Frailty and Chronic Diseases in Older Adults

Phosphatidylcholine and frailty: a Mendelian randomization study and immune mediation

OBJECTIVE

Lipid metabolism plays a significant role in the aging process, and the prevalence of frailty increases with advancing age. However, few studies have employed Mendelian randomization (MR) to investigate the associations between lipids and frailty.

METHODS

This study utilized large-scale genome-wide association study (GWAS) and a bidirectional two-sample, two-step MR approach to explore the causal associations of 179 lipid species with the frailty index (FI) and the mediating effects of immune cells. The inverse variance weighted (IVW) method was used primarily to evaluate the MR results. Heterogeneity and horizontal pleiotropy were assessed via Cochran's Q, the MR-Egger intercept, MR-PRESSO and leave-one-out analysis. Phenome-wide MR (Phe-MR) was used to analyse the potential roles of frailty-related phosphatidylcholine species in diseases.

RESULTS

MR analysis revealed a causal relationship between PC species and FI. Specifically, PC (18:0_20:5), LPC (18:0_0:0), LPC (16:0_0:0), and ether-PC (O-16:0_22:5) are positively correlated with the FI, whereas PC(18:1_20:2), PC(16:0_18:3), PC(16:0_20:1), ether-PC (O-18:0_16:1), and ether-PC (O-16:1_16:0) are negatively correlated with the FI. Reverse MR analysis indicated no strong association between the FI and the nine PCs. Mediation analysis revealed that Sw mem %lymphocyte partially mediated the effect of LPC (18:0_0:0) on FI. Phe-MR analysis revealed that nine frailty-related PCs were broadly associated with various diseases.

CONCLUSION

This study provides novel evidence that supports the causal association between PC species and frailty, with the immune system playing a crucial role in this pathway. These findings offer new insights into potential targets for the intervention of frailty in the elderly population.

Frailty and pre-frailty prevalence in community-dwelling elderly with multimorbidity: A systematic review and meta-analysis

BACKGROUND

The relationship between frailty/pre-frailty, and multimorbidity in the elderly is recognized, but specific prevalence among community-dwelling elderly with multimorbidity is unclear. This study aims to determine these rates, analyze subgroup, and identify sources of heterogeneity to bolster evidence-based interventions and health policies.

METHODS

We searched nine databases from inception to November 16, 2023, for cross-sectional and cohort studies on community-dwelling elderly with multimorbidity. Data were extracted to calculate the prevalence of frailty and pre-frailty. Study quality was assessed using AHRQ and NOS tools.

RESULTS

Fifteen studies encompassing 9,683 participants with multimorbidity were analyzed. The pooled prevalence of frailty and pre-frailty was 18.1 % and 48.9 %, respectively. Age-stratified analyses found 17 % frailty and 58.4 % pre-frailty in the 70-74 age group, and 16.7 % and 54.2 % in those above 75 years. Cross-sectional studies showed 18.8 % frailty and 48.1 % pre-frailty, while cohort studies showed 18.1 % and 50.5 %, respectively. Asia had higher rates (22.7 % frailty, 43.5 % pre-frailty) than the Americas (9.9 % frailty, 56.3 % pre-frailty). By sample size, frailty prevalence was 21.3 % (<500), 9.1 % (500-999), and 17.9 % (≥1000), with pre-frailty at 51.1 %, 45.6 %, and 47.7 %. The FP method yielded higher prevalence estimates (17.7 % frailty, 51.6 % pre-frailty) than the FS method (9.5 % frailty, 39.2 % pre-frailty).

CONCLUSION

This study provides insights into the prevalence of frailty and pre-frailty among community-dwelling elderly with multimorbidity. Variations in prevalence rates may be attributed to differences in sample size and measurement tools, which also contribute to heterogeneity observed across subgroups.

Development and validation of a risk prediction model for frailty in older nappers

BACKGROUND

Frailty among older adults has received widespread attention from society, especially among nappers. The objective of this study was to develop a frailty prediction model for nappers.

METHODS

The data source was the China Health and Retirement Longitudinal Study, with a cohort of 1830 older nappers. We used the least absolute shrinkage and selection operator to screen the best predictors from multiple factors, logistic regression analysis to explore the best predictors of frailty in older nappers, and nomogram to establish a prediction model. A calibration curve was used to evaluate the precision of the model, and the predictive performance was assessed by analyzing the area under the characteristic and decision curves.

RESULTS

The prevalence of frailty among older nappers was 28.9 % (528/1830). Chronic diseases, physical activity, sleep quality, pain, fatigue, depression, nap duration, and nighttime sleep duration were the best predictive factors for frailty in older nappers. The area under the curve (AUC) in the training set was 0.751 (95 % confidence interval [CI] = 0.724-0.779) with a specificity of 0.662 and sensitivity of 0.711. The AUC in the validation set was 0.781 (95 % CI = 0.749-0.812) with a specificity of 0.730 and sensitivity of 0.714. The Hosmer-Lemeshow test values were both p > 0.05. The nomogram model showed good concordance and accuracy.

CONCLUSION

We constructed a nomogram that serves as a valuable and convenient instrument for assessing the prevalence of frailty among older nappers.

Extreme Hot Weather Events and Risk of Hospitalization for Cardiovascular and Respiratory Diseases in Older People in Hong Kong in 2012-2018

BACKGROUND

The older population is more vulnerable to the impact of extreme hot weather events (EHWEs), although the impact on the frailer institutionalized older population was seldom assessed. Our objective was to assess the relationship between EHWEs and hospitalization risks among institutionalized and community-dwelling older people.

METHODS

We used territory-wide hospitalization records of Hong Kong from the year 2012 to 2018 to assess the associations between EHWEs and cardiovascular and respiratory disease hospitalizations in the population aged 65 or above. A very hot day (VHD) was defined as the daily maximum temperature ≥33 °C, and a hot night (HN) was defined as the daily minimum temperature ≥28 °C. We assessed whether prolonged exposure to high temperatures (defined as 3 consecutive VHDs (3VHD) or HNs (3HN)) was related to a higher risk of hospitalization over a lag period of 0-21 days. Time-stratified case-crossover design was used. Analyses were stratified by old age home (OAH) residence status.

RESULTS

Exposure to 3VHDs was related to a higher risk of cardiovascular disease admissions for community-dwelling older people [relative risk (RR): 1.09; 95% confidence interval (95%CI): 1.03-1.14 (lagged 4 days, ie, delayed manifestation up to 4 days)], whereas for OAH residents, the association could have a lag of 18 days (RR: 1.28; 95%CI: 1.05-1.54). For respiratory disease admissions, such relatively long-delayed relationship was not clearly observed.

CONCLUSIONS

The warming climate could increase healthcare demand in the long run. Frailer patients could present with a generally more marked and delayed onset of cardiovascular disease aggravation than the community-dwelling population.

Pre-injury frailty and clinical care trajectory of older adults with trauma injuries: A retrospective cohort analysis of A large level I US trauma center

BACKGROUND

Pre-injury frailty among older adults with trauma injuries is a predictor of increased morbidity and mortality.

OBJECTIVES

We sought to determine the relationship between frailty status and the care trajectories of older adult patients who underwent frailty screening in the emergency department (ED).

METHODS

Using a retrospective cohort design, we pooled trauma data from a single institutional trauma database from August 2020 to June 2023. We limited the data to adults 65 years and older, who had trauma injuries and frailty screening at ED presentation (N = 2,862). The predictor variable was frailty status, measured as either robust (score 0), pre-frail (score 1-2), or frail (score 3-5) using the FRAIL index. The outcome variables were measures of clinical care trajectory: trauma team activation, inpatient admission, ED discharge, length of hospital stay, in-hospital death, home discharge, and discharge to rehabilitation. We controlled for age, sex, race/ethnicity, health insurance type, body mass index, Charlson Comorbidity Index, injury type and severity, and Glasgow Coma Scale score. We performed multivariable logistic and quantile regressions to measure the influence of frailty on post-trauma care trajectories.

RESULTS

The mean (SD) age of the study population was 80 (8.9) years, and the population was predominantly female (64%) and non-Hispanic White (60%). Compared to those classified as robust, those categorized as frail had 2.5 (95% CI: 1.86-3.23), 3.1 (95% CI: 2.28-4.12), and 0.3 (95% CI: 0.23-0.42) times the adjusted odds of trauma team activation, inpatient admission, and ED discharge, respectively. Also, those classified as frail had significantly longer lengths of hospital stay as well as 3.7 (1.07-12.62), 0.4 (0.28-0.47), and 2.2 (95% CI: 1.71-2.91) times the odds of in-hospital death, home discharge, and discharge to rehabilitation, respectively.

CONCLUSION

Pre-injury frailty is a predictor of clinical care trajectories for older adults with trauma injuries.

Association between frailty and adverse outcomes after cardiac resynchronization therapy: a systematic review and meta-analysis

AIM

To synthesize evidence, using data from published studies, on the association of frailty with the outcomes after cardiac resynchronization therapy (CRT).

METHODS

The systematic search of PubMed, Web of Science, Scopus, and Embase databases was done to identify observational studies (cohort/case-control/cross-sectional) that used an objective method for frailty assessment and had presented adjusted effect sizes. STATA version 15.0 was used to conduct analysis, which was based on random effects model.

