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TIMELY LESSONS FROM A PANDEMIC ON THE BENEFITS OF PERSON CENTRIC CARE IN LONG TERM CARE FACILITIES

S.-L. Wee, P.L.K. Yap

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Since the outbreak of Coronavirus Disease 2019 (COVID-19), there have been few deadlier places than in nursing homes. As such, several useful guidelines on coping with COVID-19 in nursing homes have emerged. The critical immediate term measures mentioned in the guidelines have longer term implications especially on quality of care. We discuss how these measures instituted for infection control can be synergistic with person-centered care which has been synonymous with quality of care in nursing homes.

CITATION:
S.-L. Wee ; P.L.K. Yap (2020): Timely lessons from a pandemic on the benefits of person centric care in long term care facilities. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.28

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

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

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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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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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CHARACTERIZING INTERVENTION OPPORTUNITIES AMONG HOME-DELIVERED MEALS PROGRAM PARTICIPANTS: RESULTS FROM THE 2017 NATIONAL SURVEY OF OLDER AMERICANS ACT PARTICIPANTS AND A NEW YORK CITY SURVEY

M. El Shatanofy, J. Chodosh, M.A. Sevick, J. Wylie-Rosett, L. DeLuca, J.M. Beasley

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Background: The Home Delivered Meals Program (HDMP) serves a vulnerable population of adults aged 60 and older who may benefit from technological services to improve health and social connectedness. Objective: The objectives of this study are (a) to better understand the needs of HDMP participants, and (b) to characterize the technology-readiness and the utility of delivering information via the computer. Design: We analyzed data from the 2017 NSOAAP to assess the health and functional status and demographic characteristics of HDMP participants. We also conducted a telephone survey to assess technology use and educational interests among NYC HDMP participants. Measurements: Functional measures of the national sample included comorbidities, recent hospitalizations, and ADL/IADL limitations. Participants from our local NYC sample completed a modified version of the validated Computer Proficiency Questionnaire. Technology readiness was assessed by levels of technology use, desired methods for receiving health information, and interest in learning more about virtual senior centers. Results: About one-third (32.4%) of national survey HDMP participants (n=902) reported insufficient resources to buy food and 17.1% chose between food or medications. Within the NYC HDMP participant survey sample (n=33), over half reported having access to the internet (54.5%), 48.5% used a desktop or laptop, and 30.3% used a tablet, iPad, or smartphone. Conclusion: The HDMP provides an opportunity to reach vulnerable older adults and offer additional resources that can enhance social support and improve nutrition and health outcomes. Research is warranted to compare technological readiness of HDMP participants across urban and rural areas in the United States.

CITATION:
M. El Shatanofy ; J. Chodosh ; M.A. Sevick ; J. Wylie-Rosett ; L. DeLuca ; J.M. Beasley (2020): Characterizing intervention opportunities among Home-Delivered Meals Program participants: Results from the 2017 National Survey of Older Americans Act Participants and a New York City survey. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.25

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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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EFFECTS OF HIGH-SPEED POWER TRAINING ON NEUROMUSCULAR AND GAIT FUNCTIONS IN FRAIL ELDERLY WITH MILD COGNITIVE IMPAIRMENT DESPITE BLUNTED EXECUTIVE FUNCTIONS: A RANDOMIZED CONTROLLED TRIAL

D. W. Lee, D. H. Yoon, J.-Y. Lee, S.B. Panday, J. Park, W. Song

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Background: Physical frailty and impaired executive function of the brain show similar pathophysiology. Both of these factors lead to dysfunction of neuromuscular and abilities in elderly. High-speed power training (HSPT) has been determined to have positive effects on neuromuscular function and gait performance, as well as executive function in the elderly. Objectives: The purpose of this study was to investigate the effects of 8-week HSPT on neuromuscular, gait and executive functions in frail elderly with mild cognitive impairment (MCI). Design, setting and participants: We performed a randomized controlled trial of frail elderly from community and medical center in republic of Korea. Forty-two physically frail elderly with MCI were randomly allocated to control (n=22, age=74.22±4.46) and intervention groups (n=18, age=73.77±4.64). The intervention group was subjected to HSPT, 3 times weekly for 8 weeks. Measurements: Isometric contraction of knee extension and flexion with electromyography (EMG) was measured to determine the neuromuscular function such as knee extensor strength, rate of torque development, movement time, pre-motor time, motor time, rate of EMG rise, and hamstrings antagonist co-activation. Additionally, the 4.44-meter gait and timed up-and-go (TUG) test were administered to assess gait performance. A frontal assessment battery was measured in this study. Results: The 8-week HSPT regimen improved the knee extensor strength from 1.13±0.08 to 1.25±0.07 (p<0.05), the 200-ms RTD from 3.01±0.3 to 3.55±0.24 (p<0.05) and the rate of EMG rise from 166.48±13.31 to 197.94±11.51 (p<0.05), whereas the movement time and motor time were statistically decreased from 921.69±40.10 to 799.51±72.84, and 271.40±19.29 to 181.15±38.08 (p<0.05), respectively. The 4.44-m gait speed and TUG significantly decreased from 6.39±0.25 to 5.5±0.24, and 11.05±0.53 to 9.17±0.43 respectively (p<0.05). Conclusion: The findings of this study suggest the favorable effects of 8-week HSPT on the neuromuscular function and the gait performance in the frail elderly with MCI without increase in the executive function.

CITATION:
D. W. Lee ; D. H. Yoon ; J.-Y. Lee ; S.B. Panday ; J. Park ; W. Song (2020): Effects of High-Speed Power Training on Neuromuscular and Gait Functions in Frail Elderly with Mild Cognitive Impairment Despite Blunted Executive Functions: A Randomized Controlled Trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.23

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PREVALENCE OF PREFRAILTY AND FRAILTY IN SOUTH AMERICA: A SYSTEMATIC REVIEW OF OBSERVATIONAL STUDIES

H.J. Coelho-Junior, E. Marzetti, A. Picca, R. Calvani, M. Cesari, M.C. Uchida

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Objectives: The present study aimed at investigating the prevalence of prefrailty and frailty in South American older adults according to the setting and region. Design: A literature search combining the terms “frailty”, “South America” or a specific country name was performed on PubMed, EMBASE, Lilacs, and Scielo to retrieve articles published in English, Portuguese or Spanish on or before August 2019. Participants: Older adults aged 60+ years from any setting classified as frail according to a validated scale were included in the study. Measurements: Frailty assessment by a validated scale. Results: One-hundred eighteen reports (98 performed from Brazil, seven from Chile, five from Peru, four from Colombia, two from Ecuador, one from Argentina, and one from Venezuela) were included in the study. The mean prevalence of prefrailty in South America was 46.8% (50.7% in older in-patients, 47.6% in the community, and 29.8% in nursing-home residents). The mean prevalence of frailty in South America was 21.7% (55.8% in nursing-home residents, 39.1% in hospitalized older adults, and 23.0% in the community). Conclusions: Prefrailty and frailty are highly prevalent in South American older adults, with rates higher than those reported in Europe and Asia. In the community, almost one-in-two is prefrail and one-in-five is frail, while hospitalized persons and nursing-home residents are more frequently affected. These findings indicate the need for immediate attention to avoid frailty progression toward negative health outcomes. Our findings also highlight the need for specific guidelines for the management of frailty in South America.

