The Development of Multidimensional Frailty Over Seven Years A longitudinal study among Dutch community-dwelling older people using the Tilburg Frailty Indicator

Physical frailty in chilean older persons: The role of social relationships, multimorbidity, and mental health

AIMS

the objective of this study is to analyze the mediating role of loneliness, social isolation, and depressive symptoms in the relationship between multimorbidity and physical frailty among Chilean older adults living in the community, following the frailty model proposed by Gobbens.

METHODS

A total of 2132 older people were studied through a cross-sectional analysis of data from a population-based survey, using hierarchical linear regression and mediations with Hayes' method. Variables of Gobbens' model guided the data analysis.

RESULTS

Regression analysis revealed significant associations between physical frailty and age, education, self-perceived economic status, physical activity, social relationships, mental health, and multimorbidity. Mediation analysis confirmed that loneliness, social isolation, and depressive symptoms are partial mediators in the relationship between multimorbidity and frailty.

CONCLUSIONS

Multimorbidity contributes significantly to physical frailty. Loneliness and social isolation show weaker associations with frailty, whereas depressive symptoms have a more substantial mediating role. These results underscore the need to integrate these factors into frailty interventions for older people.

The relationships between dysphagia risk, frailty, and depression in older adults living in nursing homes

OBJECTIVES

To examine the relationships between the risk of dysphagia, frailty, and depression in older adults living in nursing homes.

METHODS

This correlational study was conducted with 205 older adults living in a nursing home in Istanbul, Turkey. Data were collected using the Turkish Eating Assessment Tool (T-EAT-10), the Edmonton Frailty Scale (EFS), and the Geriatric Depression Scale-Short Form (GDS-15).

RESULTS

The prevalence of risk of dysphagia was 21.5 %, the prevalence of frailty was 69.3 %, and the prevalence of depression was 63 %. The risk of dysphagia alone, frailty alone, and dysphagia risk along with gender were significant predictors of depression. The risk of dysphagia alone, depression alone, and dysphagia risk along with age were significant predictors of frailty.

CONCLUSIONS

As the risk of dysphagia increases, so do frailty and depression. Depression is higher in women. Increased frailty is associated with increased depression. As age increases, frailty also increases.

SANTANA Cohort: Study on Frailty in Institutionalised Older Adults and Its Relationship With Gordon's Functional Health Patterns

AIM

This study investigated whether Gordon's Functional Health Patterns (FHPs) can predict frailty in older adults residing in nursing homes over 5 years.

DESIGN

Prospective cohort study with participants from 10 nursing homes across five countries.

METHODS

Researchers assessed 1245 participants at baseline and 903 at follow-up (5 years) using standardised frailty measures and FHP assessments. Statistical analyses explored the relationships between FHPs and frailty.

RESULTS

FHPs, particularly those related to mobility, nutrition and social interaction, significantly predicted lower frailty risk at baseline. Furthermore, FHPs showed an increased ability to predict frailty over time, explaining a substantial portion of frailty variation at both baseline and follow-up. Analyses also revealed differences in how specific FHPs impacted frailty, suggesting the importance of individual functional variations.

CONCLUSION

This study suggests that Gordon's FHPs are a valuable tool for predicting frailty in older adults within institutional settings. Integrating FHPs into clinical practice can promote early frailty detection and intervention. Future research should explore how FHPs change over time and their impact on frailty in broader populations.

REPORTING METHOD

The study followed the CONSORT guideline for cohort studies to enhance the quality and transparency of reporting the results.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

Development and Validation of a Game for Older Adults on Lifestyles and Frailty

BACKGROUND

Games are a promising strategy for rehabilitating older adults. The effect of games on promoting healthy lifestyles and preventing frailty remains uncertain. This article aims to describe the process of development and validation of the game "Bem-me-quer para a saúde"® to promote the acquisition of healthy lifestyles and prevent frailty in over 65-year-olds.

METHODS

This study comprised three distinct phases, spanning from December 2023 to June 2024. The first phase comprised a thorough review of the scientific literature on the frailty and lifestyles of older adults, a second phase of game design, and a third phase of content and semantic validation conducted by specialized nurses and older adults.

RESULTS

After revising literature, this study utilized an e-Delphi with a panel of 14 specialist nurses who underwent two rounds of evaluation. The "Bem-me-quer para a saúde"® game includes a puzzle board with 54 pieces and 30 educational cards. In the final phase, we evaluated the game on a cohort of 50 older adults, highlighting its reflective, interactive, and educational aspects.

CONCLUSIONS

The game presented sufficient evidence of content validity and relevance to clinical practice. We should conduct additional research to evaluate its impact on lifestyle modification and frailty prevention.

