Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

Sedentary lifestyle and physical inactivity: A mutual interplay with early and overt frailty

AIMS

In recent years medical science and research are increasingly directed towards a holistic approach that considers health as global well-being rather than solely as the absence of disease. In this framework, lifestyle interventions and, in particular, physical exercise, are of crucial importance in prevention and treatment. Therefore, the purpose of this study is to describe this mutual interplay between physical behaviours, sarcopenia, and frailty, as well as to illustrate the role of structured exercise training in aging and disease.

DATA SYNTHESIS

Physical activity and exercise training are determinants of lifelong global wellness and healthy aging. On the contrary, sedentary behaviour and physical inactivity are strictly linked to frailty and pre-frailty, both in adults and the elderly, with or without chronic diseases. On the other hand, the presence of pathological conditions is associated with a more inactive and sedentary behaviour. The co-presence of these factors is characterized by a mutual causal exchange in which they are imbricated in a continuous mechanistic interplay that involves inflammation, sarcopenia, osteopenia, functional impairment and many other pathophysiological aspects that rapidly can lead to a status of frailty.

CONCLUSION

A sedentary lifestyle and physical inactivity critically affect alterations in body composition and loss in functional capacity, typically linked to aging and accelerated by chronic diseases. However, physical activity and exercise can counteract the onset of pre-frailty and frailty by conferring beneficial effects on the individual's overall well-being.

Association between physical frailty and social support in community-dwelling older adults: A systematic review

INTRODUCTION

Older adults with frailty have an increased likelihood of unmet care needs, falls and fractures and so on, which brings serious burdens to society. By evaluating the association between physical frailty and social support in community-dwelling older adults, we will provide reference for preventing the occurrence of frailty.

METHODS

Cross-sectional and longitudinal studies on association between frailty and social support in community-dwelling older adults were mainly searched from the database of Medline, Embase, PsycINFO, CINAHL Plus and Web of Science from their establishment to February 16, 2024. After literature screening, two researchers completed data extraction, and the risk of bias was assessed using the 8-item Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies for cross-sectional studies and the Newcastle-Ottawa Scale for Cohort Studies for longitudinal studies.

RESULTS

The study included a total of 14 articles, including 9 cross-sectional studies and 5 longitudinal studies. There was no clear consensus on the correlation between social support and frailty among community-dwelling older adults. The overall quality of the included studies was very high.

CONCLUSION

Although the correlation between social support and frailty among community-dwelling older adults needs further verification, given the important role of social support, it is still recommended that family members provide multi-faceted social support, especially subjective support, for older adults.

Frail Older Adults' Needs and Preferences for Mobile Health Exercise Interventions Guided by Nudge Theory: AQualitative Analysis

AIM

To explore frail older adults' preferences and needs regarding mobile health (mHealth) exercise interventions in China. Additionally, it sought to identify the nudge strategies necessary for initiating and sustaining exercise behaviours among frail older adults.

DESIGN

A qualitative study.

METHOD

The semi-structured interviews were conducted between April and May 2024 from two communities in Changsha, China. The data were analysed using a deductive framework analysis aligned to nudge theory, and an inductive thematic analysis to gather relevant needs and preferences.

RESULTS

This study involved 14 participants with pre-frailty or frailty, aged 60-82 years (median age of 64 years). While participants were generally receptive to new technologies, lower levels of health literacy and competing priorities often hindered their participation. Three primary functionality requirements were as follows. (1) Profession engagement: tailored exercise prescription, professional and timely feedback and guidance; (2) personalised knowledge encompassing pain management, successful cases and inspiration; (3) beneficial, tailored, dynamic, fragmented, challenging exercise courses. Participants showed positive attitudes towards simplification nudges, gamification nudges, social nudges, trustworthy nudges, reminder nudges, economic nudges, feedback nudges and pre-commitment nudges. Addressing privacy concerns was essential to build trust and acceptance among older adults.

CONCLUSION

These findings emphasised the importance of designing mHealth interventions that address frail older adults' specific needs and preferences while incorporating effective nudge strategies to promote engagement and adherence. Future researchers should explore wearables, ChatGPT language models, virtual coaching assistants, exercise snack to further optimise the experience and analyse the effects of nudges in mHealth exercise interventions among older adults.

IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE

Exercise systems or app development for frail older adults should meet three basic functionality and essential nudge strategies.

REPORTING METHOD

The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting.

PATIENT OR PUBLIC CONTRIBUTION

Older adults' engagement and interview data contribute a lot.

Healthy ageing in older adults with cardiovascular disease

As life expectancy continues to increase due to advancements in medical technology, public health, nutrition, and socioeconomic progress, the population of older adults in the USA and Europe is rapidly growing. By 2050, individuals aged 65 and older are projected to constitute over 20% of the US population and 29% of the European population, leading to a higher prevalence of chronic diseases, including cardiovascular disease. Cardiovascular disease, the leading cause of death in the USA, poses significant challenges to healthy ageing by contributing to accelerated biological ageing and the development of geriatric syndromes. This state-of-the-art review aims to (i) define healthy ageing for older patients living with cardiovascular disease; (ii) compare chronological vs biological ageing as it pertains to cardiovascular disease; (iii) describe the impact of geriatric syndromes and provide an approach to management and prevention; and (iv) address the gaps in knowledge and future directions for potential interventions that could promote healthy ageing.

Frailty reversal and its main determinants: a population-based observational and longitudinal study

BACKGROUND

Clinical guidelines recommend frailty screening for the aged population, given that frailty is frequently reversible. However, little is known about frailty and prefrailty reversal rates in the general population if no specific interventions have been implemented.

AIM

To assess real-world frailty and prefrailty reversal rates in the general population aged ≥65 years, the main contributing clinical conditions and the main risk factors for reversing frailty and prefrailty.

METHODS

Observational longitudinal 12-month study (2019) of all 1·5 million persons aged ≥65 years in Catalonia. Data were retrospectively collected from various health databases through the Catalan Public Data Analysis for Health Research and Innovation (PADRIS) V.2022 programme. Frailty status according to the electronic Screening Index for Frailty (e-SIF) was determined for 31 December 2018 and for 31 December 2019.

RESULTS

The study included 1 465 312 Catalan inhabitants (mean age 75.8 years, 57.0% women). The annual frailty and pre-frailty reversal rates were 7.1% and 4.6%, respectively. Both rates were higher in men and decreased with age. The e-SIF components with the greatest impact on frailty reversal were non-planned hospitalisations, polypharmacy, orthostatic hypotension or syncope, anaemia and visual impairment. Female sex, age, dependency, ≥2 comorbidities and polypharmacy had an independent protective effect on 12-month frailty and pre-frailty reversals.

CONCLUSIONS

Prefrailty and frailty are reversible, but reversal is unlikely in cases of multimorbidity, polypharmacy and functional dependency in older and severely frail individuals. Interventions that mainly target the avoidance of non-planned hospitalisations, polypharmacy and falls would have the greatest impact on reversing frailty and pre-frailty.

Cognitive frailty: a useful concept or a source of confusion? Insights from a survey of European geriatricians

BACKGROUND

This report examines how European geriatricians understand the concept of 'cognitive frailty', which was first formally defined by the International Academy on Nutrition and Aging (IANA) and the International Association of Gerontology and Geriatrics (IAGG) in 2013.

METHODS

An online survey about delirium, dementia and frailty relationships and pathways was distributed across Europe through appropriate professional groups. Eligible participants were geriatricians or trainees in their final two years of specialist geriatric training, in a European country. Snowball sampling was used. In total, 440 people replied to the survey, of which 324 responded to the section on cognitive frailty. Respondents were predominantly female and there was a marked under-representation of Eastern European participants.

RESULTS

From a list of possible definitions, only one in four of the 324 respondents identified cognitive frailty as defined by the IANA and the IAGG, i.e., a combination of physical frailty and mild cognitive impairment. Almost two thirds of those who stated that they currently use the term in their work did not choose the IANA-IAGG definition. After the definition was shared with respondents, only 44% strongly agreed with it as an apt description of cognitive frailty, with some considering it too narrow (by omitting delirium and dementia) while others considered it too broad (by including physical frailty).

CONCLUSIONS

There is no clear consensus opinion among geriatricians in Europe on the definition of 'cognitive frailty'. While there is some core support for the IANA-IAGG definition, it is not intuitive to those not already familiar with the term. The variance in the current understanding of cognitive frailty among geriatricians suggests the time is right for a meaningful debate on this issue. While there is ongoing, growing research on a shared pathophysiology between physical frailty and cognitive impairment, further studies are required to evaluate the added benefit of this particular conceptual theorization in older persons care rather than its single components, and if beneficial, how awareness, understanding and correct usage of the concept can be improved.

Slow gait speed is associated with frailty, activities of daily living and nutritional status in in-patient pulmonology patients

BACKGROUND AND AIM

The 4-meter gait speed (4MGS), a functional performance test, is increasingly used to predict health outcomes. This study investigated 4MGS, nutritional status, frailty, and daily living activities in tertiary care pulmonary diseases ward patients.

METHODS

Patients were assessed for nutritional status, activities of daily living, and frailty using the Mini Nutritional Assessment (MNA) Test, Barthel Questionnaire, and FRAIL scale. Those with 4MGS < 1 m/sec were classified as having slow gait speed.

RESULTS

80 patients (F/M: 21/59, mean age 58 ± 19) were included. Diagnoses included pneumonia, chronic obstructive pulmonary disease, pleural effusion, and interstitial lung disease. Patients had a 4MGS of 0,74 ± 0,24 m/sn, MNA score of 14.0 [IQR 25-75:11.0-19.8] points, Barthel index of 95 [IQR 25-75:70-100] points, FRAIL scale of 3 [IQR 25-75:1.0-4.0], and a hand-grip strength of 18.8 [IQR 25-75:15.7-25.9] kg. Slow gait speed patients had lower MNA, FRAIL scores, and handgrip strength. Multivariable regression analysis showed that slower gait speed was associated with lower serum protein level (B = 0.013, SE = 0.005, 95% CI: 0.004 to 0.022, p = 0.004), lower hand grip strength (B = -0.002, SE = 0.001, 95% CI: -0.003 to -0.00006, p = 0.041) and malnutrition risk (B = 0.024, SE = 0.007, 95% CI: 0.011 to 0.038, p < 0.001).

DISCUSSION AND CONCLUSION

4MGS correlates with comorbidities, frailty, grip strength, and nutritional status in hospitalized pulmonary patients. Slow gait patients are more malnourished despite similar age, sex, BMI, and comorbidities.

Assessment of Gait Parameters Using Wearable Sensors and Their Association With Muscle Mass, Strength, and Physical Performance in Korean Older Adults: Cross-Sectional Study

Background

Gait speed indicates the onset or decline of physical performance in sarcopenia. However, real-time measurements of other gait parameters, such as step length, stride length, step width, and support time, are limited. The advent of wearable technology has facilitated the measurement of these parameters, necessitating further investigation into their potential applications.

