The Relationship between Anemia, Hemoglobin Concentration and Frailty in Brazilian Older Adults

Association of blood biomarkers with frailty-A mapping review

Frailty describes a geriatric syndrome characterized by an increased vulnerability. Although a variety of potential blood-based biomarkers have been discussed for its characterization, a reliable protocol considering blood-based biomarkers for this purpose is still missing. However, a comprehensive overview on these biomarkers is necessary to understand potential molecular pathways to frailty. We, therefore, performed a mapping review to identify those blood-based biomarkers most consistently associated with frailty in community-dwelling older adults as well as possible analytical gaps according to the available literature. A proposed weighted correlation index (CI) describing the direction and consistency of the association considering the number of available publications as well as the size of the study populations was calculated for each biomarker. Overall, 72 manuscripts were critically reviewed reporting on a total of 82 biomarkers. The most consistent positive association with at least 3 articles addressing the respective biomarker in unadjusted and fully adjusted models was shown for interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), neopterin, white blood cells count, glycated hemoglobin A1c (HbA1c) and sex hormone binding-globuline (SHBG) with a CI ≥ 0.7, while for negative association hemoglobin, 25-hydroxy vitamin D, free testosterone in men and albumin with a CI ≤ -0.7 were identified.

Association of Reversible Frailty with All-Cause Mortality Risk in Community-Dwelling Older Adults and Analysis of Factors Affecting Frailty Reversal in Older Adults

OBJECTIVES

Although frailty can increase the risk of premature death, whether reversal of frailty reduces the risk of premature death and what factors contribute to the reversal of frailty have not been thoroughly investigated. This study aimed to investigate the link between frailty reversal and all-cause mortality and the factors affecting frailty reversal.

DESIGN

A combination of the nested case-control study and the prospective cohort study.

SETTING AND PARTICIPANTS

Pre-frail and frail older adults in the community follow-up cohort of Dalang Town, Dongguan City.

METHODS

We used a nested case-control study to enroll pre-frail and frail older individuals. After follow-up, we determined frailty-reversible and -irreversible groups. In a prospective cohort study with these 2 groups, all-cause death was set as the endpoint. We analyzed the link between frailty reversibility and all-cause mortality risk via incidence density ratios and Cox regression. Logistic regression was used to analyze factors affecting frailty reversibility.

RESULTS

There were 637 (33.3%) participants who had a reversal of frailty status. Compared with the irreversible group, the reversible group had a 53.9% lower risk of all-cause mortality. Age, illiteracy, cigarette smoking, and daily sedentary time were negatively associated with the reversal of frailty in older adults. Hemoglobin concentration and having an exercise habit were positively associated with frailty reversal.

CONCLUSIONS AND IMPLICATIONS

The risk of all-cause mortality declined among older adults with a reversal of frailty. Hemoglobin concentration and exercise contributed to the reversal of frailty among older adults. In contrast, aging, long daily sedentary time, cigarette smoking, and illiteracy were risk factors for the reversal of frailty. These findings may provide better strategies for frailty intervention.

Interrelationships of frailty, hemoglobin, cognition, and depressive symptoms in aging: a path analysis of the ELSI-Brazil study

This study analyzed the interrelationships of anemia, depression, and cognition, as well as some of their associated factors to understand the paths to frailty. Data from 2,174 baseline participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were used. Path analysis was used to assess the relationships of exogenous variables (place of residence, education level, number of diseases, diet score, and number of natural teeth), one endogenous variable (frailty), and three mediators (cognition, depression, and hemoglobin level). Cognition and hemoglobin level showed a negative path to frailty, while depressive symptoms showed a positive path. Among the exogenous variables, rural area had a negative effect on hemoglobin, depressive symptoms, and frailty; a higher education level showed a positive path to cognition; number of diseases showed a negative path to hemoglobin and a positive path to depressive symptoms and frailty; diet score showed a negative path to hemoglobin and depressive symptoms; number of teeth had a positive effect on cognition and hemoglobin and a negative effect on frailty. Two paths without direct effects had significant indirect effects - rural area showed an indirect relationship with cognition via hemoglobin and depressive symptoms; and education level showed an indirect path to frailty, mediated by the three intermediate variables. These results show complex interrelationships of frailty, hemoglobin, cognition, and depressive symptoms, which help understand the syndrome in a broad way and support the planning of more comprehensive prevention and intervention measures.

Disentangling Anemia in Frailty: Exploring the Role of Inflammation

BACKGROUND

In older patients, frailty and anemia frequently coexist. However, only few studies have been conducted in older patients with multimorbidity and several overlapping causes of anemia, such as inflammation, inadequate nutrition, or certain pathologies. This analysis aims to decipher potential factors associated with anemia in older hospital patients with frailty.

METHODS

Patients (n = 208, age: 62-98 years) were categorized as prefrail (n = 68) and frail (n = 140) using the Fried frailty phenotype. We quantified serum concentrations of markers of iron metabolism (iron, ferritin, transferrin, soluble transferrin receptor, and hepcidin), inflammation (interleukin [IL]-6 and IL-10 C-reactive protein), and hematology (hemoglobin). Principal component analysis was conducted to evaluate biomarker patterns and associations with frailty were assessed with logistic regression analysis.

RESULTS

Anemia prevalence was higher in patients with frailty (84.3% vs 70.6%, p = .021). Three principal components (PC1-3) were identified. PC1 was characterized by high factor loadings representing inflammation and factor scores differed between patients with prefrailty and frailty (-0.04 (interquartile range [IQR]: 1.45) vs -0.51 (IQR: 0.87), p < .001]. PC2 represents macrocytic anemia and thus vitamin B12 or folate deficiency, whereas PC3 indicates hematological pathologies. Only PC1 was associated with frailty status when controlled for age, sex, number of drugs, and comorbidities (OR: 2.018, 95% CI: 1.316; 3.094, p = .001). PC2 and PC3 were not associated with frailty.

CONCLUSIONS

Our results suggest that anemia in patients with frailty is driven by inflammation rather than being disease-related or solely the result of micronutrient deficiencies.

Development and validation of prediction model for prolonged mechanical ventilation after total thoracoscopic valve replacement: a retrospective cohort study

Total thoracoscopic valve replacement (TTVR) is a minimally invasive alternative to traditional open-heart surgery. However, some patients undergoing TTVR experience prolonged mechanical ventilation (PMV). Predicting PMV risk is crucial for optimizing perioperative management and improving outcomes. We conducted a retrospective cohort study of 2,319 adult patients who underwent TTVR at a tertiary care center between January 2017 and May 2024. PMV was defined as mechanical ventilation exceeding 72 h post-surgery. A Fine-Gray competing risks regression model was developed and validated to identify predictors of PMV. Significant predictors of PMV included cardiopulmonary bypass time, ejection fraction, New York Heart Association grading, serum albumin, atelectasis, pulmonary infection, pulmonary edema, age, need for postoperative dialysis, hemoglobin levels, and PaO2/FiO2. The model demonstrated good discriminative ability, with areas under the receiver operating characteristic curves of 0.747 in the training set and 0.833 in the validation set. Calibration curves showed strong agreement between predicted and observed PMV probabilities. Decision curve analysis indicated clinical utility across a range of threshold probabilities. Our predictive model for PMV following TTVR demonstrates strong performance and clinical utility. It helps identify high-risk patients and tailor perioperative management to reduce PMV risk and improve outcomes. Further validation in diverse settings is recommended.

The Impact of Frailty on the Toxic Reaction of Chemotherapy in Patients With Cervical Cancer: A Longitudinal Study

BACKGROUND

Longitudinal research on the impact of frailty on chemotherapy toxicity in patients with cervical cancer is limited.

OBJECTIVES

To explore the impact of frailty on chemotherapy toxicity in patients with cervical cancer.

METHODS

Two hundred fifty-nine postoperative cervical cancer patients from a hospital located in Northwest China were enrolled between July 2020 and December 2021. Participating patients were followed up for 4 chemotherapy cycles after surgery. Frailty was measured using the Tilburg Frailty Indicator. Chemotherapy toxic reactions were evaluated using the Common Terminology Criteria for Adverse Events 4.0. Repeated-measures analysis of variance and Cox regression analysis were used to analyze the effect of frailty on chemotherapy toxicity.

RESULTS

Cox regression analysis showed that frailty could serve as an independent risk factor for total toxicity (hazard ratio [HR], 5.423; 95% confidence interval [CI], 3.260-9.023; P < .001), nausea (HR, 3.967; 95% CI, 2.446-6.433; P < .001), and vomiting (HR, 3.081; 95% CI, 1.921-4.942; P < .001). Repeated-measures analysis of variance showed that the white blood cell values of the frail group were lower than those of the nonfrail group (Fgroup effect = 4.172, P = .043), and the hemoglobin values of the frail group were lower than those of the nonfrail group (Fgroup effect = 6.589, P = .012).

