Frailty: What Is It?

The Association Between Impaired Dyadic Coping and Frailty in Elderly Patients With Hypertension: A Latent Profile Analysis

BACKGROUND

Lifelong hypertension highlights the importance of dyadic engagement in coping with the disease. Although dyadic coping is heterogeneous in patients with other diseases, little is known about it in elderly patients with hypertension. In addition, whether impaired dyadic coping is associated with frailty has yet to be elucidated.

OBJECTIVES

The aim of this study was to investigate the latent profiles and characteristics of dyadic coping and the potential association between impaired dyadic coping and frailty in elderly patients with hypertension.

METHODS

We recruited a total of 741 elderly patients with hypertension. Latent profile analysis was then used to identify the best-fitting model. Then, we used regression analysis to determine profile predictors and identify the association between impaired dyadic coping and frailty.

RESULTS

The 5-profile model was considered to be the best-fitting model, as follows: profile 1, severely impaired dyadic coping; profile 2, mildly impaired dyadic coping; profile 3, normal dyadic coping; profile 4, better dyadic coping; and profile 5, the highest dyadic coping. In the fully adjusted model, the probability of frailty was 1.94-fold higher in the mildly impaired dyadic coping group (odds ratio, 1.94; 95% confidence interval, 1.09-3.47) and 2.66-fold higher in the severely impaired dyadic coping group (odds ratio, 2.66; 95% confidence interval, 1.11-6.39).

CONCLUSIONS

We identified heterogeneity in dyadic coping and demonstrated that impaired dyadic coping was associated with frailty. Those at risk of dyadic coping impairment need to be identified early, followed by dyadic coping-based interventions to prevent or delay frailty.

Frailty Prevalence and Evaluation of the FRAIL Scale Questionnaire in Patients with Inflammatory Bowel Disease

BACKGROUND

Inflammatory bowel disease (IBD) predisposes individuals to frailty, linked with adverse outcomes. While the Fried Frailty Index (FFI) is a well-established phenotypic tool to assess frailty, its administration is cumbersome. The FRAIL scale, simpler but not widely used in patients with IBD, presents an alternative. We aimed to assess the prevalence of frailty and compare the FRAIL scale with the FFI.

METHODS

A cohort of patients with IBD underwent assessment using both the FFI and the FRAIL scale. Patients were categorized as non-frail, pre-frail, or frail. The primary outcome was frailty prevalence, while secondary outcomes included comparison of FFI and FRAIL scale and associations between frailty and disease-related factors. Statistical analyses included chi-square tests, ANOVA, Kruskal-Wallis tests, and ROC curve analysis using SPSS v27, with p < 0.05 indicating significance.

RESULTS

Among participants (53.5% female, median age 44), 37% were non-frail, 50% pre-frail, and 13% frail. The FRAIL scale exhibited strong correlation with the FFI for all three categories. Age showed no significant association with frailty. Frail individuals displayed higher inflammatory markers and more severe clinical disease, with frailty more prevalent in patients with UC than CD. Frail individuals also exhibited lower hemoglobin, creatinine, and albumin levels.

CONCLUSION

Frailty and pre-frailty are prevalent in patients with IBD and not necessarily linked with older age. The FRAIL scale demonstrated excellent correlation with the FFI, offering a practical tool for identifying frailty in IBD without physical measurements. Future studies should explore multivariable models incorporating frailty risk factors and interventions to mitigate adverse outcomes in patients with IBD.

Frailty identification using a sensor-based upper-extremity function test: a deep learning approach

The global increase in the older adult population highlights the need for effective frailty assessment, a condition linked to adverse health outcomes such as hospitalization and mortality. Existing frailty assessment tools, like the Fried phenotype and Rockwood score, have practical limitations, necessitating a more efficient approach. This study aims to enhance frailty prediction accuracy in older adults using a combined biomechanical and deep learning approach. We recruited 312 participants (126 non-frail, 145 pre-frail, 41 frail) and assessed frailty using the Fried index, upper-extremity function (UEF) test, and muscle force calculations. Machine learning (ML) models, including logistic regression and support vector machine (SVM), were employed alongside deep learning with long short-term memory (LSTM) networks. Results showed that incorporating muscle model parameters significantly improved frailty prediction. The LSTM model achieved the highest accuracy (74%), outperforming SVM (67%) and regression (66%), with precision and F1 scores of 81% and 75%, respectively. Notably, muscle co-contraction emerged as a critical predictor, with frail individuals exhibiting substantially higher levels. Our findings demonstrate that integrating UEF tasks with deep learning models provides superior frailty prediction, potentially offering a robust, efficient clinical tool. However, further validation with larger, more diverse populations is needed to confirm the generalizability of our results. This study underscores the potential of advanced computational techniques to improve the identification and monitoring of frailty in older adults.

Phosphatidylcholine and frailty: a Mendelian randomization study and immune mediation

OBJECTIVE

Lipid metabolism plays a significant role in the aging process, and the prevalence of frailty increases with advancing age. However, few studies have employed Mendelian randomization (MR) to investigate the associations between lipids and frailty.

METHODS

This study utilized large-scale genome-wide association study (GWAS) and a bidirectional two-sample, two-step MR approach to explore the causal associations of 179 lipid species with the frailty index (FI) and the mediating effects of immune cells. The inverse variance weighted (IVW) method was used primarily to evaluate the MR results. Heterogeneity and horizontal pleiotropy were assessed via Cochran's Q, the MR-Egger intercept, MR-PRESSO and leave-one-out analysis. Phenome-wide MR (Phe-MR) was used to analyse the potential roles of frailty-related phosphatidylcholine species in diseases.

RESULTS

MR analysis revealed a causal relationship between PC species and FI. Specifically, PC (18:0_20:5), LPC (18:0_0:0), LPC (16:0_0:0), and ether-PC (O-16:0_22:5) are positively correlated with the FI, whereas PC(18:1_20:2), PC(16:0_18:3), PC(16:0_20:1), ether-PC (O-18:0_16:1), and ether-PC (O-16:1_16:0) are negatively correlated with the FI. Reverse MR analysis indicated no strong association between the FI and the nine PCs. Mediation analysis revealed that Sw mem %lymphocyte partially mediated the effect of LPC (18:0_0:0) on FI. Phe-MR analysis revealed that nine frailty-related PCs were broadly associated with various diseases.

CONCLUSION

This study provides novel evidence that supports the causal association between PC species and frailty, with the immune system playing a crucial role in this pathway. These findings offer new insights into potential targets for the intervention of frailty in the elderly population.

Relationship between the laboratory test-based frailty index and overall mortality in critically ill patients with acute pancreatitis: a retrospective study based on the MIMIC-IV database

Background and aims

The frailty index, based on laboratory assessments, helps identify individuals at risk for adverse health outcomes. However, its relationship with overall mortality in acute pancreatitis patients in ICUs remains unclear. This study aims to investigate the association between the frailty index and all-cause mortality and assess its prognostic value for these patients.

Methods

We carried out a retrospective observational investigation utilizing data from the Medical Information Mart for Intensive Care IV (MIMIC-IV 2.2) database. Extract data from the database for all ICU patients (first-time ICU admissions, age ≥ 18 years) who meet the diagnostic criteria for acute pancreatitis. The frailty index derived from laboratory tests (FI-lab) encompassed three vital sign indicators and 30 laboratory test indicators. Patients were categorized into four groups based on quartiles of the FI-lab score. To assess the differences in 28-day all-cause mortality among these groups, we employed Kaplan-Meier analysis, whereas the relationship between FI-lab scores and 28-day mortality was explored through Cox proportional hazards analysis. In addition, we applied Harrell's C statistic, Integrated Discrimination Improvement (IDI), and Net Reclassification Improvement (NRI) to assess the additional predictive capability of FI-lab scores compare to traditional disease severity metrics.

Results

The study included a total of 741 patients (all age ≥ 18 years, 19.84% age > 75 years, 41.16% Female). The Kaplan-Meier analysis demonstrated that individuals with elevated FI-lab scores exhibited a significantly heightened risk of all-cause mortality (log-rank p < 0.0001). The multivariate Cox regression analysis suggested that treating FI-lab as a continuous variable (per 0.01 increment) was linked to an increased risk of 28-day all-cause mortality [hazard ratio (HR) 1.072, 95% confidence interval (CI) (1.055-1.089), p < 0.001]. Moreover, when FI-lab was analyzed as a categorical variable, patients in the fourth quartile of FI-lab had a notably greater risk of 28-day all-cause mortality in comparison to those in the first quartile [HR 9.933, 95% CI (4.676-21.104), p < 0.001]. Additionally, the integration of FI-lab scores with conventional disease severity scores improved the predictive performance for 28-day mortality.

Conclusion

In patients in the ICU who have been diagnosed with acute pancreatitis, the FI-lab score functions as a reliable indicator of short-term mortality. Early detection of patients at high risk for acute pancreatitis through the implementation of the FI-lab score, along with prompt interventions, is essential for enhancing these individuals' prognoses.

Assessing Frailty in the Older: The Role of Bite Force as an Independent Indicator

Background: This study investigates the relationship between bite force and grip strength as indicators of frailty in older adults. Frailty syndrome, characterized by increased vulnerability to adverse health outcomes, poses significant challenges in geriatric care. Objectives: This research builds on previous findings linking oral health to frailty risk, emphasizing the need for targeted interventions. Methods: A total of 59 older participants, aged 60 years and older, were enrolled in this cross-sectional study conducted at the Egas Moniz School of Health and Science. The participants underwent assessments of bite force using an electric dynamometer and grip strength using a specialized device. Body composition was also measured using bioelectrical impedance analysis (BIA). Results: Statistical analysis revealed a significant positive correlation between bite force and grip strength, even after adjusting for age and body mass index (BMI). Age was significantly correlated with bite and grip force (p < 0.05), while BMI was correlated only with handgrip force but not with bite force (coefficient = -0.047, p = 0.737). Notably, bite force was found to be independent of BMI, unlike grip strength, which is generally influenced by body composition. This independence highlights the potential of bite force as a reliable and distinct marker for frailty that is not confounded by BMI-related factors. This study highlights the importance of oral health in maintaining overall well-being in older adults. Reduced bite force may indicate an increased risk of frailty, which can lead to malnutrition and decreased quality of life. These findings suggest that integrating bite force measurements into clinical assessments may improve the assessment of frailty and inform interventions aimed at improving health outcomes in the older population. Conclusions: This research provides new insights into the association between bite force and grip strength, emphasizing the unique value of bite force as an independent marker of frailty. It advocates for further studies to explore its role in geriatric care strategies.

