
Show summaryHide summaryFrailty, a biologic syndrome of decreased reserve and resistance to stressors, affects 5 % to 17 % of older adults and is linked to factors like low BMI, female sex, and low exercise levels. With India's older population expected to double by 2050, frailty presents major public health and economic challenges. This study summarizes the prevalence of frailty among community-dwelling Indians. This systematic review and meta-analysis followed PRISMA guidelines to determine the prevalence of frailty among adults in India. We conducted a comprehensive search across multiple databases, including PubMed, Scopus, EMBASE, and Web of Science, up to January 16, 2024, excluding hospital-based studies and reviews. Data were analyzed using STATA software with a random-effects model, and quality was assessed using the JBI Critical Appraisal Checklist. The meta-analysis revealed a pooled frailty prevalence of 36 % (95 % CI: 29 % to 44 %) among 330,007 community-dwelling adults in India, with significant heterogeneity across studies (I² = 99.95 %). Frailty prevalence varied by assessment method, with 48 % using the frailty index and 31 % using the Fried phenotype. Subgroup analyses indicated significant variability in frailty prevalence by gender, data source, and assessment tool, with no significant publication bias detected. This meta-analysis found a pooled frailty prevalence of 36 % and pre-frailty prevalence of 48 % among adults in India, with higher frailty in women (45 %) than men (35 %) and variation across assessment tools. Future research should focus on longitudinal studies and developing tailored frailty assessment tools.
CITATION:
Sunanda Gupta ; Aninda Debnath ; Ankit Yadav ; Anubhav Mondal ; Shweta Charag ; Jugal Kishore (2025): Nationwide insights into frailty: Systematic review and meta-analysis of community-based prevalence studies from India. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100032
A SYSTEMATIC REVIEW OF ASSESSMENT TOOLS FOR COGNITIVE FRAILTY: USE, PSYCHOMETRIC PROPERTIES, AND CLINICAL UTILITY
Kate Dobie, Christopher J. Barr, Stacey George, Nicky Baker, Morgan Pankhurst, Maayken Elizabeth Louise van den Berg
J Frailty Aging 2025;14(2)
Show summaryHide summaryBACKGROUND: The concept of ‘cognitive frailty’ (CF) was first developed by an international consensus group in 2013 and defined as evidence of both physical frailty and cognitive impairment without a clinical diagnosis of AD or another dementia. CF has been associated with adverse health outcomes and early identification is vital. Difficulty in the assessment of CF however is the lack of a diagnostic gold standard.
OBJECTIVES: This review aimed to identify assessment tools used to diagnose cognitive impairment in the diagnosis of cognitive frailty, their psychometric qualities and clinical utility. RESEARCH DESIGN AND METHOD: Six databases were searched between 2013–2024. Studies were eligible if they reported a method of defining cognitive frailty, named the assessment tools, and stated cutoff values used to define cognitive impairment.
RESULTS: In the 116 included studies, large heterogeneity was found in the tools utilised, and cutoff scores applied, to diagnose cognitive impairment in the diagnosis of cognitive frailty. This review has demonstrated that diagnosis of CF relies predominantly on the use of three cognitive assessment tools (Mini Mental State Examination, Montreal Cognitive Assessment, Clinical Dementia Rating) from a total of 22 different tools identified in the literature. For assessment of physical frailty, 11 different tools were identified, with the Fried Frailty Index and FRAIL Scale predominantly utilised.
DISCUSSION AND IMPLICATIONS: The variation in the tools used to identify the diagnosis of CF means there is inconsistency in reporting, potentially impacting both the understanding of the prevalence, and the appropriate direction of intervention strategies.
CITATION:
Kate Dobie ; Christopher J. Barr ; Stacey George ; Nicky Baker ; Morgan Pankhurst ; Maayken Elizabeth Louise van den Berg (2025): A systematic review of assessment tools for cognitive frailty: Use, psychometric properties, and clinical utility. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100033
CARDIOMETABOLIC DISEASE AMONG FRAILTY PHENOTYPE CLUSTERS IN ADULTS AGING WITH HIV
Raymond Jones, Ene M. Enogela, Stephanie A. Ruderman, Mari M. Kitahata, Richard Moore, Jeffrey M. Jacobson, Maile Karris, Meredith Greene, Julia Fleming, Sonia Napravnik, Greer Burkholder, Joseph A.C. Delaney, Heidi M. Crane, Amanda L. Willig, Thomas W. Buford
J Frailty Aging 2025;14(2)
Show summaryHide summaryBACKGROUND: Age-related morbidity, including frailty and cardiometabolic disease has become increasingly prevalent among people living with HIV (PWH), and each frailty characteristic may, independently and synergistically, play a role in cardiometabolic disease.
