High-Technology Based Gait Assessment in Frail People: Associations between Spatio-Temporal and Three-Dimensional Gait Characteristics with Frailty Status across Four Different Frailty Measures

Prevalence and Associated Factors with Frailty Using the Kihon Checklist among Community-Dwelling Older Adults in Taiwan

Background and Objectives: Frailty in older adults is associated with adverse health outcomes. This study aimed to analyze the frailty status of community-dwelling older adults in Taiwan using the Kihon Checklist (KCL) and explore associations with demographic, physiological, and functional factors. Materials and Methods: In this cross-sectional study, 278 community-dwelling older adults were classified as robust, prefrail, or frail based on their KCL scores. Participants underwent physical fitness assessments including muscle strength and endurance tests, walking speed tests, and flexibility tests. One-way ANOVA and logistic regression analyses were used to examine differences and associations between frailty status and physical fitness indicators. Results: 36% of participants were robust, 47.1% prefrail, and 16.9% frail. The robust group significantly outperformed the prefrail and frail groups in the 30 s sit-to-stand test, 2.44 m sit-to-walk test, and walking speed (p < 0.001). The 2.44 m sit-to-walk test was a significant predictor of prefrailty (OR = 1.18, 95% CI = 1.02-1.36) after adjusting for other physical fitness indicators. Conclusions: Lower limb functional capacity, particularly in the 2.44 m sit-to-walk test, was significantly associated with pre-frailty among community-dwelling older adults in Taiwan. Early screening, the classification of frailty by the Kihon Checklist, and targeted interventions focusing on lower limb strength, endurance, and mobility are crucial for preventing and delaying frailty progression in older populations.

Technologies for frailty, comorbidity, and multimorbidity in older adults: a systematic review of research designs

BACKGROUND

Frailty, neurodegeneration and geriatric syndromes cause a significant impact at the clinical, social, and economic level, mainly in the context of the aging world. Recently, Information and Communication Technologies (ICTs), virtual reality tools, and machine learning models have been increasingly applied to the care of older patients to improve diagnosis, prognosis, and interventions. However, so far, the methodological limitations of studies in this field have prevented to generalize data to real-word. This review systematically overviews the research designs used by studies applying technologies for the assessment and treatment of aging-related syndromes in older people.

METHODS

Following the PRISMA guidelines, records from PubMed, EMBASE, and Web of Science were systematically screened to select original articles in which interventional or observational designs were used to study technologies' applications in samples of frail, comorbid, or multimorbid patients.

RESULTS

Thirty-four articles met the inclusion criteria. Most of the studies used diagnostic accuracy designs to test assessment procedures or retrospective cohort designs to build predictive models. A minority were randomized or non-randomized interventional studies. Quality evaluation revealed a high risk of bias for observational studies, while a low risk of bias for interventional studies.

CONCLUSIONS

The majority of the reviewed articles use an observational design mainly to study diagnostic procedures and suffer from a high risk of bias. The scarce presence of methodologically robust interventional studies may suggest that the field is in its infancy. Methodological considerations will be presented on how to standardize procedures and research quality in this field.

Assessing the validity of inertial measurement units for shoulder kinematics using a commercial sensor-software system: A validation study

Background and  Aims

Wearable inertial sensors may offer additional kinematic parameters of the shoulder compared to traditional instruments such as goniometers when elaborate and time-consuming data processing procedures are undertaken. However, in clinical practice simple-real time motion analysis is required to improve clinical reasoning. Therefore, the aim was to assess the criterion validity between a portable "off-the-shelf" sensor-software system (IMU) and optical motion (Mocap) for measuring kinematic parameters during active shoulder movements.