Objective

This study aimed to investigate the relationship between gait parameters measured using wearable sensors and muscle mass, strength, and physical performance in community-dwelling older adults.

Methods

In a cross-sectional study of 91 participants aged ≥65 years, gait parameters, such as step count, step length, cadence, single and double support times, vertical oscillation, and instantaneous vertical loading rate (IVLR), measured using a wireless earbud device, were analyzed on the basis of the appendicular skeletal muscle mass index (SMI), calf circumference, handgrip strength, 5-time chair stand test, short physical performance battery (SPPB), and the SARC-F (strength, assistance with walking, rise from a chair, climb stairs and fall frequency) questionnaire. This study was conducted from July 10 to November 1, 2023, at an outpatient clinic of a university hospital in Seoul, Korea. Multiple regression analysis was performed to investigate independent associations after adjusting for age, sex, BMI, and comorbidities.

Results

Among 91 participants (45 men and 46 women; mean age 74.1 years for men and 73.6 years for women), gait speed and vertical oscillation showed negative associations with their performance in the 5-time chair stand test (P<.001) and SARC-F and positive associations with their performance in the SPPB (P<.001). Vertical oscillations were also associated with grip strength (P=.003). Single and double support times were associated with performance in the 5-time chair stand test and SPPB (P<.001). In addition, double support time was associated with SARC-F scores (P<.001). Gait speed, support time, vertical oscillation, and IVLR showed independent associations with performance in the 5-time chair stand test and SPPB (P<.001), both related to muscle strength or physical performance. Gait speed, double support time, and vertical oscillation all had significant associations with SARC-F scores.

Conclusions

This study demonstrated a significant association between gait monitoring using wearable sensors and quantitative assessments of muscle strength and physical performance in older people. Furthermore, this study substantiated the extensive applicability of diverse gait parameters in predicting sarcopenia.

Low-volume resistance training: a feasible, cost-effective strategy for musculoskeletal frailty in older adults attending daycare centers

Introduction

Frailty is a prevalent geriatric syndrome, posing significant health risks for older adults attending daycare centers or residing in institutional settings. Addressing frailty with interventions that are feasible and cost effective and also promote high adherence within these environments is crucial.

Objective

This study aimed to evaluate the impact of a low-volume, remotely supervised resistance training protocol on physical frailty among frail older adults attending daycare centers. Secondary outcomes included changes in sarcopenia prevalence and fall risk.

Methods

Thirty-one frail older adults participated in a 12-week usual care period, followed by a 12-weeks intervention featuring low-volume (10-minute sessions) resistance training three times weekly. The program was delivered locally by non-specialized staff under remote supervision. Musculoskeletal, functional, and clinical assessments were conducted at three-time points: baseline, pre-intervention, and post-intervention.

Results

During the usual care period, a decline was observed in handgrip strength (19.2-18.5 kg) and sit-to-stand time (14.5-17.4s) (p < 0.05). However, these measures were preserved during the intervention. Relative muscle power decreased during the usual care but improved with training (4.3-5.2 W/Kg, p < 0.001). While body composition, physical function, gait speed, and Short Performance Physical Battery scores remained stable, reductions were observed in exhaustion and physical inactivity prevalence (p < 0.05). Frailty prevalence showed a decreasing trend (48%-26%, p = 0.099), with significant reductions in sarcopenia prevalence (29%-10%, p = 0.045), and fall frequency (p = 0.022).

Conclusion

The low-volume strength training protocol was a feasible, cost-effective strategy for mitigating musculoskeletal frailty criteria, sarcopenia and fall risk among older adults in daycare centers, potentially delaying the progression of these conditions.

Effectiveness and cost-effectiveness of a home-based functional exercise programme for community-dwelling frail older adults, ACTIVE-AGE@home, provided by professionals and volunteers: protocol of a pragmatic randomised controlled trial

Between 2020 and 2050, the world's population aged 80 years and over will triple, drastically increasing the prevalence of frailty and associated healthcare costs. Multimodal exercise programmes have proven to be an ideal countermeasure for frailty, but the current Flemish standard of care does not include them. The purpose of this study is to investigate the effect of the home-based exercise programme for frail community-dwelling older adults (>70 years), ACTIVE-AGE@home, on frailty-associated outcomes, when delivered by professionals or volunteers, as well as its cost-effectiveness. A pragmatic randomised controlled trial will be conducted. Participants will be randomised into three parallel groups using permuted block randomisation. There will be two intervention groups: in one group, the intervention is delivered by professionals with a bachelor or masters' degree in physiotherapy, occupational therapy and/or physical education, and in the other by trained volunteers. Both groups will be compared with a control group receiving usual care. Participants (n=195) are community-dwelling physically frail older adults (>70 years), as defined by Fried et al. (2001). The intervention is a 24 week programme that consists of three 1 hour visits per week and contains aerobic, strength, balance, flexibility, coordination and dual tasking exercises, accompanied by goal-setting and motivational interviewing. The Timed Chair Stand (TCS) test is the primary outcome. Functional ability, cognition, loneliness, self-management, health-related quality of life, healthcare utilisation and meaningful activities will be measured in all groups at 0, 24 and 48 weeks. Time and expenses invested by professionals or volunteers will be kept in diaries for trial and model-based cost-effectiveness analyses, expressed in incremental cost per QALY (quality-adjusted life year). The model will be designed to associate the frailty at the end of follow-up with further expected healthcare expenses beyond the duration of the trial. Statistical analysis will be blinded to group allocation, and outcome assessors will be blinded to the maximal extent possible. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Medical Ethics Committee of UZ Brussel (O.G. 016), Peer reflection group Biomedical Ethics, Laarbeeklaan 101, 1090 Brussels. Results will be disseminated in publications and other relevant platforms. This study was registered at Clinicaltrials.gov on 6 July 2023 and posted on 14 July 2023 after National Library of Medicine quality control review. Registration details: NCT05946109 TRIAL REGISTRATION NUMBER: NCT05946109.

Machine Learning Models for Frailty Classification of Older Adults in Northern Thailand: Model Development and Validation Study

Background

Frailty is defined as a clinical state of increased vulnerability due to the age-associated decline of an individual's physical function resulting in increased morbidity and mortality when exposed to acute stressors. Early identification and management can reverse individuals with frailty to being robust once more. However, we found no integration of machine learning (ML) tools and frailty screening and surveillance studies in Thailand despite the abundance of evidence of frailty assessment using ML globally and in Asia.

Objective

We propose an approach for early diagnosis of frailty in community-dwelling older individuals in Thailand using an ML model generated from individual characteristics and anthropometric data.

Methods

Datasets including 2692 community-dwelling Thai older adults in Lampang from 2016 and 2017 were used for model development and internal validation. The derived models were externally validated with a dataset of community-dwelling older adults in Chiang Mai from 2021. The ML algorithms implemented in this study include the k-nearest neighbors algorithm, random forest ML algorithms, multilayer perceptron artificial neural network, logistic regression models, gradient boosting classifier, and linear support vector machine classifier.

Results

Logistic regression showed the best overall discrimination performance with a mean area under the receiver operating characteristic curve of 0.81 (95% CI 0.75-0.86) in the internal validation dataset and 0.75 (95% CI 0.71-0.78) in the external validation dataset. The model was also well-calibrated to the expected probability of the external validation dataset.

Conclusions

Our findings showed that our models have the potential to be utilized as a screening tool using simple, accessible demographic and explainable clinical variables in Thai community-dwelling older persons to identify individuals with frailty who require early intervention to become physically robust.

The relationship among socioeconomic status, social support and frailty: is there a gender difference?

OBJECTIVE

This study aimed to determine the relationship among socioeconomic status, social support and frailty, and its gender difference.

METHODS

Education and income were combined to indicate the socioeconomic status. The Social Support Rating Scale (SSRS) was used to measure the level of social support. Frailty was measured by the FRAIL Scale. Mediation effects were analyzed using the PROCESS 4.1 macro in SPSS version 26.0.

RESULTS

Among the 936 participants, socioeconomic status had a direct effect on frailty (effect = - 0.088, 95% CI: - 0.142, - 0.021). Social support was an indirect pathway for the relationship between socioeconomic status and frailty (effect = - 0.011, 95% CI: - 0.023, - 0.003), accounting for 11.11% of the total effect. Stratified by gender, we found that the total, direct and indirect effects of socioeconomic status on frailty were significant only in the female subsample.

CONCLUSION

Overall, there was a significant association between socioeconomic status and frailty among the rural older adults, and social support mediated this relationship. However, there were gender differences in the association among socioeconomic status, social support and frailty. Specifically, the correlation between socioeconomic status and frailty and the mediating role of social support were found only in the female subsample. The public health sector should focus on the rural older adults with low socioeconomic status and lack of social support, taking targeted interventions to avoid and delay the occurrence and progress of frailty.

Frailty Markers and Falls Among US Clergy

Studies examining frailty, physical performance, and falls among the clergy are limited. The objective of the study was to analyze sociodemographic profiles, gait, strength, and falls between diocesan and religious clergy. Participants included eighty-eight male Catholic clergy primarily in the northeast United States. Participants completed a demographic profile and gait velocity and strength measures. Results noted that more diocesan priests were retired (p = .02). Participants with a fall history demonstrated slower gait (p = .001) and weaker grip strength (p = .017) and were more likely to have a fear of falling (p = .009). Findings underscore the importance of fall screening among clergy.

Comparison of non-exercise physical activity and exercise habits for preventing frailty among community-dwelling older adults: A 7-year follow-up from the Kashiwa cohort study

BACKGROUND

Engagement in non-exercise physical activities (NEPA) has a significant correlation with health. This study aimed to compare the impact of moderate-to-vigorous-intensity NEPA and exercise habit (EH) on frailty among community-dwelling older adults.

METHODS

This study utilized data from the Kashiwa cohort study in Japan, with baseline assessments in 2014 with a 7-year follow ups (4.0 [2.0-7.0]). A total of 1,288 participants were included. Frailty was assessed using the Cardiovascular Health Study Index, NEPA through the Global Physical Activity Questionnaire, and EH via self-reported exercise engagement at each follow-up examination. Generalized estimating equations (GEE) and Cox regression analyses were used to estimate associations between NEPA, EH, and frailty.

RESULTS

Compared to participants with no NEPA nor EH, those with NEPA only, with EH only, and with both showed significantly lower adjusted odds ratio (95 %CI) of frailty: 0.29 (0.16-0.52), 0.21 (0.11-0.41) and 0.21 (0.12-0.36). NEPA and EH at baseline were predictor variables for new-onset frailty during the 7-year follow-up period, with adjusted hazard ratios (95 % CI) of 0.55 (0.33-0.92) for NEPA only, 0.51 (0.29-0.90) for EH only, and 0.42 (0.25-0.70) for both. No significant differences were observed between the associations of NEPA and EH with frailty.

CONCLUSIONS

NEPA is associated with lower frailty risk in older adults, with a similar but non-additive effect to that of EH. These findings highlight the importance of NEPA for frailty prevention, particularly for those not engaged in formal exercise programs.

