Frailty measurement in research and clinical practice: A review

Assessment of frailty in patients with heart failure: A new Heart Failure Frailty Score developed by Delphi consensus

AIMS

The Heart Failure Frailty Score (HFFS) is a novel, multidimensional tool to assess frailty in patients with heart failure (HF). It has been developed to overcome limitations of existing frailty assessment tools while being practical for clinical use. The HFFS reflects the concept of frailty as a multidimensional, dynamic and potentially reversible state, which increases vulnerability to stressors and risk of poor outcomes in patients with HF.

METHODS AND RESULTS

The HFFS was developed through a Delphi consensus process involving 54 international experts. This approach involved iterative rounds of questionnaires and interviews, where a panel of experts provided their opinions on specific questions prepared by the Steering Committee. The experts were invited to vote and share their views anonymously, using a 5-point Likert scale over iterative rounds. An 80% threshold was set for agreement or disagreement for each statement. Twenty-two variables from four domains (clinical, functional, psycho-cognitive and social) have been selected for inclusion in the HFFS after the third round of the Delphi process. A shorter version (S-HFFS), including 10 variables, has also been developed for daily clinical use.

CONCLUSIONS

The HFFS is a new multidimensional tool for the identification of frailty in patients with HF. It should also enables healthcare providers to identify potential 'red flags' for frailty in order to develop personalized care plans. The next step will be to validate the new score in patients with HF.

The temporal trend in frailty prevalence from 2011 to 2020 and disparities by equity factors among middle-aged and older people in China: A population-based study

BACKGROUND

Frailty is a challenging issue in China, however the prevalence of frailty across different population groups and whether this is changing over time remain unclear.

METHODS

Unstandardized and age-and sex-standardized prevalence of frailty (95 % confidence interval (95 % CI)) (Frailty Index) in the overall sample and for subgroups defined by equity factors (PROGRESS-Plus framework) from 2011 to 2020 were estimated using analyses of cross-sectional surveys in adults aged 45 and older participating in 5 waves (N = 16,784 to 18,904 across waves) of the China Health and Retirement Longitudinal Studies (CHARLS). Poisson regression was used to estimate prevalence ratios (PRs) of frailty by equity factors.

RESULTS

Unstandardized prevalence of frailty increased from 13.6 % (13.0 %-14.1 %) in 2011 to 18.7 % (18.1 %-19.3 %) in 2020.The standardized prevalence increased from 13.5 % (13.0 %-14.0 %) in 2011 to 16.3 % (15.8 %-16.9 %) in 2020. Frailty was consistently more prevalent at advanced ages, in rural areas, among females, as well as those less educated, without social engagement, and non-drinkers. Based on the Poisson regression model, non-north region, being female and older, lower education, having no social engagement, smoking and non-drinking, and higher household capital consumption were associated with higher prevalence.

CONCLUSIONS

The prevalence of frailty among the middle-aged and older population in China has increased. There will be an associated health and social care cost. Interventions targeted at older adults, those in rural areas, women, as well as those less educated, having no social engagement, and non-drinkers to mitigate the negative effects of frailty may be warranted.

Genetic evidence for the effects of glucokinase activation on frailty-related outcomes: A Mendelian randomisation study

AIMS

We aimed to use the Mendelian randomisation (MR) design to investigate the potential causal effects of glucokinase (GK) activation on frailty-related outcomes and to explore the potential mediating effects of metabolic and inflammatory biomarkers.

MATERIALS AND METHODS

Seventeen independent single-nucleotide polymorphisms (SNPs) located within the GCK gene and significantly correlated with the glycated haemoglobin (HbA1c) level were used as genetic proxies for the effect of GK activation. We employed two-sample MR analysis to assess the relationship between genetically proxied GK activation and multifactorial frailty-related outcomes (frailty index, grip strength, walking pace, appendicular lean mass [ALM] and telomere length) We also explored the potential mediating effects using two-step MR.

RESULTS

Genetically proxied GK activation was significantly associated with a lower frailty index (beta: -0.161 per 1% decrease in HbA1c level due to GK activation, 95% confidence interval: -0.282 to -0.040, false discovery rate-adjusted p = 0.011). Additionally, GK activation showed significant associations with increased grip strength, higher ALM, faster walking pace and longer telomere length. GK activation also demonstrated a significant indirect effect on total grip strength and telomere length by reducing C-reactive protein levels (proportion of mediation: 6.79% to 8.21%).

CONCLUSION

Our study provides genetic evidence supporting the causal effects of GK activation on lowering the risk of frailty. These findings suggest that GK activators (GKAs) may aid in the management of frailty and sarcopaenia in people with diabetes; however, future randomized controlled trials are necessary to validate these results and establish their clinical applicability.

Translation and validation of the Thai clinical frailty scale and classification tree in older adults

BACKGROUND

The Clinical Frailty Scale (CFS) is widely used for frailty assessment, but has not yet been formally validated for use in Thai populations. This study evaluated the reliability and validity of the Thai versions of the CFS (CFS-Thai) and its Classification Tree (CFS-CT-Thai).

METHODS

In this cross-sectional study, 213 participants aged ≥ 65 years (127 outpatients and 86 inpatients) were enrolled from two tertiary care hospitals in Thailand. The CFS and CFS-CT were translated into Thai using standard procedures. Inter-rater reliability was evaluated in a subsample of 53 inpatients. Concurrent validity was examined using the Thai version of the FRAIL scale (T-FRAIL), the Eastern Cooperative Oncology Group Performance Status (ECOG PS), and the modified Thai Frailty Index (mTFI).

RESULTS

The CFS-Thai showed strong inter-rater reliability (κ = 0.80, p < 0.001) and excellent agreement with the CFS-CT-Thai (κ = 0.94, p < 0.001). It demonstrated moderate correlation with T-FRAIL (ρ = 0.53) and strong correlation with ECOG PS (ρ = 0.76) and mTFI (ρ = 0.73). Using mTFI as the reference standard, the CFS-Thai showed high sensitivity (92.7%) and lower specificity (55.0%) at cut-off ≥ 4 (AUC = 0.74, 95% CI: 0.62-0.86), while cut-off ≥ 5 improved specificity (79.3%) and retained high sensitivity (93.5%) (AUC = 0.86, 95% CI: 0.81-0.92). ECOG PS ≥ 2 provided balanced diagnostic performance (sensitivity 83.9%, specificity 93.3%, AUC = 0.89, 95% CI: 0.82-0.95).

CONCLUSIONS

The CFS-Thai and CFS-CT-Thai are reliable and valid instruments for frailty assessment in Thai older adults. Their diagnostic accuracy supports integration into clinical practice, especially in settings with limited geriatric expertise. Further studies should examine their implementation across diverse populations and their predictive value for clinical outcomes.

Frailty indices based on routinely collected data: a scoping review

A frailty index (FI) is a frailty assessment tool calculated as the proportion of the number of health-related deficits an individual has to the total number of variables in the index. Routinely collected clinical and administrative data can be used as sources of deficits to automatically calculate FIs. This scoping review aimed to evaluate the current research landscape on routine data-based FIs. We searched seven databases to find literature published in 2013-2023. Main inclusion criteria were original research articles on FIs constructed from routine data, with deficits in at least two of the following categories: "symptoms/signs", "laboratory values", "diseases", "disabilities", and "others". From 7526 publications screened, 218 were included. Studies were primarily from North America (47.7 %), conducted in the community (35.3 %), and used routine data-based FIs for risk stratification (51.4 %). FIs were calculated using various routine data sources; however, most were initially developed and validated using hospital records. We noted geographical differences in study settings and routine data sources. We identified 611 unique deficits comprising these FIs. Most were either "diseases" (34.4 %) or "symptoms/signs" (32.1 %). Routine data-based FIs are feasible and valid risk stratification tools, but research is confined to high-income countries, their routine adoption is slow, and deficits comprising these FIs emphasise a reactive and overtly medical approach in addressing frailty. Future directions include exploring the feasibility and applicability of using routine databases for frailty assessment in lower- and middle-income countries, and leveraging non-clinical routine data through data linkages to proactively identify and manage frailty.

Self-reported outcomes following lower extremity, carotid and aortic artery disease: protocol for the Danish Vascular (DanVasc) survey

INTRODUCTION

Among lower extremity artery disease (LEAD), symptomatic carotid stenosis (SCS) and abdominal aortic aneurysm (AAA), the disease burden is insufficiently illuminated from a patient and societal perspective. Such knowledge is central to identifying patients at risk of poorer outcomes. Therefore, the Danish Vascular (DanVasc) survey aims to describe self-reported health status, health literacy, medication adherence and loneliness, including changes over time, and investigate characteristics associated with worse self-reported health at baseline and their associations with poorer outcomes within 1 year (healthcare utilisation and mortality) in patients with LEAD, SCS and AAA.