The current state and development trends of frailty research in diabetic patients: a bibliometric analysis

Background

Diabetes mellitus is a global public health issue, often leading to organ damage, complications, and disabilities. Frailty is an age-related syndrome characterized by reduced physiological reserve and increased vulnerability to stressors, significantly affecting the prognosis of older diabetic patients. The prevalence of frailty is notably higher in older adults with diabetes than in those without. Therefore, a bibliometric analysis of research on diabetes-related frailty can provide deeper insights into the current state of this field and inform future research directions.

Methods

This study retrieved English-language publications on diabetes-related frailty from the Web of Science Core Collection (WOS) database, covering the period from 2005 to 2023. A total of 403 articles were included in the analysis. Statistical analysis and data visualization were conducted using Microsoft Excel, R Studio, VOS viewer, and Cite Space 6.3.R1. The analysis emphasized journals, authors, keywords, country collaborations, institutional collaborations, and references to elucidate trends and knowledge structures within the field of diabetes-related frailty research.

Results

The number of publications on diabetes-related frailty has been steadily increasing each year, with research predominantly focused in developed countries, particularly the United States and Europe. The University of London has emerged as the institution with the highest volume of publications, while Alan J. Sinclair has been recognized as a significant contributor to this field. Key research hotspots include the complications associated with diabetes-related frailty, epidemiology, and quality of life. Additionally, a timeline analysis of references suggests that diabetic nephropathy is currently at the forefront of research in this area.

Conclusion

This comprehensive bibliometric analysis of diabetes-related frailty research underscores the necessity for improved international collaboration to further investigate the mechanisms underlying diabetes-related frailty and to devise more effective prevention and treatment strategies. Future research should emphasize the relationship between diabetic nephropathy and frailty, as well as the development of personalized intervention programs tailored for frail diabetic patients.

Characteristics of older patients undergoing major oncological surgery: Insights from the Geriatric Surgery Verification Program

INTRODUCTION

Studies outlining the unique burden of geriatric medical conditions and syndromes among older adults undergoing major oncological surgery are lacking, along with understanding of the goals of care for this population.

MATERIALS AND METHODS

We conducted a single-institutional review of the initial 50 patients who enrolled in the American College of Surgeons' Geriatric Surgery Verification Program (GSV) program implemented for those ≥65 years undergoing major oncological surgery during the year 2023. Patient variables were categorized into four domains - somatic, functional, psychological, and social. The impact of GSV was analyzed by comparing the GSV cohort to historical controls from 2021 using patients' goals of care as the outcome of interest.

RESULTS

The mean age of participants was 75.4 years (± 7.5). They were mostly White (72 %), English-speaking (78 %), with similar distribution of sex (54 % female). In the somatic category, nearly 40 % were at moderate to high nutrition risk and 61.5 % had a Geriatric 8 score of ≤14. In the functional category, 34.7 % used a cane or walker, 6.4 % had history of falls, and 22.4 % had some degree of frailty. In the psychological category, >70 % reported some degree of depression. Delirium risk factors were identified in 43 % of the patients. In the social category, more than half (54.3 %) of patients were never married, widowed, or divorced. Financial distress screening was positive in 23.3 %. In regard to goals of care, most patients (79.3 %) reported wanting to maintain independence while only 37.9 % reported extending life as primary concern. Using a composite adverse outcome (CAE) variable incorporating 30-day mortality and institutionalization 30-days after discharge as surrogate for these goals, we found that GSV group had an 8.0 % 30-day CAE rate compared to 28.9 % in the historical controls (p = 0.01).

DISCUSSION

We found high proportions of patients with low G8 score, frailty, perioperative risk of falls and delirium, lack of social support, and financial distress. To meet the care goals of this population, a comprehensive geriatric surgery program is essential to preoperatively capture and mitigate risk factors.

Frailty Influence on Postoperative Surgical Site Infections After Surgery for Degenerative Spine Disease and Adult Spine Deformity. Can a Frailty Index be a Valuable Summary Risk Indicator? A Systematic Review and Metanalysis of the Current Literature

STUDY DESIGN

Metanalysis.

OBJECTIVE

Surgical site infections (SSI) is one of the commonest postoperative adverse events after spine surgery. Frailty has been described as a valuable summary risk indicator for SSI in spine surgery. The aim of this metanalysis is to evaluate the influence of frailty on postoperative SSI in this cohort and provide hints on which index can predict the risk of SSI.

METHODS

Papers describing the postoperative SSI rate in adult degenerative spine disease or adult spine deformity patients with varying degrees of frailty were included in the analysis. The SSI rate in different grades of frailty was considered for outcome measure. Meta-analysis was performed on studies in whom data regarding patients with different levels of frailty and occurrence of postoperative SSI could be pooled. P < .05 was considered significant.

RESULTS

16 studies were included. The frailty prevalence measured using mFI-11 ranged from 3% to 17.9%, these values were inferior to those measured with mFI-5. Significant difference was found between frail and non-frail patients in postoperative SSI rate at metanalysis (z = 5.9547, P < .0001 for mFI-5 and z = 3.8334, P = .0001 for mFI-11).

CONCLUSION

This is the first meta-analysis to specifically investigate the impact of frailty, on occurrence of SSI. We found a relevant statistical difference between frail and non-frail patients in SSI occurrence rate. This is a relevant finding, as the ageing of population increases alongside with spine surgery procedures, a better understanding of risk factors may advance our ability to treat patients while minimizing the occurrence of SSI.

The relationship between psychological distress and frailty in stroke patients: the mediating effect of depression

BACKGROUND

Frailty is a significant factor affecting the quality of life of stroke patients. psychological distress is an essential factor affecting depression in stroke patients. However, the mediating role of depression between psychological distress and debilitation has not been explored.

METHODS

In this study, 315 stroke patients in Shandong and Liaoning provinces were investigated by convenience sampling method from May 2024 to October 2024. Questionnaires included Frailty Scale and Psychological Distress and Depression scale.

RESULTS

In this study, psychological distress scores (4.16 ± 2.29), depression scores (8.81 ± 4.55) and frailty scores (8.92 ± 4.09) were obtained. There was a significant positive correlation between depression and psychological distress in stroke patients (r = 0.483, P < 0.001), depression and frailty (r = 0.575, P < 0.001). There was a significant positive correlation between psychological distress and frailty in stroke patients (r = 0.391, P < 0.001). The direct effect of psychological distress in stroke patients was 0.264. The direct mediating effect of depression on psychological distress and frailty was 0.435.

CONCLUSION

This study provides further insights into the psychological mechanism of psychological distress and frailty in stroke patients. Clinicians and nurses can actively help stroke patients reduce psychological distress, reduce the depression of stroke patients, so as to reduce the occurrence of frailty and improve the quality of life of patients.

Can a novel set of handgrips on a walking frame increase stability and support users when transferring to/from a chair?

INTRODUCTION

One important aspect of walking aid use is transferring safely to the aid from sitting and transferring back to the chair after walking, since these activities have been associated with falls in older adults. Standard frames require their user to push off the chair or ask for help from a carer, which may over time lead to back pain. This study's aim was to assess whether novel handgrips located above the rear feet of a walking frame would facilitate safe transfer as compared to utilizing only the seat cushion or armrests of the chair.

METHODS

In a gait lab-based trial 10 healthy older adults repeatedly transferred from sitting to standing, pushing off the chair's seat cushion, armrests, or using the new lower handles on the frame (alone or in combination with the seat cushion or armrest). The stability margin 'SM', defined as the distance between the centre of pressure and the nearest edge of the base of support for the user-device-chair system, was calculated as a mechanical measure of stability. Specifically, SM provides a measure of how close the system is to the point of tipping over. Additionally, 13 older frame users tried to use the new handgrips to transfer to/from the new frame and gave interviews which were thematically analysed.

RESULTS

Stability for the 10 healthy older adults was statistically either equivalent or better when using one or both handles on the novel frame as compared to pushing off the chair's seat cushion or armrests. Amongst the 13 older frame users the frame's new handgrips were useful to those living in the community and one person living in care, and they perceived them to facilitate independence and control.

DISCUSSION & CONCLUSIONS

The novel handgrips offer continuous support when getting up/sitting down and are well-received by those able to use them. The significance of the research lies in the reported number of falls during transfer from sitting to standing and vice versus, with underlying causes reported including loss of support. The proposed design is timely considering the documented increases in frailty and walking aid use in our ageing population.

Multimodal Prehabilitation for Gynecologic Cancer Surgery

Surgical treatment is commonly employed to treat patients with gynecologic cancer, although surgery itself may function as a stressor, reducing the patients' functional capacity and recovery. Prehabilitation programs attempt to improve patients' overall health and baseline function prior to surgery, thereby enhancing recovery and lowering morbidity. In recent years, prehabilitation has come to primarily refer to multimodal programs that combine physical activity, nutritional support, psychological well-being, and other medical interventions. However, the specific methods of implementing prehabilitation and measuring its effectiveness are heterogeneous. Moreover, high-level evidence regarding prehabilitation in gynecologic cancer surgery is limited. This review provides a summary of multimodal prehabilitation studies in gynecologic oncologic surgery. Enhanced postoperative recovery, lower postoperative complications, lower rate of blood transfusions, and faster gastrointestinal functional recovery have been reported after multimodal prehabilitation interventions. Patients and healthcare professionals should recognize the importance of prehabilitation in the field of gynecologic oncologic treatment, based on the emerging evidence. In addition, there is a need to establish an appropriate target group and construct a well-designed and tailored prehabilitation program.

Relationship between social capital and medication adherence among frail and pre-frail older people: a cross-sectional study from China

BACKGROUND

The number of frail older people is increasing. To alleviate poor health and improve quality of life, pre-frail and frail older people need to adhere to their medication. Yet, studies examining the connection between social capital (including six dimensions) and medication adherence are currently scarce. Therefore, this study aims to examine their relationship in older individuals with pre-frailty and frailty, respectively.

METHODS

Information concerning the socio-demographics, frailty, social capital, and medication adherence of 4218 participants was collected through a structured questionnaire during November and December 2020. This study employed descriptive analysis and binary logistic regression to fit their relationship.

RESULTS

Among the pre-frail respondents, those with lower social participation (AOR 0.55 [95% CI 0.44-0.69]) had less risk of inadequate medication adherence; while lower social connection (AOR 1.91 [95% CI 1.54-2.36]), lower trust (AOR 2.80 [95% CI 2.25-3.47]), lower cohesion (AOR 2.04 [95% CI 1.65-2.53]), and lower reciprocity (AOR 2.32 [95% CI 1.87-2.88]) were all related to higher odds of inadequate medication adherence. Also, lower social participation (AOR 0.54 [95% CI 0.40-0.74]) was linked to less risk of inadequate medication adherence, while lower trust (AOR 1.89 [95% CI 1.41-2.54]), lower cohesion (AOR 1.68 [95% CI 1.24-2.26]), and lower reciprocity (AOR 1.52 [95% CI 1.14-2.04]) were all found to have a greater odds of inadequate medication adherence in frail respondents.