Estimated Glucose Disposal Rate Associated With Risk of Frailty and Likelihood of Reversion

BACKGROUND

Estimated glucose disposal rate (eGDR) is a simple and effective measure for insulin resistance, which is associated with higher risk of frailty. We aim to analyse the associations of eGDR with frailty risk and its reversibility.

METHODS

A population-based longitudinal study was conducted of 11 670 participants from the China Health and Retirement Longitudinal Study and 19 355 participants from the Health and Retirement Study. Frailty was assessed by the frailty index and reversibility was measured by transitions from frailty at baseline to non-frailty during follow-up. The eGDR was divided into Q1, Q2, Q3 and Q4 according to the quartiles. Multi-state Markov model was performed to evaluate the effects of eGDR on transitions among non-frailty, frailty and death. Cox regression model was used to estimate eGDR associated with the risk of frailty and the likelihood of reversion.

RESULTS

In Chinese population characterized by a median age of 60 years (IQR: 54-66) with 6119 women (52.43%), compared with the Q1 level of eGDR, participants exposure to Q3 and Q4 level decreased the probability of transitioning from non-frailty to frailty by 22% (HR = 0.78, 95% CI: 0.69-0.88) and 25% (HR = 0.75, 95% CI: 0.66-0.86), respectively. But its Q2, Q3 and Q4 levels increased the probability of transitioning from frailty to non-frailty by 24% (HR = 1.24, 95% CI: 1.06-1.44), 39% (HR = 1.39, 95% CI: 1.19-1.64) and 33% (HR = 1.33, 95% CI: 1.13-1.58). In American population with a median age of 63 years (IQR: 56-72) and 11 189 women (57.81%), its Q2, Q3 and Q4 levels decreased the probability of transitioning from non-frailty to frailty by 17% (HR = 0.83, 95% CI: 0.77-0.89), 24% (HR = 0.76, 95% CI: 0.70-0.82) and 46% (HR = 0.54, 95% CI: 0.49-0.59), respectively. The probability of revising frailty increased by 25% (HR = 1.25, 95% CI: 1.13-1.38), 36% (HR = 1.36, 95% CI: 1.22-1.51) and 48% (HR = 1.48, 95% CI: 1.30-1.69) for levels Q2, Q3 and Q4. As shown in the prospective analysis, increased eGDR levels from Q2 to Q4 were associated with decreased frailty risk and higher likelihood of reversion, as evidenced by the dose-response relationship revealed by restricted cubic spline analysis.

CONCLUSIONS

Higher levels of eGDR were associated with a reduced risk of frailty, delayed transition from non-frailty to frailty and an increased likelihood of reversion. eGDR emerges as a promising predictor for early frailty detection, prognosis assessment and a potential therapeutic target for intervention strategies.

Getting fit for hip and knee replacement: The Fit-Joints multimodal intervention for frail patients with osteoarthritis - a pilot randomized controlled trial

BACKGROUND

Older adults with frailty have high risk for poor postoperative outcomes.

OBJECTIVE

To evaluate the feasibility of a multimodal prehabilitation program in older adults with frailty awaiting hip or knee replacement.

DESIGN

Parallel two-arm randomized controlled pilot trial.

PARTICIPANTS AND SETTING

Community-dwelling older adults with frailty awaiting joint replacement aged ≥60 years recruited from the Musculoskeletal Central Intake and Assessment Centre (MSK CIAC), Ontario.

INTERVENTION

Exercise, protein and vitamin D supplements, and medication review.

MEASUREMENT

Feasibility was assessed based on predefined progression criteria for recruitment, retention, data completion and adherence to intervention components. Clinical outcomes including Oxford Knee and Hip Scores, frailty index, Short Physical Performance Battery and health-related quality of life were collected at baseline, 1-week preoperative, 6-weeks and 6-months postoperative and were evaluated using generalized linear mixed models for repeated measures.

RESULTS

A total of 69 participants were enrolled. Recruitment rate was 35 %. Participants' mean age was 74 (standard deviation (SD): 7.5); 51 % were prefrail and 36 % were frail. Participant retention was 81 %, and data completion was ≥80 %. Mean adherence to strength exercises was 4 days (95 % confidence interval (CI): 3-5 days/week), balance 3 days (95 % CI: 2-4 days/week), and flexibility 3 days (95 % CI: 3-4 days/week). Adherence to vitamin D intake was 82 % (95 % CI: 73-92 %), and medication review consultation completion was 86 % (95 % CI: 68-95 %). These outcomes met the target values for feasibility success. The Oxford Knee Score at 6-months postoperative 8.78 (95 % CI: 0.40-17.16) showed a clinically meaningful and statistically significant difference between treatment groups. There were also indications of clinically relevant changes for frailty and quality of life post-surgery.

CONCLUSION

This trial provides strong evidence of feasibility and indications of improvements in postoperative clinical outcomes. Challenges to implementation and adherence were identified that can inform modifications to study design for future trials.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02885337. Registered August 31, 2016. https://classic.

CLINICALTRIALS

gov/ct2/show/NCT02885337.

Frailty integration in medical specialties: Current evidence and suggested strategies from the Clin-STAR frailty interest group

Frailty is a syndrome that can inform clinical treatments and interventions for older adults. Although implementation of frailty across medical subspecialties has the potential to improve care for the aging population, its uptake has been heterogenous. While frailty assessment is highly integrated into certain medical subspecialties, other subspecialties have only recently begun to consider frailty in the context of patient care. In order to advance the field of frailty-informed care, we aim to detail what is known about frailty within the subspecialties of internal medicine. In doing so, we highlight cross-disciplinary approaches that can enhance our understanding of frailty, focusing on ways to improve the implementation of frailty measures, as well as develop potential interventional strategies to mitigate frailty within these subspecialties. This has important implications for the clinical care of the aging population and can help guide future research.

Protein supplementation alone or combined with exercise for sarcopenia and physical frailty: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Sarcopenia and physical frailty are age-related syndromes characterized by progressive loss of muscle mass and function, significantly impacting mortality and quality of life in older adults. This systematic review evaluated the effectiveness of protein supplementation interventions for these conditions.

METHODS

We systematically searched Medline, CENTRAL, and Ichushi Web from January 2000 to March 2023, with additional manual searching extended to March 2024. Randomized controlled trials investigating protein supplementation, alone or combined with exercise, in adults aged ≥65 years with sarcopenia or physical frailty were included. The primary outcomes were changes in muscle mass, strength, and physical performance.

RESULTS

The systematic literature search identified 1,506 records through database searching (Medline: 357, CENTRAL: 275, Ichushi Web: 639) and 235 additional records through hand searching. Finally, 13 randomized controlled trials (n=1,057) met the inclusion criteria. Combined protein and exercise interventions demonstrated significant improvements in skeletal muscle index (MD = 0.89 kg/m², 95 % CI: 0.45 to 1.33) and handgrip strength (MD: +2.64 kg, 95 % CI: +0.75 to +4.53) compared to exercise alone. Protein supplementation alone showed modest benefits in muscle strength but limited effects on physical performance. No serious adverse events were reported.

CONCLUSIONS

While protein supplementation combined with exercise shows promising effects on muscle mass and strength in older adults with sarcopenia or physical frailty, the evidence quality was consistently rated as very low. Further high-quality trials are needed to establish optimal supplementation strategies.

REGISTRATION

PROSPERO: CRD42023408529.

Effectiveness of Mind-Body Exercise in Older Adults With Sarcopenia and Frailty: A Systematic Review and Meta-Analysis

BACKGROUND

Mind-body exercise (MBE) has shown promise in mitigating the effects of sarcopenia and frailty in older adults. Nevertheless, its effectiveness in enhancing muscle function and physical performance in this population has not been well established. This study aimed to investigate the effects of MBE on older adults with sarcopenia and frailty, to offer evidence-based exercise recommendations.

METHODS

A comprehensive search for randomized controlled trials (RCTs) was conducted through multiple databases, including PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure (CNKI), WanFang, and Chinese Scientific Journals Full-Text Database (VIP), supplemented by manual reference searches from inception until February 2024. The eligible RCTs compared MBE with passive or active exercise controls, focusing on muscle function and physical performance in older adults aged 60 years or above. Subgroup analyses were conducted to evaluate the types, duration, and frequency of MBE.

RESULTS

Nine eligible RCTs with 1838 participants were included in this study. MBE demonstrated significant improvements compared with passive control, particularly in grip strength (WMD [weighted mean difference] = 0.99; 95% CI [95% confidence interval] = 0.06, 1.92; I2 = 3%, p = 0.04), Timed Up and Go Test (TUGT) (WMD = -4.04; 95% CI = -5.54, -2.53; I2 = 12%, p < 0.01), and Berg Balance Scale (BBS) scores (WMD = 3.63; 95% CI = 0.38, 6.87; I2 = 0%, p = 0.03). Even when compared to active exercise training, improvements were still observed in TUGT and BBS (p < 0.001), with a trend toward improved grip strength (WMD = -2.20; 95% CI = -4.35, -0.04; p = 0.05). No positive effect on muscle mass was observed. Subgroup analysis indicated that MBE performed more than 5 times a week for a short or medium duration (4-24 weeks) could improve grip strength (p < 0.05). Moderate-frequency intervention over a short period in this population yielded greater improvements in gait speed and Chair Rise Test completion time (p < 0.05).

CONCLUSIONS

MBE can enhance muscle function and physical performance to some extent in older adults with sarcopenia and frailty, whether they are compared with passive or active exercise training. However, positive effects on muscle mass have not been observed. Future studies are warranted to compare it with well-designed active exercise training programs that match the exercise volume, to draw more definitive conclusions to support the notion that MBE yields comparable effects.

Frailty and malnutrition as predictors of major complications following posterior thoracolumbar fusion in elderly patients: a retrospective cohort study

BACKGROUND CONTEXT

The number of elderly patients with degenerative spinal deformity (DSD) is increasing, and posterior thoracolumbar fusion surgery is an effective treatment option, but there are often postoperative major complications, which may hinder the benefit for elderly patients. Currently, there is no consensus on the best risk assessment technique for predicting major complications in elderly patients undergoing long-segment fusion surgery.

PURPOSE

This study constructs a risk assessment model using the Modified 5-Item Frailty Index (mFI-5) and serum albumin and evaluates its predictive value.

STUDY DESIGN

This is a retrospective analysis of a prospectively established database of DSD.

PATIENT SAMPLE

Consecutive patients (aged 65 and older) who underwent open posterior thoracolumbar fusion surgery for DSD between April 2018 and December 2023 were included.

OUTCOME MEASURES

Outcome measures included postoperative major complications, length of hospital stay (LOS), readmission and reoperation within 30 days, discharge disposition, physiological function recovery.