Methods

24 healthy participants (9 female, 15 male, age 29 ± 4 years, height 177 ± 11 cm, weight 73 ± 14 kg) were included. Range of motion (ROM), total range of motion (TROM), peak and mean angular velocity of both systems were assessed during simple (abduction/adduction, horizontal flexion/horizontal extension, vertical flexion/extension, and external/internal rotation) and complex shoulder movements. Criterion validity was determined using intraclass-correlation coefficients (ICC), root mean square error (RMSE) and Bland and Altmann analysis (bias; upper and lower limits of agreement).

Results

ROM and TROM analysis revealed inconsistent validity during simple (ICC: 0.040-0.733, RMSE: 9.7°-20.3°, bias: 1.2°-50.7°) and insufficient agreement during complex shoulder movements (ICC: 0.104-0.453, RMSE: 10.1°-23.3°, bias: 1.0°-55.9°). Peak angular velocity (ICC: 0.202-0.865, RMSE: 14.6°/s-26.7°/s, bias: 10.2°/s-29.9°/s) and mean angular velocity (ICC: 0.019-0.786, RMSE:6.1°/s-34.2°/s, bias: 1.6°/s-27.8°/s) were inconsistent.

Conclusions

The "off-the-shelf" sensor-software system showed overall insufficient agreement with the gold standard. Further development of commercial IMU-software-solutions may increase measurement accuracy and permit their integration into everyday clinical practice.

Wearable gait analysis systems: ready to be used by medical practitioners in geriatric wards?

Aim

To investigate the feasibility of wearable gait analysis in geriatric wards by testing the effectiveness and acceptance of the system.

Findings

Wearable gait analysis can be implemented into geriatric wards, showing its readiness for a transformation from a pure research tool to a practically usable gait analysis system.

Message

Despite good transferability into clinical practice, future research should aim to increase functionality and applicability of wearable gait analysis systems in clinical contexts.

Purpose

We assess feasibility of wearable gait analysis in geriatric wards by testing the effectiveness and acceptance of the system.

Methods

Gait parameters of 83 patients (83.34 ± 5.88 years, 58/25 female/male) were recorded at admission and/or discharge to/from two geriatric inpatient wards. Gait parameters were tested for statistically significant differences between admission and discharge. Walking distance measured by a wearable gait analysis system was correlated with distance assessed by physiotherapists. Examiners rated usability using the system usability scale. Patients reported acceptability on a five-point Likert-scale.

Results

The total distance measures highly correlate (r = 0.89). System Usability Scale is above the median threshold of 68, indicating good usability. Majority of patients does not have objections regarding the use of the system. Among other gait parameters, mean heel strike angle changes significantly between admission and discharge.

Conclusion

Wearable gait analysis system is objectively and subjectively usable in a clinical setting and accepted by patients. It offers a reasonably valid assessment of gait parameters and is a feasible way for instrumented gait analysis.

Smart Eyeglasses: A Valid and Reliable Device to Assess Spatiotemporal Parameters during Gait

The study aims to determine the validity and reproducibility of step duration and step length parameters measured during walking in healthy participants using an accelerometer embedded in smart eyeglasses. Twenty young volunteers participated in two identical sessions comprising a 30 s gait assessment performed at three different treadmill speeds under two conditions (i.e., with and without a cervical collar). Spatiotemporal parameters (i.e., step duration and step length normalized by the lower limb length) were obtained with both the accelerometer embedded in smart eyeglasses and an optoelectronic system. The relative intra- and inter-session reliability of step duration and step length computed from the vertical acceleration data were excellent for all experimental conditions. An excellent absolute reliability was observed for the eyeglasses for all conditions and concurrent validity between systems was observed. An accelerometer incorporated in smart eyeglasses is accurate to measure step duration and step length during gait.