CITATION:
H.J. Coelho-Junior ; E. Marzetti ; A. Picca ; R. Calvani ; M. Cesari ; M.C. Uchida (2020): Prevalence of prefrailty and frailty in South America: a systematic review of observational studies. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.22

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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

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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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INCREASED INTRAMUSCULAR ADIPOSE TISSUE IS RELATED TO INCREASED CAPILLARIZATION IN OLDER ADULTS

O. Addison, A.S. Ryan, J. Blumenthal, S.J. Prior

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Background: High levels of intramuscular adipose tissue and low levels of capillarization are both predicative of low muscle and mobility function in older adults, however little is known about their relationship. Objectives: The purpose of this study was to examine the relationship of intramuscular adipose tissue and capillarization in older adults. Setting: An outpatient medical center. Participants: Forty-seven sedentary adults (age 59.9 ± 1.0 years, BMI 32.0 ± 0.7 kg/m2, VO2max 22.4 ± 0.7 ml/kg/min); Measurements: All participants underwent CT scans to determine intramuscular adipose tissue and muscle biopsies to determine capillarization in the mid-thigh. A step-wise hierarchical linear regression analysis was used to examine the contributions of age, sex, race, body mass index, 2-hour postprandial glucose, VO2max, and muscle capillarization, to the variability in intramuscular adipose tissue. Results: The predictors as a group accounted for 38.1% of the variance in intramuscular adipose tissue, with body mass index and capillarization each significantly contributing to the final model (P<0.001). The part correlation of body mass index with intramuscular adipose tissue was r = 0.47, and the part correlation of capillarization with intramuscular adipose tissue was r = 0.39, indicating that body mass index and capillarization explained 22.1%, and 15.2% of the variance in intramuscular adipose tissue. Conclusions: While increased muscle capillarization is typically thought of as a positive development, in some clinical conditions, such as tendinopathies, an increase in capillarization is part of the pathological process related to expansion of the extracellular matrix and fibrosis. This may also be an explanation for the surprising finding that high capillarization is related to high levels of intramuscular adipose tissue. Future studies are necessary to determine the relationship of changes in both capillarization and intramuscular adipose tissue after interventions, such as exercise.

CITATION:
O. Addison ; A.S. Ryan ; J. Blumenthal ; S.J. Prior (2020): Increased intramuscular adipose tissue is related to increased capillarization in older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.20

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VASTUS LATERALIS MOTOR UNIT RECRUITMENT THRESHOLDS ARE COMPRESSED TOWARDS LOWER FORCES IN OLDER MEN

R.M. Girts, J.A. Mota, K.K. Harmon, R.J. MacLennan, M.S. Stock

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Background: Aging results in adaptations which may affect the control of motor units. Objective: We sought to determine if younger and older men recruit motor units at similar force levels. Design: Cross-sectional, between-subjects design. Setting: Controlled laboratory setting. Participants: Twelve younger (age = 25 ± 3 years) and twelve older (age = 75 ± 8 years) men. Measurements: Participants performed isometric contractions of the dominant knee extensors at a force level corresponding to 50% maximal voluntary contraction (MVC). Bipolar surface electromyographic (EMG) signals were detected from the vastus lateralis. A surface EMG signal decomposition algorithm was used to quantify the recruitment threshold of each motor unit, which was defined as the force level corresponding to the first firing. Recruitment thresholds were expressed in both relative (% MVC) and absolute (N) terms. To further understand age-related differences in motor unit control, we examined the mean firing rate versus recruitment threshold relationship at steady force. Results: MVC force was greater in younger men (p = 0.010, d = 1.15). Older men had lower median recruitment thresholds in both absolute (p = 0.005, d = 1.29) and relative (p = 0.001, d = 1.53) terms. The absolute recruitment threshold range was larger for younger men (p = 0.020; d = 1.02), though a smaller difference was noted in relative terms (p = 0.235, d = 0.50). These findings were complimented by a generally flatter slope (p = 0.070; d = 0.78) and lower y-intercept (p = 0.009; d = 1.17) of the mean firing rate versus recruitment threshold relationship in older men. Conclusion: Older men tend to recruit more motor units at lower force levels. We speculate that recruitment threshold compression may be a neural adaptation serving to compensate for lower motor unit firing rates and/or denervation and subsequent re-innervation in aged muscle.

CITATION:
R.M. Girts ; J.A. Mota ; K.K. Harmon ; R.J. MacLennan ; M.S. Stock (2020): VASTUS LATERALIS MOTOR UNIT RECRUITMENT THRESHOLDS ARE COMPRESSED TOWARDS LOWER FORCES IN OLDER MEN. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.19

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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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GERIATRIC SYNDROMES AND SARS-COV-2: MORE THAN JUST BEING OLD

I. Aprahamian, M. Cesari

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CITATION:
I. Aprahamian ; M. Cesari (2020): Geriatric syndromes and SARS-Cov-2: more than just being old. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.17

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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

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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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IMPLEMENTATION OF A COMMUNITY WALKING PROGRAM (WALK ON!) FOR FUNCTIONALLY-LIMITED OLDER ADULTS