METHODS

The study reviewed consecutive patients who underwent open posterior thoracolumbar fusion surgery for DSD. Patients were divided into three groups based on the presence or absence of frailty or frailty combined with malnutrition. Spearman ρ analysis was used to assess the correlation between mFI-5 and serum albumin levels. Univariate analyses and multivariate logistic regression were conducted to explore the relationship between frailty and malnutrition defined by mFI-5 and serum albumin and major postoperative complications. Finally, the Receiver Operating Characteristic (ROC) curve was used to evaluate the predictive value of this model for major complications.

RESULTS

Compared to the Normal group (n=59), both the Frailty group (n=121) and the Frailty and Malnutrition group (n=50) had higher rates of major complications (21.5% vs 8.5%, p=.035; 28% vs 8.5%, p=.002). Multivariate logistic regression showed that frailty and malnutrition status, higher ASA score, and more bleeding were independent predictors of major postoperative complications. The ROC curve demonstrated that frailty combined with malnutrition defined by mFI-5 and serum albumin had a larger area under the curve compared to mFI-5 or serum albumin alone (AUC: 0.676; 95% CI: 1.101-14.129; p<.001).

CONCLUSIONS

Compared to considering frailty or malnutrition alone, the combined assessment of frailty and malnutrition using mFI-5 and serum albumin is valuable in predicting major complications in elderly patients undergoing posterior thoracolumbar fusion surgery.

Cross-sectional assessment of the Tinetti performance-oriented mobility tool for screening physical frailty syndrome in older adults

BACKGROUND

Physical-functional fitness (PFF) assessments have become crucial tools for identifying physical frailty syndrome (PFS) in older adults, helping guide preventive and interventional strategies.

PURPOSE

This study aimed to evaluate the predictive value of performance-based PFF tests for detecting PFS among community-dwelling older adults in Tehran, Iran. Additionally, it sought to compare PFF variables between PFS groups to assess the applicability of these tests as practical screening tools in clinical and community settings.

METHODS

Data were collected from 161 participants (91 males, 56.5%; 70 females, 43.5%), including sociodemographic, anthropometric, medical history, PFF, and PFS assessments.

RESULTS

Frail participants exhibited significantly lower scores in various PFF tests, including the Tinetti balance, walking, and total score components, physical activity levels (PAL), mean hand grip strength (MGS), 30-s arm curl (30 s-AC), 30 s-chair stand (30 s-CS), Standing Stork Balance (SSB), and back stretch (BST) tests (p < 0.001). Frail individuals also had lower levels of education, shorter stature, and higher BMI compared to non-frail/pre-frail participants, highlighting broader vulnerabilities. Logistic regression analyses showed that all PFF tests, including Tinetti balance and walking components, MGS, 30 s-AC, 30 s-CS, were significant protective factors against FS. However, ROC curve analysis revealed optimal cutoff points for PFS identification, with PAL and MGS demonstrating the highest sensitivity and specificity for predicting PFS. The all components of Tinetti scale also proved to be strong predictors of FS.

CONCLUSION

Our findings demonstrate that, regardless of age, sex, education level, stature, and fall incidence, PFF assessments remain critical for identifying older adults at risk for PFS. The study highlights the predictive strength of key variables, such as PAL, MGS, and the Tinetti-POMA components, offering novel insights into the role of these tests in improving PFS screening accuracy. These results underscore the importance of integrating PFF assessments into routine clinical and community-based health evaluations, enabling early detection and timely interventions to promote healthier aging trajectories.

Lifestyle, inflammageing, and poor physical performance in middle-aged and older adults: a prospective cohort study in Taiwan

BACKGROUND AND AIMS

Poor physical performance (PPP) in terms of weakness and slow walking speed is closely associated with frailty during ageing. We aimed to analyse the associations between modifiable lifestyle factors, inflammation markers (hs-CRP, D-dimer, and fibrinogen), and the odds of PPP and state transitions between normal and PPP in older adults.

METHODS

A total of 3756 participants ($\ge$ 55 years) in wave 1 (2009-2013) and wave 2 (2014-2019) of the Healthy Aging Longitudinal Study in Taiwan (HALST) were analysed. A logistic regression model was used to assess the associations between lifestyle factors (physical activity [PA], diet, and psychosocial health), inflammation markers, comorbidities, and PPP (two or more of the criteria: grip strength, 6-minute walking distance, or gait speed among the lowest 20%).

RESULTS

In total, 229 and 149 of the 773 PPP participants at wave 1 reversed and persistent in PPP state at wave 2, respectively. Higher PA (OR 0.917, 95% CI 0.894-0.941), psychosocial health (OR 0.964, 95% CI 0.955-0.972), LDL-C, and education level had significant protective effects, whereas greater waist circumference, D-dimer, fibrinogen, longer sleeping time, and comorbidities were positively associated with PPP. Higher PA, psychosocial health, and diet scores were protective against conversion to PPP, and increased PA and higher psychosocial health score were significant for reversion.

CONCLUSIONS

Older adults are encouraged to engage in various forms of PA and participate in societal events to increase their physical performance. To avoid further deterioration in physical frailty, screening for PPP may be adopted as a standard clinical practice for older adults.

Establishing Clinically Operational Domains of Multidimensional Frailty: A Consensus Approach to Improve Multidimensional Frailty Diagnosis at Point of Care

BACKGROUND AND OBJECTIVES

Frailty is common among older patients; however, there is a lack of agreement on methods to diagnose and monitor frailty at point of care. The purpose of this study was to establish consensus on important, feasible, and usable domains for point-of-care frailty assessment within all conceptual models of frailty.

RESEARCH DESIGN AND METHODS

We reviewed instruments that assess frailty and extracted the domains measured by each tool. We developed 3 use cases for frailty assessment, which provided context for voters: (1) longitudinal tracking of frailty in the aging patient (>50 years), (2) preoperative evaluation of frailty before surgery in adults (>50 years), and (3) discharge disposition after hospital admission in adults (>50 years). We conducted a modified RAND Corporation/University of California Los Angeles Delphi with a panel of 11 experts. Panelists rated each domain for each use case on a scale from 1 to 9, where 1 is definitely not important/feasible/usable and 9 is definitely important/feasible/usable.

RESULTS

Panelists achieved agreement on the following domains for the respective clinical use cases: Physical Strength 1, 2, and 3; Balance 1 and 3; Cognition 1, 2, and 3; Nutrition 1; Physical Activity 1, 2, and 3; Depression 1; Disease 1, 2, and 3; and Social Environment 1 and 3. The remaining items were indeterminate.

DISCUSSION AND IMPLICATIONS

We established consensus on 8 domains of frailty across 3 use cases. These results can inform the measurement of domains to diagnose, monitor, and inform the management of frailty within the defined use cases.

Acceptability and Effectiveness of a Fully Web-Based Nutrition and Exercise Program for Individuals With Chronic Disease During COVID-19: Randomized Controlled Trial

BACKGROUND

In-person nutrition and exercise interventions improve physical function in chronic diseases, yet the acceptability and effectiveness of web-based delivery, especially with different levels of personnel support, require further investigation.

OBJECTIVE

This study aims to evaluate a web-based nutrition and exercise intervention delivered entirely digitally from recruitment to trial completion.

METHODS

A randomized controlled trial was conducted using the Heal-Me version 1 platform across 2 levels of personnel support (Light and Intensive). Eligible adults with a history of cancer, chronic lung disease, or liver or lung transplant; internet access; and prior participation in a rehabilitation program were enrolled in a fully web-based program to minimize barriers to exercise participation. Participants were randomly assigned (1:1:1) to 1 of 3 study groups. The control group received a detailed, self-directed digital nutrition and exercise guide. The Heal-Me Light group received the web-based intervention alongside dietitian and exercise specialist-led group classes. The Heal-Me Intensive group received web-based intervention, group classes, and one-to-one sessions with the dietitians and exercise specialists. All participants received a wearable activity tracker. The primary acceptability outcome was adherence to the intervention based on a priori targets. The primary effectiveness outcome was the change in Lower Extremity Functional Scale (LEFS) score. Secondary outcomes included physical function tests, which were performed and measured by videoconference. Questionnaires were used to assess well-being, quality of life, and food intake. Analyses adhered to the intention-to-treat principle.

RESULTS

Of 216 participants, 202 (93.5%) completed the intervention (mean 61, SD 11 years; female: 130/202, 64.4%; cancer: 126/202, 62.4%). Adherence exceeded a priori targets, with 82% (105/128) attending >75% of the program elements including postintervention tests. Participants rated the program as "quite a bit" or "very" useful, with similar ratings between Heal-Me Light (56/64, 88%) and Heal-Me Intensive (51/58, 88%) groups (P=.69). No significant differences were found for changes in LEFS scores (control: mean 0.8, SD 7.7; Heal-Me: mean 0.3, SD 6.6; P=.53). Significant benefits were found in favor of the combined Heal-Me intervention groups versus controls for change in the 2-minute step test, World Health Organization-5 Well-Being Index, Short-Form-36 general, physical health role, energy or fatigue scales, and protein intake. While the change in physical function was similar between the 2 intervention arms, the more intensive one-to-one interaction (Heal-Me Intensive) led to greater improvements in perceived nutrition self-management. No serious adverse events occurred.

CONCLUSIONS

The demonstrated satisfaction, adherence, and effectiveness highlight the high acceptability of a web-based, semisupervised nutrition and exercise intervention delivered entirely digitally in individuals with chronic disease. Future studies may benefit from having a baseline physical function inclusion threshold, the use of a more sensitive primary physical function measure, and a higher intensity digital exercise intervention in exercise-experienced participants.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04666558; https://clinicaltrials.gov/study/NCT04666558.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1016/j.cct.2022.106791.

Association of potentially inappropriate medications with frailty and frailty components in community-dwelling older women in Japan: The Otassha Study

AIM

The use of potentially inappropriate medications (PIMs) in older adults can increase the risk of drug-related adverse events. We aimed to examine the associations between PIMs, frailty, and each frailty component in community-dwelling older women.

METHODS

This cross-sectional study included participants aged ≥65 years from a prospective cohort of older Japanese women. Frailty was classified using the Japanese version of Fried's Frailty Criteria, comprising five components. PIMs were identified using a screening tool for Japanese among regular prescription medications collected from participants' prescription notebooks. Multivariable logistic regression models adjusted for age and comorbidities were used to examine the association between PIMs (0, 1, 2, ≥3), frailty, and each component. The possible interactions between age groups (65-74 and ≥75 years) and PIMs were investigated. Age-stratified analyses were also performed.

RESULTS

We analyzed 530 older women (median age [interquartile range], 71 [68, 75] years) with a frailty prevalence of 5.5%. Three or more PIMs were associated with frailty and weight loss (adjusted odds ratio [95% confidence interval], 3.80 [1.23, 11.80], 2.53 [1.15, 5.39]). In age-stratified analyses, ≥3 PIMs were associated with weight loss (8.39 [1.79, 48.98]) in women aged ≥75 years, whereas 1 or 2 PIMs were associated with frailty (4.52 [1.17, 19.08]) or weakness (3.13 [1.22, 7.78]) in those aged 65-74 years.