Kinematic characteristics during gait in frail older women identified by principal component analysis

Frailty is associated with gait variability in several quantitative parameters, including high stride time variability. However, the associations between joint kinematics during walking and increased gait variability with frailty remain unclear. In the current study, principal component analysis was used to identify the key joint kinematics characteristics of gait related to frailty. We analyzed whole kinematic waveforms during the entire gait cycle obtained from the pelvis and lower limb joint angle in 30 older women (frail/prefrail: 15 participants; non-frail: 15 participants). Principal component analysis was conducted using a 60 × 1224 input matrix constructed from participants’ time-normalized pelvic and lower-limb-joint angles along three axes (each leg of 30 participants, 51 time points, four angles, three axes, and two variables). Statistical analyses revealed that only principal component vectors 6 and 9 were related to frailty. Recombining the joint kinematics corresponding to these principal component vectors revealed that frail older women tended to exhibit greater variability of knee- and ankle-joint angles in the sagittal plane while walking compared with non-frail older women. We concluded that greater variability of knee- and ankle-joint angles in the sagittal plane are joint kinematic characteristics of gait related to frailty.

A Wearable Biofeedback Device to Increase Gait Swing Time Could Have Positive Effects on Gait among Older Adults

Older adults walk with a shorter stride length, reduced hip range of motion (ROM) and higher cadence. These are signs of reductions in walking ability. This study investigated whether using a wireless smart insole system that monitored and provided biofeedback to encourage an extension of swing time could increase stride length and hip flexion, while reducing the cadence. Seven older adults were tested in this study, with and without the biofeedback device, in an outdoor environment. Gait analysis was performed by using GaitRite system and Xsens MVN. Repeated measures analysis demonstrated that with biofeedback, the swing time increased by 6.45%, stride length by 4.52% and hip flexion by 14.73%, with statistical significance. It also decreased the cadence significantly by 5.5%. This study has demonstrated that this smart insole system modified positively the studied gait parameters in older adults and has the potential to improve their walking ability.

Detecting Fall Risk and Frailty in Elders with Inertial Motion Sensors: A Survey of Significant Gait Parameters

In the elderly, geriatric problems such as the risk of fall or frailty are a challenge for society. Patients with frailty present difficulties in walking and higher fall risk. The use of sensors for gait analysis allows the detection of objective parameters related to these pathologies and to make an early diagnosis. Inertial Measurement Units (IMUs) are wearables that, due to their accuracy, portability, and low price, are an excellent option to analyze human gait parameters in health-monitoring applications. Many relevant gait parameters (e.g., step time, walking speed) are used to assess motor, or even cognitive, health problems in the elderly, but we perceived that there is not a full consensus on which parameters are the most significant to estimate the risk of fall and the frailty state. In this work, we analyzed the different IMU-based gait parameters proposed in the literature to assess frailty state (robust, prefrail, or frail) or fall risk. The aim was to collect the most significant gait parameters, measured from inertial sensors, able to discriminate between patient groups and to highlight those parameters that are not relevant or for which there is controversy among the examined works. For this purpose, a literature review of the studies published in recent years was carried out; apart from 10 previous relevant reviews using inertial and other sensing technologies, a total of 22 specific studies giving statistical significance values were analyzed. The results showed that the most significant parameters are double-support time, gait speed, stride time, step time, and the number of steps/day or walking percentage/day, for frailty diagnosis. In the case of fall risk detection, parameters related to trunk stability or movements are the most relevant. Although these results are important, the total number of works found was limited and most of them performed the significance statistics on subsets of all possible gait parameters; this fact highlights the need for new frailty studies using a more complete set of gait parameters.

Short- and long-term effects of different exercise programs on the gait performance of older adults with subjective cognitive decline: A randomized controlled trial

BACKGROUND

Older adults, especially those with cognitive decline, often have poor gait performance, which results in poor clinical outcomes due to falls or decreased daily physical activity. The effects of various exercises on gait performance have been studied, whereas the short-term and long-term effects of different exercise modalities remain unknown.

OBJECTIVE

To compare the short- and long-term effects of aerobic training (AT), resistance training (RT), and combined training (CT) on the gait performance of community-dwelling older adults with subjective cognitive decline (SCD).

DESIGN

A four-arm, randomized controlled trial.

