Comparing two frailty concepts among older people with intellectual disabilities

Definition, assessment and management of frailty for people with intellectual disabilities: A scoping review

BACKGROUND

People with intellectual disabilities may experience frailty earlier than the general population. This scoping review aimed to investigate how frailty is defined, assessed, and managed in adults with an intellectual disability; factors associated with frailty; and the potential impact of COVID-19 on frailty identification and management.

METHOD

Databases were searched from January 2016 to July 2023 for studies that investigated frailty in individuals with intellectual disabilities.

RESULTS

Twenty studies met the inclusion criteria. Frailty prevalence varied between 9% and 84%. Greater severity of intellectual disability, presence of Down syndrome, older age, polypharmacy, and group home living were associated with frailty. Multiagency working, trusted relationships and provision of evidence-based information may all be beneficial in frailty management.

CONCLUSION

Frailty is common for people with intellectual disabilities and is best identified with measures specifically designed for this population. Future research should evaluate interventions to manage frailty and improve lives.

Multimorbidity patterns and subgroups among autistic adults with intellectual disability: Results from the EFAAR study

LAY ABSTRACT

Multimorbidity relates to having multiple chronic health conditions. It is a risk factor for poor health and reduces life expectancy. Autistic people have multiple chronic health conditions and die prematurely, especially if they have an intellectual disability (autism spectrum disorder and intellectual disability). Certain pathophysiological processes observed in autism spectrum disorder are common to those related to the genesis and/or maintenance of multimorbidity. Furthermore, multimorbidity could be helpful in better identifying patient subgroups in autism spectrum disorder. It is therefore essential to better characterize multimorbidity and its consequences in the subgroup of autism spectrum disorder + intellectual disability individuals to offer them personalized care. We conducted a preliminary study of 63 autism spectrum disorder + intellectual disability adults to classify them according to their multimorbidity and search for a specific combination of chronic health conditions. We observed high and early multimorbidity in this sample and identified four classes of participants, distinguished by their multimorbidity status, independence and number of treatments. In addition, we observed a dominant combination of multimorbidity in our sample, combining immune dysfunction and gastrointestinal disorders, neurological and joint diseases. These findings support the hypothesis that an altered gut-brain relationship is involved in the risk of autism spectrum disorder, its outcome, and its association with chronic health conditions. Although larger studies are needed, our results suggest that subgroups of autism spectrum disorder + intellectual disability individuals can be identified based on their multimorbidity and potentially different ageing trajectories. A more comprehensive and personalized approach is needed to reduce the burden of multimorbidity and increase the quality of life and life expectancy in autism spectrum disorder/ intellectual disability.

Development and validation of a shortened and practical frailty index for people with intellectual disabilities

BACKGROUND

There is no widely used instrument to detect frailty in people with intellectual disabilities (IDs). We aimed to develop and validate a shorter and more practical version of a published frailty index for people with IDs.

METHOD

This study was part of the longitudinal 'Healthy Ageing and Intellectual Disability' study. We included 982 people with IDs aged 50 years and over. The previously developed and validated ID-Frailty Index consisting of 51 deficits was used as the basis for the shortened version, the ID-FI Short Form. Content of the ID-FI Short Form was based on statistics and clinical and practical feasibility. We evaluated the precision and validity of the ID-FI Short Form using the internal consistency, the correlation between the ID-FI Short Form and the original ID-Frailty Index, the agreement in dividing participants in the categories non-frail, pre-frail and frail, and the association with survival.

RESULTS

Seventeen deficits from the original ID-Frailty Index were selected for inclusion in the ID-FI Short Form. All deficits of the ID-FI Short Form are clinically and practically feasible to assess for caregivers and therapists supporting people with ID. We showed acceptable internal consistency with Cronbach's alpha of 0.75. The Pearson correlation between the ID-Frailty Index and the ID-FI Short Form was excellent (r = 0.94, P < 0.001). We observed a good agreement between the full and short forms in dividing the participants in the frailty categories, with a kappa statistic of 0.63. The ID-FI Short Form was associated with survival; with every 1/100 increase on the ID-FI Short Form, the mortality probability increased by 7% (hazard ratio 1.07, P < 0.001).