Frailty Assessment and Its Impact on Loneliness among Older Adults Receiving Home-Based Healthcare during the COVID-19 Pandemic

The purpose of this study was to identify the effect of frailty on loneliness among older adults receiving home care, in correlation to their socioeconomic and homebound statuses. This cross-sectional study recruited 218 individuals aged ≥65 years receiving home-based health services from the "Help at Home" program in the Region of Evrytania, Greece through an open invitation from the municipality authorities from March to June 2022. The Tilburg Frailty Indicator (TFI) was used for the evaluation of frailty, the UCLA Loneliness Scale version 3 was used for loneliness, and social isolation was accessed through five questions (living alone, frequency of interaction with children, relatives, friends, and participation in social organizations). The mean age of the participants was 81.48 ± 9.06, 61.9% were female, 54.1% experienced high levels of loneliness (UCLA-3 mean 45.76 ± 11.10 [range 20-68]), and 46.3% of the participants were found to be socially isolated. Also, 58.3% of the individuals were identified as frail (TFI mean 5.95 ± 3.07) [TFI range 0-13], with 57.3% experiencing physical frailty, 43.6% experiencing psychological frailty, and 27.1% experiencing social frailty. An analysis of covariance (ANCOVA) using UCLA-3 as the dependent variable revealed that loneliness across all domains of TFI was significantly higher in participants with frailty (total frailty [Yes] 49.27 vs. [No] 40,87 p < 0.001) (physical frailty [Yes] = 48.99 vs. [No] = 41.42, p < 0.001, psychological: 48.60 vs. 43.57 p < 0.001, and social: 53.38 vs. 42.94 p < 0.001), particularly compared to non-frail individuals, even after adjusting for potential confounding effects (covariates: gender, age, marital status, family status, living status, educational level, annual income, chronic diseases, homebound status, and social isolation). Our findings indicate that frail older adults experienced higher levels of loneliness, suggesting that frailty and loneliness are independently associated among older adults who receive home-based healthcare.

Disease activity at baseline is an independent predictor of frailty at one year in pre-frail patients with rheumatoid arthritis; a multicenter retrospective observational study

OBJECTIVES

To investigate factors predicting frailty for one year in pre-frail patients with rheumatoid arthritis (RA).

METHOD

A total of 298 RA patients who were pre-frail in 2020 were evaluated in this structured, retrospective observational study. Of the 298 patients, 42 who were frail and 256 who were not in 2021 were assigned to the frailty and non-frailty groups, respectively. After comparing characteristics of both groups using univariate analysis, predictive factors of frailty were assessed by logistic regression analysis. The proportion of frail patients in 2021 by DAS28-ESR level in 2020 was examined by the Cochran-Armitage trend test and chi-squared test. After dividing pre-frail patients into those with DAS28-ESR ≥3.2 and DAS28-ESR <3.2 in 2020, one-year change in DAS28-ESR in the frailty and non-frailty groups for both subgroups were compared by the paired t-test.

RESULTS

The frailty group was older (mean: 71.0 vs. 65.4 years) and had a higher DAS28-ESR (mean: 3.22 vs. 2.70) than the non-frailty group. DAS28-ESR was identified as a predictive factor for frailty (OR: 1.49). Among patients with DAS28-ESR ≥3.2 in 2020, DAS28-ESR improved in the non-frailty group in 2021 (mean: 3.97 in 2020 vs. 3.13 in 2021) but did not in the frailty group (3.97 in 2020 vs. 3.81 in 2021). Among those with DAS28-ESR <3.2 in 2020, DAS28-ESR was unchanged in the non-frailty group in 2021 (2.15 in 2020 vs. 2.23 in 2021) but increased in the frailty group (2.53 in 2020 vs. 3.23 in 2021).

CONCLUSIONS

Disease activity at baseline is an independent predictor of frailty one year later in pre-frail patients with RA.

Translation and Validation of the Swedish Version of the Tilburg Frailty Indicator

The Tilburg Frailty Indicator (TFI) is a questionnaire with 15 questions designed for screening for frailty in community-dwelling older people. TFI has a multidimensional approach to frailty, including physical, psychological, and social dimensions. The aim of this study was to translate TFI into Swedish and study its psychometric properties in community-dwelling older people with multimorbidity. A cross-sectional study of individuals 75 years and older, with ≥3 diagnoses of the ICD-10 and ≥3 visits to the Emergency Department in the past 18 months. International guidelines for back-translation were followed. Psychometric properties of the TFI were examined by determining the reliability (inter-item correlations, internal consistency, test-retest) and validity (concurrent, construct, structural). A total of 315 participants (57.8% women) were included, and the mean age was 83.3 years. The reliability coefficient KR-20 was 0.69 for the total sum. A total of 39 individuals were re-tested, and the weighted kappa was 0.7. TFI correlated moderately with other frailty measures. The individual items correlated with alternative measures mostly as expected. In the confirmatory factor analysis (CFA), a three-factor model fitted the data better than a one-factor model. We found evidence for adequate reliability and validity of the Swedish TFI and potential for improvements.