CONCLUSIONS

Frailty can increase the risk of total chemotherapy toxicity, nausea, and vomiting. Frailty can reduce the white blood cell and hemoglobin values of postoperative adjuvant chemotherapy cervical cancer patients.

IMPLICATIONS FOR PRACTICE

Findings may assist healthcare providers in taking effective measures to reduce the toxicity of chemotherapy.

Pre-transplant Anemia as a Marker of Short-term Outcomes in Lung Transplant Recipients

BACKGROUND

Anemia is a risk factor for increased morbidity and mortality in multiple medical conditions, yet the impact of pretransplant anemia in patients with advanced lung disease on post-transplant outcomes remains under-explored. We sought to determine whether pretransplant anemia serves as a marker of altered inflammation in the host and associates with short-term outcomes following lung transplantation.

STUDY DESIGN AND METHODS

We performed a single-center, retrospective analysis of 238 lung transplant recipients. We assessed for risk factors of pretransplant anemia and identified associations with short-term post-transplant outcomes.

RESULTS

Pretransplant anemia was associated with increased intraoperative transfusion of packed red blood cells and a trend towards increased index hospital length of stay and 1-year mortality. Conversely, pretransplant anemia was associated with a decreased incidence of acute cellular rejection.

CONCLUSION

These preliminary data suggest that anemia may be a biomarker of altered inflammation in the host recipient and influences post-transplant outcomes.

Exploring the moderating effects of SIRT1 and gene polymorphisms rs7895833 on the relationship between hemoglobin levels and physical frailty in elderly adults with comorbid chronic diseases: A moderated mediation analysis

Background

Relationship age, hemoglobin, and physical frailty have all been investigated in older people with more than one chronic disease. There has been little analysis of the relationship between hemoglobin, age, physical frailty, plasma levels of Sirtuin1 (SIRT1), and the gene polymorphism (SNP) rs7895833 A>G. The goal of this study was to find out how SIRT1 level, SNP rs7895833, hemoglobin, age, and physical frailty (frail score) are related in older Indonesian adults with comorbid chronic diseases.

Methods

This was an observational study. Demographic and clinical data were retrieved from the electronic health records of Universitas Sumatera Utara Hospital, Medan, Indonesia. Physical frailty, SIRT1 level, and SNP rs7895833 were measured using an appropriate and valid method. Purposive sampling was used to determine the eligibility of 132 elderly adults from November 2022 to February 2023.

Results

The indirect effect of hemoglobin on the frail score (FS) through age was negative and significant, according to a conditional mediation analysis (β=-0.0731; p=0.023). Meanwhile, the direct effect of hemoglobin on the FS was negative and not significant (β=0.1632; p=0.052). According to the conditional moderated mediation analysis, the size of the direct effect of age on FS was increased by genotype AG-GG and SIRT1 level (β low=0.2647; p=0.002, β middle=0.2956; p<0.001, and β high=0.319; p<0.001). The size of the conditional indirect effect of Hemoglobin on FS through age was negative and significantly increased by SNP genotype AG-GG and SIRT1 level (β low=-0.0647; p=0.032, β middle=-0.0723; p=0.024, and β high=-0.078; p=0.02).

Conclusions

Higher plasma levels of SIRT1 and the SNP genotype AG-GG may both contribute to physical frailty in the elderly population. Hemoglobin levels in the blood fall with age, which can negatively impact older persons who already have chronic diseases. However, the interactions between these factors are intricate, requiring more study to completely understand the processes underlying development.

Relationship between hemoglobin and grip strength in older adults: the ActiFE study

INTRODUCTION

Although anemia is associated with low muscle strength, hemoglobin has been rarely studied considering ferritin.

AIM

To analyze the association between hemoglobin and grip strength in community-dwelling older adults.

METHODS

We used data from a German cohort of adults ≥ 65 years, excluding those with CRP > 10 mg/L or taking iron supplements. Grip strength (kg) was measured using a Jamar dynamometer. Analysis was performed using multiple linear regression, adjusted for established confounders. Due to interaction, age-stratified (< 80, 80 +), further sex-stratified analysis in those < 80 years old and ferritin-stratified in men < 80 years were performed.

RESULTS

In total, 1294 participants were included in this analysis (mean age 75.5 years, 549 (42.3%) women, 910 (70.3%) < 80 years). On average, hemoglobin and grip strength were 14.9 g/dL and 41.3 kg for men, 13.9 g/dL and 25.1 kg for women. Hemoglobin was significantly positively associated with grip strength only among women < 80 years (β 0.923 [95% CI 0.196, 1.650]). For men < 80 years, the association was significant when ferritin was ≥ 300 µg/L (β 2.028 [95% CI 0.910, 3.146]). No association was detected among those participants 80 + .

DISCUSSION AND CONCLUSIONS

Our data show an association between hemoglobin and grip strength only in women < 80 years old. For men < 80 years, the association was only significant with ferritin levels ≥ 300 µg/L. Considering the decreasing levels of hemoglobin and grip strength and the high prevalence of iron deficiency in older adults further analyses investigating this relationship with more iron specific parameters such as transferrin saturation are warranted.

Nomogram model for predicting frailty of patients with hematologic malignancies - A cross-sectional survey

Objective

This study aimed to develop and validate an assessment tool for predicting and mitigating the risk of frailty in patients diagnosed with hematologic malignancies.

Methods

A total of 342 patients with hematologic malignancies participated in this study, providing data on various demographics, disease-related information, daily activities, nutritional status, psychological well-being, frailty assessments, and laboratory indicators. The participants were randomly divided into training and validation groups at a 7:3 ratio. We employed Lasso regression analysis and cross-validation techniques to identify predictive factors. Subsequently, a nomogram prediction model was developed using multivariable logistic regression analysis. Discrimination ability, accuracy, and clinical utility were assessed through receiver operating characteristic (ROC) curves, C-index, calibration curves, and decision curve analysis (DCA).

Results

Seven predictors, namely disease duration of 6-12 months, disease duration exceeding 12 months, Charlson Comorbidity Index (CCI), prealbumin levels, hemoglobin levels, Generalized Anxiety Disorder-7 (GAD-7) scores, and Patient Health Questionnaire-9 (PHQ-9) scores, were identified as influential factors for frailty through Lasso regression analysis. The area under the ROC curve was 0.893 for the training set and 0.891 for the validation set. The Hosmer-Lemeshow goodness-of-fit test confirmed a good model fit. The C-index values for the training and validation sets were 0.889 and 0.811, respectively. The DCA curve illustrated a higher net benefit when using the nomogram prediction model within patients threshold probabilities ranging from 10% to 98%.

Conclusions

This study has successfully developed and validated an effective nomogram model for predicting frailty in patients diagnosed with hematologic malignancies. The model incorporates disease duration (6-12 months and>12 months), CCI, prealbumin and hemoglobin levels, GAD-7, and PHQ-9 scores as predictive variables.

Prevalence and associated risk factors for chronic kidney disease in the elderly physically disabled population in Shanghai, China: a cross-sectional study

BACKGROUND

The global prevalence of chronic kidney disease (CKD) in the general population is relatively clear. Our previous study showed that elderly individuals who are physically disabled are more likely to experience kidney function impairment, and the main purpose of this study was to determine the prevalence and risk factors associated with CKD in elderly patients with physical disabilities.

METHODS

A total of 2679 elderly individuals with physical disabilities from the 2018 Shanghai Disability Health Survey were screened to calculate the prevalence of CKD. Multiple logistic regression was performed to identify the factors associated with CKD. Detailed subgroup analyses of disability level were also conducted.

RESULTS

We confirmed CKD in 287 of 2679 (10.7%) participants. Female sex, age, history of hypertension, red blood cell count, albumin, urea, and uric acid (UA) were independently correlated with CKD. Age and UA abnormalities were common risk factors for different levels of disabilities.

CONCLUSION

The prevalence of CKD is higher in the mild level of older physically handicapped individuals. Age and the level of UA should also be considered in this population. The preventive strategies for patients with two levels of elderly disability should have different focuses.

Adverse outcomes and health-ecological influencing factors of preoperative frailty among elderly patients with gastric cancer

PURPOSE

Frailty is defined as a state of decreased physiologic reserves arising from cumulative deficits in multiple homeostatic systems, which is important in the field of clinical oncology. We aimed to explore the relationship between preoperative frailty and adverse outcomes, and systematically analyze the factors influencing frailty based on the health ecology model among elderly gastric cancer patients.

METHODS

A observational study was conducted to select 406 elderly patients who would undergo gastric cancer surgery at a tertiary hospital. The logistic regression model was used to examine the relationship between preoperative frailty and adverse outcomes, including total complications, prolonged length of stay (PLOS), and 90-day hospital readmission. Based on the health ecology model, the factors which may influence frailty were collected from four levels. Univariate and multivariate analysis were utilized to determine the factors influencing preoperative frailty.