CONCLUSION

By enhancing the relationship between social capital and medication adherence in this challenging community and offering educational programs that promote medication adherence from the perspective of social capital, our findings emphasize the relevance of social capital in improving medication adherence in later life, especially for frail and pre-frail older adults.

Determining safety, usability, acceptability and potential for clinical use of an innovative walking frame design with in- and community patients

PURPOSE

Falls cost the NHS over £2 billion a year, with incidence increasing rapidly with age. Design of indoor walking frames remains limited, often needing to be lifted and not supporting sit-to-stand and turning manoeuvres, which can lead to falling. This study explored aspects of safety and satisfaction and potential for clinical use of a novel prototype walking frame.

METHODS

Within a proof-of-concept design study, between April and November 2023 nine healthcare professionals (HCPs) [3 male 13.4 mean years clinical experience] assessed 10 in-patients and 8 community-based patients [9 male, mean ± SD age 81 ± 9.98]. Patient participants performed mobility activities with the prototype frame and a standard frame. Professionals then completed a questionnaire on safety and satisfaction when using the devices with free text options. Data were analysed using frequency and descriptive statistics and paired comparisons for ranked data, with open comments analysed using thematic analysis.

RESULTS

HCPs reported the prototype as safe in 100% assessments (18/18), with 17/18 stating they would have prescribed it immediately if available ("Not as safe with a standard frame as she was with the prototype".). HCP satisfaction was greater for the prototype regarding dimensions (p = 0.006; "Good ability to personalize to individual".), safety and security (p = 0.003), ease of use (p = 0.005; "Automatically started to use it".), and effectiveness (p = 0.003; "Turns well, minimise lifting, glides but still grips").

CONCLUSIONS

This study demonstrates significantly better satisfaction of HCPs with the new design regarding ease of use and safety, in inpatient and community settings, and a strong desire to prescribe it.

Impact of preoperative frailty status on decision regret following elective hernia repair

PURPOSE

Decision regret following hernia repair is common, particularly for patients who experience complications. Frailty is a risk factor for complications, but whether frailty is independently associated with regret remains unknown.

METHODS

We retrospectively reviewed the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry, a representative sample of adult patients from > 70 hospitals across Michigan. We included patients who underwent elective ventral and incisional hernia repair (VIHR) or groin hernia repair (GHR) from 2020 to 2021 and completed a survey measuring regret. Frailty was quantified using validated 5-factor modified frailty index (mFI5): no (mFI5 = 0), moderate (mFI5 = 1), or severe frailty (mFI5 ≥ 2). Primary outcome was regret at 90-days. Multivariable regression models evaluated the association of frailty with regret.

RESULTS

795 patients underwent VIHR: 294 (37.0%) were moderately frail, and 127 (16.0%) were severely frail. Severely frail patients were older, more often male, more comorbid, had higher BMI, and had larger hernias (all p < 0.05). Regret was demonstrated in 88 patients (11.1%). 2502 patients underwent GHR: 966 (38.6%) moderately frail, and 213 (8.5%) severely frail. Severely frail patients were older, had higher BMI, and more comorbidities (all p < 0.001). 271 persons (10.8%) expressed regret. For both VIHR and GHR, frailty was not associated with regret (p > 0.05). There were no differences in complications by frailty status (p = 0.10 and p = 0.22).

CONCLUSION

Despite their higher risk, persons with frailty are not more likely to express regret following hernia repair. Decision regret is important for evaluating quality-of-life operations, but frailty status should not be used alone to predict risk of decision regret.

Development and validation of a nomogram to predict frailty risk in Chinese older adults combined with physical fitness test indicators

This study aimed to develop and validate a nomogram combined with the indicators of the physical fitness test to predict frailty risk in Chinese older adults. We recruited 344 participants from a community in Hebei Province, China. Data were collected on 57 candidate factor variables from sociodemographic factors, lifestyle factors, clinical factors, body composition test, and physical fitness test. Ultimately 6 factor variables were included in this predictive model: age, nutritional risk, hypertension, multimorbidity, depression and 2-Minute step test. The area under the curve (AUC) value in the training set and validation set is 0.866 and 0.854, which indicates that the model has a good ability to discriminate. The results of the H-L test indicate that the model is well calibrated. The calibration curves also indicate a good model fit. The model provides older adults with risk indicators to identify and prevent the onset of frailty as early as possible.

Comparative Analysis of Frailty Scales in Emergency Department: Highlighting the Strengths of the Triage Frailty and Comorbidity Tool

INTRODUCTION

Currently, there is uncertainty about which frailty scale is most appropriate and valid for use in the emergency department. The objective of this study was to compare the most commonly used frailty scales in triage and evaluate their performance.

METHODS

This prospective, single-center observational study was conducted from June to December 2023. Data collection spanned 80 days, during which the triage nurse recorded frailty scales using the Clinical Frailty Scale, Identification of Seniors at Risk, Program of Research to Integrate the Service for the Maintenance of Autonomy 7 (PRISMA-7), and the Triage Frailty and Comorbidity tool. The Clinical Frailty Scale, Identification of Seniors at Risk, and PRISMA-7 were used for patients aged >65 years, whereas the Triage Frailty and Comorbidity tool was applied to all patients presenting to the emergency department. The scales were compared using the area under the receiver operating characteristic curve for 90-day mortality, 30-day mortality, and hospitalization.

RESULTS

A total of 1270 patients were enrolled during the study period. In comparing the receiver operating characteristic curves, the Triage Frailty and Comorbidity tool demonstrated a receiver operating characteristic curve of 0.894 (95% CI: 0.858-0.929), whereas the Clinical Frailty Scale had 0.826 (95% CI: 0.762-0.890), PRISMA-7 had 0.814 (95% CI: 0.751-0.876), and Identification of Seniors at Risk had 0.821 (95% CI: 0.759-0.882), with a comparison P value of 0.03. The Triage Frailty and Comorbidity tool also significantly outperformed the other scales for 90-day mortality, 30-day mortality, and hospitalization across the overall population. Considering only the population aged >65 years, it identifies frail patients equally well as the other tools.

DISCUSSION

The findings of this study suggest that the Triage Frailty and Comorbidity tool is a valid instrument for assessing frailty in the emergency department. Moreover, among the scales used, it is the only 1 that considers the entire adult population, not just those aged >65 years, making it more inclusive for a setting such as the emergency department.

Intrinsic capacity transitions as predictors of frailty transitions in community-dwelling older adults: Findings from the Korean Frailty and Aging Cohort Study

BACKGROUND

Frailty is associated with reduced intrinsic capacity (IC). However, studies evaluating longitudinal transitions between IC and frailty are limited. We conducted longitudinal analyses to investigate the association between intrinsic capacity (IC) and frailty transitions among community-dwelling older adults in Korea.

METHODS

A total of 2,345 older adults who completed baseline and two-year follow-up surveys were selected from the Korean Frailty and Aging Cohort Study. IC was measured in five domains: locomotion, vitality, cognition, psychology, and sensory function. Frailty was defined using the Fried frailty phenotype. Transitions in IC and frailty were assessed. Logistic regression analysis was used to analyze the association between baseline IC, IC transitions, and frailty transitions.

RESULTS

During the two-year follow-up, 17.8 % of participants improved, 20.4 % worsened, and 61.8 % maintained the same frailty status. Low IC (odds ratio [OR]=1.93; 95 % confidence interval [CI]=1.42-2.61) significantly predicted remaining frail or worsening frailty. Worsened IC increased the risk of remaining frail or worsening frailty, whereas improved IC decreased this risk. Among the IC domains, the onset of new locomotion (OR=3.33; 95 % CI=2.39-4.64), vitality (OR=2.12; 95 % CI=1.55-2.91), and psychological (OR=3.61; 95 % CI=2.64-4.92) impairment predicted remaining frail or worsening frailty.

CONCLUSIONS

Low and worsened IC were associated with an increased risk of remaining frail or worsening frailty over two years. These findings indicate that changes in IC can predict frailty transitions, thereby emphasizing the importance of enhancing IC in preventing frailty progression.

Hospital frailty risk score and outcomes of chronic mesenteric ischemia revascularization: Nationwide Inpatient Sample 2005-2020 analysis

Chronic mesenteric ischemia (CMI) typically affects older adults, and often requiring revascularization. Frailty, a state of decreased physiological reserve, may impact the outcomes of CMI treatment. The purpose of was to determine the impact of frailty, assessed by the Hospital Frailty Risk Score, on in-hospital outcomes after CMI revascularization. Data from the Nationwide Inpatient Sample 2005-2020, were analyzed in this retrospective study. Inclusion criteria were adults ≥20 years old who underwent revascularization for CMI. Patients were categorizing patients into low-, intermediate-, and high-frailty risk groups. Logistic regression analyses, adjusted for confounders, was used to assess associations between frailty risk and outcomes. The study included 4100 patients with a mean age of 71.2 years, of whom 71% were female. Patients in the intermediate and high frailty risk groups had significantly increased odds of in-hospital mortality (intermediate risk: adjusted odds ratio [aOR] = 3.33, 95% confidence interval [CI]: 2.07-5.35; high risk: aOR = 3.68, 95% CI: 2.15-6.31), unfavorable discharge (intermediate risk: aOR = 2.25, 95% CI: 1.83-2.77; high risk: aOR = 3.77, 95% CI: 2.91-4.88), prolonged hospital stay (intermediate risk: aOR = 2.40; high risk: aOR = 4.85), transfusions (intermediate risk: aOR = 1.97; high risk: aOR = 4.58), and overall complications (intermediate risk: aOR = 3.84; high risk: aOR = 8.74) compared to low-risk patients. Frailty is associated with worse outcomes of patients with CMI undergoing revascularization. Thus, it is important to incorporate frailty assessment in preoperative risk stratification and management of CMI revascularization.