B.J. Nicklas, E.A. Chmelo, J. Sheedy, J.B. Moore

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Background: Walking interventions improve physical function, reduce fall risk, and prevent mobility disability—even in those with compromised walking ability. However, most prior studies have been conducted in controlled research settings, with no dissemination of an evidence-based walking program for older adults who have mobility limitations and/or are socially isolated. Objectives: This study reports data on the feasibility and acceptability of a community-based walking program (Walk On!) for older adults who are functionally limited, and assesses changes in physical function among attendees. The program sessions focused on long-distance walking, and took place for one-hour, for two days/week, and for 12 weeks at a time. Design: Pilot implementation study. Setting: Local church in Winston-Salem, NC. Participants: 49 program participants; Measurements: Physical function battery and satisfaction survey data, as well as formative evaluation data from six attendees of a focus group, are reported. Results: The majority of the participants were >75 years (71%), female (65%), and presented with low levels of physical function (usual gait speed=0.79±0.16; 30.6% used an assistive device). Satisfaction with the program was high (100% would recommend it to others) and focus group results were overwhelmingly positive. Mean attendance to scheduled sessions was 77%±21%, and 63% of participants attended at least 75% of scheduled sessions (n=8 attended 100%). On average, participants improved their 6-min walk distance by 8.9%, their SPPB score by 15.4%, their timed-up-go time by 9.0%, and their usual gait speed by 11.4%. Conclusion: The results of the initial evaluation of Walk On! show high feasibility and acceptability of the program, as well as efficacy for improving physical function. Further research is needed to evaluate a delivery method for wider implementation of the program and to definitively test its effectiveness for improving function and other health benefits.

CITATION:
B.J. Nicklas ; E.A. Chmelo ; J. Sheedy ; J.B. Moore (2020): Implementation of a Community Walking Program (Walk On!) for Functionally-Limited Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.12

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FAT MASS IS NEGATIVELY ASSOCIATED WITH MUSCLE STRENGTH AND JUMP TEST PERFORMANCE

B.A. Moore, D.A. Bemben, D.H. Lein, M.G. Bemben, H. Singh

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Background: It is known that maintenance of muscle mass cannot prevent loss of muscle strength in older adults. Recent evidence suggests that fat mass can weaken the relationship between muscle mass and functional performance. No information exists if fat mass can independently affect muscle strength and jump test performance in middle-aged and older adults. Objective: To assess the independent relationships between fat mass, leg muscle mass, lower extremity muscle strength, and jump test performance in adults, 55-75 years of age. Design: Cross-sectional. Setting: University laboratory. Participants: Fifty-nine older adults (men, n = 27, age = 64.8 + 6.5 years; women, n = 32, age = 62.5 + 5.1 years) participated in this study. Measurements: Dual energy X-ray absorptiometry was used to measure fat mass and leg muscle mass. An average of 3 maximal countermovement jumps was used to calculate jump power and jump height. Two leg press and hip abduction strength were assessed by 1-repetition maximum testing. Results: Stepwise sequential regression analysis of fat mass and leg muscle mass versus jump test performance and measures of muscle strength after adjusting for age, height, and physical activity revealed that fat mass was negatively associated with jump height (p = 0.047, rpartial = -0.410) in men. In women, fat mass was negatively associated with jump height (p = 0.003, rpartial = -0.538), leg press (p = 0.002, rpartial = -0.544), and hip abduction strength (p < 0.001, rpartial = -0.661). Leg muscle mass was positively associated with jump power in women (p = 0.047, rpartial = 0.372) only. Conclusions: Fat mass has an independent negative relationship with jump test performance in middle-aged and older men and women. This has clinical implications for rehabilitating neuromuscular performance in middle-aged and older adults.

CITATION:
B.A. Moore ; D.A. Bemben ; D.H. Lein ; M.G. Bemben ; H. Singh (2020): Fat Mass is Negatively Associated with Muscle Strength and Jump Test Performance. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.11

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PREDICTOR BIOMARKERS OF NONELECTIVE HOSPITAL READMISSION AND MORTALITY IN MALNOURISHED HOSPITALIZED OLDER ADULTS

K.M. Pencina, S. Bhasin, M. Luo, G.E. Baggs, S.L. Pereira, G.J. Davis, N.E. Deutz, T.G. Travison

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Background: 90-day mortality and rehospitalizations are important hospital quality metrics. Biomarkers that predict these outcomes among malnourished hospitalized patients could identify those at risk and help direct care plans. Objectives: To identify biomarkers that predict 90-day (primary) and 30-day (secondary) mortality or nonelective rehospitalization. Design and Participants: An analysis of the ability of biomarkers to predict 90- and 30-day mortality and rehospitalization among malnourished hospitalized patients. Setting: 52 blood biomarkers were measured in 193 participants in NOURISH, a randomized trial that determined the effects of a nutritional supplement on 90-day readmission and death in patients >65 years. Composite outcomes were defined as readmission or death over 90-days or 30-days. Univariate Cox Proportional Hazards models were used to select best predictors of outcomes. Markers with the strongest association were included in multivariate stepwise regression. Final model of hospital readmission or death was derived using stepwise selection. Measurements: Nutritional, inflammatory, hormonal and muscle biomarkers. Results: Mean age was 76 years, 51% were men. In univariate models, 10 biomarkers were significantly associated with 90-day outcomes and 4 biomarkers with 30-day outcomes. In multivariate stepwise selection, glutamate, hydroxyproline, tau-methylhistidine levels, and sex were associated with death and readmission within 90-days. In stepwise selection, age-adjusted model that included sex and these 3 amino-acids demonstrated moderate discriminating ability over 90-days (C-statistic 0.68 (95%CI 0.61, 0.75); age-adjusted model that included sex, hydroxyproline and Charlson Comorbidity Index was predictive of 30-day outcomes (C-statistic 0.76 (95%CI 0.68, 0.85). Conclusions: Baseline glutamate, hydroxyproline, and tau-methylhistidine levels, along with sex and age, predict risk of 90-day mortality and nonelective readmission in malnourished hospitalized older patients. This biomarker set should be further validated in prospective studies and could be useful in prognostication of malnourished hospitalized patients and guiding in-hospital care.