RESULTS

Preoperative frailty was associated with total complications (odds ratio [OR] 2.776, 95% confidence interval [CI] 1.588-4.852), PLOS (OR 2.338, 95%CI 1.342-4.073), and 90-day hospital readmission (OR 2.640, 95% CI 1.275-5.469). Besides, nutritional risk (OR 4.759, 95% CI 2.409-9.403), anemia (OR 3.160, 95% CI 1.751-5.701), number of comorbidity ≥ 2 (OR 2.318, 95% CI 1.253-4.291), low physical activity level (OR 3.069, 95% CI 1.164-8.092), apathetic attachment (OR 2.656, 95% CI 1.457-4.839), personal monthly income ≤ 1000 yuan (OR 2.033, 95% CI 1.137-3.635) and anxiety (OR 2.574, 95% CI 1.311-5.053) were independent risk factors for frailty. High physical activity level (OR 0.413, 95% CI 0.208-0.820) and improved objective support (OR 0.818, 95% CI 0.683-0.978) were independent protective factors for frailty.

CONCLUSIONS

Preoperative frailty was associated with multiple adverse outcomes and could be affected by factors of different dimensions from the health ecology perspective, including nutrition, anemia, comorbidity, physical activity, attachment style, objective support, anxiety, and income, which can guide the formation of a comprehensive prehabilitation for frailty among elderly gastric cancer patients.

Lower haemoglobin-to-red blood cell distribution width ratio is independently associated with frailty in community-dwelling older adults: a cross-sectional study

OBJECTIVES

The importance of blood cell markers in frailty has been studied. However, research on haemoglobin-to-red blood cell distribution width ratio (HRR) and frailty in older persons is still limited. We investigated the association between HRR and frailty in older adults.

DESIGN

Cross-sectional population-based study.

SETTING

Community-dwelling older adults older than 65 years were recruited from September 2021 to December 2021.

PARTICIPANTS

A total of 1296 community-dwelling older adults (age ≥65 years) in Wuhan were included in the study.

MAIN OUTCOME MEASURES

The main outcome was the presence of frailty. The Fried Frailty Phenotype Scale was used to evaluate the frailty status of the participants. Multivariable logistic regression analysis was performed to determine the relationship between HRR and frailty.

RESULTS

A total of 1296 (564 men) older adults were included in this cross-sectional study. Their mean age was 70.89±4.85 years. Receiver operating characteristic curve analysis showed that HRR is a good predictor of frailty in older people, the area under the curve (AUC) was 0.802 (95% CI: 0.755 to 0.849), and the highest sensitivity was 84.5% and the specificity was 61.9% with the optimal critical values 9.97 (p<0.001). Multiple logistic regression analysis indicated that lower HRR (<9.97) (OR: 3.419, 1.679 to 6.964, p=0.001) is independently associated with frailty in older people, even after adjusting confounding factors.

CONCLUSION

Lower HRR is closely associated with an increased risk of frailty in older people. Lower HRR may be an independent risk factor for frailty in community-dwelling older adults.

Factors Associated With Changes in Objectively Measured Moderate to Vigorous Physical Activity in Patients After Percutaneous Coronary Intervention: A Prospective Cohort Study

BACKGROUND

This study aimed to clarify factors affecting changes in moderate to vigorous physical activity (MVPA) in patients 1 to 3 months after undergoing percutaneous coronary intervention (PCI).

METHODS

In this prospective cohort study, we enrolled patients aged <75 years who underwent PCI. MVPA was objectively measured using an accelerometer at 1 and 3 months after hospital discharge. Factors associated with increased MVPA (≥150 min/wk at 3 mo) were analyzed in participants with MVPA < 150 minutes per week at 1 month. Univariate and multivariate logistic regression analyses were performed to explore variables potentially associated with increasing MVPA, using MVPA ≥ 150 minutes per week at 3 months as the dependent variable. Factors associated with decreased MVPA (<150 min/wk at 3 mo) were also analyzed in participants with MVPA ≥ 150 minutes per week at 1 month. Logistic regression analysis was performed to explore factors of declining MVPA, using MVPA < 150 minutes per week at 3 months as the dependent variable.

RESULTS

We analyzed 577 patients (median age 64 y, 13.5% female, and 20.6% acute coronary syndrome). Increased MVPA was significantly associated with participation in outpatient cardiac rehabilitation (odds ratio 3.67; 95% confidence interval, 1.22-11.0), left main trunk stenosis (13.0; 2.49-68.2), diabetes mellitus (0.42; 0.22-0.81), and hemoglobin (1.47, per 1 SD; 1.09-1.97). Decreased MVPA was significantly associated with depression (0.31; 0.14-0.74) and Self-Efficacy for Walking (0.92, per 1 point; 0.86-0.98).

CONCLUSIONS

Identifying patient factors associated with changes in MVPA may provide insight into behavioral changes and help with individualized PA promotion.

Study on Risk Factors of Primary Non-traumatic OVCF in Chinese Elderly and a Novel Prediction Model

Objective

Prevention of fragility fractures is one of the public health priorities worldwide, whilst the incidence of osteoporotic vertebral compression fractures (OVCF) continues to rise and lacks the corresponding accurate prediction model. This study aimed to screen potential causes and risk factors for primary non‐traumatic osteoporotic vertebral compression fractures (NTOVCF) in the elderly by characterizing a patient population with NTOVCF and comparing it with a population of osteoporotic patients.

Methods

Between January 2013 and January 2022, 208 elderly patients with unequivocal evidence of bone fragility manifested as painful NTOVCF were enrolled, and compared with 220 patients with osteoporosis and no fractures. The demographic data, bone turnover markers, blood routine, serum biochemical values, and radiological findings were investigated. Differences between the fracture and non‐fracture groups were analyzed, and variables significant in univariate analysis and correlation analysis were included in the logistic analysis to build the risk prediction model for osteoporotic vertebral fractures. Univariate analysis using student's t‐tests for continuous variables or a chi‐squared test for categorical variables was conducted to identify risk factors.

Results

No significant differences were revealed regarding age, gender, BMI, smoking, alcohol consumption, blood glucose, propeptide of type I procollagen (P1NP), and N‐terminal middle segment osteocalcin (N‐MID) (P > 0.05). Parathyroid Hormone (PTH), 25(OH)D, serum albumin (ALB), hemoglobin (HB), bone mineral density (BMD), and cross‐sectional area (CSA) of the paraspinal muscle in the fracture group were significantly lower than those in the control group; however, b‐C‐terminal telopeptide of type I collagen (β‐CTX), total cholesterol (TC), high‐density lipoprotein cholesterol (HDL‐C), non‐prostatic acid phosphatase (NACP), and fatty degeneration ratio (FDR) were significantly higher than those in the control group (P < 0.05). Logistic regression analysis showed that ALB, HB, CSA, and BMD were negatively correlated with NTOVCF, while β‐CTX, HDL‐C, NACP, and FDR were positively correlated with NTOVCF.

Conclusion

Decreased physical activity, anemia, hypoproteinemia, imbalances in bone metabolism, abnormal lipid metabolism, and degenerative and decreased muscle mass, were all risk factors for OVCF in the elderly, spontaneous fractures may be the consequence of cumulative declines in multiple physiological systems over the lifespan. Based on this risk model, timely detection of patients with high OVCF risk and implementation of targeted preventive measures is expected to improve the effect of fracture prevention.

Influences of Vitamin D and Iron Status on Skeletal Muscle Health: A Narrative Review

There is conflicting evidence of the roles vitamin D and iron have in isolation and combined in relation to muscle health. The purpose of this narrative review was to examine the current literature on the roles that vitamin D and iron have on skeletal muscle mass, strength, and function and how these nutrients are associated with skeletal muscle health in specific populations. Secondary purposes include exploring if low vitamin D and iron status are interrelated with skeletal muscle health and chronic inflammation and reviewing the influence of animal-source foods rich in these nutrients on health and performance. PubMed, Scopus, SPORT Discus, EMBAE, MEDLINE, and Google Scholar databases were searched to determine eligible studies. There was a positive effect of vitamin D on muscle mass, particularly in older adults. There was a positive effect of iron on aerobic and anaerobic performance. Studies reported mixed results for both vitamin D and iron on muscle strength and function. While vitamin D and iron deficiency commonly occur in combination, few studies examined effects on skeletal muscle health and inflammation. Isolated nutrients such as iron and vitamin D may have positive outcomes; however, nutrients within food sources may be most effective in improving skeletal muscle health.

Changes in dietary total and non-haem iron intake is associated with incident frailty in older men: The Concord Health and Ageing in Men Project

Background

Nutritional intake could influence the development of frailty. The aim was to evaluate the associations between dietary iron intakes and changes in dietary iron intakes with frailty.