Exploring the concept of psychological frailty in older adults: a systematic scoping review

OBJECTIVES

We reviewed the existing definitions of psychological frailty and provided a comprehensive overview of the concept and associated measurements.

STUDY DESIGN AND SETTING

We followed the PRISMA guidelines for scoping reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. The eligibility criteria for including studies were developed based on the participants-concept-context framework. We searched the Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, Web of Science and PsycINFO databases, and other sources for relevant studies published between January 2003 and March 2022.

RESULTS

The final scoping review included 58 studies. Of these, 40 defined psychological frailty, seven provided a novel definition, and 11 focused on the components defining psychological frailty. We proposed four groups of components to better characterize psychological frailty: mood, cognitive, other mental health, and fatigue-related problems. We identified 28 measuring tools across studies, and the Tilburg Frailty Indicator was the most frequently used (46.6%).

CONCLUSION

Psychological frailty is a complex concept whose definition seems to lack consensus. It could include both psychological and physical features. Depression and anxiety are commonly used to define it. This scoping review outlined future research directions for refining the concept of psychological frailty.

Use of the Tilburg frailty indicator in longitudinal studies with older adults: A scoping review

AIM

To understand how researchers applied the Tilburg Frailty Indicator (TFI) to older adults. The use of the TFI was examined based on the Integral Conceptual Model of Frailty (ICMF).

DESIGN

A scoping review.

DATA SOURCES

A database search was conducted without a time limit in PubMed, CINAHL, Embase and the Cochrane library. A hand search was also conducted.

REVIEW METHODS

Research questions were developed based on the population-concept-context framework suggested by the Joanna Briggs Institute (2017). Studies were included if topics were related to the use of the TFI or ICMF and designs were longitudinal studies.

RESULTS

A total of 37 studies met the inclusion criteria. Studies were reviewed according to the tested pathways of the ICMF: determinants of frailty or adverse outcomes, adverse outcomes of frailty and comparison of predictive power between frailty measures.

CONCLUSION

The TFI is a useful tool to screen for frailty and predict health outcomes in older adults. Among the pathways of the ICMF, relationships between social factors and frailty were reported in several studies. Despite this relationship, social factors were considered as items to assess the social domain of frailty rather than determinants of frailty. The predictive power of the TFI was not superior to other frailty measures, but it had a high sensitivity.

IMPACT

This study demonstrates the usability of the TFI in older adults living in various conditions. Further studies are required to identify more effective ways to screen frailty using the TFI.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement in this study.

Bayesian Techniques in Predicting Frailty among Community-Dwelling Older Adults in the Netherlands

Background Frailty is a syndrome that is defined as an accumulation of deficits in physical, psychological, and social domains. On a global scale, there is an urgent need to create frailty-ready healthcare systems due to the healthcare burden that frailty confers on systems and the increased risk of falls, healthcare utilization, disability, and premature mortality. Several studies have been conducted to develop prediction models for predicting frailty. Most studies used logistic regression as a technique to develop a prediction model. One area that has experienced significant growth is the application of Bayesian techniques, partly due to an increasing number of practitioners valuing the Bayesian paradigm as matching that of scientific discovery. Objective We compared ten different Bayesian networks as proposed by ten experts in the field of frail elderly people to predict frailty with a choice from ten dichotomized determinants for frailty. Methods We used the opinion of ten experts who could indicate, using an empty Bayesian network graph, the important predictors for frailty and the interactions between the different predictors. The candidate predictors were age, sex, marital status, ethnicity, education, income, lifestyle, multimorbidity, life events, and home living environment. The ten Bayesian network models were evaluated in terms of their ability to predict frailty. For the evaluation, we used the data of 479 participants that filled in the Tilburg Frailty indicator (TFI) questionnaire for assessing frailty among community-dwelling older people. The data set contained the aforementioned variables and the outcome "frail". The model fit of each model was measured using the Akaike information criterion (AIC) and the predictive performance of the models was measured using the area under the curve (AUC) of the receiver operator characteristic (ROC). The AUCs of the models were validated using bootstrapping with 100 repetitions. The relative importance of the predictors in the models was calculated using the permutation feature importance algorithm (PFI). Results The ten Bayesian networks of the ten experts differed considerably regarding the predictors and the connections between the predictors and the outcome. However, all ten networks had corrected AUCs >0.700. Evaluating the importance of the predictors in each model, "diseases or chronic disorders" was the most important predictor in all models (10 times). The predictors "lifestyle" and "monthly income" were also often present in the models (both 6 times). One or more diseases or chronic disorders, an unhealthy lifestyle, and a monthly income below 1800 euro increased the likelihood of frailty. Conclusions Although the ten experts all made different graphs, the predictive performance was always satisfying (AUCs >0.700). While it is true that the predictor importance varied all the time, the top three of the predictor importance consisted of "diseases or chronic disorders", "lifestyle" and "monthly income". All in all, asking for the opinion of experts in the field of frail elderly to predict frailty with Bayesian networks may be more rewarding than a data-driven forecast with Bayesian networks because they have expert knowledge regarding interactions between the different predictors.