CONCLUSIONS

Our results may suggest that the number of PIM prescriptions is associated with frailty and frailty components in older women. Longitudinal studies are required to clarify the causality between the number of PIMs and frailty. Geriatr Gerontol Int 2025; ••: ••-••.

Comparative Analyses Between Vulnerability Biomarkers of Aging and Health Biomarkers in Middle-Aged and Older Female Adults

Biological aging is normally associated with greater physiological changes which predispose individuals to adverse outcomes. In this way, the evaluation of vulnerability biomarkers and their relationships with other health biomarkers could contribute to the promotion of interventions and the improvement of older adults' quality of life. Thereby, this study aimed to compare vulnerability biomarkers (Growth Differentiation Factor 15 (GDF-15), General Functional Fitness Index (GFFI), and frailty phenotype) and their influence on health markers (blood biochemistry, body composition, and hemodynamic variables) in middle-aged and older female adults. Methods: A cross-sectional observational study was conducted with community-dwelling females aged 54-84 with at least 6 months of experience with physical training. The participants were categorized based on functional fitness, frailty phenotype, and GDF-15 quartiles. The General Functional Fitness Index (GFFI) was assessed using the AAHPERD test battery, while frailty phenotype was determined using Fried's criteria. GDF-15 levels were measured through ELISA. Results: A higher training status (TS) showed better functional fitness and favorable biochemical profiles, including lower total cholesterol (p = 0.006, η2p = 0.253), LDL cholesterol (p = 0.001, η2p = 0.346), triglycerides (p = 0.048, η2p = 0.195), and systolic blood pressure (p = 0.001, η2p = 0.333). Individuals classified as robust (non-frail) had better physical performance and lower total cholesterol (p = 0.002, η2p = 0.306) and LDL cholesterol (p = 0.014, η2p = 0.216) compared to those classified as frail and pre-frail. The GDF-15 quartile did not present differences in health markers between groups. Conclusions: These findings suggest that GFFI may be considered a health biomarker for middle-aged and female older adults while highlighting the need for further research on the role of biomarkers of vulnerability and healthy aging.

Frailty in Geriatrics: A Critical Review with Content Analysis of Instruments, Overlapping Constructs, and Challenges in Diagnosis and Prognostic Precision

Frailty is a key concept in geriatric care; yet its definition and assessment remain debated. Since the early 2000s, two main models have emerged: the Fried frailty phenotype, focusing on physical deficits, and the Mitnitski frailty index, which incorporates broader health factors. These divergent approaches have led to over 50 frailty instruments, reflecting the absence of a unified framework. This review explores the content, weighting, and scoring methods of frailty instruments, identifying potential concerns derived from this. This review exposes the overlap of frailty with other constructs including function, disability, morbidity, and sarcopenia. Many instruments lack content validity, and detect highly heterogeneous samples within and between scales, all labeled under the "frail" tag. This poses challenges to interpreting instrument responsiveness. In addition, frailty should not be considered a clinical entity with a unique etiology. This review discusses how the broad nature of frailty conflicts with modern paradigms of individualization and precision. They may be useful in primary care, but lack the specificity for secondary care evaluations. This article also discusses how the predictive validity of frailty should be interpreted with caution. Finally, we summarize our findings and propose a new definition of frailty, highlighting the strengths and weaknesses of the construct. The identified inconsistencies should serve as a guide for refining the concept of frailty, both in research and in its application to geriatric care.

Stay Active, Stay Healthy: A Cross-Sectional View of the Impact of Physical Activity Levels on Health Parameters of Older Adults Institutionalized in Nursing Homes of Barcelona

(1) Background: Institutionalized older adults represent a vulnerable population. It is important to understand that higher levels of physical activity in older adults are associated with less risk of cardiovascular diseases, better cognition, and lower inflammaging and sarcopenia levels. The main objective was to evaluate the differences in health parameters in institutionalized older adults who perform different levels of weekly physical activity. The secondary objective was to analyze if weekly physical activity levels are a predictor of health parameters. (2) Methods: A cross-sectional observational study was conducted in nursing homes with adults over 75 years of age. A total of 76 participants was divided into three groups based on their weekly physical exercise frequency (1 day/week, 2 days/week, and 3 days/week). We measured demographic and anthropometric variables, along with cognitive level through the Mini Exam of Lobo. Handgrip strength, leg muscle strength, and power were also evaluated, and C-reactive protein levels were assessed through blood tests. Physical performance was measured using the Short Physical Performance Battery and walking speed. (3) Results: Significant differences were found in body mass index (p < 0.01; ES = 0.96), muscular strength (p < 0.01; ES = 0.70), and power (p < 0.01; ES = 1.09), Short Physical Performance Battery (p < 0.01; ES = 1.46) and walking speed (p < 0.01; ES = 0.87), cognitive function (p < 0.01; ES = 1.21), and C-reactive protein levels (p < 0.01; ES = 1.73), favoring the group who performed 3 days/week of physical activity. (4) Conclusions: Institutionalized older adults with three days per week of physical activity have greater physical and muscle function and less cognitive decline. Three days of weekly physical activity is associated with systemic inflammation and better cognitive status in institutionalized older adults.

Digital health tools applications in frail older adults-a review article

Introduction

Frailty is a common degenerative condition highly prevalent in adults over 65 years old. A frail person has a higher risk of morbidities and mortality when exposed to health-related stressors. However, frailty is a reversible state when it is early diagnosed. Studies have shown that frail people who participated in an exercise prescription have a greater chance to transition from frail to fit. Additionally, with a rapid advancement of technology, a vast majority of studies are supporting evidence regarding the digital health tools application on frail population in recent years.

Methods

This review comprehensively summarizes and discusses about technology application in frail persons to capture the current knowledge gaps and propose future research directions to support additional research in this field. We used PubMed to search literature (2012-2023) with pre-specified terms. Studies required older adults using digital tools for frailty comparison, association, or prediction and we excluded non-English studies and those lacking frailty comparison or digital tool use.

Results

Our review found potential etiognostic factors in trunk, gait, upper-extremity, and physical activity parameters for diagnosing frailty using digital tools in older adults.

Conclusion

Studies suggest exercise improves frailty status, emphasizing the need for integrated therapeutic platforms and personalized prevention recommendations.

Physical activity, frailty, and kinesiophobia among older adult patients with coronary heart disease in China

BACKGROUND

Physical activity (PA) offers advantages in the secondary prevention of coronary heart disease (CHD). However, in older adults, frailty and kinesiophobia may exert negative influences on PA engagement.

OBJECTIVE

To investigate PA, frailty, and kinesiophobia among older adult patients with CHD in China.

METHODS

This cross-sectional study enrolled older adult patients with CHD in the cardiac outpatient care unit of the *** University. The International Physical Activity Questionnaire, the Frailty Phenotype Scale, and the Tampa Scale of Kinesiophobia were used to evaluate PA, frailty, and kinesiophobia, respectively.

RESULTS

A total of 239 participants (mean age: 72.0 ± 7.5 years, 148 males) were enrolled. The rates of frailty and pre-frailty were 20.5 % and 46.4 %, respectively. The mean kinesiophobia score was 43.13±5.48. The median metabolic equivalent of task of PA was 2784 MET-min/week, and 25.1 % of the patients did not reach the minimum recommended by AHA (150 mins/week). Spearman rank correlation analysis showed that PA was negatively correlated with frailty (r = -0.559, P < 0.001) and kinesiophobia (r = -0.463, P < 0.001). Multivariable logistic regression analysis showed that frailty [OR = 0.412, 95 % confidence interval (CI): 0.304-0.559, P < 0.001] and kinesiophobia (OR=0.936, 95 % CI: 0.879-0.997, P = 0.040) were independently associated with PA after adjustment for age, cardiovascular adverse events, comorbidities, Barthel index, and history of dizziness.

CONCLUSIONS

Older adult patients with CHD had low levels of PA. Frailty and kinesiophobia were independently associated with PA in older adult patients with CHD. Reversing frailty and reducing kinesiophobia in older adult patients with CHD may increase PA levels.

Multimodal prehabilitation to improve functional abilities and reduce the chronic inflammatory response of frail elderly patients with gastric cancer: A prospective cohort study

BACKGROUND

Population ageing and cancer burden are important global public health problems that pose unprecedented threats to health systems worldwide. Frailty is a common health problem among elderly patients with cancer. In recent years, the use of prehabilitation to improve frailty has received widespread attention. Few studies have addressed the specific physiologic effects of prehabilitation on patients undergoing surgery.

METHODS

Frail elderly patients (aged at least 65 years) who underwent elective primary surgery for gastric cancer between September 2022 and October 2023 were included in this single-centre prospective cohort study and were categorized into multimodal prehabilitation or ERAS standard care groups. Prehabilitation, including physical and respiratory training, nutritional support and psychosocial treatment, was provided at least two weeks before gastrectomy. The primary outcome was functional status. Secondary outcomes included changes in indices of lipid metabolism, oxidative stress and chronic inflammation.

RESULTS

Over a 13-month period, 137 participants were assessed for eligibility, and 110 patients (prehabilitation 55, ERAS 55) were analysed. Compared with the baseline, patients in the prehabilitation group exhibited increased physical capacity before the operation (mean 6-min walk test change +28 m; P < 0.001). After prehabilitation intervention, inflammation-related indicators (NLR, PLR, SII and CRP) improved, and proinflammatory cytokine production (IL-5, IL-6, IL-1β, IL-10 and TNF-α) decreased. After surgery, the increase in IL-6 was reduced in the prehabilitation group (P = 0.036). Moreover, prehabilitation was associated with alleviating oxidative stress as determined by the levels of MDA (P = 0.005).

CONCLUSION

Multimodal prehabilitation can play a beneficial role in improving functional abilities by reducing chronic inflammation, improving lipid metabolism, and attenuating oxidative stress.

Association between dairy products intake and frailty transitions in older adults: The InCHIANTI cohort study

OBJECTIVE

To evaluate the association between dairy products consumption and the probability of frailty transitions in community-dwelling older adults.

DESIGN

Longitudinal study.

SETTING AND PARTICIPANTS

We included 863 community-dwelling participants ≥65 years from the Chianti region in Italy.

MESUREMENTS

Habitual dietary intake of dairy products (i.e., milk, yogurt, and cheese) was assessed in daily servings using a validated food frequency questionnaire (FFQ) at baseline, 3-, 6-, and 9-years of follow-up. Frailty status at each visit was defined using the Fried criteria, and the probability of transitions between different frailty status and death was assessed through multistate models. The associations between dairy product intakes and frailty transitions during the 9-year period were expressed as hazard ratios (HRs) derived from proportional intensity models.