Impairment of the Functional Status and Decrease in Albumin in Frail Older People After a COVID-19 Outbreak: A Descriptive Study in a Long-Term Care Facility in Chile

Introduction. Frailty is a common condition among older individuals and is associated with increased vulnerability to adverse health outcomes. The COVID-19 pandemic further highlighted the impact of viral infections on frail populations. The present work aimed to determine frailty, functional and cognitive status, and clinical analysis of older persons in a long-term care facility in Chile, before and following the outbreak of COVID-19. Methods. A single-center, pre-post, and Pearson's correlational study was conducted in a cohort of 20 persons positive for COVID-19 from a total of 45 residents. Data on demographic, clinical, functional (Barthel Index (BI) and Katz) and cognitive (Mini mental Examination) status, and physiological function (hematology, lipidic and biochemical profiles) were collected. Results. The mean age was 84 ± 2.4 years, and 80% were females. The most common comorbidities were Arterial Hypertension, Diabetes Mellitus type II, and Alzheimer's disease. Physical frailty was confirmed by body weight, body mass index, and calf circumference. Pre-infection, BI was negatively correlated with lipidic profile and erythrocyte sedimentation rate (ESR), and positively with frailty (calf circumference). Pre-post analysis showed that frailty and most analytical results were not modified. However, functional dependence on daily live activities significantly increased as measured by BI, with worse grooming and bowel and bladder controls. Post-infection, correlations were lost except between BI and ESR, and decreased albumin levels were found. Conclusions. The worsening of specific functional limitations emphasizes the need for targeted interventions that can be correlated with ESR. Albumin appears as a potential biomarker for physiological dysfunction associated with their infectious/inflammatory processes.

Associations among frailty conditions and pain indicators: Data from 22 356 European older adults

AIM

Recent studies supported the presence of a relationship between pain and frailty, but more research is needed to highlight the pain-frailty association. The study aimed to investigate the prevalence and the influence of different pain indicators on frailty while controlling for age, sex and country.

METHODS

This observational study used data from the sixth wave of the SHARE survey. A sample of 22 356 community-dwelling individuals aged >60 years from six European countries (Spain, Estonia, France, Greece, Czech Republic and Sweden) was analyzed. The pain was measured through assessment of medication used for joint pain or other types of pain, pain location, polypharmacy and pain level. Frailty was assessed with the modified Fried Frailty phenotype.

RESULTS

Pain indicators, especially widespread pain and pain severity, were significantly associated with prefrailty (odds ratio 3.30, 95% CI 2.40, 4.55; and odds ratio 0.61, 95% CI 0.51, 0.72) and frailty status (odds ratio 4.69, 95% CI 3.31, 6.67; and odds ratio 0.37, 95% CI 0.30, 0.44). Advancing age and female sex consistently correlated with increased prefrailty (odds ratio 1.06, 95% CI 1.05, 1.07; and odds ratio 1.36, 95% CI 1.22, 1.53) and frailty risk (odds ratio 1.11, 95% CI 1.10, 1.12; and odds ratio 1.71, 95% CI 1.48, 1.96). Country-specific differences emerged, with Spaniards showing higher odds ratios of prefrailty and frailty compared with Swedish, French and Czech individuals, whereas Greeks showed elevated odds ratios compared with Spaniards. The factors associated jointly explained 27.5% of the variance in frailty categories.

CONCLUSION

Significant associations were identified, particularly with widespread pain and pain severity, highlighting their impact on frailty. Country-specific variations in frailty prevalence were observed, alongside consistent associations with advancing age and female sex. These findings provide valuable insights into the intricate interplay between pain and frailty, offering the potential for targeted interventions in older adults' care through tailored pain management strategies. Geriatr Gerontol Int 2024; 24: 1362-1369.

Impact of multicomponent exercise and nutritional supplement interventions for improving physical frailty in community-dwelling older adults: a systematic review and meta-analysis

OBJECTIVE

To investigate the efficacy of both multicomponent exercise and nutritional interventions on frailty by conducting a systematic review and meta-analysis to examine changes in frailty incidence.

DESIGN

A systematic review and meta-analysis.

ELIGIBLE CRITERIA

The included studies were limited to original controlled trials focused on frailty interventions in older adults aged 65 years and over. The studies involved only participants with specific diseases, and those recovering from surgery or being hospitalized were excluded.

INFORMATION SOURCES

A systematic search was performed on three databases: PUBMED, EMBASE, and Cumulative Index to Nursing and Allied Health, with the latest search in October 2024. Three authors independently extracted the data using a standardized data collection form. Relative risks were used as a summary measure. Pooled-effect estimates of each outcome were calculated by the random-effects meta-analysis.

RESULTS

After searching three databases, 5327 records were identified. After removing duplicates and screening the titles and abstracts, 19 multicomponent exercise studies and 7 nutritional intervention studies were eligible. In a pooled analysis of 18 multicomponent exercise RCTs, including a total of 3457 older adults, the multicomponent exercises showed a clinically significant reduction in frailty risk by relative change 55% times (95% CI 45% to 67%, p value < 0.001). The subgroup analysis of combinations of macronutrients and micronutrients also demonstrated statistically significant decrease in frailty risk by relative change 28% times (95% CI 11% to 72%, p value = 0.008).

CONCLUSION

Multicomponent exercises can effectively improve physical frailty, regardless of the duration and types of the activities, whereas the efficacy of nutritional supplements remains unclear. Personalized multicomponent approaches that incorporate both exercises and nutritional supplements have promised to enhance effectiveness in reducing frailty, thus warranting further investigation.

TRIAL REGISTRATION

The study was registered on 12 September 2022, under PROSPERO registration number CRD42022357357.

Effects of immersive virtual reality stimulation and/or multicomponent physical exercise on cognitive and functional performance in hospitalized older patients with severe functional dependency: study protocol for a randomized clinical trial

BACKGROUND

Hospital-associated functional decline affects nearly one-third of the hospitalized older adults. The aim of this trial is to investigate the effect of a cognitive stimulation intervention provided via immersive virtual reality (IVR), with or without a multicomponent physical exercise intervention (ME) in hospitalized patients aged 75 or older with severe functional dependency at admission (Barthel Index < 60 points).

METHODS

This clinical randomized controlled trial will be conducted in the Acute Geriatric Unit of a tertiary hospital in Spain. A total of 212 acute patients will be enrolled according to the following criteria: age ≥ 75, Barthel Index < 60, able to collaborate, expected length of stay ≥ 5 days, absence of clinical instability and severe dementia (Global Deterioration Scale 7) or other end-stage disease. Patients will be randomly assigned to a control group (CG) or any of the three intervention groups (IG): IVR, ME, or IVR + ME. The IVR group will watch ad-hoc videos showing Spanish regional landscapes and villages, approximately 4 min per day for three consecutive days. The ME group will undergo aerobic and strength exercise for progressive training of the upper and lower limbs. The IVR + ME group will do both cognitive and physical intervention. The primary outcomes will be cognitive and physical measures at discharge. Mood, quality of life, isometric strength, and acceptance of IVR will be also assessed.

DISCUSSION

This project has the potential to enhance physical and psychological well-being of patients with severe functional dependency hospitalized for acute conditions, using technology. Virtual reality is expected to be favourably perceived by hospitalized older adults. This intervention represents a novelty in the geriatric patients' care, comprising IVR and/or ME dispensed within the patient's room, and including patients who are commonly excluded from research clinical trials.

TRIAL REGISTRATION

This study was approved by the Navarra Clinical Research Ethics Committee on May 17th, 2023 (PI_2023/60). The trial is registered at ClinicalTrials.gov, registration number NCT06340282, 24th May 2024.

Physiological changes associated with aging: Identification of novel biomarkers for frailty syndrome in women

This study explores the physiological changes associated with aging that lead to frailty syndrome, characterized by reduced vitality and degeneration across multiple bodily systems, increasing susceptibility to various pathologies. While established scales like the Fried Phenotype and Frailty Trait Scale (FTS) are commonly used for assessing frailty, incorporating biomarkers is crucial for accurate diagnosis and prognosis. Our research examines plasma oxylipin levels in frail elderly individuals to identify novel biomarkers. Diagnostic criteria for frailty included assessments using the Fried Phenotype and FTS-5, with blood samples collected from 71 elderly participants (50 women and 21 men) with mean ages of 73.6 ± 5.9 and 76.2 ± 6.2 years, respectively. Women exhibited elevated platelet counts (p-value 0.0035). The significant differences in oxylipin concentrations associated with the Fried Phenotype were particularly noteworthy, predominantly observed in women. Specifically, in women, decreased grip strength (<15 kg) and slow gait speed (<0.8 m/s) correlated with increased levels of thromboxane B2 (TxB2) and 7-HDoHE (p-values 0.0404, 0.0300, 0.0033, and 0.0033, respectively). Additionally, elevated 7-HDoHE levels correlated with a BMI exceeding 28 kg/m2 (p-value 0.0123) and Physical Activity Scale for the Elderly (PASE) scores surpassing 5 points (p-value 0.0134) in women. In summary, our findings emphasize that frail older individuals, particularly women, exhibit higher levels of TxB2 and 7-HDoHE compared to their non-frail counterparts, aligning with established frailty classification and scale parameters, suggesting their potential as indicative biomarkers.

Urban-Rural Differences in the Association of eHealth Literacy With Medication Adherence Among Older People With Frailty and Prefrailty: Cross-Sectional Study

Background

With advances in science and technology and improvements in health literacy, more studies have focused on frailty prevention by promoting medication adherence, emphasizing the role of eHealth literacy. However, the association between eHealth literacy and medication adherence in frail older adults has not been well studied, and it is unknown whether urban-rural differences exist in this relationship.

Objective

This study aims to examine the relationship between eHealth literacy and medication adherence in older people with different frailty statuses, emphasizing variations between rural and urban areas.

Methods

Between November and December 2020, a total of 4218 urban and rural community members (aged ≥60 years) in China were recruited as participants using a multistage random sampling method. A face-to-face structured questionnaire survey was conducted to collect information on demographic characteristics, eHealth literacy (consisting of application, evaluation, and decision dimensions), and medication adherence. eHealth literacy was assessed using the Chinese version of the eHealth Literacy Scale developed by Norman and Skinner, and medication adherence was measured using the 4-item Morisky scale. We used a general descriptive analysis and stratified logistic regression models to examine how eHealth literacy is linked to medication adherence and urban-rural differences.

Results

There were 4218 respondents, of which 2316 (54.9%) lived in urban areas and 1902 (45.1%) in rural areas, respectively. After adjusting for potential confounders, among participants with prefrailty, eHealth literacy was associated with medication adherence in urban areas in terms of less application (adjusted odds ratio [AOR] 1.16, 95% CI 0.82-1.63), less evaluation (AOR 1.29, 95% CI 0.92-1.81), and less decision ability (AOR 1.20, 95% CI 0.86-1.68); eHealth literacy was linked with medication adherence in the rural areas in terms of less application (AOR 1.10, 95% CI 0.56-2.13), less evaluation (AOR 1.05, 95% CI 0.61-1.79), and less decision ability (AOR 1.10, 95% CI 0.64-1.90). Among frail participants, less eHealth literacy (AOR 0.85, 95% CI 0.48-1.51), along with its dimensions, including less application (AOR 0.85, 95% CI 0.47-1.54), evaluation (AOR 0.89, 95% CI 0.50-1.57), and decision ability (AOR 0.99, 95% CI 0.55-1.76), were associated with medication adherence in urban areas; less eHealth literacy (AOR 0.89, 95% CI 0.48-1.65), along with its dimensions, including less application (AOR 1.23, 95% CI 0.62-2.44), evaluation (AOR 0.98, 95% CI 0.53-1.82), and decision ability (AOR 0.90, 95% CI 0.49-1.67), were associated with medication adherence in rural areas.