Methods

Cross-sectional analyses involved 785 men with Fried frailty phenotype (FP) and 758 men with Rockwood frailty index (FI) data aged 75 years and older at nutrition assessment from the Concord Health and Ageing in Men Project prospective cohort study. Of these, 563 men who were FP robust or prefrail, and 432 men who were FI nonfrail were included in the longitudinal analyses for more than 3 years. Dietary intake was assessed at both timepoints using a validated diet history questionnaire. The dietary calculation was used to derive heme iron and nonheme iron intakes from total iron intakes. The associations were evaluated through binary logistic regression.

Results

Incidence of FP frailty was 15.3% (n = 86). In longitudinal analyses, maintaining total iron intakes (medium tertile −2.61–0.81 mg/d), increases in total iron and nonheme iron intakes (high tertiles ≥0.82 mg/d and ≥0.80 mg/d), and changes in nonheme iron intake (1 mg increment) were associated with reduced risks of incident FP frailty (OR: 0.47 [95% confindence interval (CI): 0.24, 0.93, p = .031], OR 0.48 [95% CI: 0.23, 0.99, p = .048], OR 0.41 [95% CI: 0.20, 0.88, p = .022], and OR 0.89 [95% CI: 0.82, 0.98, p = .017]).

Conclusion

Maintaining or increases in total dietary iron and increases or changes in dietary nonheme iron intakes more than 3 years were associated with reduced incidence of FP frailty in older men.

Higher hemoglobin levels are associated with better physical performance among older adults without anemia: a longitudinal analysis

Background

Anemia is the most common hematological abnormality among older adults, and it is associated with decreased physical performance. But the role of hemoglobin in the absence of anemia remains unclear. Thus, this study aimed to assess the impact of hemoglobin levels on physical performance in Brazilian older adults without anemia.

Methods

The study is longitudinal in that it relies on two waves of the Saúde, Bem-Estar e Envelhecimento (SABE; Health, Well-being, and Aging) study: 2010 and 2015-2016. Mixed-effects linear regression was used to determine the effects of the hemoglobin concentrations on the Short Physical Performance Battery-SPPB over time among the 1,023 who had complete data and did not have anemia in 2010. In the follow-up, there were 567 without anemia.

Results

In analyses adjusted for age, education, comorbidities, body mass index, and physical inactivity, we found a differential association between hemoglobin concentration and SBBP by sex, with a positive interaction (β Hb*female= 0.20, 95% CI 0.04,0.37). At lower levels of hemoglobin, women have lower levels of SPPB than men, but at higher levels of hemoglobin concentration, there are no sex differences in physical performance. In addition, higher age was negatively associated with SPPB levels and cardiometabolic diseases, other diseases, and physical inactivity. Education was positively associated with physical performance.

Conclusion

Our study demonstrates that higher hemoglobin levels were associated with better physical performance among older adults without anemia in Brazil. However, there were sex differences in this association. This finding is important because, in clinical practice, most health professionals focus on the World Health Organization definition of anemia. Our study suggests the importance of hemoglobin levels among older adults, even those without anemia, and highlights sex differences.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02937-4.

Evidence-based recommendations for resistance and power training to prevent frailty in community-dwellers

Frailty is a reversible state of reduced resilience to stressful events resulting from a multisystem impairment of the human body. As frailty progresses, people become more vulnerable to numerous adverse events, including falls and fractures, cognitive decline, disability, hospitalization, nursing home placement, and death. As such, substantial health care costs are associated with frailty. These features have led to the recognition of frailty as a public health problem. The identification of strategies for the management of frailty has, therefore, become a topic of extensive instigation. In this context, resistance (RT) and power training (PT) have received considerable attention, and experts in the field have recently suggested that both training modalities may improve frailty-related parameters. However, most studies have only included robust people and investigated frailty as a secondary outcome, so that current literature only allows RT and PT preventive programs against frailty to be designed. Here, we provide evidence-based critical recommendations for the prescription of RT and PT programs against incident frailty in community-dwellers.

Factors Associated With Frailty in Patients Undergoing Cardiac Surgery: A Longitudinal Study

BACKGROUND

Frailty may increase the risk of complications and mortality in patients undergoing cardiac surgery. Few studies on frailty and its associated factors have been conducted in these patients.

OBJECTIVE

The aim of this study was to explore frailty and related factors in patients undergoing cardiac surgery.

METHODS

A total of 154 patients undergoing cardiac surgery in northern Taiwan were recruited using a longitudinal study design and interviewed using structured questionnaires assessing physical activity, anxiety and depression, and social support before surgery and at 1 month and 3 months after surgery.

RESULTS

The prevalence of frailty in patients undergoing cardiac surgery was 16.2%, 20.5%, and 16.6% before surgery and at 1 month and 3 months after surgery, respectively. Frail and prefrail patients undergoing cardiac surgery were more likely to be unemployed, have gout, have a higher New York Heart Association class, have preoperative dysrhythmia, undergo cardiopulmonary bypass, have a lower functional ability, have a higher European System for Cardiac Operative Risk Evaluation score, have a longer anesthesia time, have longer endotracheal tube and extracorporeal circulation times, have longer intensive care unit and hospital stays, have lower hemoglobin and albumin levels, have higher anxiety and depression levels, and have lower Mini-Mental State Examination scores. The significant predictors of prefrailty and frailty included unemployment, the presence of gout, higher New York Heart Association classes, less independence in activities of daily living, lower hemoglobin levels, and higher levels of depression.

CONCLUSIONS

Frailty was associated with patients' functional status, perioperative conditions and psychosocial factors. Preoperative assessments of frailty and appropriate interventions are needed to improve frailty in patients undergoing cardiac surgery.

Effect Modification by Sex of the Hemoglobin Concentration on Frailty Risk in Hospitalized Older Patients

Background

Hemoglobin concentration differs by sex, possibly affecting any association between hemoglobin and frailty. This study aimed to evaluate the potential interaction effect of hemoglobin and sex on frailty in Chinese older inpatients.

Methods

A cross-sectional study was conducted between February 2015 and November 2017 in a tertiary hospital. Frailty was defined by the Fried phenotype. Hemoglobin concentration was measured with a standard procedure. Covariates included demographics, clinical characteristics, and serum biomarkers. Logistic regression was applied to examine the association between hemoglobin concentration and frailty. The relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were used to evaluate the additive interaction.

Results

A total of 619 older inpatients [mean age 69.26±7.44 years; 334 men, 285 women] were included. The mean hemoglobin concentration was significantly lower in the elderly who were frail (11.9 g/L in frail versus 13.1g/L in non-frail; p<0.001). In the multivariable regression models, lower hemoglobin in patients was significantly associated with frailty (adjusted odds ratio (OR) = 2.51, 95% CI:1.37, 4.60). The stratified analyses indicated that lower hemoglobin was associated with frailty among older inpatients with different characteristics. Female inpatients with lower hemoglobin had the highest risk of frailty (adjusted OR=6.43, 95%: 2.38, 17.3); there were interactions between hemoglobin and sex on the development of frailty (RERI=4.30, 95% CI=−1.41, 10.01; AP=0.67, 95% CI=0.37, 0.97;SI=4.80, 95% CI=1.22, 18.84).

Conclusions and Implications

Our study provided evidence that sex and lower hemoglobin have an interaction effect on frailty; it is suggested that clinicians may consider sex-specific strategies for the elderly to conform the concept of precision medicine.

[Anemia and frailty in older adults from Spain. The FRADEA Study]

INTRODUCTION

The objective was to examine the prevalence of anemia according to the state of frailty and to analyze the relationship between anemia, hemoglobin concentration and frailty in a cohort of Spanish older adults.

MATERIAL AND METHODS

Cross-sectional substudy of the FRADEA (Frailty and Dependency in Albacete) cohort, a population-based concurrent cohort study conducted in people older than 69 years of Albacete (Spain). Of the 993 participants included in the first wave, 790 were selected with valid data on anemia and frailty. Anemia was defined according to the criteria of the World Health Organization (hemoglobin less than 13 g/dL in men and 12 g/dL in women). Frailty was assessed using the Fried's phenotype. The association between anemia, hemoglobin concentration and frailty was determined by binary logistic regression adjusted for age, sex, educational level, institutionalization, comorbidity, cognitive status, body mass index, polypharmacy, creatinine, glucose and total white blood cell count.