OBJECTIVE: To evaluate the prevalence of unique frailty clusters and the prevalence ratios of cardiometabolic diseases within frailty clusters among a large diverse cohort of PWH in clinical care.
DESIGN: Cross-sectional analyses within longitudinal clinical cohort.
SETTING: The Center for AIDS Research Network of Integrated Clinical Systems (CNICS) from 8 Clinics.
PARTICIPANTS: 4,856 PWH, mean age 61 years. 16 % frail, 45 % pre-frail, 40 % robust.
MEASUREMENTS: The validated, modified Fried Phenotype from patient-reported outcomes and clustering (15 clusters) of the frailty characteristics and cardiometabolic diseases (7 diseases and multimorbidity) within each cluster.
RESULTS: Among 4856 PWH (age: 61 ± 6 years), the prevalence of frail, pre-frail, and robust was 16 %, 45 %, and 40 %, respectively. The most prevalent cardiometabolic disease among frail PWH was hypertension (62.6 %), followed by dyslipidemia (58.8 %) and diabetes (31.4 %). Among pre-frail PWH, the most prevalent cardiometabolic diseases were dyslipidemia (65.8 %), hypertension (61.8 %), and obesity (30.5 %). The prevalence of cardiometabolic disease among frailty clusters varied. For example, PWH in the “fatigue + poor mobility” cluster had a greater prevalence of cerebrovascular disease (PR: 2.23; 95 % CI: 1.01–4.91), diabetes (1.76; 95 % CI: 1.41–2.21), and obesity (1.66; 95 % CI: 1.35–2.05) when compared with robust PWH. Individuals in the “poor mobility” cluster had a higher prevalence of diabetes (1.37; 95 % CI: 1.15–1.64), hypertension (1.12; 95 % CI: 1.04 – 1.22), and obesity (1.38; 95 % CI: 1.17–1.61) compared with robust PWH.
CONCLUSIONS: The frailty components, independently and synergistically, were associated with an increased prevalence of cardiometabolic disease. This study identified distinct frailty clusters that may be associated with increased prevalence of cardiometabolic disease among PWH.
CITATION:
Raymond Jones ; Ene M. Enogela ; Stephanie A. Ruderman ; Mari M. Kitahata ; Richard Moore ; Jeffrey M. Jacobson ; Maile Karris ; Meredith Greene ; Julia Fleming ; Sonia Napravnik ; Greer Burkholder ; Joseph A.C. Delaney ; Heidi M. Crane ; Amanda L. Willig ; Thomas W. Buford (2025): Cardiometabolic disease among frailty phenotype clusters in adults aging with HIV. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100011
CHANGES IN FRAILTY PREDICT SOCIAL VULNERABILITY AMONG HOME CARE CLIENTS LIVING IN THE COMMUNITY FOLLOWED FOR TEN YEARS
Jasmine C. Mah, Melissa K. Andrew, Jack Quach, Susan Stevens, Janice Keefe, Kenneth Rockwood, Judith Godin
J Frailty Aging 2025;14(2)
Show summaryHide summaryBACKGROUND: Among community dwelling older adults, social vulnerability increases with age. Advanced age alone does not fully explain how or why older adults become more socially vulnerable; frailty may offer a better explanation.
OBJECTIVE: We aimed to understand how change in frailty relates to change in social vulnerability over time.
DESIGN: Retrospective cohort study.
SETTING AND PARTICIPANTS: We analyzed older adults aged 65 years and older from the province of Nova Scotia who accessed publicly funded home care in 2005 and 2008 followed for up to ten years.
MEASUREMENTS: We measured social vulnerability and frailty using indices. Controlling for time constant covariates, multi-level growth modelling was used to evaluate whether within-person changes in frailty were associated with within person changes in social vulnerability, after accounting for between-person differences.