Conclusions

The results of this study suggest that there is an association between eHealth literacy and medication adherence among older people with frailty and prefrailty. To promote medication adherence, eHealth literacy can be helpful in tailoring interventions.

Hidden Dangers of Frailty: Higher Mortality, Complications and Costs in Acute Pancreatitis

BACKGROUND

Frailty is a clinically recognizable state of increased vulnerability due to age-related decline in reserve and function across multiple physiologic systems that compromises the ability to cope with acute stress. As frailty is being identified as an important risk factor in outcomes of gastrointestinal pathologies, we aimed to assess outcomes in patients with acute pancreatitis within this cohort.

METHOD

We conducted a retrospective study using the Nationwide Inpatient Sample (NIS) database. ICD-10 codes were used to inquire for patients admitted with acute pancreatitis between September 2015 through 2017. ICD-10 codes corresponding to the Hospital Frailty Risk Score (HFRS) were used to divide the study sample into 2 cohorts: low risk (< 5 points) and intermediate or high risk (> 5 points). To calculate the points, we fitted a logistic regression model that included membership of the frail group as the binary dependent variable (frail vs. non-frail) and the set of ICD-10 codes as binary predictor variables (1 = present, 0 = absent for each code). To simplify the calculation and interpretation, we multiplied regression coefficients by five to create a points system, so that a certain number of points are awarded for each ICD-10 code and added together to create the final frailty risk score. Multivariate regression analysis was performed to find adjusted mortality.

RESULTS

Out of a total of 1,267,744 patients admitted with acute pancreatitis, 728,953 (57.5%) were identified as intermediate and high risk (> 5 points) (study cohort) and 538,781 (42.5%) as low risk (< 5 points). The mean age in the study cohort was 64.8 ± 12.6 and that in the low-risk group was 58.6 ± 9.5. Most of the patients in both groups were males and Caucasians; Medicare was the predominant insurance provider. A majority of the admissions in both groups were in an urban teaching hospital and were emergency. (Table 1). The primary outcome was in-hospital mortality which was significantly higher in the study cohort as compared to the low-risk group (4.3% vs. 2.5%, p < 0.0001). The age-adjusted Odds ratio of mortality was 1.72(95% CI (Confidence Interval) 1.65-1.80, p < 0.05). When compared between the two groups; median length of stay (6 vs. 4); hospitalization cost ($14,412 vs. $10,193), disposition to a skilled nursing facility (SNF) (17.1% vs. 8.6%) and need for home health care (HHC) was significantly higher in the study cohort. Complications like septicemia, septic shock, and acute kidney injury were also higher in the study group (Table 2). Table 1 Baseline demographics of the cohort Characteristics Acute pancreatitis with High HES Frailty score (> 5, intermediate + high) Acute pancreatitis with low HES Frailty score (< 5) P-value N = 1,267,744 N = 728,953 (57.5%) N = 538,781 (42.5%) Age  Mean years (Mean ± SD) 64.8 ± 12.6 58.6 ± 9.5  < 0.001 Gender  < 0.001  Male 59.1% 52.3%  Female 40.9% 47.7% *Missing-475 Age groups  < 0.001  18-44 3.7% 14.3%  45-64 48% 52.9%  65-84 32.2% 28.7%  ≥ 85 16.1% 4.1% Race  < 0.001  Caucasians 67.4% 61.9%  African Americans 9.6% 16.8%  Others 23% 21.3% *Missing-10 Insurance type  < 0.001  Medicare 40.9% 36.3%  Medicaid 17.2% 24.3%  Private 31.8% 27.9%  Other 9.9% 11.4% *Missing-75 Active smoking 32.7% 37.9% 0.005 Biliary Stone 36.2% 16.7%  < 0.001 Admission Type  < 0.001  Emergent 93.7% 94.3%  Elective 6.3% 5.7% *Missing-2880 Hospital ownership/control  < 0.001  Rural 7.8% 10%  Urban nonteaching 26.3% 26.6%  Urban teaching 65.9% 63.4% Table 2 Outcomes Outcomes Acute pancreatitis with High HES Frailty score (> 5, intermediate + high) Acute pancreatitis with low HES Frailty score (< 5) P-value In-hospital mortality *Missing-920 4.3% 2.5%  < .0001 1.72(1.65-1.80)  < .0001 Length of stay, days (Median,IQR) 6(3-8) 4(2-6)  < .0001 Total hospitalization cost, $ (Median,IQR) 14,412(8843-20,216) 10,193(6840-13,842)  < .0001 In-Hospital Complications  ARDS 0.4% 0.3% 0.08  Ventilator dependence respiratory failure 0.23% 0.29% 0.25  Septicemia 15.2% 9.6%  < .0001  Septic Shock 6.1% 2.9%  < .0001  AKI 24.8% 14.9%  < .0001 Disposition  < .0001  Discharge to home 58.9% 74.9%  Transfer other: includes  Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), and another type of facility 17.1% 8.6%  Home health care 11.5% 8.1%  Against medical advice (AMA) 1.6% 3.4% *Missing-920 CONCLUSION: Using frailty as a construct to identify those who are at greater risk for adverse outcomes, can help formulate interventions to target individualized reversible factors to improve outcomes in patients with acute pancreatitis. Future large-scale prospective studies are warranted to understand the dynamic and longitudinal relationship between pancreatitis and frailty.

Frailty and the Correlation Between Total Testosterone Levels and Urinary Incontinence Among Elderly Women

INTRODUCTION AND HYPOTHESIS

The objective was to explore the correlation between total testosterone levels and stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) in older patients, emphasizing frailty.

METHODS

This prospective cross-sectional study included 1,328 women over 60 years of age at an incontinence specialty clinic. Participants were assessed for UI, frailty, using the Japanese Frailty Scale, and total testosterone levels. Analysis of a logistic regression model was employed for age, body mass index (BMI), and vaginal deliveries adjustment, with association and multivariate analyses to evaluate the associations with SUI and UUI.

RESULTS

The frailty and nonfrailty groups each consisted of 664 individuals. After age, BMI, and the number of vaginal deliveries adjustment, the analysis showed a negative association between total testosterone levels and both SUI (p < 0.001) and UUI (p < 0.001) in the frailty group. Multivariate analysis revealed that, in the nonfrailty group, factors such as low total testosterone levels (p = 0.0145), diabetes (p = 0.0052), and cerebral infarction (p = 0.0254) were related to SUI, whereas no significant factors were associated with UUI. In the frailty group, factors associated with SUI included low total testosterone levels (p < 0.0001), the number of vaginal deliveries (p < 0.0001), smoking (p = 0.0240), chronic lung disease (p < 0.0248), and hypertension (p < 0.0265). Factors associated with UUI were age (p < 0.0001), low total testosterone levels (p = 0.0025), diabetes (p < 0.0001), and the number of vaginal deliveries (p = 0.0152).

CONCLUSIONS

The study highlights the significance of incorporating the assessment of frailty and testosterone levels in addressing UI among older women, particularly in the aged population, underscoring the need for tailored approaches in this demographic.

Impact of Gut Microbiota on Aging and Frailty: A Narrative Review of the Literature

Aging is a natural, complex, and individual process that focuses on the progressive decay of the body and a decrease in cell function that begins in approximately the sixth decade of life and ends with death. Current scientific evidence shows that the aging process is mostly related to genetic load and varies because of the environment. Therefore, aging can be adjusted through the intervention of factors that control homeostasis in genetic, biochemical, and immunological processes, including those involving the gut microbiota. Indeed, the diversity of the gut microbiota decreases during aging, based on the presence of modifications in the hormonal, immunological, and operational processes of the gastrointestinal tract. These modifications lead to a state of dysbiosis. However, altering bacterial communities remains complicated due to the great diversity of factors that influence their modification. Alterations caused by the aging process are known to foster dysbiosis and correspond to conditions that determine the degree of frailty in senior citizens. Consequently, the microbial structure can be used as a biomarker for geriatric care in the promotion of healthy aging.

Curcumin: A Golden Approach to Healthy Aging: A Systematic Review of the Evidence

Aging-related disorders pose significant challenges due to their complex interplay of physiological and metabolic factors, including inflammation, oxidative stress, and mitochondrial dysfunction. Curcumin, a natural compound with potent antioxidant and anti-inflammatory properties, has emerged as a promising candidate for mitigating these age-related processes. However, gaps in understanding the precise mechanisms of curcumin's effects and the optimal dosages for different conditions necessitate further investigation. This systematic review synthesizes current evidence on curcumin's potential in addressing age-related disorders, emphasizing its impact on cognitive function, neurodegeneration, and muscle health in older adults. By evaluating the safety, efficacy, and mechanisms of action of curcumin supplementation, this review aims to provide insights into its therapeutic potential for promoting healthy aging. A systematic search across three databases using specific keywords yielded 2256 documents, leading to the selection of 15 clinical trials for synthesis. Here, we highlight the promising potential of curcumin as a multifaceted therapeutic agent in combating age-related disorders. The findings of this review suggest that curcumin could offer a natural and effective approach to enhancing the quality of life of aging individuals. Further research and well-designed clinical trials are essential to validate these findings and optimize the use of curcumin in personalized medicine approaches for age-related conditions.

Practical consensus for the treatment and follow-up of primary aldosteronism: a multidisciplinary consensus document

Primary aldosteronism (PA) is the most frequent cause of secondary hypertension and is associated with a higher cardiometabolic risk than essential hypertension. The aim of this consensus is to provide practical clinical recommendations for its surgical and medical treatment, pathology study and biochemical and clinical follow-up, as well as for the approach in special situations like advanced age, pregnancy and chronic kidney disease, from a multidisciplinary perspective, in a nominal group consensus approach of experts from the Spanish Society of Endocrinology and Nutrition (SEEN), Spanish Society of Cardiology (SEC), Spanish Society of Nephrology (SEN), Spanish Society of Internal Medicine (SEMI), Spanish Radiology Society (SERAM), Spanish Society of Vascular and Interventional Radiology (SERVEI), Spanish Society of Laboratory Medicine (SEQC(ML)), Spanish Society of Anatomic-Pathology and Spanish Association of Surgeons (AEC).