SETTING AND SUBJECTS

388 community-dwelling older adults with SCD (mean age, 72.3 years).

METHODS

Participants attended an exercise or education class twice a week for 26 weeks. 10 gait performance parameters were examined at baseline, post-intervention (Week 26), and after 26 weeks of follow-up (Week 52) using an electronic walkway system.

RESULTS

The mean adherence of exercise sessions was 82.5 to 85.9%. All exercise intervention induced an improvement in gait speed, stride time, cadence, stride length, and double-support time at Week 26 (p < .05), without significant intergroup differences among exercise interventions. However, only RT showed a significant effect on some spatiotemporal gait parameters at Week 52. The analyses for the gait variability parameters showed mild effects of all exercise interventions.

CONCLUSION

All of the exercise programs examined had a positive short-term effect on spatiotemporal gait parameters of older adults with SCD, despite no effect on gait variability parameters. RT are most recommended when long-lasting effects are the primary aim.

Wearable inertial sensors for human movement analysis: a five-year update

INTRODUCTION

The aim of the present review is to track the evolution of wearable IMUs from their use in supervised laboratory- and ambulatory-based settings to their application for long-term monitoring of human movement in unsupervised naturalistic settings.

AREAS COVERED

Four main emerging areas of application were identified and synthesized, namely, mobile health solutions (specifically, for the assessment of frailty, risk of falls, chronic neurological diseases, and for the monitoring and promotion of active living), occupational ergonomics, rehabilitation and telerehabilitation, and cognitive assessment. Findings from recent scientific literature in each of these areas was synthesized from an applied and/or clinical perspective with the purpose of providing clinical researchers and practitioners with practical guidance on contemporary uses of inertial sensors in applied clinical settings.

EXPERT OPINION

IMU-based wearable devices have undergone a rapid transition from use in laboratory-based clinical practice to unsupervised, applied settings. Successful use of wearable inertial sensing for assessing mobility, motor performance and movement disorders in applied settings will rely also on machine learning algorithms for managing the vast amounts of data generated by these sensors for extracting information that is both clinically relevant and interpretable by practitioners.

Effects of age, gender, frailty and falls on spatiotemporal gait parameters: a retrospective cohort study

BACKGROUND

Many studies have explored spatial and temporal gait parameters in the elderly, and showed that frailty status, fall history, age, and gender may individually strongly influence these parameters. However, it appears necessary to investigate the confounding factors more deeply in order to better know the specific role of each of these factors impacting the evolution of gait with the increase of age.

AIM

The aim of the present study was to determine the influence of frailty status, fall history, age and gender on spatiotemporal gait parameters. We hypothesized that frailty was the factor that most influence gait parameters.

SETTING

This is a monocentric retrospective study performed at Nice University Hospital Center on older out-patients.

POPULATION

Older adults were included in the study. This study explored for the first time how frailty status, age, gender and history of falls impact the multiple spatiotemporal parameters of gait using linear mixed models (LMM).

RESULTS

479 older adults (360 women and 119 men; 213 non-frail, 228 pre-frail and 38 frail; aged from 65 to 94 years; 403 non-fallers and 73 fallers). Frailty status explained fully: i) the gait speed; ii) the cadence: iii) the initial double contact: DS1; iv) the percentage of the single support phase v) the final double contact: DS2; v) the percentage of the swing phase of the gait cycle.

CONCLUSIONS

The results of this study allow a deeper understanding of the confounding factors since LMM highlighted the importance of frailty status for explaining all the spatiotemporal gait parameters.

CLINICAL REHABILITATION IMPACT

These results showed that to improve gait, clinical intervention should focus on reducing frailty status. It is also interesting to note that a history of falls explains none of the spatiotemporal gait parameters which suggests that it may be possible to improve gait in all frail subjects irrespective of their history of falls.