CONCLUSION

The first validation of the ID-FI Short Form shows it to be a promising, practical tool to assess the frailty status of people with ID.

Short-Term Changes of Frailty in Prematurely Aging Adults With Intellectual Disability

The purpose of this study was to investigate short-term changes of frailty in adults and identify predictors of frailty and disability changes between baseline and the follow-up. A cohort study was conducted in 85 adults with intellectual disability (ID) in southern Taiwan. Variables of frailty phenotype, Barthel Index, fall, comorbidity, and hospitalization were measured at baseline and at a 9-month follow-up. Descriptive statistics, correlations, and generalized linear model technique were used for data analysis. The percentages of frailty and pre-frail conditions were high at baseline. Improvement or deterioration on frailty was noticed in 37.6% of participants. Disability and comorbidity were significant predictors to changes in frailty, and severity of ID and frailty conditions were significant predictors to changes in disability.

Relationship Between Medication Literacy and Frailty in Elderly Inpatients With Coronary Heart Disease: A Cross-Sectional Study in China

Background: Mastering medication literacy may be related to medication safety, and the identification of frailty is very important for the prognosis of coronary heart disease (CHD). Few studies have examined the relationship between medication literacy and frailty in patients with CHD. The aim of this study was to investigate the state of medication literacy and frailty in patients with CHD and to explore the relationship between medication literacy and frailty. Methods: A cross-sectional investigation evaluated 295 inpatients with CHD recruited from hospitals in Yangzhou, China. Demographic and clinical data on participants were collected using a general information questionnaire. The Chinese medication literacy scale was used to evaluate medication literacy. The Fried Frailty Phenotype scale was used to evaluate frailty. Univariate analysis employed chi-square test and Kruskal-Wallis H test to examine the potential factors affecting frailty. Taking frailty status as the outcome variable, the ordered logistic regression model was used to analyze the relationship between the degree of medication literacy and frailty. Spearman's correlation analysis was used to analyze the correlation between medication literacy and frailty. Results: A total of 280 elderly CHD inpatients were included in the analysis. There were 116 (41.4%) individuals with inadequate medication literacy and 89 (31.8%) frail individuals. Ordered logistic regression analysis showed that the age (p < 0.001, OR = 1.089), Charson Comorbidity Index (p = 0.029, OR = 1.300), number of medications taken (p = 0.012, OR = 1.137), and medication literacy (p < 0.05, OR > 1) were independent predictors of debilitating risk factors. The population with inadequate medication literacy had a 2.759 times greater risk of frailty than adequate medication literacy (p < 0.001, OR = 2.759); The population with marginal medication literacy had a 2.239 times greater risk of frailty than adequate medication literacy (p = 0.010, OR = 2.239). Spearman's correlation analysis showed that the medication literacy grade was associated with the frailty grade in elderly CHD patients (R = -0.260, p < 0.001). Conclusion: The study showed a significant correlation between medical literacy and frailty in patients with CHD. The results suggested that medication literacy was an important consideration in the development, implementation, and evaluation of frailty.

Effects of exercise interventions on frailty in pre-maturely aging adults with intellectual disabilities- a preliminary study

BACKGROUND

Effects of exercise interventions targeting frail adults with intellectual disabilities (ID) are unknown.

OBJECTIVE

This study compared the effects of a combined exercise, walking programs and no intervention on frailty and muscle mass in adults with ID and pre-frail or frail conditions.

METHODS

This study was a quasi-experimental design, with 103 adults from six residential care and day-care centers in southern Taiwan completing study participation. A 10-week combined exercise and walking program were administered to the experimental (n = 36) and comparison (n = 32) groups respectively, with no intervention provided to the control group (n = 35). A questionnaire, measurements of frailty phenotype and a body composition machine were used to collect data. Descriptive statistics, chi-squared test, ANOVA and repeated measure ANOVA tests were conducted in the Chinese IBM SPSS 20.0.