RESULTS: There were 2,791 older adults in the 2005 cohort and 2,741 older adults in the 2008 cohort. Mean age, frailty index and social vulnerability index were 80.6 years (SD 7.5), 0.23 (SD 0.10), 0.22 (SD 0.07) and 80.4 (SD 7.6), 0.23 (SD 0.10), and 0.23 (SD 0.07) for each cohort respectively. After accounting for age, sex and baseline frailty, a 0.1 point increase in change of FI from baseline was associated with a 0.017 (CI 0.016 – 0.019, p < 0.001) increase in SVI in the 2005 cohort and a 0.014 (CI 0.013 – 0.016, p < 0.001) increase in SVI in the 2008 cohort.
CONCLUSIONS: Although social vulnerability tends to remain constant in the absence of increases in frailty, changes in frailty are closely associated with changes in social vulnerability. Incorporating within-person changes in health into quantitative models of late-life social vulnerability may further improve our understanding of how and why some individuals are able to stay in the community despite their vulnerabilities.
CITATION:
Jasmine C. Mah ; Melissa K. Andrew ; Jack Quach ; Susan Stevens ; Janice Keefe ; Kenneth Rockwood ; Judith Godin (2025): Changes in frailty predict social vulnerability among home care clients living in the community followed for ten years. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100031
ASSOCIATION OF OBJECTIVE AND SUBJECTIVE SOCIOECONOMIC STATUS WITH INTRINSIC CAPACITY DEFICITS AMONG COMMUNITY-DWELLING MIDDLE-AGED AND OLDER ADULTS IN CHINA: A CROSS-SECTIONAL STUDY
Fangqin Tan, Xiaoxia Wei, Ji Zhang, Yihao Zhao, Yue Zhang, Haiying Gong, Jean-Pierre Michel, Enying Gong, Ruitai Shao
J Frailty Aging 2025;14(2)
Show summaryHide summaryBACKGROUND: Intrinsic capacity (IC), representing an individual's full range of physical and mental abilities, is influenced by objective socioeconomic status (SES); however, the impact of subjective SES remains unclear.
OBJECTIVES: This study aims to assess IC and investigate the relationship between SES and IC deficits, with a particular focus on the role of subjective SES.
DESIGN: Cross-sectional study.
SETTING: 45 communities in two provinces in China
PARTICIPANTS: Community-dwelling middle-aged and older adults aged 50 and above
MEASUREMENTS: IC was assessed following the Integrated Care for Older People guideline. SES was measured through objective SES (education and occupation) and subjective SES (measured by MacArthur Scale). Ordinal logistic regression models were performed to estimate the association between SES and IC.
RESULTS: Among 3,058 participants (61.3 ± 8.05 years, 54.8 % women), 2,333 (76.3 %) showed deficits in at least one IC subdomain, particularly sensory (63.5 %), vitality (25.8 %) and cognition (18.4 %). A dose-response association was observed between SES and IC deficits. Individuals with high subjective SES (OR: 0.72, 0.60–0.87), high education (OR: 0.54, 0.38–0.75), and high occupation (OR: 0.64 0.50–0.81) exhibited lower IC deficits risk compared with counterparts. Individuals with high education and middle subjective SES or high occupation and middle subjective SES had 67 % (OR: 0.33, 0.18–0.60) and 49 % (OR: 0.51, 0.35–0.74) lower risk than those with low SES.
CONCLUSIONS: These findings suggest that individuals with low SES may be more vulnerable to IC deficits. Addressing social inequalities in the early assessment of IC is crucial for reducing health disparities and promoting healthy ageing.
CITATION:
Fangqin Tan ; Xiaoxia Wei ; Ji Zhang ; Yihao Zhao ; Yue Zhang ; Haiying Gong ; Jean-Pierre Michel ; Enying Gong ; Ruitai Shao (2025): Association of objective and subjective socioeconomic status with intrinsic capacity deficits among community-dwelling middle-aged and older adults in China: A cross-sectional study. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100036
PREVALENCE AND RISK FACTORS OF FRAILTY IN PEOPLE EXPERIENCING HOMELESSNESS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Thomas Cronin, David Healy, Noel McCarthy, Susan M Smith, John Travers
J Frailty Aging 2025;14(2)
Show summaryHide summaryBACKGROUND: The experience of homelessness has been associated with premature ageing and an earlier onset of geriatric syndromes. Identification of frailty and appropriate intervention, may help improve health outcomes for people experiencing homelessness (PEH). This review aimed to identify prevalence, use of screening tools and risk factors for frailty in PEH.