RESULTS

The mean age at baseline was 74 ± 7 years and 46% of the participants were male. There were no statistically significant associations between the consumption of total, fermented, or non-fermented dairy products and the probabilities of transition from robust or from pre-frail to any of the other frailty conditions or to death. Conversely, a direct association between the consumption of fermented dairy products and the probability of transition from frail to pre-frail was observed in a model adjusted for age, sex, and energy intake (HRper serving/day = 1.90, 95%CI 1.12-3.22). This association was primarily related to yogurt consumption (HRper serving/day = 4.07, 95%CI 1.38-12.02), as the association with cheese consumption was not significant (HRper serving/day = 1.57, 95%CI 0.91-2.71). In the fully adjusted model, only the association between yogurt consumption and frail to pre-frail transition remained statistically significant (HRper serving/day = 3.68, 95%CI 1.10-12.31).

CONCLUSION

Dairy products, such as milk, yogurt, and cheese, are unlikely to play a predominant role in frailty development in an Italian community-dwelling older population. However, it is advisable to maintain a moderate consumption of dairy products, especially fermented ones, as part of a well-balanced diet to promote healthy aging.

Prevalence and Associated Factors of Frailty in Patients with Chronic Heart Failure: A Systematic Review and Meta-Analysis

Background

Although numerous studies have investigated the prevalence of chronic heart failure (CHF) and the factors influencing frailty in patients with CHF, the findings remain inconsistent. Therefore, this review aimed to systematically evaluate the prevalence and associated frailty factors in patients with CHF to establish an evidence-based foundation for risk assessment and treatment strategies.

Methods

A comprehensive search was conducted across multiple databases, including EMBASE, the Cochrane Library, PubMed, Web of Science, CINAHL, Chinese Biological Medicine (CBM), CNKI, and Wan Fang up to August 25, 2024. The objective was to identify observational studies that examined factors influencing frailty in CHF patients. The quality of the selected studies was evaluated using appropriate assessment tools, and a meta-analysis was performed to determine the relevant factors associated with frailty in this population.

Results

A total of 23 articles containing 6287 patients were included. The prevalence of frailty in patients with CHF was 39% (95% confidence interval (CI): 0.33-0.45). Factors shown to be positively associated with frailty in CHF patients were older age, cerebrovascular accidents, longer hospital stay, larger left atrial diameter, higher number of comorbidities, poor New York Heart Association (NYHA) functional class, and poor sleep quality. Conversely, higher albumin, hemoglobin, and left ventricular ejection fraction (LVEF) levels were negatively associated with frailty.

Conclusions

The prevalence of frailty in patients with CHF is relatively high and varies according to different assessment tools applied. Thus, establishing specific frailty assessment tools for CHF patients and providing targeted interventions based on important factors are essential for reducing the burden of frailty and improving outcomes.

The PROSPERO registration

CRD42023448771, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023448771.

Advances in pathophysiology and assessment methods of chronic obstructive pulmonary disease with frailty

Frailty, a multidimensional syndrome characterized by decreased physiological reserves and vulnerability to stressors, presents significant challenges in the management of chronic obstructive pulmonary disease (COPD). COPD and frailty share common risk factors and pathophysiological pathways, such as muscle wasting, chronic inflammation, and malnutrition. Both COPD and frailty lead to a significant reduction in patients' physical functionality and quality of life. Consequently, early screening for frailty and proactive interventions for patients with COPD are increasingly considered essential. There are several methods for screening and assessing frailty in patients with COPD, such as the Fried Frailty Phenotype and the Frailty Index, each with its own advantages and limitations. However, there is currently no unified standard, nor a method specifically tailored to the Chinese population. The treatment of patients with COPD and concurrent frailty currently favors exercise interventions, nutritional interventions, or a combination of both. Further treatment approaches, including pharmacological interventions, are still being explored. Therefore, the development of frailty screening and assessment tools tailored to the Chinese population, along with the exploration of reasonable and effective new intervention measures, represents a crucial direction in China's efforts to prevent and treat frailty.

The velocity of temporalis muscle wasting in cerebral metastasis is prognostic for poor survival

Purpose

Recently, the temporalis muscle thickness on cranial CT scan was proposed as a surrogate marker for patients' baseline frailty that correlates with outcome in primary and metastatic brain tumor patients. In this study, we investigated whether the velocity of temporalis muscle atrophy (TMA) affects the outcome of patients with cerebral metastases.

Methods

We analyzed radiological and clinical data sets of 96 patients who received craniotomy for cerebral metastasis resection in our institution. We then correlated the radiological data with clinical course and outcome after stratification for the velocity of temporalis muscle atrophy.

Results

The median velocity of TMA was 0.0016 mm/day. In patients with a slow TMA rate, the median overall survival was significantly longer than in patients with a fast TMA rate (37.7 months versus 22.9, p = 0.0007). Furthermore, patients with slow TMA had longer progression-free survival postoperatively (7.6 versus 4.38 months, p <0.0001). The overall survival postoperatively (OS-PO) was also significantly longer in patients with slow TMA (8.9 months versus 5.1, p=0002).

Conclusion

Based on this study, the velocity of temporalis muscle atrophy may represent an objective and dynamic index with potential for survival prognostication for patients with cerebral metastases.

Frailty, malnutrition, healthcare utilization, and mortality in patients with dementia and cognitive impairment obtained from hospital administrative data

Introduction

With aging populations, the prevalence of dementia, frailty and malnutrition will increase. The aim of this study is twofold (a) to determine the demographic data, including frailty and malnutrition prevalence in older patients with diagnosis of dementia and/or cognitive impairment and (b) to determine its impact on outcomes such as length of stay (LOS), readmission and mortality stratified by frailty status.

Methods

Retrospective single-center cohort study conducted using hospital database on older patients ≥65 yrs. admitted to a tertiary hospital between March 2022 and Dec 2023 and discharged with either primary or secondary diagnosis of dementia or cognitive impairment. Data on age, gender, ethnicity, comorbidities, discharge diagnoses, Hospital Frailty Risk Score (HFRS), Clinical Frailty Scale (CFS), activity of daily living (ADL), 3-Minute Nutrition Screening and outcomes such as LOS, readmission, mortality and cost of hospitalization were extracted. Those aged between 65 to 74 years old were categorized as "young-old," and ≥75 years old as "old-old."

Results

Dementia or cognitive impairment diagnosis was prevalent in 8.6% (3090) older patients, and 33.7% were malnourished. 54.5% were female with a mean age of 82.0 years. Almost one fourth were dependent on ADL. Based on frailty defined by (i) HFRS-26.0% had intermediate and 18.2% high frailty (ii) CFS-41.0% were mild/moderately frail, and 32.2% severely frail. Median LOS was 8 days. 30 and 90-days readmission rates were 23.2 and 35.4%, respectively. In-hospital mortality was 7.8% and 30-day mortality 14.0%. High HFRS (aOR 1.511, 95% CI: 1.089-2.097; p = 0.013), severe frailty (aOR 4.325, 95% CI: 0.960-2.684; p < 0.001) and terminal frailty (aOR 39.762, 95% CI: 18.311-86.344; p < 0.001) were significantly associated with inpatient mortality. Intermediate HFRS (aOR 1.682, 95% CI: 1.380-2.050; p < 0.001), mild/moderate frailty (1.609, 95% CI: 1.254-2.065; p < 0.01), high HFRS (aOR 2.178, 95% CI: 1.756-2.702; p < 0.001) and severe frailty (2.333, 95% CI: 1.804-3.017; p < 0.01) were significantly associated with 30-days readmission. The impact of malnutrition on healthcare utilization was highest in the old-old with high HFRS and severe frailty.

Conclusion

Frailty and malnutrition have significant impact on healthcare utilization, readmission rates, and mortality among older adults with dementia and/or cognitive impairment.

Development and validation of a generalizable electronic frailty index: a prospective study in China

BACKGROUND

Frailty is a multidimensional geriatric syndrome recognized as a critical public health challenge in 771 million aging population worldwide. Although electronic frailty index (eFI) is successfully adopted for frailty screening in developed countries, such a tool is still absent in China. Furthermore, for facilitate early illness prevention, China offers annual physical examinations for the elderly which offers a potential opportunity for the early detection of frailty. This study aimed to develop a new eFI algorithm leveraging routinely collected healthcare data and validated it within both the development and an independent external cohort.

METHODS

Individuals aged 65 or older from the development and external validation cohort were enrolled in this study. Data were extracted from the annual physical examinations and medical records. Based on the cumulative deficit model, a tailored eFI calculation algorithm was developed. The eFI's validity was assessed through correlation with the established FRAIL scale, and its predictive utility for hospitalization and mortality was prospectively evaluated.

RESULTS

A set of 30 variables across 13 functional domains was selected to calculate the eFI. It demonstrated a strong correlation with the FRAIL scale (P < 0.001). In the development cohort, individuals categorized as prefrail and frail had higher (62% and 137% respectively) risk of hospitalization compared to the robust group. Regarding all-cause mortality, the risk was also higher (59% and 117% respectively) for prefrail and frail participants. Similar associations were observed in the external validation cohort.

CONCLUSION

Utilizing standardized healthcare records, this study successfully developed and validated an eFI algorithm that can offer a reliable and scalable tool for early frailty screening in China and populations with similar preventive physical examination data.

Impact of Modifiable Factors Associated with Physical Frailty and Cognitive Impairment Trajectory of Older Adults: Using the Korean Longitudinal Study of Aging 2006-2018

Background/Objectives: To identify joint trajectories of physical frailty and cognitive impairment among community-dwelling older adults and to determine modifiable factors for each trajectory. Methods: Data were utilized from the Korean Longitudinal Study of Aging, which was conducted between 2006 and 2018. Physical frailty was assessed using the Fried phenotype, and cognitive impairment was evaluated using the Korean version of the Mini-Mental State Examination. Group-based trajectory modeling and logistic regression were employed for the analyses. Results: Based on longitudinal data, 415 participants averaging 72.2 years of age were analyzed. Three trajectories of physical frailty were identified: mild physical frailty, moderate physical frailty, and improving frailty. Two trajectories of cognitive impairment were identified: stable cognitive impairment and improving cognitive impairment. Factors influencing physical frailty trajectories included the number of medications taken, being overweight or obese, and depression. Education level was found to be associated with cognitive impairment trajectories. Conclusions: This study provides evidence for the distinct identification of joint trajectories of physical frailty and cognitive impairment, which can inform the target groups for intervention. It offers a basis for including modifiable physical and mental factors in intervention components for physical frailty trajectories.

Quadriceps Muscle Layer Thickness and its association with frailty in critically ill patients: A prospective observational study

BACKGROUND

Frailty is a well-recognized clinical entity known to influence the outcomes of critically ill patients. Muscle ultrasound, particularly Quadriceps Muscle Layer Thickness (QMLT), assesses muscle mass, which is a key component determining frailty. However, no studies have assessed the association between frailty and QMLT. This study aimed to determine the association between the QMLT and frailty in critically ill elderly patients.

METHOD

In this prospective, observational, single-center study conducted in an ICU in India, patients aged >65 years were enrolled. Baseline frailty was assessed using the Clinical Frailty Scale (CFS). Quadriceps muscle thickness was measured via axial cross-section ultrasound at admission. Patients were categorized as non-frail (CFS 1-4) and frail (CFS ≥5), and their characteristics were compared. Multivariate regression analysis was used to identify factors associated with frailty.