Modified 5-Item Frailty Index: A Useful Tool for Assessing the Impact of Frailty on Postoperative Morbidity and Mortality Following Surgical Fixation of Thoracolumbar Fractures

OBJECTIVES

The modified 5-item frailty index (mFI-5) is a comorbidity-based risk stratification tool to predict adverse events following various neurologic surgeries. This study aims to quantify the association between increased mFI-5 and postoperative complications and mortality following surgical fixation of traumatic thoracolumbar fractures.

METHODS

The 2011-2021 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing fusion surgeries for thoracolumbar spine fractures. The mFI-5 score was calculated based on the presence of 5 major comorbidities: congestive heart failure within 30 days before surgery, insulin-dependent or noninsulin-dependent diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status at the time of surgery, and hypertension requiring medication. Multivariate analysis assessed the independent impact of increasing mFI-5 scores on postoperative 30-day morbidity and mortality while controlling for baseline clinical characteristics.

RESULTS

A total of 66,904 patients were included in our analysis (54.2% female, mean age 62.27 ± 12.93 years). On univariate analysis, higher mFI-5 score was significantly associated with increased risks of superficial surgical site infection, deep surgical site infection, wound dehiscence, unplanned reoperation, pneumonia, unplanned intubation, postoperative ventilator use, progressive renal insufficiency, acute renal failure, urinary tract infection, stroke, myocardial infarction, cardiac arrest, pulmonary embolism, deep vein thrombosis, bleeding requiring transfusion, sepsis, septic shock, and longer hospital length of stay (LOS). On multivariate logistic regression, increasing mFI-5 score versus a mFI-5 score of zero was associated with higher odds of overall complications (mFI-5 ≥2: odds ratio [OR] 1.38 CI: 1.24-1.54, P < 0.001; mFI-5 = 1: OR 1.18 CI: 1.11-1.24, P < 0.001) and 30-day mortality (mFI-5 ≥2: OR 2.33 CI: 1.60-3.38, P < 0.001).

CONCLUSION

This study demonstrates that frailty, when measured using the mFI-5, independently predicts postoperative complications, hospital LOS, and 30-day mortality after surgical repair of thoracolumbar fractures. These findings are important for risk stratification in patients undergoing thoracolumbar fusion surgery and for standardization in reporting outcomes after those procedures.

Predictors of Frailty in Patients With Liver Cirrhosis

Introduction Frailty is noticed in a large number of cirrhotic patients with advanced liver disease. Frailty not only disposes cirrhotic patients to increased rates of decompensation and hospitalization but also leads to prolonged hospital stay and increased psychological and social impact, resulting in the delisting of these patients from the transplant list. Therefore, our aim was to identify the factors that are independent predictors of frailty in patients with liver cirrhosis. Methods This cross-sectional study was carried out at the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from March 1, 2022, to August 31, 2022. All the patients diagnosed with liver cirrhosis and aged 18-70 years were included in the study. The excluded patients comprised those with disorders that over-estimate frailty such as cardiopulmonary disease and hepatocellular carcinoma. The measurement of the Liver Frailty Index (LFI) was done using the hand grip strength method, timed chair stands, and balance testing. Patients with LFI >4.5 were considered frail. All data was entered and analyzed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States). Continuous variables were analyzed using the student-t test while categorical variables were analyzed using the chi-square test. Variables with significance on univariate analysis then underwent multivariate analysis to identify the independent predictors of frailty in cirrhotic patients. A p-value < 0.05 was considered statistically significant. Results A total of 132 patients were included in the study. Out of them, 89 (67.4%) were males. On assessment, 51 (38.6%) patients were frail on presentation. On univariate analysis, female gender, advanced age, raised total leucocyte count, increased percentage of neutrophils on peripheral smear, raised serum creatinine, raised total bilirubin, raised prothrombin time, high Child Turcotte Pugh (CTP) score, and high model for end-stage liver disease along with low hemoglobin and low serum albumin levels were statistically significantly associated with frailty in cirrhosis. On multivariate analysis, female gender, age >40 years, CTP>B7, Hemoglobin <10g/dl, and neutrophils >60% on peripheral smear were independent predictors of liver frailty in cirrhotic patients. Conclusion Female gender, advanced age, increased neutrophils on peripheral smear, decreased hemoglobin along with increased degree of liver dysfunction were independent predictors of increased frailty in patients with chronic liver disease.

Stroke and frailty index: a two-sample Mendelian randomisation study

INTRODUCTION

Previous observational studies have found an increased risk of frailty in patients with stroke. However, evidence of a causal relationship between stroke and frailty is scarce. The aim of this study was to investigate the potential causal relationship between stroke and frailty index (FI).

METHODS

Pooled data on stroke and debility were obtained from genome-wide association studies (GWAS).The MEGASTROKE Consortium provided data on stroke (N = 40,585), ischemic stroke (IS,N = 34,217), large-vessel atherosclerotic stroke (LAS,N = 4373), and cardioembolic stroke (CES,N = 7 193).Summary statistics for the FI were obtained from the most recent GWAS meta-analysis of UK BioBank participants and Swedish TwinGene participants of European ancestry (N = 175,226).Two-sample Mendelian randomization (MR) analyses were performed by inverse variance weighting (IVW), weighted median, MR-Egger regression, Simple mode, and Weighted mode, and heterogeneity and horizontal multiplicity of results were assessed using Cochran's Q test and MR-Egger regression intercept term test.

RESULTS

The results of the current MR study showed a significant correlation between stroke gene prediction and FI (odds ratio 1.104, 95% confidence interval 1.064 - 1.144, P < 0.001). In terms of stroke subtypes, IS (odds ratio 1.081, 95% confidence interval 1.044 - 1.120, P < 0.001) and LAS (odds ratio 1.037, 95% confidence interval 1.012 - 1.062, P = 0.005). There was no causal relationship between gene-predicted CES and FI. Horizontal multidimensionality was not found in the intercept test for MR Egger regression (P > 0.05), nor in the heterogeneity test (P > 0.05).

CONCLUSIONS

This study provides evidence for a causal relationship between stroke and FI and offers new insights into the genetic study of FI.

Effects of Exercise on Frailty in Older People Based on ACSM Recommendations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives: The objective of the study was to carry out an analysis of the methodological quality of clinical trials (effects of exercise on frailty in older people) based on ACSM recommendations. Methods: The search scope included PubMed, Embase, Web of Science, Cochrane, and literature that cannot be retrieved from the database. The topic was the impact of exercise on frailty in elderly people. Changes in five outcome measures (FP, BI, SPPB, GS, and BMI) were assessed using mean differences (MD) and 95% confidence intervals (95% CI). A random effects model (RE) was used to conduct a meta-analysis and compare the results between subgroups. Results: The intervention effects of exercise on the five outcome indicators of frailty in elderly people were all significant (p < 0.05). The effect of a high-consistency subgroup on outcome indicators FP and GS was more significant than that of the low- or uncertain-consistency subgroup (MD: -1.09 < -0.11, MD: 2.39 >1.1). There was no significant difference in the intervention effect as reflected in the outcome measures SPPB and BMI in the high-consistency subgroup (p = 0.07, p = 0.34). There was no significant difference in the impact of the intervention on the outcome measure BI between the two subgroups (p = 0.06, p = 0.14). Conclusions: Exercise prescriptions with high consistency with ACSM recommendations may be more effective in both FP and GS interventions than those with uncertain or low consistency. However, it is essential to note that the data derived from the meta-analysis is still subject to the small number of studies, the unknown degree of consistency of participants in individual studies, and the different mix of cases in the studies.

Age- and sex-related changes in motor functions: a comprehensive assessment and component analysis

Age-related motor impairments often cause caregiver dependency or even hospitalization. However, comprehensive investigations of the different motor abilities and the changes thereof across the adult lifespan remain sparse. We, therefore, extensively assessed essential basic and complex motor functions in 444 healthy adults covering a wide age range (range 21 to 88 years). Basic motor functions, here defined as simple isolated single or repetitive movements in one direction, were assessed by means of maximum grip strength (GS) and maximum finger-tapping frequency (FTF). Complex motor functions, comprising composite sequential movements involving both proximal and distal joints/muscle groups, were evaluated with the Action Research Arm Test (ARAT), the Jebsen-Taylor Hand Function Test (JTT), and the Purdue Pegboard Test. Men achieved higher scores than women concerning GS and FTF, whereas women stacked more pins per time than men during the Purdue Pegboard Test. There was no significant sex effect regarding JTT. We observed a significant but task-specific reduction of basic and complex motor performance scores across the adult lifespan. Linear regression analyses significantly predicted the participants' ages based on motor performance scores (R2 = 0.502). Of note, the ratio between the left- and right-hand performance remained stable across ages for all tests. Principal Component Analysis (PCA) revealed three motor components across all tests that represented dexterity, force, and speed. These components were consistently present in young (21-40 years), middle-aged (41-60 years), and older (61-88 years) adults, as well as in women and men. Based on the three motor components, K-means clustering analysis differentiated high- and low-performing participants across the adult life span. The rich motor data set of 444 healthy participants revealed age- and sex-dependent changes in essential basic and complex motor functions. Notably, the comprehensive assessment allowed for generating robust motor components across the adult lifespan. Our data may serve as a reference for future studies of healthy subjects and patients with motor deficits. Moreover, these findings emphasize the importance of comprehensively assessing different motor functions, including dexterity, force, and speed, to characterize human motor abilities and their age-related decline.

The Influencing Factors of Frailty and Quality of Life in Elderly Patients After Spinal Surgery

Background

To study the related factors of frailty and quality of life in elderly patients after spinal surgery.

Methods

The anxiety, depression, frailty, and quality of life of all patients were assessed by the Anxiety screening scale (GAD-7), Depression screening scale (PHQ-9), Frailty screening scale (FRAIL), and European five-dimensional health scale (EQ-5D-5L) 1 day before surgery (DAY-0). A numeric rating scale (NRS) was used to evaluate patients' pain during activities on the 1st day (POD-1), 3rd day (POD-3), and 30th day (POD-30) after operation. FRAIL scale and EQ-5D-5L were used to evaluate patients' frailty and quality of life on POD-30 and 90th day (POD-90) after the operation.

Results

There were significant differences in age, body mass index (BMI), preoperative serum albumin level (ALB), and NRS score on POD-1 between the two groups (P<0.05). Age and PHQ-9 score were positively correlated with EQ-5D-5L score (P<0.05, r Age=0.245, rPHQ-9=0.217), and preoperative ALB level was negatively correlated with EQ-5D-5L score (P<0.05, r ALB=-0.274).