RESULTS

Fifteen studies were included. Frailty was found to be associated with an increased risk of in-hospital mortality (odds ratio (OR) 6.96, 95% confidence interval (CI) 5.48, 8.85). The effect of frailty on the response to CRT was not statistically significant (OR 0.55, 95% CI 0.19, 1.59). The pooled effect size indicated that frailty was associated with somewhat bigger but not statistically significant increase in the risk of complications (OR 1.70, 95% CI 0.93, 3.12). The risks of mortality and decompensated heart failure on long-term follow up were higher in frail patients (Hazard ratio (HR) 1.75, 95% CI 1.40, 2.17 and HR 3.03, 95% CI 1.33, 6.90, respectively) compared to patients without frailty. The risk of readmission was higher in frail patients, however, it did not achieve statistical significance (HR 2.63, 95% CI 0.89, 7.75).

CONCLUSION

Frail CRT patients could be at higher risks of mortality, decompensated heart failure, and may have potentially higher rates of complications. Integrating frailty assessment into pre-CRT evaluation and customizing interventions for frail patients might be an essential steps towards enhancing outcomes in this population.

The relationship between nonalcoholic fatty liver disease and frailty: A systematic review and meta-analysis

BACKGROUND AND AIM

Frailty is frequently observed in end-stage liver disease of various etiologies, but its role in nonalcoholic fatty liver disease (NAFLD) remains incompletely understood. We aimed to conduct a systematic review and meta-analysis to assess the association and prevalence of frailty in NAFLD.

METHODS

A systematic review of PubMed/MEDLINE, EMBASE, Web of Science, and Scopus was performed. The random-effects model was used to estimate the pooled prevalence of frailty. Meta-analyzed odds ratios (OR) were calculated to examine the association between frailty and NAFLD.

RESULTS

Among the initial 430 articles identified, 18 studies were included. Three studies involving 3673 participants had a pooled OR of 2.03 (95% CI: 1.51-2.72; Iˆ2 = 1.1%; p < 0.0001) for the association between frailty and NAFLD. The pooled prevalence of frailty in individuals with NAFLD was 23% (95% CI: 13%-38%; Iˆ2 = 93.5%) using the liver frailty index (LFI) and 8% (95% CI: 3%-21%; Iˆ2 = 98.1%) using the Fried frailty index (FFI). NAFLD patients' mean grip strength and balance time were 26.4 kg (95% CI: 23.0-29.8) and 23s (95% CI: 10-35), respectively. Among studies that also included individuals with liver cirrhosis, grip strength was lower in those with cirrhosis vs. the broader population of those with NAFLD.

CONCLUSIONS

Our study suggests that frailty is highly prevalent in individuals with NAFLD, with a significantly higher prevalence compared to those without NAFLD. Individuals with NAFLD have more than two-fold increased odds of frailty. Assessing frailty in NAFLD patients enables targeted management to improve outcomes.

A review of effects of electromagnetic fields on ageing and ageing dependent bioeffects of electromagnetic fields

Thanks to the progress of science and technology, human life expectancy has dramatically increased in the past few decades, but accompanied by rapid ageing of population, resulting in increased burden on society. At the same time, the living environment, especially the electromagnetic environment, has also greatly changed due to science and technology advances. The effect of artificial electromagnetic fields (EMFs) emitted from power lines, mobile phones, wireless equipment, and other devices on ageing and ageing-related diseases are receiving increasing attention. However, the information on the relationship between EMFs and ageing and ageing related susceptibility to EMFs is fragmentary, a review is needed. Only few studies directly investigate the effect of EMFs on ageing, and we reviewed the impact of EMFs on lifespan and cellular senescence to pry whether EMFs have an effect on ageing, and reviewed the age-dependent bioeffects and health impacts of EMFs to see whether ageing would affect biological susceptibility to EMFs. The results indicated that EMFs may have an effect on longevity and cellular senescence, but the results were inconsistent which may depend on EMF types (frequency, intensity, wave shape, etc.), species, and cell lines. Ageing has an impact on the biological or health effects of EMFs; however, the results differ depending on the EMF type and the endpoint or health outcome. Age-dependent changes in free radical metabolism, ion homeostasis, gene expression, enzyme activity, and tissue biophysical properties may be the reason; however, the underlying mechanisms are not fully elucidated.

Frailty as a predictor of mortality in the oldest old: A systematic review and meta-analysis

AIM

Frailty is highly prevalent in old age and is associated with a high risk of mortality. Few studies have evaluated frailty as a predictor of mortality in the oldest old. This systematic review and meta-analysis aims to determine the mortality risk associated with frailty in this age group.

METHODS

An electronic systemic literature search was performed in May 2023 on three databases (Medline/PubMed, Embase, and Cochrane Library) for studies investigating the risk of mortality with frailty. A meta-analysis was done to calculate pooled mortality estimates.

RESULTS

Frail participants had significantly lower overall survival (OS) compared with non-frail participants (hazard ratio [HR]: 1.81; 95% confidence interval [CI]: 1.32 to 2.50; P < 0.01, I2 = 100%; risk ratio [RR]: 4.15; 95% CI: 2.50 to 6.88; P < 0.01, I2 = 97%). Among participants aged 90 and above, a higher percentage of male participants was associated with poorer OS in frail participants. While the pooled association of frailty with OS remained significant across studies in participants aged less than 90 years old (HR: 2.09; 95% CI: 1.55 to 2.82; I2 = 75%), frailty was not significantly associated with OS in studies for participants aged 90 and above. The pooled association of frailty with OS was only significant for the Fried Frailty Phenotype (HR: 2.73; 95% CI: 1.05 to 7.12; I2 = 93%) and not for the Frailty Index. The pooled association also remained significant among studies that adjusted for age (HR: 1.74; 95% CI: 1.50 to 2.02; I2 = 0%) and sex (HR: 1.77; 95% CI: 1.48 to 2.11; I2 = 94%) as a covariate.

CONCLUSIONS

Frailty was significantly associated with a poorer OS in participants below the age of 90. This association was not statistically significant in those older than 90 years, with sex-differentiated effects observed. Geriatr Gerontol Int 2025; 25: 102-107.

Genetic insights into the causal linkage between systemic inflammatory regulators and frailty

OBJECTIVES

Previous studies have suggested the associations between systemic inflammation and the risk of frailty, but causal relationships between them remain not well established. We conducted a bi-directional Mendelian randomization (MR) analysis to investigate the causal links between systemic inflammatory regulators and frailty.

METHODS

Genetic variants associated with systemic inflammatory regulators were obtained from a comprehensive genetic study on 41 circulating cytokines, such as interleukin-4 (IL-4), eotaxin, and macrophage inflammatory protein-1β (MIP1β). We integrated summary-level data on frailty from two independent genetic studies on frailty index (FI) and Fried frailty score (FFS). The inverse-variance weighted method was used to assess the causal estimate. Sensitivity and heterogeneity analysis was performed to evaluate the stability of the estimates. The false discovery rate (FDR) method was used for P value adjustment of multiple comparisons.

RESULTS

Genetically elevated levels of MIP1β and decreased levels of eotaxin were suggestively associated with increased FI (MIP1β: β = 0.016, Praw = 0.006, PFDR = 0.083; eotaxin: β = -0.030, Praw = 0.007, PFDR = 0.083) and FFS (MIP1β: β = 0.008, Praw = 0.027, PFDR = 0.247; eotaxin: β = -0.015, Praw = 0.014, PFDR = 0.247). In contrast, genetically predicted FI was suggestively associated with decreased levels of IL-4 (β = -0.395, Praw = 0.040, PFDR = 0.638) and platelet-derived growth factor BB (PDGF-BB, β = -0.385, Praw = 0.047, PFDR = 0.638) and increased levels of stem cell factor (SCF, β = 0.527, Praw = 0.005, PFDR = 0.204). Similar results were obtained from different sensitivity analysis.

CONCLUSIONS

The present study demonstrates that increased MIP-1β levels and decreased eotaxin levels might lead to a higher risk of frailty, whereas frailty might reduce the levels of IL-4 and PDGF-BB and increase the levels of SCF.

Is Cancer Associated With Frailty? Results From a Longitudinal Study of Old Danish Twins

BACKGROUND

Although age is an important risk factor for both cancer and frailty, it is unclear whether cancer itself increases the risk of frailty. We aimed to assess the association between cancer and frailty in a longitudinal cohort of older Danish twins, taking familial effect into account.

METHODS

Using the Danish Cancer Registry, cancer cases were identified among participants aged 70 and over in the Longitudinal Study of Aging Danish Twins (LSADT). Frailty was evaluated over 10 years of follow-up using the frailty index (FI) and defined as FI > 0.21. Stratified Cox regressions were performed on discordant twin pairs (pairs where one twin had incident cancer and the other was cancer-free) and on all LSADT individual twins (twin pairs and singletons) with no history of cancer.

RESULTS

Among the 72 discordant pairs (n = 144, median age at inclusion = 75) included in the study, the median FI at inclusion was 0.08 for both cancer twins and cancer-free co-twins. From the stratified Cox regression, twins with cancer had an increased hazard of developing frailty (hazard ratio [HR] = 3.67, 95% confidence interval [CI] = 1.02-13.14) compared with their cancer-free co-twins. The analyses on individual twins (n = 4 027) provided similar results, showing an increased hazard of frailty in individuals with cancer (HR = 2.57, 95% CI = 1.77-3.74) compared with those without cancer.