CITATION:
K.M. Pencina ; S. Bhasin ; M. Luo ; G.E. Baggs ; S.L. Pereira ; G.J. Davis ; N.E. Deutz ; T.G. Travison (2020): Predictor Biomarkers of Nonelective Hospital Readmission and Mortality in Malnourished Hospitalized Older Adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.10

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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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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

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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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FRAILTY CHECKUP SUPPORTERS’ INTENTIONS TO PARTICIPATE IN HUMAN-RESOURCE DEVELOPMENT AND TRAINING ACTIVITIES

M. Fujisaki-Sueda-Sakai, K. Takahashi, Y. Yoshizawa, K. Iijima

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Background: Frailty prevention is one of social prescriptions for an aging society. That requires community level intervention. Objectives: This study examined frailty checkup supporters’ (FCSs’) intentions to engage in human-resource development and training activities (i.e., leadership activities) and related factors. Design: Cross-sectional study. Setting: Three municipalities in suburban area, Eastern Japan. Participants: Forty-five of 59 FCSs completed anonymous self-administered questionnaires. Measurements: Questionnaire sought information regarding their sociodemographic data, their perceptions and experiences of FCS activities, and their intentions to participate in human-resource development and training activities. Participants were divided into a high intention (HI) and low intention group (LI). The two groups were compared using quantitative and qualitative data. Results: Eleven FCSs reported intending to engage in leader-related activities. Factors associated with FCSs’ intentions were finding FCS activities rewarding and the willingness to continue performing FCS activities. The participants who changed their daily activities (p = .041) and perceptions regarding contributing to the community (p = .018) showed significantly higher intention than LI participants. Free description about the changes in perceptions and lifestyles as a consequence of participating in FCS activities were analyzed qualitatively. FCSs who changed their daily activities and perspectives about contributing to the community described positive changes in both the groups. Meanwhile, FCSs who did not change their daily activities and perspectives about contributing to the community described their reason only in the LI group. Conclusions: The results might encourage FCSs to participate in training and guidance activities, as they have positive experiences and receive recognition obtained through participation in such activities.

CITATION:
M. Fujisaki-Sueda-Sakai ; K. Takahashi ; Y. Yoshizawa ; K. Iijima (2020): Frailty checkup supporters’ intentions to participate in human-resource development and training activities. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.6

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THE VALIDITY OF THE SUNFRAIL TOOL: A CROSS-SECTIONAL STUDY AMONG DUTCH COMMUNITY-DWELLING OLDER PEOPLE

R.J.J. Gobbens, M. Maggio, Y. Longobucco, M. Barbolini

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Background: Early detection of frail older people is important. Timely intervention may allow health care professionals to prevent or delay the occurrence of adverse outcomes such as disability, increases in health care utilization, and premature death. Objectives: We assessed the construct and criterion validity of the SUNFRAIL tool, a questionnaire for measuring frailty among older people. Design, Setting and Participants: This cross-sectional study was carried out in a sample of Dutch citizens. A total of 195 community-dwelling persons aged 71 years and older completed the questionnaire. Measurements: Construct validity was examined by determining the correlation between the SUNFRAIL tool and the Tilburg Frailty Indicator (TFI). Criterion validity for the SUNFRAIL tool was determined by establishing the correlations with chronic diseases and adverse outcomes of frailty (disability, falls, indicators of health care utilization). Disability was measured using the Groningen Activity Restriction Scale. Participants also answered questions regarding falls and health care utilization. Results: The construct validity of this tool was good and showed significant correlations with the TFI. The correlation between SUNFRAIL total and TFI total was 0.624. The criterion validity of the SUNFRAIL tool was good for chronic diseases and good-to-excellent for adverse outcomes disability, receiving nursing care, and falls. The area under the curve for these outcomes was 0.840 (95% CI 0.781–0.899), 0.782 (95% CI 0.696–0.868), and 0.769 (95% CI 0.686–0.859), respectively. Conclusions: The results of our study suggest that the SUNFRAIL tool is a valid instrument for assessing frailty in community-dwelling older people. It is an attractive instrument for use in practice because it takes little time for health care professionals and older people to complete the questionnaire, and it expresses the integral functioning of human beings.

CITATION:
R.J.J. Gobbens ; M. Maggio ; Y. Longobucco ; M. Barbolini (2020): The validity of the SUNFRAIL tool: A cross-sectional study among Dutch community-dwelling older people. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.4

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CLINICAL CHARACTERISTICS OF FRAILTY IN JAPANESE RHEUMATOID ARTHRITIS PATIENTS

I. Yoshii, M. Kondo

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Objective: The relationship between clinical characteristics and frailty was investigated in rheumatoid arthritis (RA) patients >40 years old. Methods: RA patients followed for >1 year were interviewed and diagnosed as frail according to a 5-item frailty score index: (1) weight loss >2 kg within 6 months (WL); (2) slower gait speed (GS); (3) exercise less than once per week (EX); (4) decline in short-term memory (SM); and (5) general fatigue in the past 2 weeks (GF). The relationship between frailty status and background parameters was evaluated. Results: Among 739 subjects, frail patients comprised 221, pre-frail patients comprised 203, and robust comprised 315. The most common symptom in the Frailty group was GS, followed by SM, GF, EX, and WL, whereas the most common symptom in the Pre-frailty group was GS followed by SM, GF, WL, and EX. Frailty was significantly correlated with aging. Elderly onset rheumatoid arthritis, disease activity, serum C-reactive protein concentration, degree of joint deformity, activities in daily living (ADL), dementia treated, and glucocorticoid steroid administration demonstrated significant correlations with frailty status, although all factors also demonstrated significant correlation with aging. In addition, the EuroQol score (EQ5D) was significantly correlated with both aging and frailty. Conclusion: The results suggest that a remission state for disease activity, ADL, and dementia is correlated with frailty. The most common and primary symptom is GS. Elderly RA patients require careful attention for symptoms of frailty, which may damage the EQ5D score, specifically, the quality of life for RA patients.

CITATION:
I. Yoshii ; M. Kondo (2020): Clinical Characteristics of frailty in Japanese rheumatoid arthritis patients. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.1

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PREDICTIVE FACTORS OF IN-HOSPITAL MORTALITY IN OLDER ADULTS WITH COMMUNITY-ACQUIRED BLOODSTREAM INFECTION

D. Angioni, M. Hites, F. Jacobs, S. De Breucker

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Objectives: To assess the prevalence of intra-hospital mortality and associated risk factors in older people aged 75+, admitted with blood stream infections (BSI). Design: Single center retrospective study performed in an 850-bed of the academic hospital of the Université Libre de Bruxelles. Setting and Participants: From January 2015 to December 2017, all inpatients over 75 years old admitted with BSI were included. Measures: Demographical, clinical and microbiological data were collected. Results: 212 patients were included: median age was 82 [79-85] years and 60 % were female. The in-hospital mortality rate was 19%. The majority of microorganisms were Gram-negative strains, of which Escherichia coli was the most common, and urinary tract infection was the most common origin of BSI. Compared to patients who survived, the non-survivor group had a higher SOFA score (6 versus 3, p<0.0001), a higher comorbidity score (5 versus 4, p<0.0001), more respiratory tract infections (28 vs 6 %, p < 0.0001) and fungal infections (5 vs 1 %, p = 0.033), bedridden status (60 vs 25 %, p < 0.0001), and healthcare related infections (60 vs 40 %, p = 0.019). Using Cox multivariable regression analysis, only SOFA score was independently associated with mortality (HR 1.75 [95%IC 1.52-2.03], p<0.0001).Conclusions and Implications: BSI in older people are severe infections associated with a significant in-hospital mortality. Severity of clinical presentation at onset remains the most important predictor of mortality for BSI in older people. BSI originating from respiratory source and bedridden patients are at greater risk of intra-hospital mortality. Further prospective studies are needed to confirm these results.