RESULTS

The mean age was 79 years. The prevalence of anemia was 19.6%. The prevalence of anemia was significantly higher in frail subjects (29.6%) compared to prefrail (16.6%) and robust ones (6%), p<0.001. The average hemoglobin concentrations were significantly lower in frail (12.7 g/dL), compared to the prefrail (13.5 g/dL) and robust participants (14.4 g/dL), p < 0.001. In the fully adjusted regression model, anemia was associated with frailty (OR 1.95; 95% CI: 1.02-3.73, p<0.05), and similarly, the average hemoglobin concentrations showed a significant association with frailty (OR 0.79; 95% CI: 0.66-0.96, p < 0.05).

CONCLUSION

Anemia in older adults, defined according to WHO criteria, is independently associated with frailty.

High anemia prevalence in Korean older adults, an advent healthcare problem: 2007-2016 KNHANES

BACKGROUND

Anemia is associated with high morbidity and mortality in older people. However, the prevalence and characteristics of anemia in older individuals are not fully understood, and national data on these aspects in older Korean adults are lacking. This study aimed to evaluate the prevalence and characteristics of anemia in older adults using data from the Korea National Health and Nutrition Examination Survey (KNHANES), which is a nationwide cross-sectional epidemiological study conducted by the Korean Ministry of Health and Welfare.

METHODS

Data from a total of 62,825 participants of the 2007-2016 KNHANES were compiled and analyzed to investigate differences in participant characteristics and potential risk factors for anemia. Differences in clinical characteristics of participants were compared across subgroups using the chi-square test for categorical variables and independent t-test for continuous variables. Univariate and multivariate analyses using logistic regression were performed to identify related clinical factors.

RESULTS

The prevalence of anemia was higher in the population aged ≥65 years than in the younger population. Anemia was also more prevalent among females than among males, but this difference was not significant in people aged > 85 years. Being underweight, receiving a social allowance, living alone, and having comorbidities such as hypertension, rheumatoid arthritis, diabetes mellitus (DM), cancer, and chronic renal failure (CRF) were more common among older adults with anemia than among the population without anemia. In univariate and multivariate analyses, older age, female sex, underweight, and presence of comorbidities including rheumatoid arthritis, DM, cancer, and CRF were associated with an increased risk of anemia.

CONCLUSIONS

This study revealed that age, female sex, underweight, and the presence of comorbidities such as rheumatoid arthritis, DM, cancer, and CRF were associated with an increased risk of anemia in older Korean adults. Further study on causal relationships between anemia and other variables in the older population is necessary.

Circulating biomarkers characterizing physical frailty: CRP, hemoglobin, albumin, 25OHD and free testosterone as best biomarkers. Results of a meta-analysis

INTRODUCTION

During aging, individuals can be classified as being in one of 3 different states: robust, frail or dependent. Frailty is described as reversible, so early detection offers the potential of returning the subject to a robust status. There are multiple clinical frailty scales but no gold standard and frailty is not systematically assessed in clinicians' daily practice. Reliable biomarkers of frailty are lacking, however, while their identification and systematic use would make this simple scale a useful clinical tool.

OBJECTIVE

To conduct a review of the literature concerning the biomarkers associated with frailty and to compare in a meta-analysis the plasmatic values of each biomarker in the frail with the robust group.

RESULTS

503 articles were identified on PubMed, 467 on Scopus and 369 on Web Of Science. 67 articles were included, collecting a total of 32,934 robust subjects and 6864 frail subjects. C-reactive protein (CRP) (Standardized Mean Difference (SMD): 0.49 CI 95% [0.37-0.61]) was significantly higher in the frail group whereas hemoglobin (SMD: -0.67[-0.90; -0.44]), albumin (SMD: -0.62[-0.84; -0.41]), 25-hydroxyvitamin D (25OHD) (SMD: -0.43 [-0.64; -0.21]) and, in men, free testosterone (SMD: -0.77 [-1.05; -0.49]) were significantly lower in the frail group.

CONCLUSION

We found 5 biomarkers that were associated with frailty (CRP, hemoglobin, albumin, 25OHD and free testosterone in men) belonging to multiple physiological systems. Further cohort studies are needed to verify their ability to screen for frailty.

Influence of the Amazonian context on the frailty of older adults: A population-based study

The study aimed to identify the prevalence of frailty syndrome and its associated factors in older adults residents in an urban area in the interior of Amazonas, Brazil. This is a population-based cross-sectional study with a sample of 265 older adults (60 years or older), representative of the urban area of Coari-AM. Using the adapted Fried phenotype, those with 3 criteria or more were considered frail. Socio-demographic, health, and functionality information was collected. Multivariate analysis was used through Poisson regression with robust variance, using a hierarchical method for the dichotomous outcome of frailty. The prevalence of frailty was 9.4 % and in the final multivariate analysis model the factors associated with frailty were: advanced age (PR: 4.1; 95 % CI: 1.8-9.3), income less than one minimum wage (PR: 3.4; 1.7-6.9), masonry housing (PR: 3.3; 1.3-8.2), never having lived in a riverside community (PR: 2.7; 1.4-5.4), use of 3 medications or more (PR: 3.1; 1,4-6.9), history of falling (PR: 2.3; 1.1-4.9), and fear of falling (PR: 4.1; 1.3-13.0). The study concluded that the prevalence of frailty in Coari-AM was lower than other Brazilian cities with a similar HDI. In addition to factors associated with frailty already well described in the literature, the influence of the Amazonian culture and environment during the course of life was shown to have a possible protective effect on health outcomes in later life.

Hemoglobin concentration; a pathway to frailty

BACKGROUND

Frailty and hemoglobin concentration, above what would be considered clinical anemia, are two common findings in older patients that lead to an increased risk of negative health outcomes. The objective of this study is to evaluate whether hemoglobin concentration is an independent predictor of frailty and investigate possible causal pathways with a focus on the relationship between inflammation or nutrition and hemoglobin concentration.

METHODS

1829 community-dwelling participants aged 65 years or older who visited the Toulouse frailty day hospital during 2011 and 2016 were included in this analysis. Patients underwent a comprehensive geriatric assessment and had a blood sample taken. A series of multivariate logistic regression models were performed after minimizing potential influence from age, gender, kidney function, inflammation, cognition, nutritional status and certain socio-economic factors.

RESULTS

Hemoglobin concentration and frailty are significantly associated after minimizing potential influence from other covariates (p < 0.005). An increase in one point of hemoglobin concentration is associated with a 14% risk reduction of being frail (OR = 0.86, 95%IC = 0.79-0.94). There was no evidence of a significant causal relationship between inflammation and nutritional status in the relationship between hemoglobin concentration and frailty status (p > 0.005).

CONCLUSIONS

Hemoglobin concentration is strongly associated with frailty in older adults. These results can have potentially important implications for prevention policies targeting frailty by identifying potential patients with high risk of adverse outcomes and functional outcomes.

Older adults with frailty syndrome present an altered platelet function and an increased level of circulating oxidative stress and mitochondrial dysfunction biomarker GDF-15

INTRODUCTION

The elderly population is increasing worldwide and in Chile, it is expected to grow rapidly. The World Health Organization (WHO) ICOPE guideline (Integrated Care for Older People) emphasizes the importance of frailty diagnosis to prevent dependence. Frailty in older adults is considered an indicator of vulnerability and poor health outcomes, of multifactorial etiology. Our objective was to investigate the association of activation of coagulation and increased risk of thrombosis with frailty in people older than 64 years. A prevalent-case control study was designed with 28 frail older and 27 robust older adults (non-frail, control group) older than 64 years. Frailty was defined by Fried's Phenotype, Platelet aggregation and activation plasma levels of Thromboxane B2 (TXB2), 8-isoprostane and Growth Differentiation Factor-15 (GDF-15) were determined.

RESULTS

Compared to healthy controls, frail older adults, had a) higher percentage of platelet aggregation induction with ADP 4 μM (82.85% (3.35) and 73.41% (3.26), p-value = 0.024) and subaggregant dose of ADP (30.83% (7.47) and 13.25% (3.21), p-value = 0.002); b) higher platelet activation: P-selectin exposure (18.23% (4.41) and 6.96% (1.08), p-value = 0.011), and activated GPIIβ-IIIα (21.51% (3.41) and 8.26% (1.18), p-value = 0.001), at the baseline level and against a subaggregant dose ADP: P-selectin exposure (46.93% (5.95) and 13.41% (3.35), p-value = 0.002) and activated GPIIβ-IIIα (43.29% (6.04) and 26.71% (4.92), p-value = 0.024); c) higher plasma levels of TXB2 (201.8 ng/mL (59.53-236.3) and 45.77 ng/mL (25.14-98.26), p-value<0.0001), d) elevated plasma levels of 8-isoprostane (70.94 pg/mL, IQ: 65.89-99,96 and 56.24 pg/mL, IQ: 42.18-74.81, p-value = 0.001), and e) higher plasma GDF-15 levels (2,379 pg/mL, IQ: 1,845-4,121and 1367 pg/mL, IQ: 1190-1747, p-value = 0.0001).