METHODS: A systematic review, conducted and reported following the PRISMA checklist, was undertaken investigating the prevalence and risk factors of frailty among PEH. Searches were conducted in Ovid MEDLINE, PsycInfo, Web of Science and CINAHL from inception to July 2024. A meta-analysis examining prevalence of frailty and pre-frailty was completed with a narrative synthesis of related risk factors.
RESULTS: A total of 1672 articles were screened for eligibility and 11 studies were included, containing 1017 participants from seven countries. Six different screening tools were employed to detect frailty in the included studies. The range of frailty prevalence was 16–70 % and pre-frailty prevalence was 18–60 %. The pooled frailty prevalence from studies employing the Fried Criteria was 39 % (95 % CI 15–66); the Clinical Frailty Scale: 37 % (95 % CI 24–51); the Edmonton Frailty Scale: 53 % (95 % CI 44–63); and the Tilburg Fraily Indicator: 31 % (95 % CI 8–60). High heterogeneity was observed between the studies. Identified risk factors for developing frailty in PEH included being female, increased years spent homeless, and drug addiction.
CONCLUSION: This study highlights a high prevalence of frailty and pre-frailty in PEH. The identified risk factors illustrate potential areas to target interventions to reverse frailty. Future research should focus on the role of screening for frailty in PEH and developing appropriate frailty detection tools in this group.
CITATION:
Thomas Cronin ; David Healy ; Noel McCarthy ; Susan M Smith ; John Travers (2025): Prevalence and risk factors of frailty in people experiencing homelessness: A systematic review and meta-analysis. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100029
COMMUNITY-BASED PHYSICAL ACTIVITY AND NUTRITION INTERVENTIONS IN LOW-INCOME AND/OR RURAL OLDER ADULTS: A SCOPING REVIEW
Elizabeth Bernard, Nash Brewer, Jeanette C Prorok, Perry Kim, John Muscedere
J Frailty Aging 2025;14(2)
Show summaryHide summaryThe objective of this review was to identify evidence-based, community-based physical activity (PA) and nutrition-based programs aimed at facilitating health behaviour change among low-income older adults and/or those living in rural/remote areas. This review followed the scoping review methodology proposed by Arksey & O'Malley. The Michie behaviour change wheel was used to categorize intervention types. Of the 2954 retrieved citations, 25 articles met the inclusion criteria. All study interventions demonstrated positive outcomes, including improvements in fruit and vegetable consumption, PA levels, physical function and nutrition knowledge. Study findings highlight that PA and nutrition-based interventions can be effective to facilitate behavior change in low-income and/or rural older adults. Limited research exists looking specifically at older adults living in rural communities, with only two of the 25 included articles including rural study populations.
CITATION:
Elizabeth Bernard ; Nash Brewer ; Jeanette C Prorok ; Perry Kim ; John Muscedere (2025): Community-based physical activity and nutrition interventions in low-income and/or rural older adults: A scoping review. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100034
DIFFERENCES IN THE RISK OF FRAILTY BASED ON CARE RECEIPT, UNMET CARE NEEDS AND SOCIO-ECONOMIC INEQUALITIES: A LONGITUDINAL ANALYSIS OF THE ENGLISH LONGITUDINAL STUDY OF AGEING
David R Sinclair, Asri Maharani, Andrew Clegg, Barbara Hanratty, Gindo Tampubolon, Chris Todd, Raphael Wittenberg, Terence W O\'Neill, Fiona E Matthews
J Frailty Aging 2025;14(2)
Show summaryHide summaryBACKGROUND: The older population is increasingly reliant on social care, especially those who are frail. However, an estimated 1.5 million people over 65 in England have unmet care needs. The relationship between receiving care, or receiving insufficient care, and changes in frailty status remains unclear.
OBJECTIVES: To investigate the associations between care receipt (paid or unpaid), unmet care needs, frailty status, and mortality.