CITATION:
D. Angioni ; M. Hites ; F. Jacobs ; S. De Breucker (2019): Predictive factors of in-hospital mortality in older adults with community-acquired bloodstream infection. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.45

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THE SUSTAINED IMPACT OF A MEDICAL SCHOOL-BASED PHYSICAL ACTIVITY MODULE ON INTERNS’ PERCEIVED COMPETENCE IN ADVISING OLDER ADULTS ABOUT EXERCISE

A.D. Jadczak, R. Visvanathan

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The study aimed to examine the sustained impact of a 1.5-hour medical school-based physical activity (PA) module on interns’ perceived competence and importance in advising older adults about exercise. The modified Exercise and Physical Activity Competence Questionnaire (EPACQ) was administered in 2017 (CG: control group) and 2018 (IG: intervention group) two years post-course. The perceived competence of both, CG (n=23) and IG (n=18), decreased significantly over two years (p≤0.05) with no difference between the groups (p>0.05). However, 72.2% (n=13) of the interns who attended the PA module still felt competent in advising older adults about exercise (4.21±0.66) compared to 47.8% (n=11) of the CG (3.89±0.67). The perceived importance decreased significantly in both groups (p≤0.05) with no difference between the groups (p>0.05). However, both groups still perceived exercise for older people as important (CG:4.55±0.61; IG:4.83±0.47). Subsequently, continued professional development is likely to be a key requirement for ensuring sustainability over time.

CITATION:
A.D. Jadczak ; R. Visvanathan (2019): The sustained impact of a medical school-based physical activity module on interns’ perceived competence in advising older adults about exercise. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.39

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THE INFLUENCE OF LIFESTYLE BEHAVIORS ON THE INCIDENCE OF FRAILTY

M.G. Borda, M.U. Pérez-Zepeda, R. Samper-Ternent, R.C. Gomez, J.A. Avila-Funes, C.A. Cano-Gutierrez

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Background: Frailty is a clinical state defined as an increase in an individual’s vulnerability to developing adverse health-related outcomes. Objectives: We propose that healthy behaviors could lower the incidence of frailty. The aim is to describe the association between healthy behaviors (physical activity, vaccination, tobacco use, and cancer screening) and the incidence of frailty. Design: This is a secondary longitudinal analysis of the Mexican Health and Aging Study (MHAS) cohort. Setting: MHAS is a population-based cohort, of community-dwelling Mexican older adults. With five assessments currently available, for purposes of this work, 2012 and 2015 waves were used. Participants: A total of 6,087 individuals 50-year or older were included. Measurements: Frailty was defined using a 39-item frailty index. Healthy behaviors were assessed with questions available in MHAS. Individuals without frailty in 2012 were followed-up three years in order to determine their frailty incidence, and its association with healthy behaviors. Multivariate logistic regression models were used to assess the odds of frailty occurring according to the four health-related behaviors mentioned above. Results: At baseline (2012), 55.2% of the subjects were male, the mean age was 62.2 (SD ± 8.5) years old. The overall incidence (2015) of frailty was 37.8%. Older adults physically active had a lower incidence of frailty (48.9% vs. 42.2%, p< 0.0001). Of the activities assessed in the adjusted multivariate models, physical activity was the only variable that was independently associated with a lower risk of frailty (odds ratio: 0.79, 95% confidence interval 0.71-0.88, p< 0.001). Conclusions: Physically active older adults had a lower 3-year incidence of frailty even after adjusting for confounding variables. Increasing physical activity could therefore represent a strategy for reducing the incidence of frailty. Other so-called healthy behaviors were not associated with incident frailty, however there is still uncertainty on the interpretation of those results.

CITATION:
M.G. Borda ; M.U. Pérez-Zepeda ; R. Samper-Ternent ; R.C. Gomez ; J.A. Avila-Funes ; C.A. Cano-Gutierrez (2019): THE INFLUENCE OF LIFESTYLE BEHAVIORS ON THE INCIDENCE OF FRAILTY. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.37

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ACCELEROMETER-DETERMINED INTENSITY AND DURATION OF HABITUAL PHYSICAL ACTIVITY AND WALKING PERFORMANCE IN WELL-FUNCTIONING MIDDLE-AGED AND OLDER WOMEN: A CROSS-SECTIONAL STUDY

R.S. Thiebaud, T. Abe, M. Ogawa, J.P. Loenneke, N. Mitsukawa

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Background: The association of physical activity (PA) intensities and duration spent in those activities with different walking tasks remains unclear. Objectives: To examine the association between the duration of PA intensities and three walking speeds (usual walking speed, maximal walking speed and zig-zag walking speed). Design: Multiple linear regression analysis was used to estimate the association of age, BMI, maximum knee extension strength, light PA, moderate PA and vigorous PA with walking speeds. Setting: University lab. Participants: Eighty-six older women (67 ± 7 years). Measurements: PA was measured for 30 consecutive days using the Lifecorder-EX accelerometer. Exercise intensity was categorized as light (levels 1-3), moderate (levels 4-6) and vigorous (levels 7-9) based on the manufacturer algorithms. Usual straight walking speed (20 m), maximal straight walking speed (20 m) and zig-zag walking speed tests (10 m) were performed by each participant. Results: For the usual straight walking speed model (R2 = 0.296, SEE = 0.15 m/s), the significant predictors were BMI, knee extension strength, light PA and vigorous PA. For the maximal straight walking speed model (R2 = 0.326, SEE = 0.20 m/s), only age was a significant predictor. For the zig-zag walking speed model (R2=0.417, SEE = 0.14 m/s), age and maximum knee strength were significant predictors in the model. Conclusions: Overall, the results of this study suggest that vigorous PA and maximal knee extension strength are two important factors that are associated with different walking speeds in older women.

CITATION:
R.S. Thiebaud ; T. Abe ; M. Ogawa ; J.P. Loenneke ; N. Mitsukawa (2019): Accelerometer-determined intensity and duration of habitual physical activity and walking performance in well-functioning middle-aged and older women: A cross-sectional study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.26

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JFA N°02 - 2020

 

SHOULD WE CARE MORE ABOUT FRAILTY WHEN WE TREAT DIABETES?