DISCUSSION

Older adults with frailty syndrome have an upregulated platelet activity that may contribute to an increased risk of thrombosis and aspirin resistance. The elevated oxidative stress and increases of GDF-15 levels might be related to altered platelet responsiveness in frail patients.

CONCLUSION

The determination of biomarkers of platelet dysfunction, oxidative stress and cell senescence/mitochondrial dysfunction may contribute to frailty diagnosis, and approaches aimed at regulating platelet function in frail older adults could contribute to its prevention and treatment.

Prevalence of Frailty in Brazilian Older Adults: A Systematic Review and Meta-analysis

OBJECTIVES

Frailty is characterized by a functioning decline in multiple systems accompanied by an increase in individual's vulnerability to stressors. It appears to be higher in low and middle-income countries compared with high-income ones. This study aimed to evaluate the prevalence of frailty in non-institutionalized Brazilian older adults.

DESIGN

a systematic review and meta-analysis study.

SETTING

Cross-sectional and prospective data from Brazil.

PARTICIPANTS

non-institutionalized adults aged 60 and older.

METHODS

Electronic searches were performed in PubMed/MEDLINE, LILACS, SCOPUS and Web of Science, considering the studies published between March 2001 and July 2018, using a combination of the following terms and correlates: "elder" AND "frail" AND "prevalence" AND "Brazil". Two independent reviewers selected studies according to the inclusion criteria. Disagreements were resolved by a third reviewer (title/abstract) and by consensus. Studies with samples ≥221 subjects were considered for meta-analysis.

RESULTS

28 studies were included, while 18 had the data meta-analyzed. The majority of studies (61%) included older adults only from the Southeastern region. The number of subjects ranged from 53 to 5,532 individuals (N = 17,604) and the average age ranged from 65.6 to 85.5 years. The overall prevalence of frailty was 24%. When considering the different assessment methods, the prevalence was lower for frailty phenotype (16%) compared with other criteria (40%). Regarding sex, the prevalence of frailty was similar for women (28%) and men (25%). The prevalence of frailty was higher in older adults recruited from health care services (30%) compared to community ones (22%).

CONCLUSION

In Brazil, the overall prevalence of frailty in non-institutionalized older adults is higher than observed from more developed countries. However, it may vary according to the assessment methods and settings.

Association between anemia and frailty in 13,175 community-dwelling adults aged 50 years and older in China

BACKGROUND

Anemia and frailty contribute to poor health outcomes in older adults; however, most current research in lower income countries has concentrated on anemia or frailty alone rather than in combination. The aim of the present study was to investigate the association between anemia and frailty in community-dwelling adults aged 50 years and older in China.

METHODS

The study population was sourced from the 2007/10 SAGE China Wave 1. Anemia was defined as hemoglobin less than 13 g/dL for men and less than 12 g/dL for women. A Frailty Index (FI) was compiled to assess frailty. The association between anemia and frailty was evaluated using a 2-level hierarchical logistic model.

RESULTS

The prevalence of anemia was 31.0% (95%CI: 28.4, 33.8%) and frailty 14.7% (95%CI: 13.5, 16.0%). In the univariate regression model, presence of anemia was significantly associated with frailty (OR = 1.62, 95% CI: 1.39, 1.90) and the effect remained consistent after adjusting for various potential confounding factors including age, gender, residence, education, household wealth, fruit and vegetable intake, tobacco use, alcohol comsumption and physical activity (adjusted OR = 1.31, 95% CI:1.09, 1.57). Each 1 g/dL increase in hemoglobin concentration was associated with 4% decrease in the odds of frailty after adjusting for several confounding variables (adjusted OR = 0.96, 95% CI: 0.93, 0.99).

CONCLUSION

Anemia and low hemoglobin concentrations were significantly associated with frailty. Therefore, health care professionals caring for older adults should increase screening, assessment of causes and treatment of anemia as one method of avoiding, delaying or even reversing frailty.

A associação entre anemia e alguns aspectos da funcionalidade em idosos

Resumo O objetivo deste artigo é avaliar a associação entre a anemia e algumas atividades de vida diária associadas à alimentação e o relato de dificuldade de mastigação e deglutição. Estudo transversal, que analisou 1.256 indivíduos de 60 anos ou mais, que fizeram parte da terceira coleta do Estudo SABE (Saúde, Bem-estar e Envelhecimento). Considerou-se anêmicos homens com hemoglobina sanguínea ≤ 13g/dL e mulheres com valores ≤ 12g/dL. Houve prevalência de anemia maior nos indivíduos que relataram redução no consumo alimentar devido a queixas de mastigação e deglutição, naqueles com dificuldade de mastigação e nos que relataram dificuldade em alimentar-se devido queixas de mastigação e deglutição. A prevalência também foi maior nos indivíduos com dificuldade de alimentar-se sozinho e de fazer compras de alimentos. Nas análises, a presença de uma queixa de mastigação e deglutição foi associada à chance de anemia quase 2 vezes maior que aqueles indivíduos sem queixas, e a presença de 2 ou 3 queixas de mastigação e deglutição foi associada à chance de 2,7. Os idosos com dificuldades de deglutição e mastigação apresentaram maior prevalência de anemia, mesmo após ajuste de outros fatores associados, com efeito dose-resposta, evidenciando a importância de um trabalho multidisciplinar com o idoso.

Survival of elderly outpatients: effects of frailty, multimorbidity and disability

This study aims to analyze the impact of frailty, multimorbidity and disability on the survival of elderly people attended in a geriatric outpatient facility, and identify the clinical risk factors associated with death. It is a longitudinal study, with 133 elderly people initially evaluated in relation to frailty, multimorbidity (simultaneous presence of three or more chronic diseases) and disability in Daily Life Activities. The Kaplan Meier method was used to analyze survival time, and the Cox regression was used for association of the clinical factors with death. In follow-up over six years, 21.2% of the participants died, survival being lowest among those who were fragile (p < 0.05). The variables frailty (HR = 2.26; CI95%: 1.03-4.93) and Chronic Renal Insufficiency (HR = 3.00; CI95%: 1.20-7.47) were the factors of highest risk for death in the multivariate analysis. Frailty had a negative effect on the survival of these patients, but no statistically significant association was found in relation to multimorbidity or disability. Tracking of vulnerabilities in the outpatient geriatric service is important, due to the significant number of elderly people with geriatric syndromes that use this type of service, and the taking of decisions on directions for care of these individuals.

Inflammation and quality of life in later life: findings from the health, well-being and aging study (SABE)

BACKGROUND

Few studies have specifically investigated the inverse relationship between reduced quality of life in different domains and elevated C-reactive protein (CRP) serum levels in older adults. Therefore, this study investigates the cross-sectional association between quality of life and inflammation in older Brazilian adults.

METHODS

Data were collected from 1255 participants from the third wave (2010) of the Brazilian Health, Well-being and Aging study (SABE), a community-based cohort study of aging. Inflammation was assessed using CRP serum levels and quality of life (QoL) was measured using the 12-item Short-Form Health Survey (SF-12) questionnaire. The covariates included age, sex, education level, financial sufficiency, number of non-communicable diseases, self-reported doctor diagnosed diseases, Activity of Daily Living (ADL) difficulties, Body Mass Index (BMI), and waist circumference.

RESULTS

The fully adjusted models showed that older adults with low scores in the physical domain of the SF12 (OR 1.34, 95%CI 1.02;1.77) and high BMI values (> 30) (OR 2.05, 95%CI 1.50;2.81) were more likely to present high CRP serum levels.

CONCLUSION

Our findings suggest a significant association of lower scores in the physical domain of quality of life and the presence of obesity with high CRP serum levels.

Handgrip strength: An effective screening instrument for anemia in the elderly women

OBJECTIVE

The objectives of this study were to discover associations between anemia and functional performance indicators, and to identify the best functional performance test to screen for anemia in the elderly.

METHODS

A cross-sectional study analyzed data from 109 elderly residents in the community. For statistical analysis, the Logistic Regression and the Receiver Operating Characteristic (ROC) curve was used.

RESULTS

The prevalence of anemia in the elderly was 13.9%. There was an inverse association between handgrip strength (HGS) and anemia in women; the HGS test was an effective screening tool for anemia in the elderly.

CONCLUSION

The HGS test can be used to screen for anemia in the elderly women.

Which factors are associated with sarcopenia and frailty in elderly persons residing in the community?