Frail Older Individuals Maintaining a Steady Standing Position: Associations Between Sway Measurements with Frailty Status Across Four Different Frailty Instruments

Objective

An analysis of the relationships between static equilibrium parameters and frailty status and/or severity across four different frailty measures.

Design

Cross-sectional analysis.

Setting

Geriatric wards of a general hospital.

Participants

One hundred twenty-three geriatric inpatients comprising 70 women (56.5%) and 53 men (42.7%) with an age range of 68–95 years.

Methods

The variation in the center of pressure (CoP), ie, the length of sway, the area of sway, and the mean speed, was assessed for different positions/tasks: 1) wide standing with eyes open (WSEO); 2) wide standing with eyes closed (WSEC); 3) narrow standing with eyes open (NSEO) and 4) narrow standing with eyes closed (NSEC), using a force plate. Frailty status and/or frailty severity were evaluated using the frailty phenotype (FP), the clinical frailty scale (CFS), the 14-item frailty index based on a comprehensive geriatric assessment (FI-CGA), and a 47-item frailty index (FI).

Results

WSEO length of sway (FP, CFS, FI-CGA, FI), WSEO area of sway (FP, CFS, FI-CGA, FI), and WSEO mean speed (FP, CFS, FI-CGA, FI), WSEC length of sway (FP, FI-CGA, FI), WSEC area of sway (FP, FI-CGA, FI) and WSEC mean speed (FI-CGA, FI), NSEO length of sway (FP, FI-CGA, FI), NSEO area of sway (FP, CFS, FI-CGA, FI), and NSEO mean speed (FP, CFS, FI-CGA, FI), NSEC length of sway (FI-CGA, FI), NSEC area of sway (FI-CGA, FI) and NSEC mean speed (FI-CGA, FI) were associated with the frailty status and/or severity across the four different frailty instruments (all p < 0.05, respectively).

Conclusion

Greater fluctuations in CoP with increasing frailty status and/or severity were a uniform finding across various major frailty instruments.

Effectiveness of a Combined Intervention on Psychological and Physical Capacities of Frail Older Adults: A Cluster Randomized Controlled Trial

BACKGROUND

Older adults experience physical and psychological declines affecting independency. Adapted and structured combined interventions composed of cognitive stimulation and physical exercise contribute to comorbidities' reduction. Methods: Multicenter single-blinded two-arm cluster randomized controlled trial conducted to assess effectiveness of a combined intervention (CI), composed of a cognitive stimulation program (CSP) and a physical exercise program (PEP), on psychological and physical capacities of frail older adults as to on their activities of daily living. Were recruited 50 subjects from two elderly end-user organizations. Of these, 44 (65.9% females, mean age of 80.5 ± 8.47 years) were considered eligible, being randomly allocated in experimental (EG) or control group (CG). Data collected at baseline and post-intervention. EG received CI three times a week during 12 weeks. CG received standard care. Non-parametric measures were considered. Results: At baseline, groups were equivalent for study outcomes. The comparison of pre- and post-intervention data revealed that subjects receiving CI reduced depressive symptomatology and risk of fall based on gait and balance, and improved gait speed. Simultaneously, in the CG a significant decline on activities of daily living was observed. Significant results were found among biomechanical parameters of gait (BPG). EG' effect size revealed to be small (0.2 ≤ r < 0.5). CG' effect size was also small; but for activities of daily living there was an evident decrease. Conclusion: The CI is effective on managing older adults' psychological and physical capacities.