L. Orlandini, M. Cesari

J Frailty Aging 2020;9(2)66-67

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CITATION:
L. Orlandini ; M. Cesari (2020): Should we care more about frailty when we treat diabetes?. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.5

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MOBILITY IN COMMUNITY DWELLING OLDER ADULTS: PREDICTING SUCCESSFUL MOBILITY USING AN INSTRUMENTED BATTERY OF NOVEL MEASURES

L. McInnes, E. Jones, L. Rochester, S. Lord, S.F.M. Chastin, A.W. Watson, L. Little, P. Briggs

J Frailty Aging 2020;9(2)68-73

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Mobility in older adults is associated with better quality of life. However, evidence suggests that older people spend less time out-of-home than younger adults. Traditional methods for assessing mobility have serious limitations. Wearable technologies provide the possibility of objectively assessing mobility over extended periods enabling better estimates of levels of mobility to be made and possible predictors to be explored. Eighty-six community dwelling older adults (mean age 79.8 years) had their mobility assessed for one week using GPS, accelerometry and self-report. Outcomes were: number of steps, time spent in dynamic outdoor activity, total distance travelled and total number of journeys made over the week. Assessments were also made of personal, cognitive, psychological, physical and social variables. Four regression models were calculated (one for each outcome). The models predicted 32 to 43% of the variance in levels of mobility. The ability to balance on one leg significantly predicted all four outcomes. In addition, cognitive ability predicted number of journeys made per week and time spent engaged in dynamic outdoor activity, and age significantly predicted total distance travelled. Overall estimates of mobility indicated step counts that were similar to those shown by previous research but distances travelled, measured by GPS, were lower. These findings suggest that mobility in this sample of older adults is predicted by the ability to balance on one leg. Possible interventions to improve out-of-home mobility could target balance. The fact that participants travelled shorter distances than those reported in previous studies is interesting since this high-functioning subgroup would be expected to demonstrate the highest levels.

CITATION:
L. McInnes ; E. Jones ; L. Rochester ; S. Lord ; S.F.M. Chastin ; A.W. Watson ; L. Little ; P. Briggs (2019): Mobility in community dwelling older adults: Predicting successful mobility using an instrumented battery of novel measures. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.35

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REPORTED WEIGHT CHANGE IN OLDER ADULTS AND PRESENCE OF FRAILTY

R.S. Crow, C.L. Petersen, S.B. Cook, C.J. Stevens, A.J. Titus, T.A. Mackenzie, J.A. Batsis

J Frailty Aging 2020;9(2)74-81

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ported weight change over the lifespan impacts rates of frailty in older adults. Methods: We identified 4,984 subjects ≥60 years with body composition measures from the National Health and Nutrition Examination Survey. An adapted version of Fried’s frailty criteria was used as the primary outcome. Self-reported weight was assessed at time current,1 and 10 years earlier and at age 25. Weight changes between each time point were categorized as ≥ 5%, ≤5% or neutral. Logistic regression assessed the impact of weight change on the outcome of frailty. Results: Among 4,984 participants, 56.5% were female, mean age was 71.1 years, and mean BMI was 28.2kg/m2. A weight loss of ≥ 5% had a higher association with frailty compared to current weight, age 25 (OR 2.94 [1.72,5.02]), 10 years ago (OR 1.68 [1.05,2.69]), and 1 year ago (OR 1.55 [1.02,2.36]). Weight gain in the last year was associated with increased rate of frailty (1.59 [1.09,2.32]). Conclusion: There is an association between frailty and reported weight loss over time while only weight gain in the last year has an association with frailty.

CITATION:
R.S. Crow ; C.L. Petersen ; S.B. Cook ; C.J. Stevens ; A.J. Titus ; T.A. Mackenzie ; J.A. Batsis (2019): Reported Weight Change in Older Adults and Presence of Frailty. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.44

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ASSOCIATION OF MUSCLE STRENGTH AND GAIT SPEED WITH CROSS-SECTIONAL MUSCLE AREA DETERMINED BY MID-THIGH COMPUTED TOMOGRAPHY - A COMPARISON WITH SKELETAL MUSCLE MASS MEASURED BY DUAL-ENERGY X-RAY ABSORPTIOMETRY

K. Tsukasaki, Y. Matsui, H. Arai, A. Harada, M. Tomida, M. Takemura, R. Otsuka, F. Ando, H. Shimokata

J Frailty Aging 2020;9(2)82-89

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Background: Muscle mass is often mentioned not to reflect muscle strength. For muscle mass assessment skeletal muscle index (SMI) is often used. We have reported that dual-energy X-ray absorptiometry (DXA)-derived SMI does not change with age in women, whereas the cross-sectional muscle area (CSMA) derived from computed tomography (CT) does. Objectives: The present study aimed to compare CT and DXA for the assessment of muscle tissue. Design & Setting: Cross-sectional study in the local residents. Participants: A total of 1818 subjects (age 40-89 years) randomly selected from community dwellers underwent CT examination of the right mid-thigh to measure the cross-sectional muscle area (CSMA). Skeletal muscle mass (SMM) was measured by DXA. The subjects performed physical function tests such as grip strength, knee extension strength, leg extension strength, and gait speed. The correlation between CT-derived CSMA and DXA-derived SMM along with their association with physical function was examined. Results: After controlling for related factors, the partial correlation coefficient of muscle cross-sectional area (CSA) with physical function was larger than that of DXA-derived SMM for gait speed in men (p=0.002) and knee extension strength in women (p=0.03). The partial correlation coefficient of quadriceps (Qc) CSA with physical function was larger than that of DXA-derived SMM for leg extension power in both sexes (p=0.01), gait speed in men (p<0.001), and knee extension strength in women (p<0.001). Conclusion: Mid-thigh CT-derived CSMA, especially Qc CSA, showed significant associations with grip strength, knee extension strength, and leg extension power, which were equal to or stronger than those of DXA-derived SMM in community-dwelling middle-aged and older Japanese people. The mid-thigh CSMA may be a predictor of mobility disability, and is considered to be useful in the diagnosis of sarcopenia.