Conclusion

The older the age, the larger the BMI and the higher the NRS score on the first day after surgery, the more prone to frailty in elderly patients after spinal surgery; The older age and the lower the preoperative ALB level, the worse the quality of life in elderly patients after spinal surgery.

Impact of clinical frailty on surgical and non-surgical complications after major emergency abdominal surgery

BACKGROUND

Major emergency abdominal surgery is associated with a high risk of morbidity and mortality. Given the ageing and increasingly frail population, understanding the impact of frailty on complication patterns after surgery is crucial. The aim of this study was to evaluate the association between clinical frailty and organ-specific postoperative complications after major emergency abdominal surgery.

METHODS

A prospective cohort study including all patients undergoing major emergency abdominal surgery at Copenhagen University Hospital Herlev, Denmark, from 1 October 2020 to 1 August 2022, was performed. Clinical frailty scale scores were determined for all patients upon admission and patients were then analysed according to clinical frailty scale groups (scores of 1-3, 4-6, or 7-9). Postoperative complications were registered until discharge.

RESULTS

A total of 520 patients were identified. Patients with a low clinical frailty scale score (1-3) experienced fewer total complications (120 complications per 100 patients) compared with patients with clinical frailty scale scores of 4-6 (250 complications per 100 patients) and 7-9 (277 complications per 100 patients) (P < 0.001). A high clinical frailty scale score was associated with a high risk of pneumonia (P = 0.009), delirium (P < 0.001), atrial fibrillation (P = 0.020), and infectious complications in general (P < 0.001). Patients with severe frailty (clinical frailty scale score of 7-9) suffered from more surgical complications (P = 0.001) compared with the rest of the cohort. Severe frailty was associated with a high risk of 30-day mortality (33% for patients with a clinical frailty scale score of 7-9 versus 3.6% for patients with a clinical frailty scale score of 1-3, P < 0.001). In a multivariate analysis, an increasing degree of clinical frailty was found to be significantly associated with developing at least one complication.

CONCLUSION

Patients with frailty have a significantly increased risk of postoperative complications after major emergency abdominal surgery, especially atrial fibrillation, delirium, and pneumonia. Likewise, patients with frailty have an increased risk of mortality within 90 days. Thus, frailty is a significant predictor for adverse events after major emergency abdominal surgery and should be considered in all patients undergoing major emergency abdominal surgery.

Frailty prevalence in 42 European countries by age and gender: development of the SHARE Frailty Atlas for Europe

Comparative frailty prevalence data across European countries is sparse due to heterogeneous measurement methods. The Survey of Health, Ageing and Retirement (SHARE) initiative conducted interviews with probability sampling of non-institutionalized elderly people in several European countries. Previous frailty analyses of SHARE datasets were limited to initial SHARE countries and did not provide age- and gender-stratified frailty prevalence. Our aim was to provide age- and gender-stratified frailty prevalence estimates in all European countries, with predictions where necessary. From 29 SHARE participating countries, 311,915 individual surveys were analyzed. Frailty prevalence was estimated by country and gender in 5-year age bands using the SHARE Frailty Instrument and a frailty index. Association of frailty prevalence with age, gender, and GDP per capita (country-specific economic indicator for predictions) was investigated in multivariate mixed logistic regression models with or without multiple imputation. Female gender and increasing age were significantly associated with higher frailty prevalence. Higher GDP per capita, with or without purchasing power parity adjustment, was significantly associated with lower frailty prevalence in the 65-79 age groups in all analyses. Observed and predicted data on frailty rates by country are provided in the interactive SHARE Frailty Atlas for Europe. Our study provides age- and gender-stratified frailty prevalence estimates for all European countries, revealing remarkable between-country heterogeneity. Higher frailty prevalence is strongly associated with lower GDP per capita, underlining the importance of investigating transferability of evidence across countries at different developmental levels and calling for improved policies to reduce inequity in risk of developing frailty across European countries.

Nutrition Status Plays a Partial Mediation Role in the Relationship between Number of Teeth and Frailty: A Cross-Sectional Multicenter Study

INTRODUCTION

Although the relationship between the number of teeth and frailty has been extensively studied, the mediating role of nutrition status in the association between the number of teeth and frailty remains to be clarified.

METHODS

A number of 6,664 participants lived in the communities of West China were analyzed in our study. Physical frailty was determined based on the phenotype established by Fried. Nutrition status was evaluated using the Mini Nutrition Assessment-Short Form (MNA-SF) scale. Multiple linear regression was employed to evaluate the direct relationships between the number of teeth, nutrition, and frailty. Mediation models and structural equation model (SEM) pathway analysis were used to test the mediating role of nutrition status in the relationship between the number of teeth and frailty.

RESULTS

Among the 6,664 participants aged over 50 years old, the prevalence of frailty was 6.2%. Multiple linear regression analysis showed a significant total relationship between the number of teeth (β = -0.359, 95% CI: -0.473 to -0.244, p < 0.001) and frailty. After adjusting for MNA-SF scores, the relationship between the number of teeth and frailty remained significant (β = -0.327, 95% CI: -0.443 to -0.211, p < 0.001), indicating a partial mediating effect of nutrition. Mediation analysis verified that nutrition partially mediated the relationship between the number of teeth and frailty (indirect effect estimate = -0.0121, bootstrap 95% CI: -0.0151 to -0.0092; direct effect estimate = -0.0874, bootstrap 95% CI: -0.1086 to -0.0678) in the fully adjusted model. This mediating effect occurred through influencing weight loss, low level of physical activity, and debility. SEM framework pathway analysis confirmed the association between the number of teeth, nutrition, and frailty.

CONCLUSIONS

Our findings demonstrated that frailty was correlated with the number of teeth and poorer nutritional status, with nutrition partially mediating the correlation between the number of teeth and frailty. Our results supported early nutritional evaluation and intervention in oral health to decrease the risk of frailty.

Prevalence and population characteristics associated with frailty in a rural low socioeconomic area in Denmark: the Lolland-Falster Health Study

BACKGROUND

Frailty is a major geriatric syndrome that predicts increased vulnerability to minor stressor events and adverse outcomes such as falls, fractures, disability and death. The prevalence of frailty among individuals above the age of 65 varies widely with an overall weighted prevalence of 10.7%.

OBJECTIVES

The purpose of this study was to examine the prevalence of prefrailty and frailty in community-dwelling older adults from the regions of Lolland-Falster, which is one of the most socioeconomically disadvantaged areas of Denmark with lower income and lower life expectancy compared with the general Danish population. Moreover, the objective was to find selected individual characteristics associated with frailty.

DESIGN

An observational, cross-sectional registry-based population study with data from the regions of Lolland-Falster collected between February 2016 and February 2020.

RESULTS

The study included 19 000 individuals. There were 10 154 above the age of 50 included for analysis. Prevalence of frailty in the age group of 50-64 years was 4.7% and 8.7% in the age group of 65 years and above.The study demonstrates associations between frailty and high age, female gender, low education level, low income, smoking, living alone, frequency of seeing one's children and getting help when needed. These associations are comparable with findings from other studies.

CONCLUSION

The syndrome of frailty consists of not only physiological and medical issues but also education, life conditions such as living alone and living in poverty and how you evaluate your own health.

Relation between frailty and adverse outcomes in elderly patients with gastric cancer: a scoping review

BACKGROUND

Playing an exemplary role, frailty have crucial effect on the preoperative evaluation of elderly patients. Previous studies have shown that frailty is associated with complications and mortality in patients with gastric cancer (GC). However, with the development of the concept of "patient-centered", the range of health-related outcomes is broad. The differences in relation between frailty and various adverse outcomes will be further explored.

METHOD

The PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wan Fang, and Chinese Biomedical Literature databases were searched for keywords, including frailty (such as frail) and gastric cancer (such as stomach neoplasms or stomach cancer or gastrectomy or gastric surgery). The search period is until August 2023. The included studies were observational or cohort studies with postoperative related adverse outcomes as primary or secondary outcome measures. Valid assessment tools were used. The Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was used to assess methodological quality in the included literature.

RESULT

Fifteen studies were included, including 4 cross-sectional studies, 8 retrospective cohort studies, and 3 prospective cohort studies. Among them, 6 studies were rated as "Good" and 9 studies were rated as "Fair," indicating that the quality of the literature was high. Then, 10 frailty assessment tools were summarized and classified into two broad categories in accordance with frailty models. Results of the included studies indicated that frailty in elderly patients with GC was associated with postoperative complications, mortality, hospital days, readmissions, quality of life, non-home discharge, and admission to the intensive care unit.

CONCLUSION

This scoping review concludes that high levels of preoperative frailty increase the risk of adverse outcomes in elderly patients with GC. Frailty will be widely used in the future clinical evaluation of elderly gastric cancer patients, precise risk stratification should be implemented for patients, and frailty management should be implemented well to reduce the occurrence of adverse treatment outcomes.

Lung function and the risk of frailty in the European population: a mendelian randomization study

BACKGROUND

Epidemiological evidence has suggested a relationship between lung function and frailty, but the precise nature of the causality remains unclear. In this study, we applied a two-sample Mendelian randomization (MR) analysis to determine the causal effects of lung function on frailty.

METHODS

Single nucleotide polymorphisms (SNPs) independently related (P ≤ 5E-08) to lung function, as identified by genome-wide association study (GWAS), were applied as instrumental variables (IV). The association with frailty index (FI) was investigated using summary-level data from the latest GWAS on FI (n = 175,226). Different statistical methods were employed to evaluate the causal estimates between lung function and FI. The pleiotropy, heterogeneity, and leave-one-out analysis were applied to confirm the stability of the MR estimates.

RESULTS

Using the random-effect inverse-variance weighted approach, genetically proxied forced expiratory volume in the first second (FEV1), ratio of FEV1 on forced vital capacity (FVC) [FEV1/FVC], and peak expiratory flow (PEF) were significantly and inversely associated with FI (FEV1, β = -0.08, P = 2.03E-05; FEV1/FVC, β = -0.06, P = 9.51E-06; PEF, β = -0.07, P = 4.09E-04) with good statistical power (99.7-100%). However, no significant association was observed between FVC and FI (β = -0.01, P = 0.681). Leave-one-out analysis showed that there was no single SNP driving the bias of the estimates. There was potential heterogeneity, but no obvious pleiotropy was founded in this MR study.

CONCLUSIONS

Our findings indicate that impaired pulmonary function is closely related to the risk of frailty. Enhancing lung function in the elderly population may contribute to the prevention of frailty to a certain extent.