[Assessment of walking function in neurological practice]

An accurate diagnosis of the existing defect of motor function in patients with neurological pathology is necessary for the optimal formulation of the rehabilitation program, selection of drug therapy and evaluation of the effectiveness of treatment. In current clinical practice, clinical scales such as the Dynamic Gait Index, the Rivermid Mobility Index, the Hauser Walk Index, the Stand Up and Go Test, the MDS-UPDRS III are used most often to assess walking function. Evaluation of walking function using valid scales is very accessible, however, it has such a disadvantage as subjectivity. That's why the study of motor functions by instrumental methods gains more prominence. The most well-known methods of objective walking assessment include an analysis of human movements using accelerometers, three-dimensional video analysis, sub-metric, goniometric and impregnation methods. Each of these methods has both advantages and disadvantages. The main requirement to objective methods of assessing walking functions in neurological pathology is the universality of the complex (the accuracy of measurements, regardless of the type of walking disorder), the ability to determine both temporal and spatial characteristics of the step, the ease of use. Considering these requirements, the use of the 'Induction Analyzer of the kinematic parameters of walking' seems promising in the diagnosis of motor disorders.

Foot-ground clearance characteristics in women: A comparison across different ages

BACKGROUND

Tripping is a common event leading to falls amongst elderly. Minimum foot clearance (MFC) is a critical swing phase control factor associated with tripping and falls.

RESEARCH QUESTION

Are there differences in MFC characteristics among three age groups of women and are there association between MFC and lower limb kinematics?

METHODS

Cross-sectional observational study. Three-dimensional gait analysis of 55 healthy women. ANOVA was used to compare (p<0.05) MFC characteristics among young, middle-aged and elderly groups. Multiple Linear Regression Analysis was used to test prediction over MFC.

RESULTS

Elderly women walked slower, with lower MFC and lower maximum foot velocity during swing (MFV) than young and middle-aged women. There were more hip flexion and less ankle dorsiflexion during MFC among elderly. There is a strong positive relationship between dorsiflexion and MFC. And ankle dorsiflexion was the most predictive variable over MFC.

SIGNIFICANCE

Elderly women walk slower with lower MFC value and less ankle dorsiflexion than gender-matched young controls. Increased hip flexion may represent a gait adaptation to avoid tripping. Gait speed had no effect on those findings.

Changes of a frailty index based on common blood and urine tests during a hospital stay on geriatric wards predict 6-month and 1-year mortality in older people

Background

We aimed to evaluate the abilities of a 21-item frailty index based on laboratory blood and urine tests (FI-Lab21) assessed at different points in time, ie, at admission to hospital (FI-Lab21_admission) and before discharge from hospital (FI-Lab21_discharge), and the change of the FI-Lab21 during the hospital stay to predict 6-month and 1-year mortality in hospitalized geriatric patients.

Methods

Five hundred hospitalized geriatric patients aged ≥65 years were included in this analysis. Follow-up data were acquired after a period of 6 months and 1 year.

Results

The FI-Lab21_admission and FI-Lab21_discharge scores were 0.33±0.15 and 0.31±0.14, respectively (P<0.001). The FI-Lab21_admission and FI-Lab21_discharge both predicted 6-month and 1-year mortality (areas under the receiver operating characteristic curves: 0.72, 0.72, 0.77, and 0.75, respectively, all P<0.001). The predictive abilities for 6-month and 1-year mortality of the FI-Lab21_admission were inferior compared with those of the FI-Lab21_discharge (all P<0.05). Patients with a reduction in or stable FI-Lab21 score during the hospital stay revealed lower 6-month and 1-year mortality rates compared with the persons whose FI-Lab21 score increased during the hospital stay (all P<0.05). After adjustment for age, sex, and FI-Lab21_admission, each 1% decrease in the FI-Lab21 during the hospital stay was associated with a decrease in 6-month and 1-year mortality of 5.9% and 5.3% (both P<0.001), respectively.

Conclusion

The FI-Lab21 assessed at admission or discharge and the changes of the FI-Lab21 during the hospital stay emerged as interesting and feasible approaches to stratify mortality risk in hospitalized geriatric patients.

Effect of 6-month community-based exercise interventions on gait and functional fitness of an older population: a quasi-experimental study

Background

Gait ability in older adults has been associated with independent living, increased survival rates, fall prevention, and quality of life. There are inconsistent findings regarding the effects of exercise interventions in the maintenance of gait parameters.