CONCLUSIONS

We showed a higher risk of becoming frail following a cancer diagnosis in both discordant twin pairs and individual twins. These findings support the importance of monitoring frailty in older adults with cancer through geriatric assessments and the implementation of frailty interventions.

Patient- and Areal-Level Risk Factors Associated With Lung Cancer Mortality in Victoria, Australia: A Bayesian Spatial Survival Analysis

BACKGROUND

In Australia, lung cancer is the leading cause of cancer-related deaths. In Victoria, the mortality risk is assumed to vary across Local Government Areas (LGAs) due to variations in socioeconomic advantage, remoteness, and healthcare accessibility. Thus, we applied Bayesian spatial survival models to examine the geographic variation in lung cancer survival in Victoria.

METHODS

Data on lung cancer cases were extracted from the Victorian Lung Cancer Registry (VLCR). To account for spatial dependence and risk factors of survival in lung cancer patients, we employed a Bayesian spatial survival model. Conditional Autoregressive (CAR) prior was assigned to model the spatial dependence. Deviance Information Criterion (DIC), Watanabe Akaike Information Criterion (WAIC), and Log Pseudo Marginal Likelihood (LPML) were used for model comparison. In the final best-fitted model, the Adjusted Hazard Ratio (AHR) with the 95% Credible Interval (CrI) was reported. The outcome variable was the survival status of lung cancer patients, defined as whether they survived or died during the follow-up period (death was our interest).

RESULTS

Our study revealed substantial variations in lung cancer mortality in Victoria. Poor Eastern Cooperative Oncology Group (ECOG) performance status, diagnosed at a regional hospital, Small Cell Lung Cancer (SCLC), advanced age, and advanced clinical stage were associated with a higher risk of mortality, whereas being female, presented at Multidisciplinary Team (MDT) meeting, and diagnosed at a metropolitan private hospital were significantly associated with a lower risk of mortality.

CONCLUSION

Identifying geographical disparities in lung cancer survival may help shape healthcare policy to implement more targeted and effective lung cancer care services.

A predictive nomogram among hypertension old population from the community: A cross-sectional study

BACKGROUND

Frailty presents a significant challenge for aging adults, with a multitude of factors needing consideration. Despite this, there is a lack of research on predicting frailty in the old population with hypertension.

AIM

This study aims to create and validate a nomogram model for the old population with hypertension, to predict frailty and gain valuable insights into its prevalence and determinants.

METHOD

Data for this study were extracted from the "Psychology and Behavior Investigation of Chinese Residents (PBICR) in 2022 (PBICR-2022)", with information on frailty and related factors obtained through self-reported questionnaires. Frailty was assessed using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale. The independent variables encompassed sociodemographic, physiological, psychological, and family health factors. A total of 1135 participants aged over 60 with hypertension were included in the study. Univariate and stepwise binary logistic regression analyses were conducted to identify the relationship between frailty and multiple risk factors and to establish the frailty risk prediction nomogram.

RESULTS

The prevalence of social frailty was found to be 30.91%. The final model included the degree of hypertension, history of falling in the past 3 months, Brief Illness Perception Questionnaire score, depression levels, and Family Health Scale score. The model exhibited good accuracy in the testing set, with an area under the ROC curve of 0.984 (95% CI: 0.978, 0.990).

CONCLUSION

These findings suggest that the prediction model effectively estimated the prevalence of frailty in the older population with hypertension from community and identified associated factors. The model demonstrated good performance and holds potential for further study on the management of frailty.

Frailty and chronic diseases: A bi-directional relationship

Frailty is a multidimensional syndrome associated with a decline in reserve capacity across multiple organ systems involving physical, psychological, and social aspects. Weakness is the earliest indicator of the frailty process. Multi-morbidity is the state of presence of two or more chronic diseases. Frailty and chronic diseases are interlinked as frail individuals are more prone to develop chronic diseases and multi-morbid individuals may present with frailty. They share common risk factors, pathogenesis, progression, and outcomes. Significant risk factors include obesity, smoking, aging, sedentary, and stressful lifestyle. Pathophysiological mechanisms involve high levels of circulating inflammatory cytokines as seen in individuals with frailty and chronic diseases such as hypertension, cardiovascular diseases, type 2 diabetes mellitus, chronic kidney disease, and anemia. Hence, frailty and chronic diseases go hand in hand and it is of utmost importance to identify them and intervene during early stages. Screening frailty and treating multi-morbidity incorporate both pharmacological and majorly non- pharmacological measures, such as physical activities, nutrition, pro-active care, minimizing polypharmacy and addressing reversible medical conditions. The purpose of this mini-review is to highlight the interrelation of frailty and chronic diseases through the discussion of their predictors and outcomes and how timely interventions are essential to prevent the progression of one to the other.

Impact of frailty on postoperative outcomes after hepatectomy: A systematic review and meta-analysis

BACKGROUND

The impact of frailty on postoperative outcomes in patients undergoing hepatectomy is still unclear.

AIM

To study the influence of frailty on postoperative outcomes, such as mortality, rate of complications, and length of hospitalization, following hepatectomy.

METHODS

PubMed, EMBASE, and Scopus databases were searched for observational studies with adult (≥ 18 years) patients after planned/elective hepatectomy. A random-effects model was used for all analyses, and the results are expressed as weighted mean difference (WMD), relative risk (RR), or hazards ratio (HR) with 95% confidence interval (CI).

RESULTS

Analysis of the 13 included studies showed a significant association of frailty with elevated risk of in-hospital mortality (RR = 2.76, 95%CI: 2.10-3.64), mortality at 30 d (RR = 4.60, 95%CI: 1.85-11.40), and mortality at 90 d (RR = 2.52, 95%CI: 1.70-3.75) in the postoperative period. Frail patients had a poorer long-term survival (HR = 2.89, 95%CI: 1.84-4.53) and higher incidence of "any" complications (RR = 1.69, 95%CI: 1.40-2.03) and major (grade III or higher on the Clavien-Dindo scale) complications (RR = 2.69, 95%CI: 1.85-3.92). Frailty was correlated with markedly lengthier hospital stay (WMD = 3.65, 95%CI: 1.45-5.85).

CONCLUSION

Frailty correlates with elevated risks of mortality, complications, and prolonged hospitalization, which need to be considered in surgical management. Further research is essential to formulate strategies for improved outcomes in this vulnerable cohort.

Development and validation of a risk prediction model for physical frailty in older adults who are disabled

Physical frailty is highly prevalent among the older adults who are disabled. The aim of this study was to explore the risk factors for physical frailty in older adults who are disabled and construct a nomogram prediction model. The data source was the China Health and Retirement Longitudinal Study (CHARLS). The prediction model was validated with a cohort of 1183 older adults who are disabled. The results showed that sleep quality, depression, fatigue, and chronic disease were the best predictive factors. These factors were used to construct the nomogram model, which showed good concordance and accuracy. The prediction model yielded an Area under the curve (AUC) value of 0.760. Calibration curves showed significant agreement between the nomogram model and actual observations. Receiver operating characteristic (ROC) and Decision curve analysis (DCA) showed that the nomogram had good predictive performance. The nomogram is contributed to the screening of specific populations by clinicians.

What patient-reported outcome measures may be suitable for research involving older adults with frailty? A scoping review

INTRODUCTION

The need to develop and evaluate frailty-related interventions is increasingly important, and inclusion of patient-reported outcomes is vital. Patient-reported outcomes can be defined as measures of health, quality of life or functional status reported directly by patients with no clinician interpretation. Numerous validated questionnaires can thus be considered patient-reported outcome measures (PROMs). This review aimed to identify existing PROMs currently used in quantitative research that may be suitable for older people with frailty.

METHOD

PubMed and Cochrane were searched up to 24/11/22. Inclusion criteria were quantitative studies, use of a PROM, and either measurement of frailty or inclusion of older adult participants. Criteria were created to distinguish PROMs from questionnaire-based clinical assessments. 197 papers were screened. PROMs were categorized according to the domain assessed, as derived from a published consensus 'Standard Set of Health Outcome Measures for Older People'.

RESULTS

88 studies were included. 112 unique PROMs were used 289 times, most frequently the SF-36 (n = 21), EQ-5D (n = 21) and Barthel Index (n = 14). The most frequently assessed outcome domains included Mood and Emotional Health and Activities of Daily Living, with fewer assessments of Participation in Decision-Making and Carer Burden.

CONCLUSIONS

PROM usage in frailty research is highly heterogeneous. Frequently used PROMs omit important outcomes identified by older adults. Further research should evaluate the importance of specific outcomes and identify PROMs relevant to people at different stages of frailty. Consistent and appropriate PROM use in frailty research would facilitate more effective comparisons and meaningful evaluation of frailty interventions.

Epilepsy surgery in adults older than 50 years: A systematic review and meta-analysis

OBJECTIVE

Despite the general safety and efficacy of epilepsy surgery, there is evidence that epilepsy surgery remains underutilized. Although there are an increasing number of studies reporting epilepsy surgery in older adults, there is no consensus on whether epilepsy surgery is efficacious or safe for this population. Our objective was to systematically assess the efficacy as well as safety of resective surgery in people aged 50 years or older with drug-resistant epilepsy.