DESIGN: We used multistate models to estimate the risk of increasing or decreasing levels of frailty, using English Longitudinal Study of Ageing (ELSA) data. Covariates included age, gender, wealth, area deprivation, education, and marital status. Care status was assessed through received care and self-reported unmet care needs, while frailty status was determined using a frailty index.
PARTICIPANTS: 15,003 individuals aged 50+, using data collected over 18 years (2002–2019).
RESULTS: Individuals who receive care are more susceptible to frailty and are less likely to recover from frailty to a less frail state. The hazard ratio of males receiving care transitioning from prefrailty to frailty was 2.1 [95 % CI: 1.7–2.6] and for females 1.8 [1.5–2.0]. Wealth is an equally influential predictor of changes in frailty status: individuals in the lowest wealth quintile who do not receive care are as likely to become frail as those in the highest wealth quintile who do receive care. As individuals receiving care (including unpaid care) are likely to be in poorer health than those who do not receive care, this highlights stark inequalities in the risk of frailty between the richest and poorest individuals. Unmet care needs were associated with transitioning from prefrailty to frailty for males (hazard ratio: 1.7 [1.2–2.4]) but not for females.
CONCLUSIONS: Individuals starting to receive care (paid or unpaid) and people in the poorest wealth quintile are target groups for interventions aimed at delaying the onset of frailty.
CITATION:
David R Sinclair ; Asri Maharani ; Andrew Clegg ; Barbara Hanratty ; Gindo Tampubolon ; Chris Todd ; Raphael Wittenberg ; Terence W O'Neill ; Fiona E Matthews (2025): Differences in the risk of frailty based on care receipt, unmet care needs and socio-economic inequalities: A longitudinal analysis of the English Longitudinal Study of Ageing. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100012
FRAILTY AND ASSOCIATED HEALTHCARE EXPENDITURES AMONG PATIENTS UNDERGOING TOTAL HIP AND KNEE ARTHROPLASTY
Donna Ron, Alton B. Daley , Marcus P. Coe, Michael D. Herrick, Robert H. Roth, Alexander T. Abess, Pablo Martinez-Camblor, Stacie G. Deiner , Myles D. Boone
J Frailty Aging 2025;14(2)
Show summaryHide summaryBACKGROUND: Major joint surgery is one of the largest components of Medicare spending in the US and the most frequent major procedure performed in older adults. Increasing age is associated with increasing prevalence of frailty, but the influence of frailty on healthcare expenditures following arthroplasty has yet to be adequately explored.
OBJECTIVE: To explore the association between frailty and healthcare expenditures in the year following total hip and knee arthroplasties.
DESIGN: Retrospective cohort study.
SETTING: United States population.
PARTICIPANTS: Medicare beneficiaries 65 and older undergoing total knee or hip arthroplasty (n = 1,152,872) from 2017 through 2018.
MEASUREMENTS: Claims-based frailty index (exposure), total 1-year Medicare expenditures broken down by category (primary outcome), in-hospital complications, length of stay, discharge destination, readmission and mortality (secondary outcomes).
RESULTS: Among 435,496 patients who underwent hip (37.8 %) and 717,376 patients who underwent knee arthroplasty (62.2 %), the mean age was 73.7 years and 19.2 % were classified as frail. Median total expenditures in US dollars at one year were higher in those with frailty ($247,503; IQR [$169,400-$391,176]) relative to the prefrail ($179,379 [$127,396-$265,039]) and robust ($130,314 [$85,438-$199,605]) groups. Total expenditures included the index surgical admission, rehospitalization, skilled nursing care, and outpatient care, all of which were higher with increasing frailty. However, the surgical procedure accounted for less than a third of the total 1-year healthcare costs and was the category with the lowest degree of variation between patients. Frailty was also associated with longer lengths of stay, higher risks of complications, readmission, and mortality and lower likelihood of being discharged home after the procedure.
CONCLUSIONS: Among older adults undergoing total hip and knee arthroplasty, frailty is associated with higher healthcare expenditures, predominantly driven by longitudinal care during the year following the procedure. More research is needed to test interventions to improve outcomes and reduce cost in this high-risk population.