METHODS AND ANALYSIS

The DanVasc survey, a national prospective cohort study combining survey data measured at several time points with register-based data, includes validated patient-reported outcome measures (PROMs) and ancillary questions developed with patient representatives. Our baseline survey (T0) follows the index contact in vascular outpatient clinics with follow-up surveys determined by the patient's trajectory: (1) newly referred patients in conservative treatment trajectories; the date for the outpatient visit activates 1-month (T1), 3-month (T2) and 12-month (T3) follow-ups. (2) Patients referred for vascular surgery; the surgery date activates 1-month (T1), 3-month (T2) and 12-month (T3) follow-ups. The included PROMs assess health-related quality of life (HRQoL), anxiety and depression, sleep, frailty status, health literacy, medication adherence and loneliness. For LEAD, a disease-specific PROM evaluates HRQoL. For AAA, disease-specific ancillary questions are added. Additionally, the DanVasc survey includes questions on health behaviour, preventive measures and sexual life. The DanVasc survey will be linked to national registries to obtain socio-demographic information and data on redeemed prescriptions, clinical information, healthcare utilisation, comorbidities and mortality. From December 2023 to December 2024, we aim to recruit approximately 5500 patients from all seven DanVasc surgery departments. Patient characteristics will be reported using descriptive statistics. Changes over time and factors associated with poorer health outcomes will be analysed using linear, logistic and Cox proportional hazard models, presented as univariate and multivariate regressions.

ETHICS AND DISSEMINATION

Approval for the collection of medical record data was granted by the Central Denmark Region, acting on behalf of all Danish regions (record 1-45-70-94-22). Consent to participate is obtained prior to answering the survey. Results will be disseminated through peer-reviewed scientific publications and conference presentations, and findings will be shared with patients and relevant stakeholders via public and social media.

Validation of the hospital frailty risk score in China

PURPOSE

To validate the Hospital Frailty Risk Score (HFRS) in Chinese hospital settings, describing how patients are allocated to frailty risk groups and how frailty risk is associated with length of stay (LoS) and hospital costs.

DESIGN

Retrospective observational study.

SETTING

Forty-eight hospitals in Lvliang City, Shanxi Province, China.

SUBJECTS

Patients aged 75 years or older hospitalised between 1 January 2022 and 31 December 2023 (n = 34,731).

METHODS

A logistic regression model examined the association between long length of stay (LoS) and frailty risk. A generalised linear model assessed the association between hospital costs and frailty risk. Subgroup analyses of age group, sex, and hospital tiers were conducted.

RESULTS

22.2% of patients were categorised as having zero risk, 62.4% as low risk, 15.3% as intermediate risk, and 0.08% as high risk. Compared to the zero risk group: for those with low risk, the probability of long LoS was 1.92 (95% CI 1.79-2.06) times higher and hospital costs were ¥1926 (95% CI 1655-2197) higher; for those with intermediate risk, the probability of long LoS was 2.7 (95% CI 2.49-2.96) times higher and hospital costs were ¥4284 (95% CI 3916-4653) higher; and for those with high risk, the probability of long LoS was 6.7 (95% CI 3.06-14.43) times higher and hospital costs were ¥16,613 (95% CI 12,827-20,399) higher. The explanatory power of the HFRS held across subgroups.

CONCLUSIONS

Compared to patients aged 75 + elsewhere, those in China had lower frailty risk scores, likely reflecting a younger age structure and recording of fewer diagnosis codes. Even so, the HFRS is a powerful predictor of long length of stay and hospital costs in China.

Diagnostic Accuracy of Self-Reported Tools for Frailty Assessment in Older Adults With Cancer: A Diagnostic Meta-Analysis

INTRODUCTION

Questionnaires are commonly used for rapid frailty assessment. However, which scale is most appropriate for the identification of frailty in older adults with cancer remains unclear.

OBJECTIVE

A diagnostic meta-analysis was conducted to examine the sensitivity and specificity of questionnaire-based assessment tools in detecting frailty among older adults with cancer.

METHODS

Five databases were searched for eligible studies from inception to January 26, 2025. Study quality was evaluated using the revised Quality Assessment of Diagnostic Accuracy Studies tool. The pooled sensitivity and specificity of the frailty assessment tools were assessed through a bivariate random-effects model. Factors influencing the heterogeneity of sensitivity and specificity values were assessed through moderator analysis, which comprised a subgroup analysis and metaregression.

RESULTS

Five questionnaire-based tools (i.e., the Edmonton Frailty Scale, FRAIL scale, Groningen Frailty Indikator [GFI], Tilburg Frailty Indikator, and Vulnerable Elders Survey-13 [VES-13]) for assessing frailty in older adults with cancer were identified in the literature; the most commonly used were the GFI and VES-13. The sensitivity and specificity of the GFI (67% and 81%, respectively) and VES-13 (65% and 81%) were calculated. Studies with a high proportion of male participants had poorer GFI sensitivity. Older patient samples were associated with lower VES-13 sensitivity, and a high prevalence of frailty or patients having stage III-IV cancer was associated with higher sensitivity.

CONCLUSION

The GFI and VES-13 demonstrated high specificity but low sensitivity for frailty assessment in older adults with cancer. Frequent assessment with the GFI or VES-13 is recommended to improve frailty detection.

IMPLICATIONS FOR PRACTICE

Health-care professionals, including oncology nurses, care managers, and oncologists, can incorporate the GFI and VES-13 into cancer care settings to improve early frailty detection and management. Pre-Registration: The study protocol was registered at PROSPERO (CRD42024505836).

Association between laboratory data-based frailty index and clinical health outcomes in critically ill older patients: A retrospective correlational study

BACKGROUND

Although frailty assessment is crucial for understanding critically ill patients' prognosis, traditional frailty measures require substantial efforts and time from health care professionals. To address this limitation, the laboratory frailty index (FI-LAB) based on laboratory clinical data was developed. However, knowledge regarding its correlation with health outcomes among critically ill older patients is limited.

AIM

To identify the association between the FI-LAB and acute, mid- and long-term outcomes among critically ill older adults.

STUDY DESIGN

This retrospective correlational study used electronic health records of 2106 older patients who were admitted to the intensive care unit at a tertiary hospital in Seoul, Korea. Acute and mid-term outcomes included occurrence of delirium and in-hospital mortality, and the long-term outcome included 1-year mortality. Logistic regression was used to explore the relationships across FI-LAB, delirium, and in-hospital mortality, while Cox proportional hazard regression was used to analyse the relationship between FI-LAB and 1-year mortality.

RESULTS

Frailty assessed by FI-LAB was significantly associated with increased risk of delirium (odds ratio [OR] = 6.21, 95% confidence interval [CI] = 2.31-25.39, p = .009), in-hospital mortality (OR = 2.38, 95% CI = 1.15-5.79, p = .014), and 1-year mortality (hazard ratio = 2.47, 95% CI = 1.16-5.25, p = .019) after controlling for covariates.

CONCLUSIONS

The study highlighted the importance of using FI-LAB for screening frailty in critically ill older adults. Health care providers can improve patients' acute, mid- and long-term outcomes to develop more individualised management plans based on FI-LAB scores.

RELEVANCE TO CLINICAL PRACTICE

The FI-LAB score calculated from routine laboratory data can be used by nurses as a screening tool to identify frail older adults in critical care. Early detection of frailty would allow for closer monitoring and the implementation of interventions to reduce delirium and mortality.

Association of blood biomarkers with frailty-A mapping review

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

Role of brain-derived neurotrophic factor in frailty: From mechanisms to interventions

Frailty is a common medical syndrome which largely increases the risk of disability, depression, falls, hospitalization and mortality. An increasing number of research suggests that frailty is reversible by medical interventions at its early stage. Therefore, efficient detection is utterly important for frail population. Since numerous biological processes have been indicated in frail population, the critical regulators in these biological processes could provide biomarkers for early detection or treatment for frailty. The brain-derived neurotrophic factor (BDNF) has been associated with several biological process ranging from cognitive function to inflammation, therefore it could be an important regulator for frailty. In this review, we would discuss the mechanism association between different indicators of frailty and BDNF. Furthermore, we summarize the approaches to interfere with BDNF in healthy and pathologic condition, which could lead to identification of potential interventional strategies for frailty.