CITATION:
K. Tsukasaki ; Y. Matsui ; H. Arai ; A. Harada ; M. Tomida ; M. Takemura ; R. Otsuka ; F. Ando ; H. Shimokata (2020): Association of muscle strength and gait speed with cross-sectional muscle area determined by mid-thigh computed tomography - a comparison with skeletal muscle mass measured by dual-energy X-ray absorptiometry. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.16

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IMPACT OF FAT-FREE ADIPOSE TISSUE ON THE PREVALENCE OF LOW MUSCLE MASS ESTIMATED USING CALF CIRCUMFERENCE IN MIDDLE-AGED AND OLDER ADULTS

T. Abe, S.J. Dankel, Z.W. Bell, E. Fujita, Y. Yaginuma, T. Akamine, R.W. Spitz, V. Wong, R.B. Viana, J.P. Loenneke

J Frailty Aging 2020;9(2)90-93

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Previous studies proposed calf circumference cutoff values for predicting dual-energy X-ray absorptiometry (DXA)-derived low muscle mass. However, DXA-derived appendicular lean mass (aLM) includes non-skeletal muscle components such as the appendicular fat-free component of adipose tissue fat cells (aFFAT). The purpose of this study was to compare the calf circumference method of classification before (Model #1) and after (Model #2) eliminating the influence of FFAT in healthy Japanese adults (50 to 79 years; mean age 70 (SD 7) years). Model 1, and Model 2 for classifying low muscle mass had a sensitivity of 78% and 64%, specificity of 76% and 75%, positive predictive value of 31% and 28%, and negative predictive value of 96% and 93%, respectively. Appendicular fat-free component of adipose tissue has the potential to influence the ability of calf circumference to accurately classify individuals with low muscle mass. Consideration should be made when using this as a screening tool for low muscle mass.

CITATION:
T. Abe ; S.J. Dankel ; Z.W. Bell ; E. Fujita ; Y. Yaginuma ; T. Akamine ; R.W. Spitz ; V. Wong ; R.B. Viana ; J.P. Loenneke (2019): Impact of fat-free adipose tissue on the prevalence of low muscle mass estimated using calf circumference in middle-aged and older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.34

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THE ASSOCIATION OF FRAILTY WITH HOSPITALIZATIONS AND MORTALITY AMONG COMMUNITY DWELLING OLDER ADULTS WITH DIABETES

J. Ferri-Guerra, R. Aparicio-Ugarriza, D. Salguero, D. Baskaran, Y.N. Mohammed, H. Florez, J.G. Ruiz

J Frailty Aging 2020;9(2)94-100

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Background: Diabetes (DM) is associated with an accelerated aging that promotes frailty, a state of vulnerability to stressors, characterized by multisystem decline that results in diminished intrinsic reserve and is associated with morbidity, mortality and utilization. Research suggests a bidirectional relationship between frailty and diabetes. Frailty is associated with mortality in patients with diabetes, but its prevalence and impact on hospitalizations are not well known. Objectives: Determine the association of frailty with all-cause hospitalizations and mortality in older Veterans with diabetes. Design: Retrospective cohort. Setting: Outpatient. Participants: Veterans 65 years and older with diabetes who were identified as frail through calculation of a 44-item frailty index. Measurements: The FI was constructed as a proportion of healthcare variables (demographics, comorbidities, medications, laboratory tests, and ADLs) at the time of the screening. At the end of follow up, data was aggregated on all-cause hospitalizations and mortality and compared non-frail (robust, FI≤ .10 and prefrail FI=>.10, <.21) and frail (FI≥.21) patients. After adjusting for age, race, ethnicity, median income, history of hospitalizations, comorbidities, duration of DM and glycemic control, the association of frailty with all-cause hospitalizations was carried out according to the Andersen-Gill model, accounting for repeated hospitalizations and the association with all-cause mortality using a multivariate Cox proportional hazards regression model. Results: We identified 763 patients with diabetes, mean age 72.9 (SD=6.8) years, 50.5% were frail. After a median follow-up of 561 days (IQR=172), 37.0% they had 673 hospitalizations. After adjustment for covariates, frailty was associated with higher all-cause hospitalizations, hazard ratio (HR)=1.71 (95%CI:1.31-2.24), p<.0001, and greater mortality, HR=2.05 (95%CI:1.16-3.64), p=.014. Conclusions: Frailty was independently associated with all-cause hospitalizations and mortality in older Veterans with diabetes. Interventions to reduce the burden of frailty may be helpful to improve outcomes in older patients with diabetes.

CITATION:
J. Ferri-Guerra ; R. Aparicio-Ugarriza ; D. Salguero1 ; D. Baskaran ; Y.N. Mohammed ; H. Florez ; J.G. Ruiz (2019): The Association of Frailty with Hospitalizations and Mortality among Community Dwelling Older Adults with Diabetes. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.31

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A NOVEL TOOL FOR THE EARLY IDENTIFICATION OF FRAILTY IN ELDERLY PEOPLE: THE APPLICATION IN PRIMARY CARE SETTINGS

M. Maggio, M. Barbolini, Y. Longobucco , L. Barbieri, C. Benedetti, F. Bono, I. Cacciapuoti, A. Donatini, E. Lezzi, D. Papini, P.M. Rodelli , S. Tagliaferri, M.L. Moro

J Frailty Aging 2020;9(2)101-106

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Objectives: Frailty is a pre-disability condition in older persons providing a challenge to Health-Care Systems. Systematic reviews highlight the absence of a gold-standard for its identification. However, an approach based on initial screening by the General Practitioner (GP) seems particularly useful. On these premises, a 9-item Sunfrail Checklist (SC), was developed by a multidisciplinary group, in the context of European Sunfrail Project, and tested in the Community. Objectives: - to measure the concordance between the judgments of frailty (criterion-validity): the one formulated by the GP, using the SC, and the one subsequently expressed by a Comprehensive Geriatric Assessment Team (CGA-Team); - to determine the construct-validity through the correspondence between some checklist items related to the 3 domains (physical, cognitive and social) and the three tools used by the CGA-Team; - to measure the instrument’s performance in terms of positive predictive value (PPV) and negative predictive value (NPV). Design: Cross-sectional study, with a final sample-size of 95 subjects. Setting: Two Community-Health Centers of Parma, Italy. Participants: Subjects aged 75 years old or more, with no disability and living in the community. Measurements: We compared the screening capacity of the GP using the SC to that one of CGA-Team based on three tests: 4-meter Gait-Speed, Mini-Mental State Examination and Loneliness Scale. Results: 95 subjects (51 women), with a mean age of 81±4 years were enrolled. According to GPs 34 subjects were frail; the CGA-Team expressed a frailty judgment on 26 subjects. The criterion-validity presented a Cohen’s k of 0.353. Construct-validity was also low, with a maximum contingency-coefficient of 0.19. The analysis showed a PPV of 58.1% and a NPV equal to 84.6%. Conclusions: Our data showed a low agreement between the judgements of GP performed by SC and CGA-Team. However, the good NPV suggests the applicability of SC for screening activities in primary-care.