Progression of frailty as measured by a cumulative deficit index: A systematic review

BACKGROUND

Frailty is a risk factor for adverse health outcomes. There is a paucity of literature on frailty progression defined by a cumulative deficit model among community dwelling older people. The objective of this review was to synthesise evidence on these changes in health and mortality among community-dwelling older people.

METHODS

Six databases (Medline, Embase, CINAHL, Cochrane, PsycInfo, Web of Science) and a clinical trials registry were searched in July 2021. The inclusion criteria were studies using a frailty index and providing information on transition between frailty states or to death in community-dwelling older people aged ≥ 50. Exclusion criteria were studies examining specific health conditions, conference abstracts and non-English studies. To standardise the follow-up period and facilitate comparison, we converted the transition probabilities to annual transition rates.

RESULTS

Two reviewers independently screened 5078 studies and 61 studies were included for analysis. Of these, only three used the same frailty state cut-points to facilitate cross-cohort comparison. This review found that frailty tends to increase with time, people who are frail at baseline have greater likelihood to progress in frailty and die, and the main factor that accelerates frailty progression is age. Other risk factors for progression are having chronic disease, smoking, obesity, low-income or/and low-education levels. A frailty index is an accurate predictor of adverse outcomes and death.

DISCUSSION

This systematic review demonstrated that worsening in frailty was a common frailty transition, and older people who are frail at baseline are more likely to die. A frailty index has significant power to predict adverse health outcomes. It is a useful tool for within-cohort comparison but there are challenges comparing different cohorts due to dependence of frailty progression on age and differences in how frailty index is defined and measured.

Oral Health and Frailty in Community-Dwelling Older Adults in the Northern Netherlands: A Cross-Sectional Study

The aim of this study was to explore the association between oral health and frailty in community-dwelling Dutch adults aged 55 years and older. Included were 170 participants (n = 95 female [56%]; median age 64 years [IQR: 59−69 years]). Frailty was assessed by the Groningen Frailty Indicator. Oral health was assessed by the Oral Health Impact Profile-14-NL (OHIP-NL14). OHIP-NL14 item scores were analyzed for differences between frail and non-frail participants. Univariate and multivariate logistic regression analyses were performed to assess the association between oral health and presence of frailty. The multivariate analysis included age, gender, and depressive symptoms as co-variables. After adjustment, 1 point increase on the OHIP-NL14 scale was associated with 21% higher odds of being frail (p = 0.000). In addition, significantly more frail participants reported presence of problems on each OHIP-NL14 item, compared to non-frail participants (p < 0.003). Contrast in prevalence of different oral health problems between frail and non-frail was most prominent in ‘younger’ older adults aged 55−64 years. In conclusion: decreased oral health was associated with frailty in older adults aged ≥55 years. Since oral health problems are not included in most frailty assessments, tackling oral health problems may not be sufficiently emphasized in frailty policies.

FRAGILIDADE EM PESSOAS IDOSAS RESIDENTES NO DOMICÍLIO INSCRITAS NUMA UNIDADE DE SAÚDE DO NORTE DE PORTUGAL

Introdução: Com o aumento da longevidade e declínio da função física, psicológica e social dos idosos é essencial perceber as condições sociodemográficas e de saúde que concorrem para a fragilidade. Objetivos: Analisar o perfil de fragilidade dos idosos de uma unidade de saúde do norte de Portugal. Metodologia: Estudo descritivo, transversal com 173 idosos a residir no domicílio e inscritos numa Unidade de Saúde. Como instrumento de recolha de dados usou-se um inquérito, realizado por telefone, contendo dados sociodemográficos, de saúde e o Índice de fragilidade de Tilburg (TFI). Resultados: Amostra predominantemente feminina com idade média de 81,11 anos, maioritariamente casados, com diversas comorbilidades e polimedicados. A representação da fragilidade foi de 60,7%, estando essa condição significativamente associada ao género, estado civil, número de doenças crónicas, polimedicação e autoperceção da saúde. Para a maioria dos idosos (83,8%), a condição de fragilidade é influenciada cumulativamente pelas dimensões físicas, psicológicas e sociais. Conclusão: A fragilidade é uma condição prevalente e o perfil está associado a um conjunto de caraterísticas nas quais é possível intervir retardando a progressão da fragilidade que ocorre com o envelhecimento.