Ethnicity and frailty: A systematic review of association with prevalence, incidence, trajectories and risks

BACKGROUND

Ethnic variations in frailty are not fully understood. This systematic review examined ethnic differences in the prevalence, incidence and trajectories of frailty; associations between frailty and sociodemographic/lifestyle risk-factors; and health-related outcomes of frailty.

METHODS

We searched four electronic databases from 2000 to July 2023 using terms for ethnicity and frailty.

INCLUSION CRITERIA

observational studies assessing frailty in adults ≥ 18 years from community-based settings, including care homes; ethnicity defined by race, country of birth, language, ancestry, or culture. We supplemented searches with manual citation and reference list searches. Outcomes included prevalence, incidence, and transitions of frailty; factors associated with frailty; and health-related outcomes (e.g., mortality). Two reviewers independently screened all articles.

RESULTS

We included 82 studies, representing data from 13 countries plus two multi-national samples. Across the included countries, frailty prevalence was higher in minority groups compared to majority groups. Ethnic differences appear sensitive to methods used to measure frailty. Two United States-based studies found that ethnic differences were independent of sociodemographic differences such as income or education. Six studies from the United States or United Kingdom showed that Black and South-Asian people, respectively, had higher frailty incidence or more rapid frailty progression. Two studies showed that frailty was associated with mortality across ethnic groups but with some small differences in magnitude between groups.

CONCLUSION

Ethnic disparities in frailty prevalence persist across community-based settings in different countries and are not fully explained by known inequalities. Addressing these disparities will likely require careful frailty measurement and assessment; confronting structural inequalities; and tailoring interventions to the needs of minoritised populations.

Frailty identification using a sensor-based upper-extremity function test: a deep learning approach

The global increase in the older adult population highlights the need for effective frailty assessment, a condition linked to adverse health outcomes such as hospitalization and mortality. Existing frailty assessment tools, like the Fried phenotype and Rockwood score, have practical limitations, necessitating a more efficient approach. This study aims to enhance frailty prediction accuracy in older adults using a combined biomechanical and deep learning approach. We recruited 312 participants (126 non-frail, 145 pre-frail, 41 frail) and assessed frailty using the Fried index, upper-extremity function (UEF) test, and muscle force calculations. Machine learning (ML) models, including logistic regression and support vector machine (SVM), were employed alongside deep learning with long short-term memory (LSTM) networks. Results showed that incorporating muscle model parameters significantly improved frailty prediction. The LSTM model achieved the highest accuracy (74%), outperforming SVM (67%) and regression (66%), with precision and F1 scores of 81% and 75%, respectively. Notably, muscle co-contraction emerged as a critical predictor, with frail individuals exhibiting substantially higher levels. Our findings demonstrate that integrating UEF tasks with deep learning models provides superior frailty prediction, potentially offering a robust, efficient clinical tool. However, further validation with larger, more diverse populations is needed to confirm the generalizability of our results. This study underscores the potential of advanced computational techniques to improve the identification and monitoring of frailty 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.

Muscle power predicts frailty and other adverse events across different settings

OBJECTIVES

To evaluate the association between lower-limb muscle power (MP) and frailty, measured using eight different scales, in older adults from four clinical settings. Additionally, to examine the predictive capacity of MP for adverse health events.

DESIGN

A cross-sectional and longitudinal analysis using data from the Spanish cohort of the Frailtools project.

SETTING

Nursing homes, primary care clinics, geriatric inpatient wards, and outpatient clinics.

PARTICIPANTS

245 older adults (mean age 82 ± 4.6 years, 64% women).

MEASUREMENTS

MP measures were estimated using the five-time sit-to-stand (5STS) test and validated equations to obtain absolute (AMP), relative to body weight (RMP), and allometric (ALMP) values. Frailty was evaluated using eight scales, including the Frailty Phenotype and the Frailty Trait Scale. The incidence of adverse events (e.g., frailty, hospitalization, falls, and disability) was recorded over 12 months.

RESULTS

Frailty prevalence varied significantly across scales and settings, with the lowest rates observed in primary care and the highest in nursing homes. Cross-sectional analysis revealed significant associations between all MP measures and frailty for most scales. RMP demonstrated the strongest associations, particularly with the Frailty Trait Scale-5 and FRAIL scale, across primary care, nursing homes, and outpatient clinics. Longitudinally, RMP was significantly associated with incident frailty and several adverse events, including hospitalizations (AUC: 0.71) and disability in activities of daily living (AUC: 0.71). Sex-specific MP cut-off points were identified for predicting health events. No significant differences were observed among MP measurements.

CONCLUSION

Lower-limb MP is a valid clinical biomarker associated with frailty and negative health events in older adults. The degree of associations varied according to frailty scale and clinical context, but no significant differences were observed when we compared their predictive ability. The proposed MP cut-off points may enhance frailty assessment and screening, particularly in primary care, nursing homes, and outpatient clinics. These findings highlight the clinical potential of incorporating MP measures into frailty tools and stress the need for further research to refine age-specific cut-off points and explore the influence of body composition.

Frailty and hospital outcomes among patients with neurological disorders

INTRODUCTION

Patients with neurological disorders, particularly those who are chronologically and biologically older, may display highly varied clinical courses and trajectories. The present study explored the association between frailty and hospital outcomes among patients with acute neurological presentations admitted to an Italian university hospital.

MATERIALS AND METHODS

A cross-sectional study considered all patients consecutively admitted to the Neurology Unit of the Policlinico Umberto I University Hospital of Rome (Italy). A 40-item Frailty Index (FI) was retrospectively developed based on the clinical information collected in the Emergency Department (ED). Data on hospitalization outcomes were prospectively collected during the patient's stay at the Neurology Unit. Linear and logistic regression models were conducted to test the association between FI and hospital outcomes.

RESULTS

Overall, 185 participants (women 50.3%; mean age 68.6, SD 18.6 years) were included. FI scores ranged between 0 and 0.43, with a median value of 0.15 [IQR 0.10], and were positively correlated with age (Spearman's rho 0.55, p < 0.001). In a linear regression model adjusted by age, sex, and diagnosis, FI was significantly associated with the number of days spent in the Neurology Unit (B 2.18, 95%CI 0.25-4.11, per 0.1 increase; p = 0.03). In bivariate logistic regression models adjusted by age, sex, and diagnosis, increasing FI scores were significantly associated with a lower likelihood of being discharged at home (OR 0.37, 95%CI 0.20-0.63, per 0.1 increase; p < 0.001), with higher odds of nosocomial infections (OR 1.67, 95%CI 1.05-2.73 per 0.1 increase; p = 0.03), and prescription of antibiotics (OR 1.77, 95%CI 1.11-2.92, per 0.1 increase; p = 0.02).

CONCLUSION

Frailty is adversely associated with hospital outcomes in patients with acute neurological disorders. Assessing frailty could improve patient stratification, prognostication, and care planning, with a relevant impact on healthcare resources.

Sex Bias in Frailty Screening: A Cross-Sectional Analysis of PRISMA-7 and the Clinical Frailty Scale in Primary Care

Background/Objectives: Frailty screening is essential in primary care for the early identification of vulnerable older adults. PRISMA-7 is a widely used screening tool, but Item 2 ("Are you male?") introduces potential sex bias and overestimates frailty in men. PRISMA-6, a modified version that excludes Item 2, might provide a more equitable alternative. This study evaluates PRISMA-6's alignment with the Clinical Frailty Scale (CFS) and its impact on sex-specific frailty classification. Methods: A cross-sectional study was conducted in 142 general practices across South Tyrol, including 9190 general practice patients aged ≥75 years. Frailty was assessed using PRISMA-7, PRISMA-6, and the CFS. Correlations between tools were calculated using Kendall's Tau-b, whereas Fisher's z-test was used to compare differences in alignment. The frailty prevalence and odds ratios were stratified according to sex and age. Results: PRISMA-6 showed a stronger correlation with the CFS (τ = 0.492) than PRISMA-7 (τ = 0.308, z = -10.2, p < 0.001). This effect was pronounced in men (z = -9.8, p < 0.001), whereas no difference was observed in women (z = 0.00, p = 1.000). PRISMA-6 reduced the frailty detection rate in men and was more closely aligned with the CFS. Conclusions: PRISMA-6 demonstrated improved alignment with the CFS and reduced sex bias compared to PRISMA-7. However, its use as a screening tool for men requires prospective validation in diverse settings. PRISMA-6 shows promise as a reliable and equitable frailty screening tool and should be considered for use in future studies, particularly in primary care settings, while awaiting further prospective validation.