CITATION:
M. Maggio ; M. Barbolini ; Y. Longobucco ; L. Barbieri ; C. Benedetti ; F. Bono ; I. Cacciapuoti ; A. Donatini ; E. Iezzi ; D. Papini ; P.M. Rodelli ; S. Tagliaferri ; M.L. Moro (2019): A novel tool for the early identification of frailty in elderly people: the application in Primary Care Settings. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.41

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ASSOCIATION BETWEEN THE USE OF ANGIOTENSIN-BLOCKING MEDICATIONS WITH HIP FRACTURE AND DEATH IN OLDER PEOPLE

C. Shea, M.D. Witham

J Frailty Aging 2020;9(2)107-110

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It is unclear if angiotensin blocking drugs (angiotensin converting enzyme inhibitors and angiotensin receptor blockers) reduce or increase the risk of falls and fractures. We retrospectively analysed routinely-collected, linked health and social care data for patients aged 65 and over from Tayside, Scotland, including hospital discharge diagnoses, biochemistry, deaths, care package provision and community prescribing. We conducted unadjusted and adjusted Cox regression analyses for time to hip fracture and time to death, for any exposure to angiotensin blocking drugs and for time-dependent exposure to angiotensin blocking drugs. We analysed data on 16782 patients. Angiotensin blocking drug use was associated with an exposure-dependent lower risk of hip fracture (hazard ratio 0.988 [95%CI 0.982-0.994] per year of exposure; p<0.001) and death (hazard ratio 0.986 [95%CI 0.983-0.989] per year of exposure; p<0.001). These findings call into question the appropriateness of stopping angiotensin blocking drugs for older people at risk of falls.

CITATION:
C. Shea ; M.D. Witham (2019): Association between the use of angiotensin-blocking medications with hip fracture and death in older people. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.38

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MULTI-COMPONENT EXERCISE WITH HIGH-INTENSITY, FREE-WEIGHT, FUNCTIONAL RESISTANCE TRAINING IN PRE-FRAIL FEMALES: A QUASI-EXPERIMENTAL, PILOT STUDY

N.W. Bray, G.J. Jones, K.L. Rush, C.A. Jones, J.M. Jakobi

J Frailty Aging 2020;9(2)111-117

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Background: No study has performed an exercise intervention that included high-intensity, free-weight, functional resistance training, and assessed frailty status as an inclusion criteria and outcome measure via original, standardized tools, in pre-frail females. Objectives: Determine if the intervention strategy is not only feasible and safe, but can also improve frailty status, functional task performance, and muscle strength. Design: Pilot, quasi-experimental. Setting: Community. Participants: 20 older-adults with pre-frailty characteristics. Intervention: 12-weeks (3 days/week, 45-60 minutes/session) of multi-component exercise, inclusive of aerobic, resistance, balance and flexibility exercises. The crux of the program was balance and resistance exercises, the latter utilized high-intensity, free-weight, functional resistance training. The control group maintained their usual care. Measurements: 1) Feasibility and safety (dropout, adherence, and adverse event); 2) Frailty (Frailty Phenotype, Clinical Frailty Scale, and gait speed); 3) Functional task performance (grip strength and sit-to-stand time); and 4) Isometric and isotonic strength of the knee extensors and elbow flexors. Results: No participants dropped out of the intervention or experienced an adverse event, and adherence averaged 88.3%. The exercise group became less frail, whereas the control group became more frail. There was a significant within-group improvement in exercise participants gait speed (p ≤ 0.01, +0.24 m/sec), grip strength (p ≤ 0.01, +3.9 kg), and sit-to-stand time (p ≤ 0.01, -5.0 sec). There was a significant within-group improvement in exercise participants knee extension isometric torque (p ≤ 0.05, +7.4 Nm) and isotonic velocity (p = ≤ 0.01, +37.5 ˚/sec). Elbow flexion isotonic velocity significantly declined within the control group (p ≤ 0.01, -20.2 ˚/sec) and demonstrated a significant between-group difference (p ≤ 0.05, 40.73 ˚/sec) post-intervention. Conclusions: The intervention strategy appears to be feasible and safe, and may also improve frailty status, functional task performance, and muscle strength. These results help calculate effect size for a future randomized controlled trial.

CITATION:
N.W. Bray ; G.J. Jones ; K.L. Rush ; C.A. Jones ; J.M. Jakobi (2020): Multi-component exercise with high-intensity, free-weight, functional Resistance Training in pre-frail females: A quasi-experimental, pilot study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.13

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PRACTICAL IMPLICATIONS FOR STRENGTH AND CONDITIONING OF OLDER PRE-FRAIL FEMALES

N.W. Bray, G.J. Jones, K.L. Rush, C.A. Jones, J.M. Jakobi

J Frailty Aging 2020;9(2)118-121

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Approaches to and benefits from resistance training for non-compromised older adults are well known. Less is understood about resistance training with pre-frail older adults, and even less information is available on the practical approaches to delivery. Herein, we describe an approach in pre-frail females who undertook a multi-component exercise intervention, inclusive of high-intensity, free-weight, functional resistance training. Capitalizing on the principle of overload is possible and safe for pre-frail females through constant reassurance of ability and adjustments in technique. Making exercise functionally relevant, for example, a squat is the ability to get on and off a toilet, resonates meaning. Older pre-frail females are affected by outside (clinical) influences. The exercise participant, and extraneous persons need to be educated on exercise approaches, to increase awareness, debunk myths, and enhance support for participation. Identification of individuality in a group session offers ability to navigate barriers for successful implementation.

CITATION:
N.W. Bray ; G.J. Jones ; K.L. Rush ; C.A. Jones ; J.M. Jakobi (2020): Practical Implications for Strength and Conditioning of Older Pre-Frail Females. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.15

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LETTER TO THE EDITOR: USE OF A HIGH-INTENSITY RESISTANCE EXERCISE PROGRAM TO IMPROVE LOWER EXTREMITY STRENGTH AND MOBILITY IN A 105-YEAR OLDER WOMAN: A CASE REPORT

M.D. Basco

J Frailty Aging 2020;9(2)122-123

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CITATION:
M.D. Basco (2020): Letter to the editor: Use of a high-intensity resistance exercise program to improve lower extremity strength and mobility in a 105-year older woman: a case report. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2020.3

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