METHODS

We considered studies that examine the efficacy and safety of epilepsy surgery in adults aged 50 years and older. Study eligibility was limited to studies carried out after 1990, with a minimum of 10 participants and 6 months of follow-up. We searched the following databases for published studies: Ovid MEDLINE, Ovid Embase, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, and Web of Science Conference Proceedings Citation Index - Science. The risk of bias of each included study was independently assessed by two reviewers using the MINORS (Methodological Index for Non-Randomized Studies) instrument.

RESULTS

Eleven case series and 14 cohort studies met the criteria for inclusion, for a total of 1111 older adults who underwent epilepsy surgery along with 4111 adults younger than 50 years as control groups. The pooled cumulative incidence of older adults achieving seizure freedom after resective surgery was 70.1% (95% confidence interval [CI] = 65.3-74.7). There was no evident difference in the incidence of seizure freedom among older adults as compared to younger adults (risk ratio [RR] = 1.05, 95% CI = .97-1.14) in cohort studies. The pooled cumulative incidence of perioperative complications in older adults was 26.2% (95% CI = 21.3-31.7). Among them, 7.5% (95% CI = 5.8-9.5) experienced major complications. Older adults were significantly more at risk of experiencing any complication than younger adults (RR = 2.8, 95% CI = 1.5-5.4).

SIGNIFICANCE

Despite important considerations, epilepsy surgery may be considered appropriate among carefully selected individuals older than 50 years.

Frailty and social isolation before and during the coronavirus disease 2019 pandemic among older adults: A path analysis

AIM

To explore the prevalence of social isolation among Japanese community-dwelling older adults before and during the COVID-19 pandemic as well as determine how family and friend connections before and during the pandemic affected frail older adults during the pandemic.

DESIGN

A cross-sectional study.

METHODS

A total of 852 community-dwelling older adults in Hokkaido and Tokyo, Japan were surveyed conducted between April and November 2021 using convenience sampling. The Lubben social network scale-6, frailty screening index, and geriatric depression scale were used to assess social isolation, frailty and depression, respectively. A path analysis was conducted to evaluate the effect of social isolation on frailty.

RESULTS

Participants had a mean age of 76.8 ± 6.6 years. Overall, 46% and 59% of participants were socially isolated before and during the COVID-19 pandemic, respectively. Frailty was found in 19% of participants during the pandemic. Friends and family connectedness before the pandemic had no direct relationship with frailty; only friend connectedness affected frailty indirectly via depression. Family connectedness during the pandemic had a significant, negative and direct relationship with frailty.

CONCLUSION

The findings show that connectedness with family and friends is critical for older people's physical and mental health.

IMPACT

Nurses in the community should consider these findings to reduce mental health problems and physical decline among older adults. It is important to identify older adults who are socially isolated from their families or friends and provide resources to help them build relationships within their communities.

PATIENT OR PUBLIC CONTRIBUTION

Community centre staff and community volunteers assisted in data collection. The public was not involved in data analysis, interpretation or manuscript preparation.

Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

Association Between Chronic Diseases and Frailty in a Sample of Older Greek Inpatients

INTRODUCTION

Previous reports have associated frailty with the existence of various chronic diseases. Especially for cardiovascular diseases, this relationship seems to be bidirectional as common pathophysiological mechanisms lead to the progression of both diseases and frailty. The study aimed to examine the relationship between chronic diseases and frailty in a sample of older Greek inpatients Methodology: In 457 consecutively admitted older patients (226, 49.5% females), the median age was 82 years (interquartile range [IQR] 75-89), and demographic factors, medical history, cause of admission, and the degree of frailty assessed with the Clinical Frailty Scale were recorded. The level of frailty was calculated for the pre-hospital status of the patients. Parametric tests and logistic regression analysis were applied to identify diseases independently associated with frailty.

RESULTS

Using the scale, 277 patients (60.6%) were classified as frail and 180 as non-frail (39.4%). In univariate analysis, frail patients were more likely to have respiratory disease, dementia, Parkinson's disease, chronic kidney disease (CKD), atrial fibrillation (AFIB), neoplastic disease, depression, stroke, heart failure (HF), and coronary artery disease. In binomial regression analysis, the diseases that were statistically significantly associated with frailty were respiratory diseases (P = 0.009, odds ratio [OR] = 2.081, 95% confidence interval [CI] 1.198-3.615), dementia (P ≤ 0.001, OR = 20.326, 95% CI 8.354-49.459), Parkinson's disease (P = 0.049, OR = 3.920, 95% CI 1.005-15.295), CKD (P = 0.018, OR = 2.542, 95% CI 1.172-5.512), AFIB (P = 0.017, OR = 1.863, 95% CI 1.118-3.103), HF (P = 0.002, OR = 2.411, 95% CI 1.389-4.185), and coronary artery disease (P = 0.004, OR = 2.434, 95% CI 1.324-4.475).

CONCLUSIONS

Among diseases independently associated with frailty, chronic diseases such as respiratory diseases, dementia, Parkinson's disease, CKD, and cardiovascular diseases (AFIB, HF, and coronary heart disease) have an important role. Recognizing the diseases that are highly related to frailty may contribute, by their optimal management, to delaying the progression or even reversing frailty in a large proportion of the elderly.

Safety, feasibility, and acceptability of physiotherapy combined with strength training using active video games for older patients with musculoskeletal conditions

PURPOSE

This study aimed to determine the safety, feasibility, and acceptability of physiotherapy (PT) combined with strength training using active video games (AVG) for older patients with musculoskeletal conditions.

METHODS

Sixteen patients underwent AVG + PT on day 1 and only conventional physiotherapy (CPT) on day 2. The AVG was conducted in 6 upper- and lower-limb training performed in standing position using Ring Fit Adventure (RFA) on Nintendo Switch. Outcome measured adverse events and deviant movements associated with the AVG as safety, execution rate of each AVG programme as feasibility, and questionnaires (4-point Likert scale) regarding enjoyment, motivation to continue, and feeling of efficacy as acceptability.

RESULTS

The berg balance scale/functional independence measure indicated 45 ± 8/90 ± 16. No adverse events occurred. Some of deviant movements were observed that could be an injury risk, such as a slight forward movement during the stepping exercise. The execution rate for each AVG programme ranged from 81% to 100%. The categories of enjoyment, motivation to continue, and feeling of efficacy had >90% of positive responses (strongly agree, slightly agree) in AVG + PT, and enjoyment tended to be higher in AVG + PT than in CPT.

CONCLUSIONS

Strength training using RFA was considered to be a safe and feasible exercise tool enough to be applicable as part of a rehabilitation programme in older patients with musculoskeletal conditions. However, should be supervised, at least during the introductory phase. It was also positively accepted by older adults, suggesting enhanced enjoyment.IMPLICATIONS FOR REHABILITATIONActive video games (AVG) training with Ring Fit Adventure (RFA) was found to be safe enough to be considered for application as part of a rehabilitation programme for older patients with musculoskeletal conditions, but should be supervised, at least during the introductory phase.AVG training comprising strength training with RFA was found to be a highly feasible exercise tool for rehabilitation in older patients with musculoskeletal conditions.Physiotherapy combined with AVG training using RFA was also well received, suggesting enhanced enjoyment for older patients with musculoskeletal conditions.

Identifying Frailty in Older Adults in Rural Victoria, Australia: A Secondary Analysis of Population Health Data

Objectives: To determine the prevalence of frailty among community-dwelling older adults in regional Victoria, Australia. Methods: Frailty status of 376 participants from the Crossroads II cross-sectional study was assessed by selected markers of frailty. The selected variables were psychometrically tested. Associations between frailty and socio-demographic, environmental and health factors were analysed using chi-square, ANOVA and binary logistic regression (BLR). Results: Estimated prevalence of frailty was 39.4%. BLR indicated that frailty decreased with higher educational attainment, (OR = .23; 95% CI: .10-.51) increased for divorced/separated participants (OR = 2.68; 95% CI: 1.29-5.56) and when having three (OR = 3.27; 95% CI: 1.07-9.98), four (OR = 7.20; 95% CI: 2.22-23.31) or five or more chronic conditions (OR = 9.18; 95% CI: 2.83-29.72). Discussion: Frailty in this Australian regional community-dwelling sample was higher than other studies conducted in urban areas of Australia. Present results highlight the importance of exploring the multidimensionality of the frailty construct to have a better understanding which factors are associated with the development of this syndrome.

Associations of individual chronic diseases and multimorbidity with multidimensional frailty

OBJECTIVE

To examine the associations between individual chronic diseases and multidimensional frailty comprising physical, psychological, and social frailty.

METHODS

Dutch individuals (N = 47,768) age ≥ 65 years completed a general health questionnaire sent by the Public Health Services (response rate of 58.5 %), including data concerning self-reported chronic diseases, multidimensional frailty, and sociodemographic characteristics. Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). Total frailty and each frailty domain were regressed onto background characteristics and the six most prevalent chronic diseases: diabetes mellitus, cancer, hypertension, arthrosis, urinary incontinence, and severe back disorder. Multimorbidity was defined as the presence of combinations of these six diseases.