Objectives

The aim of the study was to analyze the effects of a community-based periodized exercise intervention on the improvement of gait parameters and functional fitness in an older adult group compared with a non-periodized program.

Methods

A quasi-experimental study with follow-up was performed in a periodized exercise group (N=15) and in a non-periodized exercise group (N=13). The primary outcomes were plantar pressure gait parameters, and the secondary outcomes were physical activity, aerobic endurance, lower limb strength, agility, and balance. These variables were recorded at baseline and after 6 months of intervention.

Results

Both programs were tailored to older adults’ functional fitness level and proved to be effective in reducing the age-related decline regarding functional fitness and gait parameters. Gait parameters were sensitive to both the exercise interventions.

Conclusion

These exercise protocols can be used by exercise professionals in prescribing community exercise programs, as well as by health professionals in promoting active aging.

Operationalizing a frailty index using routine blood and urine tests

Background

Uncomplicated frailty instruments are desirable for use in a busy clinical setting. The aim of this study was to operationalize a frailty index (FI) from routine blood and urine tests, and to evaluate the properties of this FI compared to other frailty instruments.

Materials and methods

We conducted a secondary analysis of a prospective cohort study on 306 patients aged ≥65 years hospitalized on geriatric wards. An FI comprising 22 routine blood parameters and one standard urine parameter (FI-Lab), a 50-item FI based on a comprehensive geriatric assessment (FI-CGA), a combined FI (FI-combined [items from the FI-Lab + others from the FI-CGA]), the Clinical Frailty Scale, rule-based frailty definition, and frailty phenotype were operationalized from data obtained during patients’ hospital stays (ie, before discharge [baseline examination]). Follow-up data were obtained up to 1 year after the baseline examination.

Results

The mean FI-Lab score was 0.34±15, with an upper limit of 0.74. The FI-Lab was correlated with all the other frailty instruments (all P<0.001). The FI-Lab revealed an area under the receiver-operating characteristic curve (AUC) for 6-month and 1-year mortality of 0.765 (0.694–0.836) and 0.769 (0.706–0.833), respectively (all P<0.001). Each 0.01 increment in FI-Lab increased the risk (adjusted for age and sex) for 6-month and 1-year mortality by 7.2% and 7.1%, respectively (all adjusted P<0.001). When any of the other FIs (except the FI-combined) were also included in the models, each 0.01 increment in FI-Lab score was associated with an increase in the risk of 6-month and 1-year mortality by 4.1%–5.4% (all adjusted P<0.001).

Conclusion

The FI-Lab showed key characteristics of an FI. The FI-Lab can be applied as a single frailty measure or in combination with/in addition to other frailty instruments.

Comparing the predictive accuracy of frailty, comorbidity, and disability for mortality: a 1-year follow-up in patients hospitalized in geriatric wards

BACKGROUND

Studies evaluating and comparing the power of frailty, comorbidity, and disability instruments, together and in parallel, for predicting mortality are limited.

OBJECTIVE

This study aimed to evaluate and compare the measures of frailty, comorbidity, and disability in predicting 1-year mortality in geriatric inpatients.

DESIGN

Prospective cohort study.

PATIENTS AND SETTING

A total of 307 inpatients aged ≥65 years in geriatric wards of a general hospital participated in the study.

MEASUREMENTS

The patients were evaluated in relation to different frailty, comorbidity, and disability instruments during their hospital stays. These included three frailty (the seven-category Clinical Frailty Scale [CFS-7], a 41-item frailty index [FI], and the FRAIL scale), two comorbidity (the Cumulative Illness Rating Scale for Geriatrics [CIRS-G] and the comorbidity domain of the FI [Comorbidity-D-FI]), and two disability instruments (disability in basic activities of daily living [ADL-Katz] and the instrumental and basic activities of daily living domains of the FI [IADL/ADL-D-FI]). The patients were followed-up over 1 year.