Comparative analysis of frailty identification tools in community services across the Asia-Pacific: A systematic review and meta-analysis

OBJECTIVES

This study aimed to compare various frailty screening and assessment tools with the Frailty Phenotype (FP), Frailty Index (FI), and Comprehensive Geriatric Assessment (CGA), which are considered the current gold standards, among the Asia-Pacific population in community settings.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

This review included studies evaluating frailty identification tools based on the criteria of population, index and reference tests, and diagnosis of interest.

METHODS

A diagnostic test accuracy review was conducted to assess frailty instruments recommended by the Asia-Pacific Clinical Practice Guidelines. Comprehensive electronic database searches and manual searches were conducted up to August 20, 2024. Study quality, including risks of bias and applicability, was assessed using the QUADAS-2 tool. Hierarchical analysis and Youden's index were employed to identify the optimal tool and cutoff points, and pooled frailty prevalence was calculated.

RESULTS

Fourteen studies were included: 10 for the FRAIL scale, 3 for TUG, and 2 for the SOF index (screening tools), and 2 each for the CFS and KCL, and 1 for the REFS (assessment tools). All studies demonstrated a high risk of bias. The pooled sensitivity and specificity for screening tools were 0.63 and 0.89, respectively, whereas for assessment tools, they were 0.79 and 0.85. The pooled prevalence of frailty and pre-frailty was 19.7% and 31.7%, respectively. The pooled diagnostic odds ratios were highest for the FRAIL scale (15.72) and CFS (35.03) among the screening and assessment tools. The subgroup analysis revealed that the setting had no significant impact on screening tool performance (p = 0.58), but a borderline significant effect was observed for assessment tools (p = 0.06), although this result is limited by the small number of studies, with only one conducted in a community setting. The FRAIL scale, with a cutoff of 2, had a Youden's index of 0.60, signifying optimal screening performance.

CONCLUSION

Among the frailty instruments recommended by the Asia-Pacific Clinical Practice Guidelines, this meta-analysis identifies the FRAIL scale as the most robust tool for distinguishing frailty, with a cutoff of 2 significantly enhancing diagnostic accuracy. Furthermore, the estimated prevalence of frailty in the Asia-Pacific region is 19.7% across various community settings, underscoring the need for further research and the development of validated assessment tools tailored to this population.

Frailty screening in older patients undergoing elective colorectal surgery: Comparative study of seven screening instruments

BACKGROUND

Frailty screening instruments are increasingly studied as risk predictors for adverse postoperative outcomes. However, because of the lack of comparative research, it is unclear which screening instrument performs best. This study therefore compared the diagnostic accuracy of seven frailty screening instruments for adverse postoperative outcomes in patients aged ≥70 years undergoing colorectal surgery.

METHODS

We conducted a prospective cohort study at an academic hospital, examining the Fried and Robinson frailty criteria, the Edmonton Frail Scale, the Rockwood Clinical Frailty Scale, the Modified Frailty Index, the FRAIL questionnaire, and the Geriatric 8 for predicting postoperative complications with a Clavien-Dindo (CD) severity grade ≥2. Secondary outcomes were complications with CD severity grade ≥3, prolonged length of stay, increased care level after discharge, and functional decline in basic or instrumental activities of daily living up to 1 month after surgery.

RESULTS

The study included 172 consecutive patients. Positive frailty screening ranged from 13.4% to 73.8%. CD≥2 complications were present in 37.8% of patients. At the original cutoffs, most instruments had a high specificity (76.7%-92.4%) at the expense of sensitivity (21.5%-38.5%) with a moderate negative predictive value (NPV) for predicting CD≥2 complications. The Geriatric 8 showed the opposite pattern (sensitivity 81.5%-specificity 30.8%) and a high NPV. Diagnostic accuracy was moderate for all screening instruments, since the areas under the receiver operating characteristic curve did not exceed 0.61 across instruments. Altering the cutoff scores did not yield sufficient improvement. Comparable results were found for the secondary outcomes.

CONCLUSIONS

Comparing the predictive value of the screening instruments showed that frailty screening cannot be used in isolation as risk predictor for adverse postoperative outcomes. Further research should focus on a two-step approach in which additional diagnosis of frailty by means of comprehensive geriatric assessment is included in the prediction model.

Current Practices of Irish Dietitians Assessing and Monitoring Muscle Strength, Mass and Function: A Cross-Sectional Survey

BACKGROUND AND AIMS

Measuring muscle mass, strength, and function is vital in nutritional assessment, offering valuable insights into overall health, including nutritional adequacy, metabolic function and physical well-being. Nonetheless, the use of these measures for nutritional assessment and monitoring in dietetic practice is not widely implemented, and gaps in care remain. This study aimed to explore Irish dietitians' current nutritional assessment practices related to muscle health.

METHODS

A cross-sectional descriptive 29-item online survey was adapted and distributed via link in email and social media to state-registered dietitians (N = 1340) in Ireland between 21 September 2023 and 26 October 2023. Data were analysed descriptively.

RESULTS

The majority of dietitians (84/85) agreed that musculature was important in the assessment of nutritional status, with 80% (n = 56/70) reporting the integration of at least one assessment of muscle health into their clinical practice. Handgrip strength (HGS) was viewed as the most important (95.7%; n = 67/70), frequently applied (64.3%; n = 45/70) and most useful for monitoring muscle health (77.1%; n = 54/70). Regardless, the frequency of muscle health assessment in routine practice was low. The muscle health assessments that are routinely ( > once/week) measured include body weight (82.9%; n = 58/70), BMI (81.4%; n = 57/70), HGS (25.7%; n = 18/70) and the Timed up and go test, chair stand test or short physical performance battery (10%; n = 7/70). The main barriers to muscle health assessment were 'lack of training/application experience' (61.4%, n = 43/70) and 'lack of device availability' (58.5%, n = 41/70).

CONCLUSION

This study provides insights into the application of muscle health assessments within nutritional assessment among Irish dietitians. Results indicate a gap between the recognised value of muscle health and its use in nutritional assessment. Despite an almost unanimous agreement on the importance of musculature, challenges such as insufficient training and lack of equipment hinder the widespread implementation of muscle health assessment as a standard component of nutritional assessment. These findings emphasise the need for further practical education and measures to improve the availability of equipment to bridge this gap and optimise nutritional care.

Opportunistic screening for atrial fibrillation among frail older patients, little effort for a high diagnostic yield. Outcomes of the Dutch-GERAF study

BACKGROUND AND AIMS

Frailty increases the risk of atrial fibrillation (AF) and its complications. This study investigated the feasibility and diagnostic yield of an eHealth screening for the detection of new AF, in frail older patients.

METHODS

Patients referred to the Geriatric Medicine outpatient clinics were eligible. A Frailty Index (FI) was calculated. Patients were screened for AF with electrocardiograms (ECGs) at baseline and a smartphone photoplethysmography (PPG) application, during 6 months.

RESULTS

Nine hundred fifty-two patients (median age 79 years) were included, mean FI of 0.16, 311 were frail (33%) and 751 had sinus rhythm (79%) at baseline. Six hundred forty-one patients (85%) performed PPG recordings (median 2), 295 (39%) at least 3 recordings. Twenty (2.7%) new cases of AF were found, 10 at baseline and 10 during follow-up. Among 16 (2%) patients, additional irregular PPG recordings were acquired, but no confirmatory ECG took place.

CONCLUSION

The screening strategy proved feasible in very old and frail patients. A diagnostic yield of 2.7% was found by ECG, and an additional 0.9% of new AF cases were suspected on PPG recordings. The non-binding approach of the strategy might be disadvantageous for the patient category. Future PPG AF screening programmes for very old and frail patients should strictly organise their means of AF confirmation.

Digital biomarkers for real-life, home-based monitoring of frailty: a systematic review and meta-analysis

BACKGROUND

Frailty, characterised by decreased physiological function and increased vulnerability to stressors, was associated with an increase in numerous adverse outcomes. Although the number of digital biomarkers for detecting frailty in older adults is increasing, there remains a lack of evidence regarding their effectiveness for early detection and follow-up in real-world, home-based settings.