RESULTS

The six chronic diseases had medium and strong associations with total ((f2 = 0.122) and physical frailty (f2 = 0.170), respectively, and weak associations with psychological (f2 = 0.023) and social frailty (f2 = 0.008). The effects of the six diseases on the frailty variables differed strongly across diseases, with urinary incontinence and severe back disorder impairing frailty most. No synergetic effects were found; the effects of a disease on frailty did not get noteworthy stronger in the presence of another disease.

CONCLUSIONS

Chronic diseases, in particular urinary incontinence and severe back disorder, were associated with frailty. We thus recommend assigning different weights to individual chronic diseases in a measure of multimorbidity that aims to examine effects of multimorbidity on multidimensional frailty. Because there were no synergetic effects of chronic diseases, the measure does not need to include interactions between diseases.

To Be Frail or Not to Be Frail: This Is the Question-A Critical Narrative Review of Frailty

Many factors have contributed to rendering frailty an emerging, relevant, and very popular concept. First, many pandemics that have affected humanity in history, including COVID-19, most recently, have had more severe effects on frail people compared to non-frail ones. Second, the increase in human life expectancy observed in many developed countries, including Italy has led to a rise in the percentage of the older population that is more likely to be frail, which is why frailty is much a more common concern among geriatricians compared to other the various health-care professionals. Third, the stratification of people according to the occurrence and the degree of frailty allows healthcare decision makers to adequately plan for the allocation of available human professional and economic resources. Since frailty is considered to be fully preventable, there are relevant consequences in terms of potential benefits both in terms of the clinical outcome and healthcare costs. Frailty is becoming a popular, pervasive, and almost omnipresent concept in many different contexts, including clinical medicine, physical health, lifestyle behavior, mental health, health policy, and socio-economic planning sciences. The emergence of the new "science of frailty" has been recently acknowledged. However, there is still debate on the exact definition of frailty, the pathogenic mechanisms involved, the most appropriate method to assess frailty, and consequently, who should be considered frail. This narrative review aims to analyze frailty from many different aspects and points of view, with a special focus on the proposed pathogenic mechanisms, the various factors that have been considered in the assessment of frailty, and the emerging role of biomarkers in the early recognition of frailty, particularly on the role of mitochondria. According to the extensive literature on this topic, it is clear that frailty is a very complex syndrome, involving many different domains and affecting multiple physiological systems. Therefore, its management should be directed towards a comprehensive and multifaceted holistic approach and a personalized intervention strategy to slow down its progression or even to completely reverse the course of this condition.

Assessment of frailty and its predictors in chronic obstructive pulmonary disease

BACKGROUND

Frailty represents a state of risk in which a relatively small stressor results in a disproportionate decline in health status. This study aims to determine the prevalence of frailty among patients with COPD in the Indian population and its associated risk factors.

METHODS

A descriptive cross-sectional study was conducted in 150 COPD patients. Frailty was assessed using the frailty phenotype method.

RESULTS

The mean age (SD) of the study population was 60.59 (5.9) years with 88.67% males and 53.33% ex-smokers. The prevalence of frailty was 51.33% (n = 77). Most of the frail patients belonged to GOLD group D (66.23%) (P < 0.0001). Post-bronchodilator FEV1(%) was lowest in the frail group (40 [36-47]%) (P < 0.0001). Risk of frailty significantly correlated with smoking pack years (1.036; 1.001-1.074), history of 1 exacerbation in last year (6.810; 2.036-22.779), post-bronchodilator FVC(%) (0.955; 0.926-0.985), post-bronchodilator FEV1(%) (0.940; 0.913-0.968), distance covered in 6-minute walk test [0.975; 0.965-0.986] and dyspnoea severity [1.044; 1.024-1.063]. In multivariate regression, 6-minute walk distance and GOLD group B were the independent predictors of frailty in COPD.

CONCLUSION

The prevalence of frailty in Indian patients with COPD was 51.33%. Six-minute walk distance is an important predictor of frailty. Early identification of frailty will lead to prompt intervention and rehabilitation.

Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea

Frailty has become increasingly relevant in a rapidly aging society, highlighting the need for its accurate identification and exploring associated clinical outcomes. Using a multidimensional framework to estimate frailty in a sample of community dwelling older adults, its effect on mortality, incurred healthcare costs and utilization were investigated. We obtained data from the 2008-2018 Korean Longitudinal Study of Aging (KLoSA). After excluding individuals aged < 65 years and those with missing data, a total of 3578 participants were included in our study. Cox proportional hazard analysis was conducted to investigate the impact of frailty on all-cause mortality by generating hazard ratios (HRs) and population attributable risks (PARs). Healthcare utilization and out-of-pocket costs incurred by frailty were examined using the Generalized Linear Mixed Model (GLMM). Subgroup analyses were conducted according to frailty components. Among 3578 older adults, 1052 individuals died during a 10-year follow up period. Compared to the low risk frailty group, the moderate risk group (HR: 1.52, 95% CI:1.37-1.69) and severe risk group (HR: 3.10, 95% CI: 2.55-3.77) had higher risks for all-cause mortality. 27.4% (95% CI: 19.0-35.3%) of all-cause mortality was attributable to frailty, and the PARs ranged from 0.5 to 22.6% for individual frailty components. Increasing frailty levels incurred higher total healthcare costs and cost per utilization, including inpatient and outpatient costs. Frailty also increased likelihood of inpatient use, longer length of stay and more frequent outpatient visits. Among the frailty components, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) in particular were linked to elevated mortality, higher incurred healthcare costs and utilization. Frailty-tailored interventions are of utmost relevance to policy makers and primary caregivers as frailty threatens the ability to maintain independent living and increases risk of detrimental outcomes such as mortality and increased utilization and out-of-pocket costs of healthcare in older adults.

Mediating effects of depression on sleep disturbance and frailty in older adult type 2 diabetes patients in the community

Introduction

With the progressive aging of the population, frailty is now a significant challenge in geriatrics research. A growing amount of evidence suggests that sleep disturbance and depression have independent effects on frailty, although the underlying mechanisms are not yet clear. This study aimed to investigate the mediating role of depression in the relationship between sleep disturbance and frailty in older adult patients with type 2 diabetes (T2DM) in the community.

Method

Purposive sampling was used to collect face-to-face data from 342 community-dwelling T2DM patients in Chengdu, Sichuan Province, China, between February and May 2023. The Pittsburgh Sleep Quality Index (PSQI) scale was used to evaluate sleep quality, the Simple Geriatric Depression Scale (GDS-15) was used to evaluate depressive symptoms, and the FRAIL Scale (FRAIL) was used to evaluate frailty. Linear regression equation and bootstrap self-sampling were used to verify the mediating role of depressive symptoms in sleep disturbance and frailty.

Result

The study found that sleep disturbance had a direct positive effect with frailty [β = 0.040, 95% CI: (0.013, 0.069)]. Additionally, depression had a direct positive effect on frailty [β = 0.130, 95% CI: (0.087, 0.173)], and depression was found to partially mediate the relationship between sleep disturbance and frailty.

Conclusion

Poor sleep quality and frailty are common in patients with T2DM. To reduce the frailty of older adult T2DM patients, all levels of society (government, medical institutions, and communities) must pay more attention to mental health. A variety of interventions should be considered to improve sleep quality and depression, which in turn may prevent or control frailty.

Association of frailty with health service use among older Chinese adults: analysis of population-based panel data

Background

Frailty is a common syndrome characterized by rapid growth in the aging population that has an impact on healthcare systems. This study aimed to investigate the impact of frailty on health service use and whether this effect varies with chronic diseases and socioeconomic status among older individuals in China.

Methods

A balanced panel data analysis was conducted on 3,306 older individuals who completed follow-ups for the three waves of the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, and 2015. The Physical Frailty Phenotype (PFP) Scale was used to assess frailty status. Negative binomial regression was used to test the associations between frailty status, outpatient visits in the past 4 weeks, and annual inpatient hospital days.

Results

Compared with robust individuals, individuals with pre-frail or frail status were likely to report a higher number of outpatient visits [pre-frail: incidence rate ratio (IRR) = 1.28, 95% CI = 1.16-1.41; frail: IRR = 1.45, 95% CI = 1.23-1.71], and inpatient hospital days (pre-frail: IRR = 1.40, 95% CI = 1.24-1.58; frail: IRR = 2.17, 95% CI = 1.81-2.60) after controlling for all covariates. All five frailty components (weight loss, exhaustion, low physical activity, slowness, and weakness) were associated with a higher number of inpatient hospital days, and two components (weight loss and exhaustion) were associated with a higher number of outpatient visits. The effect of frailty on inpatient hospital stays persisted in different socioeconomic groups, across all health insurance programmes and physical comorbidities.

Conclusion

Frailty is associated with greater health service use among older individuals. Effective screening, prevention, intervention, and management of frailty may be important to reduce health service use.

Technology-Assisted Cognitive Motor Dual-Task Rehabilitation in Chronic Age-Related Conditions: Systematic Review

BACKGROUND

Cognitive-motor dual-task (CMDT) is defined as the parallel processing of motor (eg, gait) and cognitive (eg, executive functions) activities and is an essential ability in daily life. Older adults living with frailty, chronic conditions (eg, neurodegenerative diseases), or multimorbidity pay high costs during CMDT. This can have serious consequences on the health and safety of older adults with chronic age-related conditions. However, CMDT rehabilitation can provide useful and effective therapies for these patients, particularly if delivered through technological devices.