RESULTS

120 patients were included. The median APACHE II and SOFA scores were 19 [IQR 14.25-23] and 4.5 [IQR 3-6], respectively. The median age was 75 years [IQR 70-82]; 62.5 % were male. The most common comorbidities were diabetes mellitus (60 %) and hypertension (59 %). 65 % were mechanically ventilated. 65 % of patients were frail. Frail patients had higher mortality (37.17 % vs. 16.66 %, p = 0.022). QMLT was lesser in frail than non-frail (1.77 cm vs 2.21 cm, p < 0.001). QMLT decreased with an increase in CFS (p < 0.001). Frail and non-frail patients were further divided into four groups based on the median QMLT (1.96 cm). Frail patients with QMLT below the median had a higher 28-day mortality than non-frail and frail patients with QMLT above the median (48.97 % vs. 16.12 % vs. 18.18 % vs. 17.24 %, p = 0.003). Frailty was independently associated with increasing age (OR, 1.14; 95 % CI: 1.055-1.231, p = 0.001), higher APACHE II score (OR, 1.078; 95 % CI: 1.009-1.151, p = 0.025), and lower QMLT (OR, 0.205; 95 % CI: 0.083-0.509, p = 0.001).

CONCLUSIONS

We found an independent association between Quadriceps Muscle Layer Thickness (QMLT) and frailty. QMLT decreased progressively with CFS scores. Frail patients with lower QMLT had increased 28-day mortality. These findings highlight the role of incorporating QMLT measurements along with CFS in frailty evaluations to improve decision-making in critically ill elderly patients.

High dietary acid load increases the risk of disability in women aged 75 years and older: A community-based cohort study

BACKGROUND

Metabolic acidosis caused by acidogenic diets increases muscle catabolism. High acidogenic diets can increase muscle loss in older adults; however, their association with functional outcomes remains unclear.

OBJECTIVES

To investigate whether high acidogenic diets increase the incidence of disability.

DESIGN

Longitudinal study.

SETTING

Community-based.

PARTICIPANTS

We included 1,704 community-dwelling Japanese individuals aged ≥ 75 years without disabilities at baseline (52.2 % females).

MEASUREMENTS

Baseline dietary acid load was assessed using potential renal acid load (PRAL) values, which reflect urinary acidity-with higher values indicating more acidogenic diets. The outcome measure was the one-year incidence of disability, defined as needing for long-term care or support based on certification by the Japanese long-term care insurance system. As the effects of PRAL are reportedly sex-specific, separate analyses were conducted for males and females. The participants were categorized into tertiles (T1-T3, with T1 as the reference) based on their PRAL values. Odds ratios (ORs) and 95 % confidence intervals (CIs) for outcome were calculated using multiple logistic regression analysis after adjusting for age, body mass index, living status, smoking status, hypertension, diabetes, dyslipidemia, energy intake, and alcohol intake.

RESULTS

The PRAL ranges in groups T1, T2, and T3 were: -64.51 to 0.21, 0.27 to 11.34, and 11.41 to 61.00, respectively, in males, and -61.22 to -3.84, -3.75 to 5.89, and 5.90 to 38.68, respectively, in females. Disabilities occurred in 44 (5.7 %) males and 71 (8.7 %) females. ORs (95 % CIs) for disability in T2 and T3 were 0.79 (0.35-1.76) and 0.81 (0.37-1.79), respectively, in males and 1.10 (0.57-2.13) and 1.96 (1.06-3.61), respectively, in females.

CONCLUSIONS

A high dietary acid load increased the incidence of disability in older females. Therefore, managing an acidogenic diet may help maintain daily living functions in older females. Future studies should investigate whether sex is an effect modifier.

Age Self Care-Resilience, a medical group visit program targeting pre-frailty: A mixed methods pilot clinical trial

BACKGROUND

Pre-frailty is highly prevalent and multimodal lifestyle interventions are effective for preventing transition to frailty. However, little is known about the potential for medical group visits (MGV) to prevent frailty progression.

OBJECTIVES

To assess the feasibility and acceptability of the MGV Age Self Care-Resilience.

DESIGN

Single-arm mixed methods pilot clinical trial.

SETTING

Virtual MGV delivered in an ambulatory setting at a U.S. academic medical center.

PARTICIPANTS

Community-dwelling older adults (n = 11; age 65+) with pre- to mild frailty.

INTERVENTION

Age Self Care-Resilience, an 8-week virtual MGV (90-minute sessions once per week) with sessions focused on physical activity, nutrition, social engagement, mind-body practice, and home environment modification.

MEASUREMENTS

Primary outcomes were feasibility of recruitment, attendance, satisfaction, and feasibility of study measurements, collected via quantitative and qualitative approaches. Exploratory outcomes included frailty, psychosocial health, and physical function.

RESULTS

A priori feasibility criteria were met for recruitment, with 15 (48 %) of those screened (31) meeting eligibility criteria, 11 (35 %) enrolling (mean age 74.5 yrs), and recruitment completed in less than one month. The nine participants who completed the study attended a mean of 7.2 of 8 sessions and completed 100 % of baseline and follow-up study measures; participants completed 58 % of the home practice log. Themes from participant interviews included: (1) mixed reactions to the recruitment term "pre-frailty;" (2) finding group participation as meaningful and empowering; and (3) perception that the program positively changed attitudes and lifestyle behaviors.

CONCLUSIONS

Age Self Care-Resilience is feasible and acceptable to pre- to mildly frail older adults. Next steps include evaluating the efficacy of Age Self Care-Resilience for preventing frailty progression with a fully powered randomized controlled trial.

A systematic review of the relationship between body composition including muscle, fat, bone, and body water and frailty in Asian residents

International guidelines suggested that overweight and underweight are risk factors for frailty. However, body composition, which directly affects body weight, was not mentioned as a risk factor. We aimed to investigate whether the body composition, including muscle, fat, bone, and body water, is a risk factor for frailty. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched up to June 03, 2022. We included cohort studies or observational studies using a cross-sectional design that reported an association between body composition and frailty. Two reviewers assessed the quality of the included cohort studies. Furthermore, we examined whether body composition as a risk factor for frailty varies depending on the participant's place of residence. Of the 3871 retrieved studies, 77 were ultimately included, 7 of which were cohort studies. The risk-of-bias evaluation in each cohort study showed that all studies had at least one concern. Low lean mass, waist circumference-defined abdominal obesity, and bone mineral density were significantly associated with frailty in the cohort studies. The results of bone mineral density were conflicted in the cross-sectional studies. Considering the participants' place of residence, a significant association between lower-extremity muscle mass and frailty was demonstrated, particularly among Asian residents. Low lean mass and abdominal obesity were likely risk factors for frailty. These results could be useful for developing frailty prevention strategies and could have a positive impact on individual health management. Further, future studies are needed because body composition affecting frailty may differ by race.

A simplified multidimensional scale approach is effective in predicting mortality in hospitalized older adults and highlights the role of nutrition

BACKGROUND & AIMS

Malnutrition and cognitive impairment are among the major contributors to frailty, that significantly increases the risk of mortality of older hospitalized patients. Multidimensional frailty assessment tools, such as the multidimensional prognostic index-MPI, a tool based on a standard comprehensive geriatric assessment (CGA), have proven valuable for predicting adverse outcomes, including mortality of older adults following acute illness but its application in everyday clinical practice is limited. We hypothesized that removing parameters not closely associated with mortality and sorting the patient population according to the presence or not of cognitive impairment with possible integration of common laboratory markers, could provide a simplified approach that could improve practicability in all settings with at least comparable 1-year mortality predictive value.

METHODS

A retrospective cohort study was conducted in patients consecutively admitted to the Geriatric Clinic of the Maggiore University Hospital in Trieste, Italy from January 1st 2018 to December 31st 2019. Their demographics, functional, clinical, laboratory parameters and 1-year mortality were recorded. In a development cohort of 1032 consecutive patients, best predictors of mortality were selected via systematic analysis and included in simplified prognostic models and algorithms and subsequently compared for prediction of 1-year mortality. The predictive relevance of the best algorithms was then validated, in comparison to MPI, in a separate cohort of 575 consecutive patients.

RESULTS

While all demographic and tested laboratory parameters as well as MPI domains correlated with 1-year mortality, exclusion from MPI calculation of Short Portable Mental Status Questionnaire (SPSMQ), Exton Smith scale (ESS) and Mini Nutritional Assessment (MNA) significantly reduced MPI mortality predictivity, suggesting that not all MPI domains have the same weight. Further analysis showed that in the whole study cohort and in subgroups according to cognitive function, selected models including up to 3 parameters were superior to MPI in predicting 1-year mortality. In particular, models including MNA and albumin, or Exton Smith scale proved to better predict mortality in patients without or with severe cognitive impairment, respectively. A derived diagnostic algorithm applying different models according to cognitive status showed improved predictive value compared to MPI while requiring shorter estimated assessment time. Internal validation confirmed these results [HR: 4.37 (3.02-6.31) vs 3.16 (2.18-4.61), p < 0.0001].

CONCLUSIONS

In older acutely ill patients, a simplified multidimensional algorithm approach based on the assessment of cognitive function followed by nutritional status with the addition of plasma albumin or of functional status in patients without or with severe cognitive impairment respectively, may significantly improve 1-year mortality prediction while reducing assessment time. Moreover, these results highlight the prognostic value of MNA in association with albumin for 1-year mortality risk screening in the hospital setting and, for the first time, demonstrate its differential performance according to the presence or not of cognitive impairment.

Frailty and comorbidities among young adult cancer survivors enrolled in an mHealth physical activity intervention trial

PURPOSE

The physical frailty phenotype identifies individuals at risk for adverse health outcomes but has rarely been assessed among young adult cancer survivors (YACS). This study describes frailty status among YACS participating in a physical activity (PA) intervention trial.

METHODS

YACS were categorized at baseline using the 5-item FRAIL scale: fatigue; weight loss; illness; ambulation; resistance. Chi-square tests compared frailty and non-cancer comorbidities by characteristics. Prevalence rates (PRs) for the independent associations between characteristics, frailty, and comorbidities were estimated using modified Poisson regression models.

RESULTS

Among 280 YACS (82% female; mean (M) age = 33.4 ± 4.8 years, M=3.7 ± 2.4 years post-diagnosis), 11% frail, 17% prefrail; the most frequent criteria were fatigue (41%), resistance (38%), and ambulation (14%). Compared to BMI < 25, higher BMI was associated with increased likelihood of frailty (BMI 25-30, PR: 2.40, 95% CI: 1.38-4.17; BMI > 30, PR: 2.95, 95% CI: 1.71-5.08). Compared to 0, ≥ 30 min/week of moderate-to-vigorous PA was associated with reduced frailty (PR: 0.39, 95% CI: 0.25-0.60). Most YACS (55%) reported ≥ 1 comorbidity, most frequently depression (38%), thyroid condition (19%), and hypertension (10%). Comorbidities were more common for women (59% vs. 37%) and current/former smokers (PR: 1.71, 95% CI: 1.29-2.28).