METHODS

Five databases were searched from inception until 1 August 2024. Standardised forms were utilised for data extraction. The Quality Assessment of Diagnostic Accuracy Studies was used to assess the risk of bias and applicability of included studies. A meta-analysis was conducted to assess the overall sensitivity and specificity for frailty detection.

RESULTS

The systematic review included 16 studies, identifying digital biomarkers relevant for frailty detection, including gait, activity, sleep, heart rate, hand movements and room transition. Meta-analysis further revealed pooled sensitivity of 0.78 [95% confidence interval (CI): 0.70-0.86] and specificity of 0.79 (95% CI: 0.72-0.86) to classify robust and pre-frailty/frailty participants. The overall risk of bias indicated that all the included studies were characterised as having a high or unclear risk of bias.

CONCLUSION

This study offers a thorough characterisation of digital biomarkers for detecting frailty, underscoring their potential for early prediction in home settings. These findings are instrumental in bridging the gap between evidence and practice, enabling more proactive and personalised healthcare monitoring. Further longitudinal studies involving larger sample sizes are necessary to validate the effectiveness of these digital biomarkers as diagnostic tools or prognostic indicators.

Validation of the nurse directed frailty assessment tool, to identify patients at risk of emergency department visits, hospitalisation, and 1-year all-cause mortality

METHODS

This is a validation study of a new frailty assessment that can be administered by outpatient care nurses. The nurse directed frailty assessment (NDFA) encompasses the medical, psychological, social, and functional domain, based on standard care, and can be performed without any specialised equipment. Performance of the NDFA is compared to a comprehensive geriatric assessment (CGA)-based frailty index (FI), with generalised linear model with reporting of hazard ratios (HR) and 95% confidence intervals (95% CI). The best cutoff value for the NDFA was assessed by Youden index and the area under the receiver operator curve (ROC).

RESULTS

Within 1 year, 15 patients (5%) died, 57 (18%) had an unplanned hospital admission, and 83 (26%) visited the emergency department (ED). Based on the Youden index and ROC curve, the best cutoff value for the NDFA was 4 points. With a binary logistic regression model, an HR of 3.59 (95% CI 1.16-11.15, p < 0.001) was found for mortality. In the general mixed model with Poisson logistic regression, an HR of 1.78 (95% CI 1.06-2.97, p 0.028) was found for unplanned hospital and an HR of 1.87 (95% CI 1.25-2.78, p 0.002) was found for ED visits. The HR and 95% CI of the FI were similar for all three outcome measures.

CONCLUSIONS

The NDFA identifies patients at risk for hospitalisation, emergency department visits, and mortality within 12 months equally well as the FI. Further research is necessary to determine the effectiveness of the NDFA in other settings than the geriatric medicine outpatient population.

The association between gut microbiota and accelerated aging and frailty: a Mendelian randomization study

BACKGROUND

The recent observational studies have unveiled the correlation between the composition and dynamic alterations of the gut microbiome and aging; however, the causal relationship remains uncertain.

AIMS

The objective of this study is to investigate the causal relationship between the gut microbiome and accelerated aging as well as frailty, from a genetic perspective.

METHODS

We obtained data on the gut microbiome, intrinsic epigenetic age acceleration, and Frailty Index from published large-scale genome-wide association studies. A two-sample Mendelian randomization analysis was conducted primarily using inverse variance weighting model. We utilized the MR-Egger intercept analysis, IVW method, the Cochran Q test, and the leave-one-out analysis to assess the robustness of the results.

RESULTS

IVW analysis indicated a potential association between Peptococcus (OR: 1.231, 95% CI 1.013-1.497, P = 0.037), Dialister (OR: 1.447, 95% CI 1.078-1.941, P = 0.014) and Subdoligranulum (OR: 1.538, 95% CI 1.047-2.257, P = 0.028) with intrinsic epigenetic age acceleration; while Prevotella 7 (OR: 0.792, 95% CI 0.672-0.935, P = 0.006) was associated with a potential protective effect. Allisonella (OR: 1.033, 95% CI 1.005-1.063, P = 0.022), Howardella (OR: 1.026, 95% CI 1.002-1.050, P = 0.031) and Eubacterium coprostanoligenes (OR: 1.037, 95% CI 1.001-1.073, P = 0.042) were associated with an increased risk of frailty; conversely, Flavonifractor (OR: 0.954, 95% CI 0.920-0.990, P = 0.012) and Victivallis (OR: 0.984, 95% CI 0.968-1.000, P = 0.049) appeared to exhibit a potential protective effect against frailty.

CONCLUSION

The findings of this study provide further evidence for the genetic correlation between gut microbiota and accelerated aging as well as frailty, enhancing the understanding of the role of gut microbiota in aging-related processes. However, the underlying mechanisms and potential clinical applications require further investigation before any targeted interventions can be developed.

Barriers and facilitators of exercise behaviour for frail older adults in nursing homes: protocol for a qualitative study in China

Exercise is significant for older adults to improve their poor health outcomes. It can delay weakness, enhance the quality of muscle and body balance, and prevent adverse events. However, the factors that hinder or promote exercise among frail nursing home residents are unclear. Few studies have investigated the exercise-related experiences and coping strategies of frail older adults, and it is necessary to further understand the overall situation among older adults. Therefore, this study aims to obtain information about the impact of exercise-related barriers and facilitators on the daily life of frail older adults and how they cope with this condition. Qualitative research design uses a phenomenological framework. Older adults participating in the study will be invited to describe their life experiences with exercise-related barriers and facilitators, the impact on their daily lives and the strategies they use to cope with the condition. This study will use purposeful sampling to ensure the sample provides informative cases representative of frail older adults with exercise-related barriers and facilitators. Face-to-face, personal and semi-structured interviews will be conducted in nursing homes in Sichuan, China. A trained qualitative researcher will conduct interviews. Transcripts will be analysed using NVivo V.10 qualitative software, and themes will be synthesised to highlight the critical issues raised by frail older adults about the exercise process. Understanding the awareness of frail older adults on exercise management care will help improve the existing health services in this area. This research data will be used in future research to develop a validated survey, which can be used by medical staff working in nursing homes to understand and strengthen the health service provision of frail older adults.

Validation of the Italian Version of the Rapid Geriatric Assessment in Community-Dwelling Older Adults

Background/Objectives: The Rapid Geriatric Assessment (RGA) is a tool designed to screen for frailty, sarcopenia, anorexia related to aging, and cognitive impairment. This study aimed to translate and validate the RGA for use among Italian community-dwelling older adults. Methods: This cross-cultural study involved 100 community-dwelling older adults randomly recruited through convenience sampling from general practitioner offices in Genoa (Italy), between January and June 2019. The RGA includes the Simple FRAIL Questionnaire Screening Tool, SARC-F Screening for Sarcopenia, Simplified Nutritional Assessment Questionnaire (SNAQ), and Rapid Cognitive Screening (RCS). These were validated against gold-standard tools: the Abbreviated Comprehensive Geriatric Assessment (aCGA) and Multidimensional Prognostic Index (MPI). Additional assessments included the Timed Up and Go (TUG) and Handgrip test. The validation process included forward-backward translation, synthesis, and consensus by independent reviewers. Psychometric properties, internal consistency (Cronbach alpha), and validity correlations were analyzed. Results: The RGA demonstrated satisfactory psychometric properties, with internal consistency (Cronbach alpha = 0.59) and significant validity correlations (RGA and aCGA, rho = 0.34, p = 0.001; RGA and MPI, rho = 0.49, p < 0.001). Discriminant validity was confirmed by significant correlations between specific subitems and reference measures: FRAIL with TUG (p < 0.05), SARC-F with Handgrip strength (p = 0.013), SNAQ with BMI, and RCS with MMSE (p < 0.001). Conclusions: The Italian version of the RGA is a reliable screening tool for geriatric syndromes in community-dwelling older adults. While it does not replace a CGA, the RGA may identify individuals who may benefit from further evaluation using a complete CGA.

Development and Feasibility Study of HOPE Model for Prediction of Depression Among Older Adults Using Wi-Fi-based Motion Sensor Data: Machine Learning Study

BACKGROUND

Depression, characterized by persistent sadness and loss of interest in daily activities, greatly reduces quality of life. Early detection is vital for effective treatment and intervention. While many studies use wearable devices to classify depression based on physical activity, these often rely on intrusive methods. Additionally, most depression classification studies involve large participant groups and use single-stage classifiers without explainability.

OBJECTIVE

This study aims to assess the feasibility of classifying depression using nonintrusive Wi-Fi-based motion sensor data using a novel machine learning model on a limited number of participants. We also conduct an explainability analysis to interpret the model's predictions and identify key features associated with depression classification.