RESULTS

Significant differences on level of frailty among the three groups were revealed after interventions. Mean differences of muscle mass demonstrated significant changes between baseline and after interventions, although improvements of frailty score between baseline and after interventions were not significant.

CONCLUSIONS

Our preliminary findings demonstrated the tendency of positive effects of combined exercise or walking programs in improving level of frailty and muscle mass in adults with ID. Early implementation of exercise interventions might be beneficial for prematurely aging adults with ID.

Accessing the discriminatory performance of FRAIL-NH in two-class and three-class frailty and examining its agreement with the frailty index among nursing home residents in mainland China

Background

FRAIL-NH has been commonly used to assess frailty in nursing home residents and validated in many ethnic populations; however, it has not been validated in mainland China, where such an assessment tool is lacking. This study aimed to (1) assess the discriminatory performance of FRAIL-NH in two-class frailty (non-frail+ pre-frail vs. frail) and three-class frailty (non-frail vs. pre-frail vs. frail), based on the Frailty Index (FI), (2) determine the appropriate cutoff points for FRAIL-NH that distinguish two-class and three-class frailty, and (3) examine the agreement in classification between FRAIL-NH and FI.

Methods

A cross-sectional study of 302 residents aged 60 years or older from six nursing homes in Changsha was conducted. The FRAIL-NH scale and 34-item FI were used to measure frailty. Two-way and three-way receiver operating characteristic (ROC) curves were used to estimate the performance of FRAIL-NH. Cohen’s Kappa statistics were used to examine the agreement between these two measures.

Results

The agreement between FRAIL-NH and FI ranged from 0.33 to 0.55. Regardless of what FI cutoff points were based on, the volume under the ROC surface (VUS) for FRAIL-NH from the three-way ROC were higher than the VUS of a useless test (1/6), and the area under the ROC curve (AUC) for FRAIL-NH from the two-way ROC were higher than the clinically meaningless value (0.5). When using FI cutoff points of 0.20 for pre-frail and 0.45 for frail, FRAIL-NH cutoff points of 1 and 9 in classifying three-class frailty had the highest VUS and the largest correct classification rates. Whichever FI was chosen, the performance of FRAIL-NH in distinguishing between pre-frailty and frailty, and between non-frailty and pre-frailty was equivalent. According to FRAIL-NH, the proportion of individuals with frailty misclassified as pre-frailty was higher than that of individuals with non-frailty misclassified as pre-frailty.

Conclusion

FRAIL-NH can be used as a preliminary frailty screening tool in nursing homes in mainland China. FI should be further used especially for those classified as pre-frailty by FRAIL-NH. It is not advisable to simply combine adjacent two classes of FRAIL-NH to create a new frailty variable in research settings.

Dietary Protein, Exercise, and Frailty Domains

Increasing awareness of the impact of frailty on elderly people resulted in research focusing on factors that contribute to the development and persistence of frailty including nutrition and physical activity. Most effort so far has been spent on understanding the association between protein intake and the physical domain of frailty. Far less is known for other domains of frailty: cognition, mood, social health and comorbidity. Therefore, in the present narrative review, we elaborate on the evidence currently known on the association between protein and exercise as well as the broader concept of frailty. Most, but not all, identified studies concluded that low protein intake is associated with a higher prevalence and incidence of physical frailty. Far less is known on the broader concept of frailty. The few studies that do look into this association find a clear beneficial effect of physical activity but no conclusions regarding protein intake can be made yet. Similar, for other important aspects of frailty including mood, cognition, and comorbidity, the number of studies are limited and results are inconclusive. Future studies need to focus on the relation between dietary protein and the broader concept of frailty and should also consider the protein source, amount and timing.