CONCLUSION

Prevalence of frailty and comorbidities in this sample was similar to other YACS cohorts and older adults without cancer and may be an indicator of accelerated aging and increased risk for poor outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

Assessment of frailty may help identify YACS at increased risk for adverse health outcomes.

Clinical and cost-effectiveness of a home-based health promotion intervention for older people with mild frailty in England: a multicentre, parallel-group, randomised controlled trial

BACKGROUND

Health promotion for people with mild frailty has the potential to improve health outcomes, but such services are scarce in practice. We developed a personalised, home-based, behaviour change, health promotion intervention (HomeHealth) and assessed its clinical effectiveness and cost-effectiveness in maintaining independent functioning in activities of daily living in older adults with mild frailty.

METHODS

This trial was an individual, multicentre, parallel-group, randomised controlled trial done in England. Participants were mainly recruited from general practices in three different areas of England (the London north Thames region, east and north Hertfordshire, and west Yorkshire). Participants were individuals residing in the community who were registered with a general practice, 65 years and older with mild frailty (scoring 5 on the CFS), with a life expectancy of more than 6 months, and with capacity to consent to participate. We excluded adults residing in nursing or care homes, those with moderate-to-severe frailty or with no frailty, those receiving palliative care, and those already case managed (eg, receiving a similar ongoing intervention from the voluntary sector or community service). Eligible participants were randomly assigned 1:1 to either the HomeHealth intervention or to treatment as usual. HomeHealth is a multidomain health promotion intervention delivered by the voluntary sector at home in six sessions over 6 months. The primary outcome was independent functioning (assessed using the modified Barthel Index [BI]) at 12 months. Outcome assessments were masked and were analysed by intention to treat using linear mixed models. Incremental costs and quality-adjusted life-years (QALYs) were calculated using seemingly unrelated regression and bootstrapping. The trial is registered on the ISRCTN registry (ISRCTN54268283).

FINDINGS

We recruited 388 participants between Jan 8, 2021 and July 2, 2022 (mean age 81 years, SD 6·5; 249 (64%) of 388 were women and 139 (36%) were men). 195 participants were randomly assigned to HomeHealth and 193 to treatment as usual. Median follow-up was 363 days (IQR 356-370) in the HomeHealth group and 362 days (IQR 355-373) in the treatment-as-usual group. HomeHealth did not improve BI scores at 12 months (mean difference 0·250, 95% CI -0·932 to 1·432). HomeHealth was superior to treatment as usual with a negative point estimate for incremental costs (-£796; 95% CI -2016 to 424) and positive point estimate for incremental QALYs (0·009, -0·021 to 0·039). There were 55 serious adverse events in the HomeHealth group and 85 in the treatment-as-usual group; none were intervention related.

INTERPRETATION

HomeHealth is a safe intervention with a high probability of cost-effectiveness, driven by a reduction in unplanned hospital admissions. HomeHealth should be considered as a health promotion intervention for older people with mild frailty.

FUNDING

National Institute for Health Research Health Technology Assessment.

Initial participant perspectives about participating in an online, semi-supervised, cirrhosis-specific nutrition and exercise intervention

OBJECTIVES

In chronic diseases, there have been issues with low levels of participant adherence and retention during well-supported lifestyle behaviour change interventional studies. Theoretically informed, the objective was to explore the types of challenges participants are experiencing to inform future designs.

DESIGN

We conducted an exploratory descriptive study in an adult cirrhosis population after the first 4-6 weeks of a 12-week semi-supervised nutrition and exercise online program.

METHODS

Participants in the parent feasibility study, assessing the nutrition and exercise intervention (Heal-Me), were eligible for this nested study. Heal-Me is a multimodal program that is tailorable to a participant's abilities through regular interaction with the study's registered dietician and exercise specialist. Interviews (~60 min) with participants were recorded then analysed descriptively, guided by the capability, opportunity and motivational behaviour change model.

RESULTS

The 20 participants preferred the expert-led group online nutrition and exercise classes over independent activities such as protein tracking and the exercise videos. Social gamification (e.g., weekly polls on favourite things like movies or sports teams) contributed to the group experience. All except one person required program tailoring to address preferences, abilities and new onset health events. Findings led to the inclusion of 4 behaviour change techniques to the initial 17, whereas 2 others were expanded.

CONCLUSIONS

While program tailoring, awareness of cirrhosis nutrition and regular interactions with staff influenced participant retention and adherence in the first 4-6 weeks of the online program.

The Association of Modified 5-Item Frailty Index on Perioperative Cochlear Implant Speech Perception

OBJECTIVE

This study aims to evaluate the potential association of perioperative hearing outcomes with frailty by Modified 5-Item Frailty Index (mFI-5).

DESIGN

Retrospective cross-sectional study.

SETTING

Single-institutional study conducted at a tertiary care hospital between January 2018 and January 2022.

PATIENTS

All adult patients older than 50 years who underwent cochlear implantation (CI).

INTERVENTIONS

Cochlear implantation.

MAIN OUTCOMES MEASURES

Hearing outcomes were measured using pre-CI and longitudinal post-CI quiet AzBio scores. Frailty was determined by mFI-5 scores (0 = not frail, 1 = prefrail, and 2+ = frail). Univariable and multivariable linear regressions, ordinal logistic regressions, and time-to-event curves were used to determine perioperative speech perception and likelihood of high-performance hearing (defined as ≥70% on AzBio).

RESULTS

Of the 126 patients, the median age was 70 (63-77) years, 50% (63) were female, and 39% (49) identified as non-Hispanic Black, Hispanic, or other. By mFI-5 scoring, 38% (48) had no frailty, with 34% (43) and 28% (35) scoring 1 and 2+, respectively. When adjusting for age, sex, race, and BMI, scoring 1 point on mFI-5 was associated with significantly lower pre-implantation and post-implantation AzBio scores (pre: = -15 [-26, -3.4], p < 0.05; post: = -14 [-25, -3.0], p < 0.05). When controlling for all covariates, prefrailty and frailty were associated with significantly decreased likelihood of high-performance hearing (prefrailty OR: 0.22 [0.07, 0.63], p < 0.01; frailty OR: 0.31 [0.10, 0.92], p < 0.05). Time-to-event curves demonstrate significantly reduced likelihood of reaching high-performance hearing within 7 months after CI in patients with mFI-5 scores >0 (p < 0.05).

CONCLUSION AND RELEVANCE

Our findings suggest that prefrailty is associated with worse pre-CI and post-CI hearing and lower likelihood of high-performance hearing within 7 months post-CI. Preoperative frailty screening in adult CI candidates may better inform providers of patients' long-term risk-to-benefit.

Association between frailty, as measured by the FRAIL scale, and 1-year mortality in older patients undergoing hip fracture surgery

BACKGROUND

The FRAIL scale is a concise and user-friendly tool for frailty assessment. However, its effectiveness in predicting 1-year mortality among older patients undergoing hip fracture surgery remains unclear. This study explored the relationship between preoperative frailty, as measured by the FRAIL scale, and 1-year mortality after surgery in this population.

METHODS

This retrospective analysis included 194 older patients (aged ≥ 75 years) with hip fractures who underwent surgical treatment in our departments from January 2019 to December 2022. Perioperative clinical data were collected, and all-cause mortality within 1 year after surgery was monitored. Patients were categorized into non-frail (n = 114) and frail (n = 80) groups based on their FRAIL scores. Postoperative complications and 1-year mortality rates were compared between these groups. The association of preoperative frailty with 1-year mortality and its predictive capability were assessed.

RESULTS

Among the 194 older hip fracture patients, 78 (40.2%) were male, with a mean (standard deviation [SD]) age of 84.4 (6.3) years. The overall incidence of 1-year mortality after surgery was 11.3% (22/194). Frail patients had a higher incidence of Clavien-Dindo (CD) classification of surgical complications ≥ II (31.3% vs. 12.3%, p = 0.00) and greater 1-year mortality (21.3% vs. 4.4%, p = 0.00) compared with non-frail patients. Cox regression analysis indicated that preoperative frailty was independently associated with 1-year mortality (adjusted hazard ratio: 3.88; 95% confidence interval [CI]: 1.28-11.77; p = 0.02). The FRAIL scale demonstrated acceptable discriminatory capacity for predicting 1-year mortality in these patients (area under the curve: 0.70; 95% CI: 0.59-0.81).

CONCLUSIONS

Frailty, as measured by the FRAIL scale, was independently associated with 1-year mortality in older patients undergoing hip fracture surgery. The scale can be used to stratify risk and facilitate personalized perioperative treatment and management.

The simpler modified fried frailty scale predicts 2-year mortality in older adults with heart failure: a pilot study

OBJECTIVE

The Simpler Modified Fried Frailty Scale (SMFFS) has recently been developed from the original Fried scale to ease its use in clinical practice, by transforming the items requiring measurements into the self-reported inquiries. Its predictive validity needs to be clarified, especially in populations with a high prevalence of frailty, such as patients with heart failure (HF). Primary aim of this study is to find out the prevalence of frailty in older patients with HF by using SMFFS and show its concordance with other frailty assessment tools. Secondary aim is to reveal whether SMFFS is useful to predict mortality in follow-up.

METHOD

This is a prospective, follow-up study including older adults (≥ 65 years) with HF. SMFFS was used to assess frailty phenotype and presence of ≥ 3 items was accepted as frailty. FRAIL scale, the Study of Osteoporosis Fractures (SOF) index, and Edmonton Frailty Scale (EFS) were alternatively used to study the correlation of SMFFS with different scales. Cox-regression analysis was performed to identify whether SMFFS-defined frailty could predict mortality in follow-up, with adjusting for a list of clinical characteristics and geriatric syndromes.

FINDINGS

Among 101 patients with HF, 44 (42.8%) were female. Mean age was 75.8 ± 7.6 and frailty prevalence was 63.4% according to SMFFS. SMFFS showed a strong correlation with the other frailty scales. In a median follow-up of 759 days, cardiomegaly, increased pulmonary artery pressure (PAP) and frailty defined by SMFFS were the only predictors of mortality in older adults with HF after adjustments for age, falls in the previous year, undernutrition, probable sarcopenia, functional impairments, and quality of life [HR (95% CI) were 3.88 (1.05-14.3), 1.05 (1.01-1.09), and 10.96 (1.07-112.05) (p = 0.027); for older age, PAP, and frailty, respectively].

CONCLUSIONS

As a self-reported screening tool, SMFFS was independently associated with mortality in a median follow-up of two years. Frailty assessment recommended by the guidelines for risk stratification in patients with HF seems to be more effectively integrated into routine HF practice with the use of the easy and practical SMFFS. Further large scale studies are needed to support the predictive validity of SMFFS in older patients with HF.