METHODS

In this study, we recruited adults aged 65 years and older through web-based and in-person methods, supported by a McGill University health care facility directory. Participants provided consent, and we collected 6 months of activity and sleep data via nonintrusive Wi-Fi-based sensors, along with Edmonton Frailty Scale and Geriatric Depression Scale data. For depression classification, we proposed a HOPE (Home-Based Older Adults' Depression Prediction) machine learning model with feature selection, dimensionality reduction, and classification stages, evaluating various model combinations using accuracy, sensitivity, precision, and F1-score. Shapely addictive explanations and local interpretable model-agnostic explanations were used to explain the model's predictions.

RESULTS

A total of 6 participants were enrolled in this study; however, 2 participants withdrew later due to internet connectivity issues. Among the 4 remaining participants, 3 participants were classified as not having depression, while 1 participant was identified as having depression. The most accurate classification model, which combined sequential forward selection for feature selection, principal component analysis for dimensionality reduction, and a decision tree for classification, achieved an accuracy of 87.5%, sensitivity of 90%, and precision of 88.3%, effectively distinguishing individuals with and those without depression. The explainability analysis revealed that the most influential features in depression classification, in order of importance, were "average sleep duration," "total number of sleep interruptions," "percentage of nights with sleep interruptions," "average duration of sleep interruptions," and "Edmonton Frailty Scale."

CONCLUSIONS

The findings from this preliminary study demonstrate the feasibility of using Wi-Fi-based motion sensors for depression classification and highlight the effectiveness of our proposed HOPE machine learning model, even with a small sample size. These results suggest the potential for further research with a larger cohort for more comprehensive validation. Additionally, the nonintrusive data collection method and model architecture proposed in this study offer promising applications in remote health monitoring, particularly for older adults who may face challenges in using wearable devices. Furthermore, the importance of sleep patterns identified in our explainability analysis aligns with findings from previous research, emphasizing the need for more in-depth studies on the role of sleep in mental health, as suggested in the explainable machine learning study.

Incremental healthcare costs of the simple SOF measure of phenotypic frailty in community-dwelling older adults

BACKGROUND

Frailty defined by the Cardiovascular Health Study (CHS) phenotype is associated with higher healthcare expenditures in community-dwelling Medicare beneficiaries after accounting for claims-based cost indicators. However, frailty assessment using the CHS phenotype is often not feasible in routine clinical practice. We evaluated whether frailty identified by the simple Study of Osteoporotic Fractures (SOF) phenotype is associated with subsequent incremental costs after accounting for claims-derived cost indicators.

METHODS

Prospective study utilizing data from four cohort studies of older adults linked with Medicare claims composed of 8264 community-dwelling fee-for-service beneficiaries (4389 women, 3875 men). SOF Frailty Phenotype (three components: weight loss, poor energy, and inability to rise from chair five times without using arms) and CHS Frailty Phenotype (operationalized using five components) derived from cohort data. Participants were classified as robust, prefrail, or frail using each phenotype. Multimorbidity index (CMS Hierarchical Conditions Categories score) and Kim frailty indicator (approximating the deficit accumulation index) derived from claims. Annualized total and sector-specific healthcare costs ascertained for 36 months after frailty assessment.

RESULTS

Average annualized total healthcare costs (2023 US dollars) were $15,021 in women and $15,711 in men. After accounting for claims-based multimorbidity and frailty indicators, average incremental costs of SOF phenotypic frailty (two or three components) versus robust (none) were $7142 in women and $5961 in men, only modestly lower than incremental costs of CHS phenotypic frailty ($9422 in women, $6479 in men). SOF phenotypic frailty in both sexes was associated with higher subsequent expenditures in the inpatient, skilled nursing facility, and home healthcare sectors.

CONCLUSIONS

As observed with CHS phenotypic frailty, SOF phenotypic frailty is associated with higher subsequent total and sector-specific expenditures after accounting for claims-derived indicators. The parsimonious SOF phenotype can be readily assessed in space-constrained and time-limited practice settings to improve identification of older adults at high risk of costly care.

Daily life mobility detects frailty, falls, and functioning in older prostate cancer survivors treated with androgen deprivation therapy

INTRODUCTION

Androgen deprivation therapy (ADT) increases the risk of frailty, falls, and poor physical functioning in older adults with prostate cancer. Detection of frailty is limited to self-report instruments and performance measures, so unbiased tools are needed. We investigated relationships between an unbiased measure - daily life mobility - and ADT history, frailty, fall history, and functioning in older prostate cancer survivors treated with ADT.

MATERIALS AND METHODS

This cross-sectional study recruited prostate cancer survivors with a history of ADT from an exercise clinical trial, an academic medical center, and the community. Participants completed performance measures and surveys to assess frailty, fall history, and physical functioning, then wore instrumented socks for up to seven days to continuously monitor daily life mobility. We performed a principal component analysis on daily life mobility metrics and used regression analyses to investigate relationships between domains of daily life mobility and frailty, fall history, and physical functioning.

RESULTS

Participants (N = 99) were aged 73.0 +/- 7.3 years, most were pre-frail or frail (75 %), and 35 % had fallen at least once in the last year. Daily life mobility metrics clustered into four domains: Gait Pace, Rhythm, Activity, and Balance. Worse scores on Rhythm and Activity were associated with increased odds of frailty (odds ratio [OR] 1.59, 95 % confidence interval [CI]: 1.04, 2.49 and OR 1.81, 95 % CI: 1.19, 2.83, respectively). A worse score on Rhythm was associated with increased odds of ≥1 falls in the previous year (OR 1.60, 95 % CI: 1.05, 2.47). Worse scores on Gait Pace, Rhythm, and Activity were associated with worse physical functioning. Mobility metrics were similar between current and past users of ADT.

DISCUSSION

Continuous passive monitoring of daily life mobility may identify prostate cancer survivors who have developed frailty, falls, and declines in physical functioning.

Frailty in kidney transplant recipients

Kidney transplantation is the treatment of choice even for the elderly, as it improves quality of life and life expectancy, lowering the financial burden to the health care system compared to dialysis therapy. In Japan, kidney transplant recipients have become older due to the shift in demographics. Compared to community-dwelling elderly adults, elderly kidney transplant recipients undergoing immunosuppressive therapy have a higher risk of age-related outcomes including hospital readmissions, infections, dementia, malignancies, and fractures. In frailty, patients become vulnerable to adverse events after stressors due to a lack of physiologic reserve. Although it is often associated with aging, frailty can also occur in younger individuals with certain chronic illnesses or conditions including chronic kidney disease. Limited compensatory mechanisms result in functional impairment and adverse health outcomes, such as disability, falls, decreased mobility, hospitalization, and death. Although kidney transplant recipients can restore their kidney function after transplantation, most of them still have chronic kidney disease, as well as a gradual decline in graft function as a result of chronic allograft nephropathy. Wait-listed candidates for kidney transplantation with frailty are more likely to experience wait-list removal or death. Frailty at the time of transplantation is associated with complications after kidney transplantation such as delayed graft function, longer hospital stays, rehospitalizations, immunosuppression intolerance, surgical complications, and death. Nevertheless, kidney transplantation can be a viable intervention for frailty in dialysis patients.

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

OBJECTIVE

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

DESIGN

Longitudinal study.

SETTING AND PARTICIPANTS

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

MESUREMENTS

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

RESULTS

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

CONCLUSION

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

The causal association between plasma caffeine and frailty: A two-sample mendelian randomization study

BACKGROUND

Frailty is one of the most common and challenging consequences of aging, which negatively affects older adults, their families, and society. Caffeine has been shown to be associated with a reduced risk of frailty by observational studies, yet its causal relationship with frailty remains to be tested using more robust methods.

AIMS

This study aimed to explore the causal association between plasma caffeine and frailty using a two-sample Mendelian Randomization (MR) analysis.

METHODS

Single nucleotide polymorphisms related to plasma caffeine concentrations were selected as instrumental variables. Data on the Frailty Index (FI) were sourced from the UK Biobank and TwinGen meta-analysis (n = 175,226), while data on the Fried Frailty Score (FFS) were obtained from the UK Biobank (n = 386,565). The causal association between plasma caffeine levels and frailty was tested using five MR methods, with the inverse-variance weighted method as the primary approach.