Relationship between dietary inflammation index and frailty in patients with osteoarthritis

BACKGROUND

Osteoarthritis (OA) is a common chronic joint disease that significantly affects an individual's quality-of-life and frailty has become one of the common complications in OA patients as the disease progresses. The relationship between dietary patterns is not clear.

METHODS

All participants are from the National Health and Nutrition Examination Survey (NHANES) and have been diagnosed with OA. The dietary inflammation index (DII) is calculated based on the dietary intake reported by the participants. Logistic regression analysis is used to investigate the relationship between DII and frailty. Restricted cubic splines are utilised to explore their nonlinear relationship. Mediation analysis is conducted to explore the role of inflammation in this relationship.

RESULTS

A total of 2,530 OA patients were included in the study, with an average age of 64.46 (12.67) years. After adjusting for covariates, for each one standard deviation increase in DII, the risk of frailty increased by 15% (OR = 1.15, 95% CI = 1.03-1.28). Compared to patients with DII < -1, patients with DII > 1 had a significantly higher risk of frailty (OR = 1.50, 95% CI = 1.05-2.14).

CONCLUSIONS

The findings of this study indicate a positive association between DII and the risk of frailty in OA patients. These results underscore the potential impact of dietary interventions in improving the quality-of-life for OA patients.

The influence of prehabilitation in patients with liver cirrhosis before liver transplantation: a randomized clinical trial

BACKGROUND

The high prevalence of liver cirrhosis in Slovakia leads to a great need for transplant treatment. The outcome of liver transplantation is influenced by several factors.

AIM

The main objective of this study is to test the effectiveness of prehabilitation compared to standard of care.

DESIGN

Prospective, double-arm, randomized, open-registry study.

SETTING

Patient in F. D. Roosevelt Teaching Hospital, Slovakia, Banská Bystrica.

POPULATION

The participants consisted of patients with liver cirrhosis (55 men, 25 women).

METHODS

The patients were randomized to the active prehabilitation group (N.=39) or the standard of care group (SOC) (N.=41). SOC represents the standard of care for patients prior to liver transplantation, consisting of a formal oral interview lasting 30 minutes. In addition to SOC, each patient with decompensated liver cirrhosis also underwent a prehabilitation intervention that included rehabilitation and nutrition support. Patients completed the exercises under the supervision of a physician during hospitalisation.

RESULTS

After one month, the liver frailty index improved in the prehabilitation group (P=0.05). No improvement in MELD (Model of End Stage Liver Disease) was found in the group that underwent the prehabilitation program (P=0.28), and no improvement was found in the Child-Pugh score after one month (P=0.13). In the prehabilitation groups compared with the SOC group, differences were not found in the MELD score (P=0.11). Better clinical outcomes according to the Child-Pugh score was found for the prehabilitation group compared with the SOC group (P=0.02). According to LFI, there was no difference between the groups (P=0.26). Very low adherence was found after three months. Only three patients in the SOC group and six patients in the prehabilitation group came to the check-up. Due to low adherence after 3 months in patients with liver cirrhosis, it is not possible to make an adequate comparison between groups after three months.

CONCLUSIONS

Despite the great effort to maintain adherence, it was not possible to draw a conclusion about the effectiveness of prehabilitation in patients before liver transplantation compared to standard of care because the main problem in Slovak patients with liver cirrhosis is low adherence. More studies are needed to identify the barriers that lead to low adherence in patients with liver cirrhosis.

CLINICAL REHABILITATION IMPACT

A promising result was found due to improvement of the Liver Frailty Index and the Child-Pugh Score after one month in the prehabilitation group.

The Association Between Allostatic Load and Frailty Trajectories Among Adults Aged 50+ Years: Mediating Role of Physical Activity

OBJECTIVES

To identify frailty trajectories and examine its association with allostatic load (AL) and mediating effect of physical activity (PA).

METHODS

This study included 8,082 adults from the English Longitudinal Study of Aging over Waves 4-9. AL was calculated by 14 biological indicators, and a 53-item frailty index was used to evaluate frailty. Frailty trajectories were classified by group-based trajectory modeling, and the mediated effect of PA was tested by causal mediation analysis.

RESULTS

Four frailty trajectories were identified: "Robustness" (n = 4,437, 54.9%), "Incident prefrailty" (n = 2,061, 25.5%), "Prefrailty to frailty" (n = 1,136, 14.1%), and "Frailty to severe frailty" (n = 448, 5.5%). High baseline AL was associated with increased odds of "Incident prefrailty," "Prefrailty to frailty," and "Frailty to severe frailty" trajectories. PA demonstrated significant mediated effects in aforementioned associations.

CONCLUSIONS

AL is significantly associated with the onset and progression of frailty, and such associations are partially mediated by PA.

To Be Frail or Not to Be Frail: This Is the Question-A Critical Narrative Review of Frailty

Many factors have contributed to rendering frailty an emerging, relevant, and very popular concept. First, many pandemics that have affected humanity in history, including COVID-19, most recently, have had more severe effects on frail people compared to non-frail ones. Second, the increase in human life expectancy observed in many developed countries, including Italy has led to a rise in the percentage of the older population that is more likely to be frail, which is why frailty is much a more common concern among geriatricians compared to other the various health-care professionals. Third, the stratification of people according to the occurrence and the degree of frailty allows healthcare decision makers to adequately plan for the allocation of available human professional and economic resources. Since frailty is considered to be fully preventable, there are relevant consequences in terms of potential benefits both in terms of the clinical outcome and healthcare costs. Frailty is becoming a popular, pervasive, and almost omnipresent concept in many different contexts, including clinical medicine, physical health, lifestyle behavior, mental health, health policy, and socio-economic planning sciences. The emergence of the new "science of frailty" has been recently acknowledged. However, there is still debate on the exact definition of frailty, the pathogenic mechanisms involved, the most appropriate method to assess frailty, and consequently, who should be considered frail. This narrative review aims to analyze frailty from many different aspects and points of view, with a special focus on the proposed pathogenic mechanisms, the various factors that have been considered in the assessment of frailty, and the emerging role of biomarkers in the early recognition of frailty, particularly on the role of mitochondria. According to the extensive literature on this topic, it is clear that frailty is a very complex syndrome, involving many different domains and affecting multiple physiological systems. Therefore, its management should be directed towards a comprehensive and multifaceted holistic approach and a personalized intervention strategy to slow down its progression or even to completely reverse the course of this condition.

Baduanjin exercise intervention trial: research protocol of a randomised controlled trial for frail kidney transplant recipients

INTRODUCTION

Frailty is one of the most common comorbidities in kidney transplant recipients (KTRs). Physical, psychological and social frailty could be improved by exercise intervention. Baduanjin, also known as Eight-section Brocades, is a type of traditional Chinese medicine exercise characterised by the interplay between physical postures and movements, breathing and mind. It can help frail patients strengthen their upper and lower body muscles, improve their mood, quality of life and frailty. However, the effectiveness of Baduanjin on frail KTRs remains unknown. Therefore, we will conduct a randomised controlled trial (RCT) to evaluate the effectiveness of Baduanjin on frail KTRs.

METHODS AND ANALYSIS

This protocol describes an assessor and analyst blinded, parallel RCT for frail KTRs comparing Baduanjin group (n=72) with care-as-usual group (n=72). The primary outcomes are frailty assessed by Frailty Phenotype scale and Tilburg Frailty Indicator scale, and muscle strength assessed by a grip strength metre. The secondary outcomes are quality of life assessed by Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-36) and depression assessed by the Hospital Anxiety and Depression Scale. All these data will be collected at the baseline, after 3, 6, 9 and 12 months, respectively. Two-way mixed analysis of variance (ANOVA) will be used to test the effectiveness of Baduanjin exercise. Qualitative interviews with participants in the intervention group will also be performed after 6 months. Themes will be extracted from interview transcripts using NVivo software.

ETHICS AND DISSEMINATION

The Ethics Committees of Beijing University of Chinese Medicine (2022BZYLL1018) and China-Japan Friendship Hospital (2022-KY-250) had approved the study. The organ donors were all from China-Japan Friendship Hospital. They provided informed consent and they were not executed prisoners. We have provided BMJ Open with documentation from the hospital that indicates that the organs will be harvested ethically. The findings of this study will be disseminated through peer-reviewed journals, international conferences, media reports and briefings.

TRIAL REGISTRATION NUMBER

ChiCTR2100041730.

Frailty and its Associated Factors Among Rural Community-Dwelling Older Adults: A Cross-Sectional Study

To investigate the status quo and influencing factors of overall frailty and its 3 domains among rural community-dwelling older adults. This is a cross-sectional study. A convenience sample of 195 older adults from 6 villages in Bashang Area of Zhangjiakou City, Hebei Province, China, were recruited from August to September, 2022. The demographic characteristics, the Chinese version of Tilburg Frailty Indicator, Charlson Comorbidity Scale and Hospital Anxiety and Depression Scale were used to investigate frailty and its influencing factors. Univariate analysis and multiple linear regression analysis were employed. The prevalence of overall frailty among the older adults in Bashang Area was 85.13%. Multiple linear regression analysis showed that age, gender, marital status, regular exercise, comorbidity, and anxiety were the influencing factors of overall frailty. While anxiety was the only shared influencing factor for physical frailty, psychological frailty, and social frailty, age, gender, marital status, financial burden, the comorbidity, and regular exercise were factors which influenced 1 or 2 domains of frailty. The prevalence of overall frailty among the older adults in rural areas, Zhangjiakou City is high. It is influenced by many factors. Medical staff and policy makers should work hand in hand to improve frailty among rural community-dwelling older adults in China.

Population pharmacokinetics of antibacterial agents in the older population: a literature review

INTRODUCTION

Older individuals face an elevated risk of developing bacterial infections. The optimal use of antibacterial agents in this population is challenging because of age-related physiological alterations, changes in pharmacokinetics (PK) and pharmacodynamics (PD), and the presence of multiple underlying diseases. Therefore, population pharmacokinetics (PPK) studies are of great importance for optimizing individual treatments and prompt identification of potential risk factors.

AREA COVERED

Our search involved keywords such as 'elderly,' 'old people,' and 'geriatric,' combined with 'population pharmacokinetics' and 'antibacterial agents.' This comprehensive search yielded 11 categories encompassing 28 antibacterial drugs, including vancomycin, ceftriaxone, meropenem, and linezolid. Out of 127 studies identified, 26 (20.5%) were associated with vancomycin, 14 (11%) with meropenem, and 14 (11%) with piperacillin. Other antibacterial agents were administered less frequently.

EXPERT OPINION

PPK studies are invaluable for elucidating the characteristics and relevant factors affecting the PK of antibacterial agents in the older population. Further research is warranted to develop and validate PPK models for antibacterial agents in this vulnerable population.