Abstract Objective: to broaden knowledge about the factors associated with sarcopenia and frailty in elderly persons residing in the community. Method: an integrative systematic review based on the PRISMA recommendations was carried out, using articles published from 2012 to March 2017 in the PubMED, SciELO, Virtual Health Library, CINAHL and Springer electronic databases with the following descriptors: frail elderly, sarcopenia and etiology and their synonyms. The articles identified by the initial search strategy were independently assessed by two researchers, according to the eligibility criteria, and the articles selected were evaluated for methodological quality. Results: the results of this survey show that frailty may be associated with sarcopenia, low serum vitamin D levels, anemia, subclinical hyperthyroidism in men, while the greatest evolution in women was for osteoporosis. An association between sarcopenia and advanced age was also observed, with worsening quality of life, physical-functional capacity, nutritional status and comorbidities, as well as an increased risk of death in sarcopenic elderly persons. Conclusion: this systematic review showed that low serum levels of vitamin D are associated with frailty and factors that predispose this condition. It is therefore important to monitor the serum levels of this vitamin in the elderly population, and it is suggested that new studies are carried out related to supplements of this vitamin in frail elderly persons.

Non-periodized and Daily Undulating Periodized Resistance Training on Blood Pressure of Older Women

The present study aimed at investigating the effects of a daily undulating periodization (DUP) and non-periodized (NP) resistance training programs on hemodynamic parameters of older women. Forty-two older women were randomized into one of the three experimental groups: NP, DUP, and control group (CG). Evaluations of the hemodynamic parameters occurred before, during and after the intervention. The exercise programs were performed twice a week over 22 weeks. NP and DUP groups were based on 3 sets of 8-10 repetitions in 9 exercises. In NP, the two exercise sessions were based on traditional strength training, which was performed at a Difficult intensity according to the rating of perceived exertion (RPE) method. In DUP, the first session was based on power resistance exercise, in which the concentric muscle contraction was performed as fast as possible at a moderate intensity based on RPE, while the second session was the same that was performed by NP. The findings demonstrated that diastolic blood pressure (90.4 vs. 76.2 mmHg) and mean arterial pressure (108.6 vs. 92.7 mmHg) were significantly reduced after NP, while no significant alterations were observed in DUP. Nevertheless, both training groups seem to have a cardio protective effect, since both training modes prevented the increase in HR reported in the experimental period in CG. In conclusion, our findings indicate that a 22-week NP resistance training program causes beneficial effects on hemodynamic parameters of older women. Trial Registration: NCT03443375.

Anemia and the frailty syndrome amongst the elderly living in the community: a systematic review

Abstract Objective: To evaluate the association between anemia and the onset of the frailty syndrome amongst the elderly living in the community. Method: A systematic literature review of articles from the MEDLINE and LILACS databases published in English, Spanish and Portuguese over the last ten years was carried out. Articles were included in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The search identified 193 studies. After deleting duplicated articles and applying the exclusion criteria only seven articles remained. Three articles used standardized criteria to define frailty, whereas four evaluated functional capacity as a synonym for the frailty syndrome. Conclusion: Anemia was related to a worsening of functional capacity and to the presence of the frailty syndrome in elderly persons living in the community. However, the risk of bias in the studies was high in relation to the selection of the criteria and instruments used to assess and define frailty.

Magnitude of Anemia in Geriatric Population Visiting Outpatient Department at the University of Gondar Referral Hospital, Northwest Ethiopia: Implication for Community-Based Screening

Objective

This study is aimed at assessing the magnitude and its associated factors of anemia in geriatric population visiting outpatient department at the University of Gondar referral hospital, northwest Ethiopia.

Method

A cross-sectional study was conducted among elder patients in Gondar town, North Gondar District, in May 2013. A total of 200 randomly selected geriatric population participated in the study. Summary statistics were computed and presented in tables and figure. Both bivariate and multivariable binary logistic regression were fitted to identify associated factors. A P value < 0.05 was considered as statistically significant.

Result

The median age of the study participants was 65 years (Interquartile range (IQR): 8 years). The prevalence of anemia in the geriatric patients was 54.5% (n = 109), of which 61.5% (n = 67) were males. Mild type anemia was predominant, 55.96% (n = 61). Geriatric patients with an elevated erythrocyte sedimentation rate (AOR = 9.04, 95% CI: 4.2–19.7) and who are vegetarians (AOR = 2.2, 95% CI: 1.03–4.71) were at high risk of developing anemia.

Conclusion

The magnitude of anemia was high in geriatrics. Mild anemia was the predominant type. Vegetarians and geriatrics with elevated erythrocyte sedimentation rate were more likely to develop anemia. Hence, early diagnosis and management of anemia have paramount importance to prevent adverse outcomes in geriatrics.

The Relationship between Anaemia and Frailty: A Systematic Review and Meta-Analysis of Observational Studies

BACKGROUND

There is increasing evidence that frailty may play a role in chronic diseases, but the associations with specific chronic disorders are still unclear.

OBJECTIVES

To conduct a systematic review and meta-analysis assessing the association of anaemia and frailty in observational studies.

METHODS

The review was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/2002-10/09/2017. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I2 statistic. Publication bias was assessed with Egger's and Begg's tests.

RESULTS

Nineteen studies were included; two longitudinal, seventeen cross-sectional. All studies except three reported an association between anaemia and frailty. The pooled prevalence of prefrailty in individuals with anaemia was 49% (95% CI=38-59%; I2=89.96%) and 24% (95% CI=17-31%; I2= 94.78%) for frailty. Persons with anaemia had more than a twofold odds of frailty (pooled OR=2.24 95% CI=1.53-3.30; I2=91.8%). Only two studies longitudinally examined the association between anaemia and frailty, producing conflicting results.

CONCLUSIONS

Frailty and prefrailty are common in anaemic persons. Older persons with anaemia have more than a two-fold increased odds of frailty. These results may have clinical implications, as they identify the need to assess frailty in anaemic people and investigate any potential negative effects associated with the co-occurrence of both conditions. Longitudinal research that examines temporal changes in anaemia and effect of treatment are needed to further clarify the relationship between anaemia and frailty.

Hemoglobin concentration is associated with self-reported disability and reduced physical performance in a community dwelling population of nonagenarians: the Mugello Study

People aged 90 and older represent a fast-growing population segment who deserve specific attention and research. Aging is associated with a progressive decrease in hemoglobin concentration, which predicts adverse outcome, such as mortality, morbidity, frailty and disability. Whether this association is independent from increased prevalence of comorbidity, causing both anemia and reduced physical function is yet under debate. The aim of this study is to explore the relationship between hemoglobin concentration and self-reported disability and reduced physical performance in a community dwelling population of nonagenarians. Data presented were collected in the framework of the Mugello Study, a clinical epidemiologic survey of nonagenarians living in the Mugello area (Tuscany, Italy). 251 persons (177 women, age 93.2 ± 3.3 years; 74 men, age 92.2 ± 2.5 years) underwent a blood draw. Along with hemoglobin concentration, self-reported disability (basic and instrumental activities of daily living), physical performance (Short Physical Performance Battery), self-reported physical activity and muscular strength (handgrip measurement) were assessed. Covariates, inherent sociodemographic and health indicators and comorbidities were also included in the analysis. This study confirms that anemia is very common in the oldest old, with a significantly higher prevalence in males (50% in men vs 24% in women). Multiple linear regression analysis, including all the comorbid conditions as confounding factors, shows that hemoglobin concentration is independently associated with handgrip strength, self-reported physical activity and disability in dressing, and taking a shower/bath. In conclusion, results from this study confirm that in the oldest old, low hemoglobin concentration is strongly associated with self-reported disability and decline of physical performance independent of comorbidity.

Prevalence and Predictors of Subclinical Micronutrient Deficiency in German Older Adults: Results from the Population-Based KORA-Age Study

Subclinical micronutrient deficiency in older adults is associated with chronic age-related diseases and adverse functional outcomes. In Germany, the older population is at risk of insufficient micronutrient intake, but representative studies on micronutrient status in old and very old adults are scarce. This study’s objectives were to estimate the prevalence of subclinical vitamin D, folate, vitamin B₁₂ and iron deficiencies among older adults, aged 65 to 93, from the KORA-Age study in Augsburg, Germany (n = 1079), and to examine associated predictors, using multiple logistic regression. Serum concentrations of 25-hydroxyvitamin D (25OHD), folate, vitamin B₁₂, and iron were analyzed. The prevalence of subclinical vitamin D and vitamin B₁₂ deficiencies were high, with 52.0% and 27.3% of individuals having low 25OHD (<50 nmol/L) and low vitamin B₁₂ concentrations (<221 pmol/L), respectively. Furthermore, 11.0% had low iron (men <11.6 µmol/L, women <9.0 µmol/L) and 8.7% had low folate levels (<13.6 nmol/L). Common predictors associated with subclinical micronutrient deficiency included very old age, physical inactivity, frailty and no/irregular use of supplements. Subclinical micronutrient deficiency is a public health concern among KORA-Age participants, especially for vitamins D and B₁₂. The predictors identified provide further rationale for screening high-risk subgroups and developing targeted public health interventions to tackle prevailing micronutrient inadequacies among older adults.