RESULTS

Our results consistently showed significantly negative associations between genetically predicted plasma caffeine with FI (β = -0.050, 95 % CI:0.077 to -0.023, P < 0.001) and FFS (β = -0.049, 95 % CI:0.064 to -0.034, P < 0.001). These results remained robust in further sensitivity analyses using a leave-one-out approach.

CONCLUSION

Our findings confirm a causal relationship between plasma caffeine and frailty and suggest that increasing plasma caffeine levels may help prevent and reduce the risk of frailty.

Challenges, current innovations, and opportunities for managing type 2 diabetes in frail older adults: a position paper of the European Geriatric Medicine Society (EuGMS)-Special Interest Group in Diabetes

PURPOSE

This position paper aims to address the challenges of managing type 2 diabetes mellitus (T2DM) in frail older adults, a diverse and growing demographic with significant variability in health status. The primary research questions are: How can frailty assessment be effectively integrated into diabetes care? What strategies can optimize glycaemic control and outcomes for frail older adults? How can innovative tools and technologies, including artificial intelligence (AI), improve the management of this population?

METHODS

The paper uses the 5 I's framework (Identification, Innovation, Individualization, Integration, Intelligence) to integrate frailty into diabetes care, proposing strategies such as frailty tools, novel therapies, digital technologies, and AI systems. It also examines metabolic heterogeneity, highlighting anorexic-malnourished and sarcopenic-obese phenotypes.

RESULTS

The proposed framework highlights the importance of tailoring glycaemic targets to frailty levels, prioritizing quality of life, and minimizing treatment burden. Strategies such as leveraging AI tools are emphasized for their potential to enhance personalized care. The distinct management needs of the two metabolic phenotypes are outlined, with specific recommendations for each group.

CONCLUSION

This paper calls for a holistic, patient-centered approach to diabetes care for frail older adults, ensuring equity in access to innovations and prioritizing quality of life. It highlights the need for research to fill evidence gaps, refine therapies, and improve healthcare integration for better outcomes in this vulnerable group.

A non-randomized pilot study to test the feasibility of developing a frailty scale for pet cats

Introduction

Human frailty has long been studied and dozens of "frailty scales" have been developed, but equivalent research is more limited in cats. This pilot study aimed to determine the feasibility of recruiting and retaining veterinary practices and owners, collecting study data, and analyzing results about frailty in older cats.

Methods

Participating feline-exclusive practice veterinarians recruited cats aged 11-20 years, of either sex and of any breed. Owners completed a questionnaire about their cat and estimated its frailty. Study veterinarians also estimated the cat's frailty after obtaining a history, conducting a physical examination, and completing a separate questionnaire. The derived variables were used to investigate the following domains of frailty: (1) cognitive function; (2) behavior; (3) activity; (4) body weight; (5) body condition score; (6) muscle condition score; (7) any unexplained changes in weight, cognitive function, or eating behavior; and (8) the number of chronic diseases identified in the cat. Some cats were followed prospectively for 6 months, and mortality during this period was compared with frailty status, as determined by the veterinarian.

Results

Half (6/12) of the veterinary practices invited to participate successfully recruited 273 owner-cat pairs, with baseline questionnaire results obtained from 189 owners (69%) and veterinarian questionnaires obtained for 210 cats (77%). Of 122 cats having both owner and veterinarian questionnaire results, 45 (37%) were classified as frail by the owner and 51 (42%) by the veterinarian, with 28 (23%) classified as frail on both questionnaires. Of the cats with follow-up data, 13 of the 64 cats (20%) reported by veterinarians to be frail died or were euthanased during the 6-month follow-up, compared with only 1 of 54 cats (2%) that were not reported to be frail (Fisher's exact test P = 0.003).

Discussion

Developing a brief feline frailty questionnaire (FFQ) was feasible, and the results of such assessments were associated with 6-month mortality. A larger definitive trial should be considered to explore further the (dis)agreement between owners and veterinarians and better understand which frailty signs owners might be missing.

Assessment of muscle fatigability using isometric repetitive handgrip strength in frail older adults. A cross-sectional study

BACKGROUND

Fatigue has a significant impact on physical performance and quality of life in older adults, but is subjectively assessed in the Fried phenotype, so early deterioration may be overlooked. This study explores whether repetitive handgrip strength (HGS) provides an objective method of differentiating levels of frailty by comparing fatigue and recovery ratios with subjective measures and their correlations with frailty indicators.

METHODS

Participants (n = 217) were included based on mobility and cognitive function (MMSE > 17), with exclusions for neuromuscular disease or hand injury. The protocol consisted of two 10-maximal grip assessments one hour apart, calculating fatigue ratios 1 and 2 (maximum/mean force) at each session and recovery ratios between sessions. Logistic regression analysed associations between Fried's criteria components (Unintentional Weight Loss, Exhaustion Single Question, Multidimensional Fatigue Inventory (MFI), Short Physical Performance Battery (SPPB), Physical Activity Scale for the Elderly (PASE), standard Maximum HGS, Fatigue Ratio, and Recovery Ratio).

RESULTS

Among the participants (58 non-frail, 68 pre-frail, 91 frail; ages 74.7, 79.4, 83.8 years), significant differences were found for Fatigue Ratio 1 of 1.12 (non-frail), 1.23 (pre-frail), 1.40 (frail), Fatigue Ratio 2 of 1.12, 1.21, 1.45, and Recovery Ratio of 1.03, 1.01, 0.90, respectively. Fatigue Ratios 1, 2 and Recovery correlated more strongly with frailty status (r = 0.67, 0.69, -0.68) than MFI (r = 0.50), standard maximum HGS (r = -0.51) or a single fatigue question (r = 0.21). In logistic regression for predicting fatigue (MFI), Fatigue Ratio (OR = 1.51, p < 0.001) and Recovery Ratio (OR = 0.83, p = 0.022) were stronger predictors than single-question fatigue (OR = 1.15, p = 0.047) and maximum HGS. For predicting frailty, physical performance (SPPB) was the strongest predictor (OR = 0.72, p < 0.001), followed by Fatigue Ratio 1 (OR = 1.28, p < 0.001), with a higher Recovery Ratio reducing frailty risk (OR = 0.86, p = 0.050).

CONCLUSION

The repetitive HGS protocol is equivalent to the SPPB in assessing frailty and outperforms standard HGS and subjective fatigue measures. This objective method supports the identification of frailty by measuring strength, fatigue resistance and recovery capacity.

Epigenetic factors and inflammaging: FOXO3A as a potential biomarker of sarcopenia and upregulation of DNMT3A and SIRT3 in older adults

Background

Epigenetic factors influence inflammaging and geriatric disorders such as sarcopenia and frailty. It is necessary to develop a biomarker/panel of biomarkers for fast and easy diagnostics. Currently, hard-to-access equipment is required to diagnose sarcopenia. The development of a biomarker/panel of biomarkers will prevent many older adults from being excluded from the diagnostic process.

Methods

In this study, we analyzed selected gene expression profiles, namely, SIRT1, SIRT3, SIRT6, DNMT3A, FOXO1, FOXO3A, and ELAVL1, in whole blood. The study included 168 subjects divided into five groups: patients hospitalized at the Geriatrics Clinic and Polyclinic with sarcopenia, frailty syndrome, or without those disorders (geriatric control), and non-hospitalized healthy controls (HC) aged 25 to 30 years and over 50 years.

Results

We revealed a lower mRNA level of FOXO3A (p<0.001) in sarcopenic patients compared to the geriatric controls. Furthermore, we detected upregulation of DNMT3A (p=0.003) and SIRT3 (p=0.015) in HC over 50 years old compared to HC aged 25 to 30 years. Interestingly, we observed 2 cluster formations during the gene expression correlation analysis (SIRT1, SIRT3, DNMT3A, and FOXO1, ELAVL1). We also noted correlations of clinical parameters with mRNA levels in the sarcopenic patients group, such as vitamin D level with SIRT1 (r=0.64, p=0.010), creatine kinase with SIRT3 (r=-0.58, p=0.032) and DNMT3A (r=-0.59, p=0.026), creatinine with DNMT3A (r=0.57, p=0.026), erythrocyte sedimentation rate (ESR) with FOXO3A (r=0.69, p=0.004), and lactate dehydrogenase (LDH) with FOXO3A (r=-0.86, p=0.007). In the frailty syndrome group, we noted a correlation of appendicular skeletal muscle mass (ASMM) with ELAVL1 (r=0.59, p=0.026) mRNA level. In the geriatric controls, we observed a correlation of serum iron with FOXO3A mRNA level (r=-0.79, p=0.036).