RESULTS

Using FI, CIRS-G, Comorbidity-D-FI, and ADL-Katz, this study identified a patient group with a high (≥50%) 1-year mortality rate in all of the patients and the two patient subgroups (ie, patients aged 65-82 years and ≥83 years). The CFS-7, FI, FRAIL scale, CIRS-G, Comorbidity-D-FI, and IADL/ADL-D-FI (analyzed as full scales) revealed useful discriminative accuracy for 1-year mortality (ie, an area under the curve >0.7) in all the patients and the two patient subgroups (all P<0.001). Thereby, CFS-7 (in all patients and the two patient subgroups) and FI (in the subgroup of patients aged ≥83 years) showed greater discriminative accuracy for 1-year mortality compared to other instruments (all P<0.05).

CONCLUSION

All the different instruments emerged as suitable tools for risk stratification in geriatric inpatients. Among them, CFS-7, and in those patients aged ≥83 years, also the FI, might most accurately predict 1-year mortality in the aforementioned group of individuals.

Significance of frailty for predicting adverse clinical outcomes in different patient groups with specific medical conditions

Frailty is a major health burden in an aging society. It constitutes a clinical state of reduced physiological reserves that is associated with a diminished ability to withstand internal and external stressors. Frail patients have an increased risk for adverse clinical outcomes, such as mortality, readmission to hospital, institutionalization and falls. Of further clinical interest, frailty might be at least in part reversible in some patients and subject to preventive strategies. In daily clinical practice older patients with a complex health status, who are mostly frail or at least at risk of developing frailty, are frequently cared for by geriatricians. Recently, clinicians and scientists from other medical disciplines, such as cardiology, pulmonology, gastroenterology, nephrology, endocrinology, rheumatology, surgery and critical care medicine also discovered frailty to be an interesting instrument for risk stratification of patients, including younger patients. In this review we highlight the results of recent studies that demonstrated the significance of frailty to predict adverse clinical outcomes in patients with specific medical conditions, such as cardiac, lung, liver and kidney diseases as well as diabetes mellitus, osteoarthritis, trauma patients, patients undergoing surgery and critically ill patients. Multiple studies in patients with the aforementioned specific medical conditions could be identified demonstrating a predictive role of frailty for several adverse clinical outcomes. The association between frailty and adverse clinical outcomes reported in these studies was in part independent of several major potential confounder factors, such as age, sex, race, comorbidities and disabilities and were also detected in younger patients.

Sensor-based foot-mounted wearable system and pressure sensitive gait analysis : Agreement in frail elderly people in long-term care

BACKGROUND

The RehaWatch® system is a portable accelerometer for measurement of gait parameters that shows good validity in young adults; however, validity data are missing for elderly persons in long-term care (LTC).

AIM

The aim was to evaluate the concurrent validity of the RehaWatch® system using the GAITRite® system as a criterion reference for gait assessment in the LTC elderly.

MATERIAL AND METHODS

In this study 23 elderly participants (mean age 90.9 ± 8.4 years) performed 4 walking trials at normal and fast walking speed during single task and dual task walking. Data for both systems were collected simultaneously for each trial. Concurrent validity was assessed through limits of agreement (LoA) methodology using Bland-Altman plots.

RESULTS

No systematic bias could be determined. Mean biases for step duration, velocity and cadence were above the prespecified ±7 % value from zero lines for normal walking during single task and dual task walking. The LoA had a wide range between -21 % and 25 %. Only cadence showed small LoA for normal walking speed during single (-8.4 % to 7.7 %) and dual tasking (-4.1 % to 3 %). Heterogeneous bias was determined for step duration during fast walking during dual task and for velocity during fast walking during single task and dual task. Heteroscedasticity was shown for step length during normal walking under the dual task condition and fast walking during single task and dual task activities.

CONCLUSION

No gait parameters are interchangeably usable between the two systems for normal walking during single task and dual task activities.