OBJECTIVE

This review aims to describe the current technological applications, CMDT rehabilitative procedures, target populations, condition assessment, and efficacy and effectiveness of technology-assisted CMDT rehabilitation in chronic age-related conditions.

METHODS

We performed this systematic review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, on 3 databases (Web of Science, Embase, and PubMed). Original articles that were published in English; involved older adults (>65 years) with ≥1 chronic condition and/or frailty; and tested, with a clinical trial, a technology-assisted CMDT rehabilitation against a control condition were included. Risk of bias (Cochrane tool) and the RITES (Rating of Included Trials on the Efficacy-Effectiveness Spectrum) tool were used to evaluate the included studies.

RESULTS

A total of 1097 papers were screened, and 8 (0.73%) studies met the predefined inclusion criteria for this review. The target conditions for technology-assisted CMDT rehabilitation included Parkinson disease and dementia. However, little information regarding multimorbidity, chronicity, or frailty status is available. The primary outcomes included falls, balance, gait parameters, dual-task performance, and executive functions and attention. CMDT technology mainly consists of a motion-tracking system combined with virtual reality. CMDT rehabilitation involves different types of tasks (eg, obstacle negotiation and CMDT exercises). Compared with control conditions, CMDT training was found to be pleasant, safe, and effective particularly for dual-task performances, falls, gait, and cognition, and the effects were maintained at midterm follow-up.

CONCLUSIONS

Despite further research being mandatory, technology-assisted CMDT rehabilitation is a promising method to enhance motor-cognitive functions in older adults with chronic conditions.

Frailty and Cancer: Current Perspectives on Assessment and Monitoring

Frailty, an age-related condition of increased vulnerability to acute endogenous or exogenous stressors, is a key barrier to successful treatment of cancer in older people. In this group of patients, assessment of frailty is required before starting a new treatment. According to guidelines, the gold standard to assess frailty in older adults with cancer is geriatric screening followed by geriatric assessment (GA) across essential GA-domains (social status, physical function, nutrition, cognition, emotion, co-morbidity, polypharmacy). GA enables tailoring of both oncological therapy and non-oncological interventions to the patient's vulnerabilities. Large clinical trials recently have demonstrated that the feasibility and tolerability of systemic cancer treatment in older patients are significantly improved by such GA-guided management. Indications and optimal tools for frailty monitoring during the course of cancer treatment have not yet been defined in greater detail. New technologies such as wearable sensors or apps offer promising new opportunities to further develop frailty monitoring. This review describes the current standards and perspectives for the assessment and monitoring of frailty in elderly patients with cancer.

Consumer wearable device-based measures of physical activity and energy expenditure in community-dwelling older adults with different levels of frailty: A STROBE compliant study

Physical activity is important for positive health outcomes, and wearable activity devices are useful for tracking physical activity patterns and energy expenditure. This study investigated differences in, and correlations of, duration of physical activity according to activity intensity and energy expenditure among community-dwelling older adults with different levels of frailty. This cross-sectional study enrolled 88 adults older than 65 years from communities between June 2019 and January 2020. The participants were divided into non-frail, pre-frail, and frail groups according to the frailty criteria. Outcomes included the frailty score, duration of physical activity according to the intensity of activity (sedentary, light, fairly active, fairly to very active, and very active), and energy expenditure measured by a consumer wearable device. The duration of physical activity according to the intensity of activity and energy expenditure were compared among non-frail, pre-frail, and frail groups. In addition, linear correlation analysis was used to identify significant associations of objectively measured physical activity and energy expenditure with frailty. Non-frail older adults showed significantly longer daily duration of light to very active physical activity and increased energy expenditure compared to the frail group (P < .05). Additionally, non-frail older adults engaged in significantly more light and fairly to very active physical activity, and showed increased energy expenditure, compared to the pre-frail group (P < .05). The non-frail group showed a significantly lower duration of sedentary behavior compared to the pre-frail group. Correlation analysis showed that frailty was significantly associated with decreased light to very active physical activity and energy expenditure, as well as increased sedentary behavior (P < .05). This study provides evidence of differences in objectively measured physical activity and energy expenditure between frail and non-frail older adults, and reveals an association of frailty with physical activity and energy expenditure. Daily physical activity that exceeds low-intensity, low-energy expenditure activity should be encouraged among older adults with frailty.

eHealth in Care Coordination for Older Adults Living at Home: Scoping Review

BACKGROUND

The population of older adults is projected to increase, potentially resulting in more older adults living with chronic illnesses or multimorbidity. Living with chronic illnesses increases the need for coordinated health care services. Older adults want to manage their illnesses themselves, and many are positive about using eHealth for care coordination (CC). CC can help older adults navigate the health care system and improve information sharing.

OBJECTIVE

This study aimed to map the research literature on eHealth used in CC for older adults living at home. This study assessed CC activities, outcomes, and factors influencing the use of eHealth in CC reported by older adults and health care professionals.

METHODS

We used a scoping review methodology. We searched four databases-MEDLINE, CINAHL, Academic Scoping Premier, and Scopus-from 2009 to 2021 for research articles. We screened 630 records using the inclusion criteria (older adults aged >65 years, primary health care setting, description of an eHealth program or intervention or measure or experiences with the use of eHealth, and inclusion of CC or relevant activities as described in the Care Coordination Atlas). The analysis of the included articles consisted of both a descriptive and thematic analysis.

RESULTS

A total of 16 studies were included in this scoping review. Of these 16 studies, 12 (75%) had a quantitative design, and the samples of the included studies varied in size. The categories of eHealth used for CC among older adults living at home were electronic health records and patient portals, telehealth monitoring solutions, and telephone only. The CC activity communication was evident in all studies (16/16, 100%). The results on patient- and system-level outcomes were mixed; however, most studies (7/16, 44%) reported improved mental and physical health and reduced rehospitalization and hospital admission rates. Observing changes in patients' health was a facilitator for health care professionals using eHealth in CC. When using eHealth in CC, available support to the patient, personal continuity, and a sense of security and safety were facilitators for older adults. Individual characteristics and lack of experience, confidence, and knowledge were barriers to older adults' use of eHealth. Health care professionals reported barriers such as increased workload and hampered communication.

CONCLUSIONS

We mapped the research literature on eHealth-enabled CC for older adults living at home. We did not map the gray literature as we aimed to map the research literature (peer-reviewed research articles published in academic journals). The study results showed that using eHealth to coordinate care for older adults who live at home is promising. To ensure the successful use of eHealth in CC, we recommend customized eHealth-enabled health care services for older adults, including individualized education and support.

Impact of frailty in elderly patients with moderate to severe asthma

Frailty assessment has been identified as critical approach in chronic respiratory diseases with substantial impact in the health status and functionality in later life. Aging modifies the immune response leading to a chronic pro-inflammatory state and increased susceptibility to airway infections. Since epigenetic changes, airway epithelium dysfunction and inflammatory cytokine activity seem to be more pronounced in the immunosenescence, elderly asthmatics are at higher risk of poor clinical outcomes. Therefore, we hypothesize that frailty would be associated with the degree of asthma control in elderly patients with moderate to severe asthma. The aims of this study are to investigate association between frailty and asthma control in patients over 60 years old to estimate the prevalence of frailty in this study population. We plan to conduct a cross-sectional study with at least 120 patients above 60 years old with diagnostic of moderate to severe asthma according to Global Initiative for Asthma (GINA) guidelines, treated at a referral outpatient clinic. We defined asthma control by the six-domain Asthma Control Questionnaire (ACQ-6) and frailty phenotype in accordance with Fried scale and visual scale of frailty (VS-Frailty). We hope to analyze the multidimensional relationships between frailty and asthma and contribute to innovative therapeutic plans in geriatric asthma.

Identifying Frail Patients by Using Electronic Health Records in Primary Care: Current Status and Future Directions

With the rapidly aging population, frailty, characterized by an increased risk of adverse outcomes, has become a major public health problem globally. Several frailty guidelines or consensuses recommend screening for frailty, especially in primary care settings. However, most of the frailty assessment tools are based on questionnaires or physical examinations, adding to the clinical workload, which is the major obstacle to converting frailty research into clinical practice. Medical data naturally generated by routine clinical work containing frailty indicators are stored in electronic health records (EHRs) (also called electronic health record (EHR) data), which provide resources and possibilities for frailty assessment. We reviewed several frailty assessment tools based on primary care EHRs and summarized the features and novel usage of these tools, as well as challenges and trends. Further research is needed to develop and validate frailty assessment tools based on EHRs in primary care in other parts of the world.

Low physical activity is the strongest factor associated with frailty phenotype and frailty index: data from baseline phase of Birjand Longitudinal Aging Study (BLAS)

Background

Frailty is the most complicated expression of aging that is related to disability or multi-morbidity. The aim of the present study was to estimate the prevalence of frailty and its associated factors among community-dwelling aged population.