Fatty Acids, Antioxidants and Physical Activity in Brain Aging

Polyunsaturated fatty acids and antioxidants are important mediators in the central nervous system. Lipid derivatives may control the production of proinflammatory agents and regulate NF-κB activity, microglial activation, and fatty acid oxidation; on the other hand, antioxidants, such as glutathione and ascorbate, have been shown to signal through transmitter receptors and protect against acute and chronic oxidative stress, modulating the activity of different signaling pathways. Several authors have investigated the role of these nutrients in the brains of the young and the aged in degenerative diseases such as Alzheimer’s and Parkinson’s, and during brain aging due to adiposity- and physical inactivity-mediated metabolic disturbances, chronic inflammation, and oxidative stress. Through a literature review, we aimed to highlight recent data on the role of adiposity, fatty acids, antioxidants, and physical inactivity in the pathophysiology of the brain and in the molecular mechanisms of senescence. Data indicate the complexity and necessity of endogenous/dietary antioxidants for the maintenance of redox status and the control of neuroglial signaling under stress. Recent studies also indicate that omega-3 and -6 fatty acids act in a competitive manner to generate mediators for energy metabolism, influencing feeding behavior, neural plasticity, and memory during aging. Finding pharmacological or dietary resources that mitigate or prevent neurodegenerative affections continues to be a great challenge and requires additional effort from researchers, clinicians, and nutritionists in the field.

Distinct Physical Function Profiles in Older Adults Receiving Cancer Chemotherapy

CONTEXT

Although physical function is an important patient outcome, little is known about changes in physical function in older adults receiving chemotherapy (CTX).

OBJECTIVES

Identify subgroups of older patients based on changes in their level of physical function; determine which demographic and clinical characteristics were associated with subgroup membership; and determine if these subgroups differed on quality-of-life (QOL) outcomes.

METHODS

Latent profile analysis was used to identify groups of older oncology patients (n = 363) with distinct physical function profiles. Patients were assessed six times over two cycles of CTX using the Physical Component Summary score from the Short Form 12. Differences, among the groups, in demographic and clinical characteristics and QOL outcomes were evaluated using parametric and nonparametric tests.

RESULTS

Three groups of older oncology patients with distinct functional profiles were identified: Well Below (20.4%), Below (43.8%), and Above (35.8%) normative Physical Component Summary scores. Characteristics associated with membership in the Well Below class included the following: lower annual income, a higher level of comorbidity, being diagnosed with depression and back pain, and lack of regular exercise. Compared with the Above class, patients in the other two classes had significantly poorer QOL outcomes.

CONCLUSION

Almost 65% of older oncology patients reported significant decrements in physical function that persisted over two cycles of CTX. Clinicians can assess for those characteristics associated with poorer functional status to identify high-risk patients and initiate appropriate interventions.

Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study

BACKGROUND

Frail individuals are at increased risk for poor outcomes, including adverse drug events. Kidney function is often compromised in frailty and is a key consideration in medication choice and dosing; however, creatinine-based measures of kidney function may be biased in frail individuals.

STUDY DESIGN

Observational study.

SETTING & PARTICIPANTS

4,987 community-dwelling older men and women with complete data who participated in visit 5 of the Atherosclerosis Risk in Communities (ARIC) Study (2011-2013).

PREDICTORS

Kidney measures included glomerular filtration rate (GFR) estimated using serum creatinine (eGFRcr) and serum cystatin C level (eGFRcys) and urine albumin-creatinine ratio.

OUTCOME

Frailty, defined using established criteria of 3 or more frailty characteristics (weight loss, slowness, exhaustion, weakness, and low physical activity).

RESULTS

341 (7%) participants were classified as frail, 1,475 (30%) had eGFRcr<60mL/min/1.73m2, 2,480 (50%) had eGFRcys<60mL/min/1.73m2, and 1,006 (20%) had albuminuria with albumin excretion ≥ 30mg/g. Among frail participants, prevalences of eGFRcr and eGFRcys<60mL/min/1.73m2 were 45% and 77%, respectively. Adjusted for covariates, frailty showed a moderate association with eGFRcr and a strong association with eGFRcys and albumin-creatinine ratio. Frail individuals with eGFRcr of 60 to <75mL/min/1.73m2 were frequently reclassified to lower eGFR categories using eGFRcys (49% to 45-<60, 32% to 30-<45, and 3% to <30mL/min/1.73m2). Hyperpolypharmacy (taking ≥10 classes of medications) was more common in frail individuals (54% vs 38% of nonfrail), including classes requiring kidney clearance (eg, digoxin) and associated with falls and subsequent complications (eg, hypnotic/sedatives and anticoagulants).

LIMITATIONS

Cross-sectional study design.

CONCLUSIONS

Frail individuals had a high prevalence of reduced kidney function, with large discrepancies when reduced kidney function was classified by eGFRcys versus eGFRcr. Given the substantial medication burden and uncertainty in chronic kidney disease classification, confirmation of kidney function with alternative biomarkers may be warranted to ensure careful prescribing practices in this vulnerable population.

Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record

INTRODUCTION

Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes.

PURPOSE

The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization.

METHODS

The sample included 278 patients ≥55 years old admitted to medicine units. Frailty was determined using clinical data from the electronic health record (EHR) for symptoms, syndromes, and conditions and laboratory data for four serum biomarkers. A frailty risk score (FRS) was created from 16 risk factors, and relationships between the FRS and outcomes were examined.

RESULTS

The mean age of the sample was 70.2 years and mean FRS was 9.4 ( SD, 2.2). Increased FRS was significantly associated with increased risk of death (hazard ratio = 1.77-2.27 for 3 days ≤ length of stay (LOS) ≤7 days), but depended upon LOS ( p < .001). Frailty was marginally associated with rehospitalization for those who did not die in hospital (adjusted odds ratio = 1.18, p = .086, area under the curve [AUC] = 0.66, 95% confidence interval for AUC = [0.57, 0.76]).

DISCUSSION

Clinical data in the EHR can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions and optimal patient outcomes.

Abdominal obesity as a risk factor for disability in Brazilian older adults

OBJECTIVE

To assess the role of abdominal obesity in the incidence of disability in older adults living in São Paulo, Brazil, in a 5-year period.

DESIGN

Longitudinal study, part of the SABE Study (Health, Wellbeing and Aging). We assessed the disability incidence in the period (reported difficulty in at least one activity of daily living (ADL) in 2010) in relation to abdominal obesity in 2006 (waist circumference ≥102 cm in men and ≥88 cm in women). We used Poisson regression to evaluate the association between obesity and disability incidence, adjusting for sociodemographic and clinical factors including BMI.

SETTING

São Paulo, Brazil.

SUBJECTS

Older adults (n 1109) who were independent in ADL in 2006. In 2010, 789 of these were located and re-interviewed.

RESULTS

The crude disability incidence (at least one ADL) was 27·1/1000 person-years in the period. The incidence rate was two times higher in participants with abdominal obesity compared with those without (39·1/1000 and 19·4/1000 person-years, respectively; P<0·001). This pattern was observed in all BMI levels. In regression models, abdominal obesity remained associated with disability incidence (incidence rate ratio=1·90; P<0·03), even after controlling for BMI, gender, age, low grip strength, cognitive impairment, physical inactivity and chronic diseases.

CONCLUSIONS

Abdominal obesity was strong risk factor for disability, showing a more significant effect than BMI, and thus should be an intervention target for older adults. Waist measure is simple, cost-effective and easily interpreted, and therefore can be used in several settings to identify individuals at higher risk of disability.

Prevalence of Frailty in Latin America and the Caribbean: A Systematic Review and Meta-Analysis

BACKGROUND

Countries in Latin America and the Caribbean (LAC) have experienced a rapid increase in their proportion of older people. This region is marked by a high prevalence of chronic diseases and disabilities among aging adults. Frailty appears in the context of LAC negatively affecting quality of life among many older people.

AIM

To investigate the prevalence of frailty among community-dwelling older people in LAC through a systematic review and meta-analysis.

METHODS

A literature search was performed in indexed databases and in the grey literature. Studies investigating the prevalence of frailty with representative samples of community-dwelling older people in Latin America and the Caribbean were retrieved. Independent investigators carried out the study selection process and the data extraction. A meta-analysis and meta-regression were performed using STATA 11 software. The systematic review was registered at the International Prospective Register of Systematic Reviews under the number CRD42014015203.

RESULTS

A total of 29 studies and 43,083 individuals were included in the systematic review. The prevalence of frailty was 19.6% (95% CI: 15.4-24.3%) in the investigated region, with a range of 7.7% to 42.6% in the studies reviewed. The year of data collection influenced the heterogeneity between the studies.

CONCLUSION

Frailty is very common among older people in LAC. As a result, countries in the region need to adapt their health and social care systems to demands of an older population.