CITATION:
Donna Ron ; Alton B. Daley ; Marcus P. Coe ; Michael D. Herrick ; Robert H. Roth ; Alexander T. Abess ; Pablo Martinez-Camblor ; Stacie G. Deiner ; Myles D. Boone (2025): Frailty and associated healthcare expenditures among patients undergoing total hip and knee arthroplasty. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100030
GETTING FIT FOR HIP AND KNEE REPLACEMENT: THE FIT-JOINTS MULTIMODAL INTERVENTION FOR FRAIL PATIENTS WITH OSTEOARTHRITIS – A PILOT RANDOMIZED CONTROLLED TRIAL
Chinenye Okpara, Ahmed Negm, Jonathan Derrick Adachi, David Armstrong, Stephanie Atkinson, Victoria Avram, Justin de Beer, Genevieve Hladysh, George Ioannidis, Courtney Kennedy, Patricia Hewston, Arthur Lau, Justin Lee, Julie Richardson, Sharon Marr, Akbar Panju, Danielle Petruccelli, Lehana Thabane, Mitchell Winemaker, Alexandra Papaioannou
J Frailty Aging 2025;14(2)
Show summaryHide summaryBACKGROUND: Older adults with frailty have high risk for poor postoperative outcomes.
OBJECTIVE: To evaluate the feasibility of a multimodal prehabilitation program in older adults with frailty awaiting hip or knee replacement.
DESIGN: Parallel two-arm randomized controlled pilot trial.
PARTICIPANTS AND SETTING: Community-dwelling older adults with frailty awaiting joint replacement aged ≥60 years recruited from the Musculoskeletal Central Intake and Assessment Centre (MSK CIAC), Ontario.
INTERVENTION: Exercise, protein and vitamin D supplements, and medication review.
MEASUREMENT: Feasibility was assessed based on predefined progression criteria for recruitment, retention, data completion and adherence to intervention components. Clinical outcomes including Oxford Knee and Hip Scores, frailty index, Short Physical Performance Battery and health-related quality of life were collected at baseline, 1-week preoperative, 6-weeks and 6-months postoperative and were evaluated using generalized linear mixed models for repeated measures.
RESULTS: A total of 69 participants were enrolled. Recruitment rate was 35 %. Participants’ mean age was 74 (standard deviation (SD): 7.5); 51 % were prefrail and 36 % were frail. Participant retention was 81 %, and data completion was ≥80 %. Mean adherence to strength exercises was 4 days (95 % confidence interval (CI): 3–5 days/week), balance 3 days (95 % CI: 2–4 days/week), and flexibility 3 days (95 % CI: 3–4 days/week). Adherence to vitamin D intake was 82 % (95 % CI: 73–92 %), and medication review consultation completion was 86 % (95 % CI: 68–95 %). These outcomes met the target values for feasibility success. The Oxford Knee Score at 6-months postoperative 8.78 (95 % CI: 0.40–17.16) showed a clinically meaningful and statistically significant difference between treatment groups. There were also indications of clinically relevant changes for frailty and quality of life post-surgery.
CONCLUSION: This trial provides strong evidence of feasibility and indications of improvements in postoperative clinical outcomes. Challenges to implementation and adherence were identified that can inform modifications to study design for future trials.
CITATION:
Chinenye Okpara ; Ahmed Negm ; Jonathan Derrick Adachi ; David Armstrong ; Stephanie Atkinson ; Victoria Avram ; Justin de Beer ; Genevieve Hladysh ; George Ioannidis ; Courtney Kennedy ; Patricia Hewston ; Arthur Lau ; Justin Lee ; Julie Richardson ; Sharon Marr ; Akbar Panju ; Danielle Petruccelli ; Lehana Thabane ; Mitchell Winemaker ; Alexandra Papaioannou (2025): Getting fit for hip and knee replacement: The Fit-Joints multimodal intervention for frail patients with osteoarthritis – a pilot randomized controlled trial. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100028
LETTER TO THE EDITOR: FACILITATING ORAL AND DENTAL CARE IN OLDER PEOPLE IN LOW- AND MIDDLE-INCOME COUNTRIES: THE ROLE OF TELEDENTISTRY
Sedighe Sadat Hashemikamangar, Behnaz Behniafar
J Frailty Aging 2025;14(2)
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CITATION:
Sedighe Sadat Hashemikamangar ; Behnaz Behniafar (2025): Letter to the Editor: Facilitating oral and dental care in older people in low- and middle-income countries: The role of teledentistry. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100035