Methods

A total of 1529 eligible community- dwelling older adults (≥ 60 years) were enrolled in the baseline phase of Birjand Longitudinal Aging Study (BLAS) from 2019 to 2020. Their frailty status was assessed using the Fried’s frailty phenotype and frailty index. Sociodemographic factors, including sex, age, marital status, and education level, were collected. Health status assessment included the history of hypertension, diabetes mellitus, cardiovascular disease, Alzheimer’s diseases and dementia, and other health conditions. Furthermore, functional assessment (ADL, IADL) and anthropometric measurements including height, weight, waist, calf, and mid-arm circumference were made and the body mass index was calculated. The nutrition status and polypharmacy (use 3 or more medication) were also evaluated.

Results

The prevalence of frailty was 21.69% according to the frailty phenotype and 23.97% according to the frailty index. A multiple logistic regression model showed a strong association between low physical activity and frailty phenotype (OR = 36.31, CI = 16.99–77.56, P < 0.01), and frailty index (OR = 15.46, CI = 5.65–42.34, P < 0.01). Other factors like old age (≥80), female sex, malnutrition, polypharmacy, obesity, and arthritis were also associated with frailty. The Kappa coefficient of the agreement between these two instruments was 0.18.

Conclusion

It seems that low physical activity is the most important determinant of frailty. Low physical activity and some other factors may be preventable or modifiable and thus serve as clinically relevant targets for intervention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03135-y.

Plasma Aromatase Activity Index, Gonadotropins and Estrone Are Associated with Frailty Syndrome in Post-Menopausal Women with Breast Cancer

Frailty syndrome is associated with poor outcomes, morbidity and premature mortality. We performed a cross-sectional study to evaluate the presence of frailty syndrome based on Fried’s frailty phenotype in post-menopausal women with breast cancer. We further analyzed the association between frailty syndrome with geriatric assessments and the association with the concentration of gonadotropins LH and FSH, estrogens, androgens and the aromatase activity index in the blood. We enrolled 47 post-menopausal women with localized breast cancer (mean age 66.8 ± 1.3 years (range 52−83)) prior to the starting of adjuvant endocrine therapy. Patients were identified as “non-frail” (robust) or “prefrail/frail” if they fulfilled at least one frailty criteria. In order to determine associations among variables and to control for other variables potentially affecting frailty syndrome (age, comorbidity index and previous chemotherapy treatment), we performed a logistic regression analysis. The receiver operating characteristic curve was performed to assess the sensitivity and specificity of the hormonal concentration to discriminate prefrail/frail versus non-frail individuals. Significant positive associations were observed between the severity of frailty syndrome and estrone, FSH and LH concentrations and the aromatase activity index in the blood (p < 0.05). Further research into the role of hormonal biomarkers should be evaluated in follow-up studies in order to recommend their use as suitable biomarkers of frailty syndrome in breast cancer patients.

Association between social capital and frailty and the mediating effect of health-promoting lifestyles in Chinese older adults: a cross-sectional study

BACKGROUND

To explore the association between social capital and frailty and the mediating effect of health-promoting lifestyles among Chinese older adults, while providing scientific evidence for frailty intervention.

METHODS

In May 2021, a cross-sectional study was conducted among 674 Chinese older adults in Changsha city. Data was collected using the Chinese Shortened Social Capital Scale (comprising structural social capital and cognitive social capital as two subscales), a simplified version of the Health-Promoting Lifestyle Profile and the Tilburg Frailty Indicator. Linear regression analysis was used to examine the association between social capital and frailty. Structural equation modeling was used to test the mediating effect of health-promoting lifestyles.

RESULTS

Cognitive social capital was significantly negatively associated with frailty and its three dimensions (physical, psychological, and social frailty), but structural social capital was not. Health-promoting lifestyles played a mediating role in the associations of cognitive social capital with frailty, physical and psychological frailty, but not with social frailty.

CONCLUSIONS

Higher cognitive social capital was associated with a reduced likelihood of frailty. The health-promoting lifestyles partially mediated the association between cognitive social capital and frailty. The use of health-promoting lifestyles or appropriate cognitive social capital interventions may reduce frailty among older adults.

Sedentary behavior is associated with arteriosclerosis in frail older adults

This prospective, cross-sectional, cohort observational study was conducted to evaluate the associations between sedentary behavior and arteriosclerosis-related vascular issues in community-dwelling frail older adults. We included 116 Japanese community-dwelling older adults (92 females and 24 males) who availed daycare at two long-term care insurance facilities in the cities of Yokkaichi and Handa between 2017 and 2019. An unpaired t-test and the chi-square test were used for intergroup comparisons. Logistic regression analysis was conducted with cardio-ankle vascular index as the dependent variable, sedentary behavior as the explanatory variable, and the other evaluated factors as covariates. Long-time sedentary behavior (based on the median value for all participants) was associated with high cardio-ankle vascular index after adjusting for age, sex, body mass index, ankle-brachial index, and walking MET-minutes in 1 week (odds ratio 3.086, 95% confidence interval 1.275-7.467, p=0.012). After adjusting for other variables (care needs certificate, skeletal muscle mass index, body fat percentage, grip strength, 4-m walking duration, etc), there was a significant association between long-time sedentary behavior and high cardio-ankle vascular index values (odds ratio 4.977, 95% confidence interval 1.497-16.554, p=0.009). The results study confirmed an association between long-time sedentary behavior in frail older adults and the degree of arterial stiffness assessed by the cardio-ankle vascular index. Interventions in older adults that focus on daily sedentary time to prevent the onset and exacerbation of geriatric syndromes secondary to the progression of arteriosclerosis warrant further investigation.

Frailty influences the vascular responsiveness of elderly individuals with chronic heart failure

INTRODUCTION

Frailty is highly prevalent in heart failure (HF) patients. HF is associated with oxidative stress and chronic inflammation, which impair oxygen use by skeletal muscles. Little is known about the influence of frailty on vascular responsiveness and tissue oxygenation.

OBJECTIVE

Analyze the influence of frailty on vascular responsiveness and muscle oxygenation in elderly individuals with and without HF.

METHODS

Individuals aged ≥60 years, with or without HF, were evaluated for frailty (phenotype). Near-infrared spectroscopy (NIRS) was used to assess muscle oxygenation at rest (oxygen saturation - StO₂ and deoxyhemoglobin) and during handgrip exercise (minimum StO₂ and maximum deoxyhemoglobin), and oxygenation variables.

STATISTICAL ANALYSIS

Results were grouped according to the frailty phenotype: non-frail, pre-frail, and frail. Shapiro-Wilk test was used to assess normality. Data were compared using a two-way analysis of variance (ANOVA). Bonferroni post hoc test was applied to determine the influence of frailty or HF on NIRS variables. SPSS software was used in the analyses; p < 0.05 was considered significant.

RESULTS

55 elderly participants (61.8% female; 70.4 ± 7.2 years old; 28 HF patients) participated in the study. 32.7% (n = 18) were classified as non-frail, 43.3% (n = 24) as pre-frail, and 23.6% (n = 13) as frail. The analysis of vascular responsiveness (n = 52) identified an influence (p < 0.05) of frailty on the reperfusion rate (slope 2 and ∆StO₂ of nadir-peak) and desaturation during occlusion (area under the curve of StO₂) in HF patients. There was no influence of frailty or HF on muscle oxygenation at rest and during exercise (n = 54; p > 0.05).

CONCLUSION

The coexistence of frailty and HF seems to impair vascular responsiveness, as frail elderly participants with HF presented lower reperfusion rates and higher desaturation levels during the arterial occlusion test. However, the presence of frailty or HF alone had no influence on muscle oxygenation at rest or during exercise.

Frailty and chronic respiratory disease: the need for a multidisciplinary care model

Background.

Frailty is a state of increased vulnerability to various health stressors but little information is summarized about frailty in patients with specific chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and asthma.

Objective.

We aimed to describe the burden of frailty on patients with chronic respiratory disorders and to discuss the need for multidisciplinary care services.

Methods.

PubMed and Cochrane Central databases were systematically reviewed for studies reporting outcomes associated with frailty in COPD, IPF, and asthma. Electronic databases were searched for relevant articles published in English from 2010 up to July 2020. Appraisal was carried out based on the Hierarchy of Evidence Rating System and the GRADE guidelines.

Results.

A total of 31 articles met all inclusion criteria with 24 of them at level IV, 1 at level V, and 6 at level VI. Frailty is likely to negatively affect quality of life and to increase the risk of mortality, especially in elderly with COPD, IPF and asthma. Each disease has a particular effect on the balance between health status, respiratory impairment and frailty. A greater understanding of frailty phenotype across different ages, as well as in a range of long-term conditions, is of great necessity in both clinical and research settings. Limited conformity was observed between different methodologies and nature of chronic diseases studied, leading to a further difficulty to extract homogeneous information.

Conclusion.

Literature shows that frailty is prevalent in COPD, IPF, and asthma, after adjusting for shared risk factors. Our findings suggest that frailty should be approached as an entity per se’, in order to assess real mortality risk, alongside respiratory disease severity and the presence of comorbidities. Health care professionals need knowledge, skills and multidisciplinary collaboration to buffer the impact of frailty on everyday practice.

Frailty and kidney transplant candidates

Frailty is a concept that has been mainly developed in geriatrics and it came from the need of identifying subjects at risk to develop complications when they faced a stressful event. Frail patients have higher risk of mortality, poor outcomes and disability, and this is independent from their age or comorbidities. Chronic kidney disease patients present with high prevalence of frailty, especially those who are in renal replacement therapy. Frail or pre-frail patients on the kidney transplant waiting list represent 20-30%, and these patients are proven to have poorer results after the transplant, which is a stressful event itself. Tools for frailty assessment, both scales or indexes, may be useful to identify which subjects might be at risk for complications after transplant, and this is necessary to adapt our clinical practice and minimize morbidity. The most used frailty scale in kidney patients is Fried scale, which is based in five phenotypic items. Besides that, knowing frail population allows potential interventions such as prehabilitation while the patient is waiting for the kidney transplant, which the aim of improving their vulnerability prior to transplant and, therefore, optimizing results after transplant. More studies are needed amongst kidney patients to improve and prevent frailty.

Associations between symptoms of pain, insomnia and depression, and frailty in older adults: A cross-sectional analysis of a cohort study

BACKGROUND

Frailty is prevalent in older adults and has adverse effects on multiple health outcomes. Pain, insomnia, and depressive symptoms are commonly seen and treatable symptoms in older adults and are associated with frailty. However, it is unknown whether these symptoms are independently associated with frailty and how they interact with each other creating a greater impact on frailty than individual symptoms. It is important to understand these associations for nurses to provide high-quality patient-centered care for older adults with frailty.

OBJECTIVES

To determine independent associations of pain, insomnia, and depressive symptoms with frailty and examine their synergistic impact on frailty among older adults.

DESIGN

A cross-sectional analysis of a cohort study.

SETTING

Communities in the United States.

PARTICIPANTS

Community-dwelling older adults from the National Health and Aging Trend Study (N = 7,609), a nationally representative survey of Medicare Beneficiaries in the United States.

METHODS

Frailty status was determined by five criteria of the Physical Frailty Phenotype: exhaustion, low physical activity, weakness, slowness, and shrinking. Pain was determined by self-reports of bothersome pain in the last month. Insomnia included self-reports of difficulty initiating sleep and difficulty maintaining sleep. Depressive symptom was assessed by the Patient Health Questionnaire-2. Logistic regression models were used adjusting for sociodemographic, health-related and behavioral covariates.

RESULTS

The sample was mainly under 80 years old (72%), female (57%), and non-Hispanic White (81%). Approximately 53% experienced bothersome pain, 11% had difficulty initiating sleep, 6% had difficulty maintaining sleep, and 15% had depressive symptom; 46% were pre-frail and 14% were frail. Independent associations with pre-frailty and frailty were found in pain (odds ratio [OR]: 1.81, 95% CI: 1.60, 2.04), difficulty initiating sleep (OR: 1.23, 95% CI: 1.04, 1.46) and depressive symptom (OR: 2.29, 95% CI: 1.85, 2.84). Interaction terms between pain and depressive symptom (OR: 1.87, 95% CI: 1.14, 3.07), and between difficulty initiating sleep and depressive symptom (OR: 2.66, 95% CI: 1.15, 6.13) were significant, suggesting a synergistic impact on pre-frailty and frailty.

CONCLUSIONS

Pain, difficulty initiating sleep, and depressive symptoms are independent risk factors of frailty and may have a synergistic impact on frailty. Interventions should be developed to address these symptoms to reduce the adverse effects of frailty.

Nutrition Status, Muscle Mass, and Frailty in Older People: A Cross-Sectional Study Conducted in Cyprus

OBJECTIVE

Aging is a worldwide serious public health problem. Frailty is also becoming an alarming geriatric syndrome. This study was conducted to analyze the relationship of frailty with nutritional and muscle status in individuals aged 65 and older.

METHOD

The study was carried out between July 2018 and September 2019 among 347 people aged 65 and older residing in Cyprus. All the data were collected and measured with face-to-face interview method by the researcher which includes demographic information, a retrospective 1-day food consumption record, Edmonton Frailty Scale (EFS), anthropometric measurements, hand grip strength, muscle mass, and walking speed.

RESULTS

The average age of individuals was 73.12 ± 6.78 years. When sex, education levels, and drug usage were compared with EFS levels, severity of frailty was found to be significantly higher in females, non-educated individuals, and in individuals using 3 or more drugs everyday (p < 0.05). Body mass index (BMI) values of non-frail participants were found significantly higher than mildly, moderately, and severely frail participants (p < 0.05). It was observed that there was a statistically significant and negative correlation between the participants' EFS scores and muscle mass (p < 0.05). A negative correlation between hand grip strength and EFS scores was also observed. Energy and protein intake was not found to be significantly different in EFS level groups, while calcium intake of participants with mild, moderate, and severe frailty was found to be significantly lower than in those who were not frail or apparently vulnerable (p < 0.05).

CONCLUSIONS

Being female, having low education levels, using more than 3 drugs per day, and having lower muscle mass increases frailty levels. As a consequence, higher education, decreasing the number of drugs used per day, and preserving muscle mass with adequate activity are important cornerstones of decreasing frailty risk.

Herbal Medications Used to Ameliorate Cardiac Conditions

Herbs have been used for centuries to treat various diseases, including cardiovascular disease. Herbs may be used by clients exclusively for disease management or in combination with conventional medications. This article increases provider awareness of certain herbs and their potential use by clients, as well as their impact on the cardiovascular system. It is important for the advanced practice nurse to collect information related to herb use during history retrieval. This information should prompt the nurse to discuss possible benefits and side effects that may occur taking herbs in isolation or in combination with cardiovascular prescription medications.

A Randomized Controlled Pilot Exercise and Protein Effectiveness Supplementation Study (EXPRESS) on Reducing Frailty Risk in Community-Dwelling Older People

This pilot study aimed to examine the feasibility and effectiveness of a 6-months multi-component exercise program combined with twice daily consumption of either rice (RicePro) or whey-based (WheyPro) protein supplements (2 × 20 g of protein) on gait speed, grip strength and physical performance in community-dwelling pre-frail and frail older adults. Secondary outcomes included: frailty score, muscle mass, quality of life, nutritional intake, cognitive performance, depression and physical activity levels. A total of 70 participants (mean age 73.34 ± 6.85 years) were randomly allocated to either RicePro (n = 36) or WheyPro (n = 34). No adverse events were reported in regards to the exercise, however, several gastrointestinal symptoms were noted with the whey protein causing two-fold more symptoms compared to the rice protein. No differences were found between the groups (p > 0.05), except the total consumed energy (kJ) (p = 0.014) and fat (g) (p = 0.012) which was significantly lower in WheyPro. The results indicate that the quality of protein may not be as important as long as a sufficient amount is consumed.

[Frailty and kidney transplant candidates]

Frailty is a concept that has been mainly developed in geriatrics and it came from the need of identifying subjects at risk to develop complications when they faced a stressful event. Frail patients have higher risk of mortality, poor outcomes and disability, and this is independent from their age or comorbidities. Chronic kidney disease patients present with high prevalence of frailty, especially those who are in renal replacement therapy. Frail or pre-frail patients on the kidney transplant waiting list represent 20-30%, and these patients are proven to have poorer results after the transplant, which is a stressful event itself. Tools for frailty assessment, both scales or indexes, may be useful to identify which subjects might be at risk for complications after transplant, and this is necessary to adapt our clinical practice and minimize morbidity. The most used frailty scale in kidney patients is Fried scale, which is based in five phenotypic items. Besides that, knowing frail population allows potential interventions such as prehabilitation while the patient is waiting for the kidney transplant, which the aim of improving their vulnerability prior to transplant and, therefore, optimizing results after transplant. More studies are needed amongst kidney patients to improve and prevent frailty.

Prevalence of Frailty in Older Men and Women: Cross-Sectional Data from the Geelong Osteoporosis Study

Few studies have investigated the prevalence of frailty in the Australian general population. This study determined the prevalence of frailty in a population-based sample of older adults and examined the relationship between frailty and comorbid conditions. Men (n = 347) and women (n = 360) aged ≥ 60 year from the Geelong Osteoporosis Study (GOS) were assessed between 2016-2019 and 2011-2014, respectively. Frailty was identified using a modified Fried frailty phenotype. Prevalence estimates were standardised to the 2011 Australian population. Kruskal-Wallis test and χ² test were used to analyse data. For women, mean standardised prevalence estimates were 18.3% (14.1-22.5) for frail, 54.1% (47.3-60.8) pre-frail and 22.9% (18.9-26.8) robust. Corresponding estimates for men were 13.1% (9.8-16.3) frail, 47.8% (42.0-53.6) pre-frail and 27.3% (22.7-31.8) robust. Women who were frail were older, shorter, tended to have a higher body mass index (BMI) and used more medications compared to other groups. Compared to robust women, those who were frail were more likely to have cardio-metabolic (OR 3.5 (0.7-20.0)), pulmonary (OR 3.5 (1.5-8.4)) and musculoskeletal (OR 10.1 (2.1-48.0)) conditions. Frail men were older, had a higher BMI and were more likely to have musculoskeletal conditions (OR 5.8 (2.8-12.3)) and tended to be from a lower SES. No further associations were observed. This study reported the prevalence of frail and pre-frail individuals in a population-based sample of Australian men and women. Frailty was associated with musculoskeletal conditions for both men and women; however, associations with cardio-metabolic and pulmonary comorbidities were evident in women only.