Conclusions

Our study revealed FOXO3A as a potential biomarker of sarcopenia. Furthermore, we observed a high expression of epigenetic factors (DNMT3A and SIRT3) in older adults.

Dietary intake of live microbes and its association with frailty in older adults: a NHANES analysis (1999-2018)

BACKGROUND

Diet plays a crucial part in maintaining a healthy body, and microbes, as an essential dietary component, have attracted more attention in recent years. In this study, we will explore the link between dietary intake of live microbes and frailty in the elderly.

METHODS

Older participants from the 1999-2018 National Health and Nutrition Examination Survey (NHANES) who were not less than 60 years of age were enrolled in this research. Participants' dietary microbe intake was assessed by a self-report questionnaire. Participants were stratified into low, medium, and high intake groups according to their consumption of foods with varying microbial content. The frailty index was assessed by 49 frailty indicators. Frailty was defined as a frailty index > 0.21. Logistic regression was used to analyze the link between dietary intake of live microbes and frailty in older adults.

RESULTS

A total of 15,179 older adults' basic information was collected for this study. The frailty index was higher than 0.21 in 32.8% of participants. Older adults with low, medium, and high dietary microbe intake accounted for 33.5%, 47.0%, and 19.5%, respectively. In models adjusted for confounders, the prevalence of frailty was lower in participants with the medium (OR = 0.825, 95%CI: 0.749-0.908) and high (OR = 0.779, 95%CI: 0.679-0.894) dietary microbe intake groups, compared with in participants with the lowest intake group. The RCS analysis revealed a significant non-linear association between dietary live microbe intake and frailty prevalence, with the strongest reduction observed below an inflection point of 161.82 (P for non-linearity < 0.05). In addition, stratified analyses did not reveal interactions between the study variables.

CONCLUSION

This study demonstrates a negative and non-linear association between dietary live microbe intake and frailty in older adults. These findings provide evidence of a potential link between live microbe intake and frailty, warranting further longitudinal and interventional studies to explore this relationship and its implications for healthy aging.

Frailty and Sleep in Adult Survivors of Childhood Cancer: A Childhood Cancer Survivor Study Report

BACKGROUND

Young adult survivors of childhood cancer exhibit rates of frailty similar to adults several decades older without a cancer history. Frailty has been associated with sleep disturbances in non-cancer populations, but the relationship has not been examined in childhood cancer survivors who are known to exhibit elevated rates of sleep problems.

AIMS

Examine associations between frailty and poor sleep quality in long-term survivors of childhood cancer.

METHODS

This study utilized data from 9044 participants (> 5 years from diagnosis, Mage = 40.8 years [SD = 9.5]) in the Childhood Cancer Survivor Study. Survivors' frailty status, chronic health conditions (CHC), health behaviors, mental health, and pain were collected in 2014-2016, and self-reported sleep quality in 2017-2019. Multivariable logistic regression models examined frailty status as a predictor of clinically significant poor sleep. All models were adjusted for age at diagnosis, age at survey, sex, race/ethnicity, smoking, risky/heavy alcohol use, and physical inactivity. Separate models included treatment-related variables, CHC burden (number/severity), and emotional health/pain as co-variates.

RESULTS

Frail survivors had 6-fold (95% CI 4.48-7.96) increased odds of future poor sleep quality. Little attenuation of this association was observed when accounting for cancer diagnosis (Odds Ratio [OR] 5.80, 95% CI 4.47-7.52), treatment exposures (OR 5.80, 95% CI 4.43-7.71), or chronic health condition burden (OR 5.12, 95% CI 3.98-6.59), but adjustment for emotional health/pain (OR 2.88, 95% CI 2.18-3.82) attenuated the association appreciably.

CONCLUSIONS

Frail childhood cancer survivors have a higher prevalence of clinically significant poor sleep quality. Addressing poor physiologic reserve may impact sleep in frail childhood cancer survivors.

Predictive Power of the Fried Phenotype in Assessing Postoperative Outcomes in Patients Undergoing Craniotomy for Tumor Resection

BACKGROUND AND OBJECTIVES

Compared with the modified Frailty Index-11 (mFI-11) frailty tool, reflective of patient comorbidities, the Fried phenotype weighs functional patient variables. This study examined using the Fried phenotype in predicting postoperative outcomes in craniotomy for patients with tumor.

METHODS

This retrospective cohort analysis included patients with Current Procedural Terminology codes for supratentorial/infratentorial tumor resections and preoperative frailty scores. Chart review collected the remaining variables for the primary outcome, length of stay (LOS), and secondary outcomes, discharge disposition and postoperative complications. Basic descriptive statistics summarized patient demographics, clinical parameters, and postoperative outcomes. χ 2 tests, t -tests, and ANOVA examined associations and mean differences. Logistic and Poisson regressions explored predictor-outcome relationships.

RESULTS

Over 7 years, these 153 patients underwent Fried assessments. The Fried score was biased toward females being more frail (nonfrail 38.0% female, prefrail 50.0% female and frail 65.6% female, P = .027) but not by age, body mass index, or tumor type. The mFI-11 was biased by age (nonfrail 67.8 years vs frail 72.3 years, P < .001) and body mass index (nonfrail 27.5 vs frail 30.8, P < .001) but not sex or tumor type. The Fried score was significantly correlated with increased LOS's (odds ratio [OR] = 5.92, 95% CI = 1.66-21.13, P < .001) but the mFI-11 was not (OR = 0.82, 95% CI = 0.35-1.93, P = .64). The Fried phenotype was significantly correlated with discharge disposition location ( P = .016), whereas the mFI-11 was not ( P = .749). The Fried score was significantly correlated with postoperative complications (OR = 1.36, 95% CI = 1.08-1.71, P = .01), whereas the mFI-11 was not (OR = 1.10, 95% CI = 0.86-1.41, P = .44).

CONCLUSION

The Fried phenotype more accurately correlates with postoperative outcomes including LOS, discharge disposition location, and complications than does the mFI-11 score. These findings can be used to guide preoperative planning, inform consent, and potentially identify patients who may benefit from functional optimization in the preoperative period to improve postoperative outcomes.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Exploring the Causal Relationship Between Frailty and Chronic Obstructive Pulmonary Disease: Insights From Bidirectional Mendelian Randomization and Mediation Analysis

Background

Observational studies have underscored a robust association between frailty and chronic obstructive pulmonary disease (COPD), yet the causality remains equivocal.

Methods

This study employed bidirectional two-sample Mendelian randomization (MR) analysis. Univariable MR investigated the causal relationship between frailty and COPD. Genetic correlation was assessed using linkage disequilibrium score (LDSC) regression. Multivariable MR and mediation analysis explored the influence of various confounders and their mediating effects. The primary analytic approach was inverse variance weighted (IVW).

Results

LDSC analysis revealed moderate genetic correlations between frailty and Global Biobank Meta-Analysis Initiative (GBMI) COPD (rg = 0.643, P = 6.66×10-62) as well as FinnGen COPD (rg = 0.457, P = 8.20×10-28). IVW analysis demonstrated that frailty was associated with increased risk of COPD in both the GBMI cohort (95% CI, 1.475 to 2.158; P = 2.40×10-9) and the FinnGen database (1.411 to 2.434; 9.02×10-6). Concurrently, COPD was identified as a susceptibility factor for frailty (P < 0.05). These consistent findings persisted after adjustment for potential confounders in MVMR. Additionally, mediation analysis revealed that walking pace mediated 19.11% and 15.40% of the impact of frailty on COPD risk, and 17.58% and 23.26% of the effect of COPD on frailty risk in the GBMI and FinnGen cohorts, respectively.

Conclusion

This study has strengthened the current evidence affirming a reciprocal causal relationship between frailty and COPD, highlighting walking pace as a pivotal mediator.

Frailty index, frailty phenotype and 6-year mortality trends in the FRASNET cohort

Background

Frailty, a geriatric syndrome associated with adverse outcomes, lacks a universal definition. No consensus exists on the most effective frailty scale for predicting mortality.

Methods

This prospective observational study followed community-dwelling volunteers for 6 years. Frailty was measured with the Frailty Index (FI) and the Frailty Phenotype (FP). Concordance was assessed using Cohen's Kappa coefficients. Age-and sex-adjusted Cox regression analyses were conducted to evaluate the association with mortality.

Results

Out of 1,114 participants (median age 72 years, IQR 69-77), 186 were classified as frail by the FI, 13 by the FP and 48 by both definitions. The concordance between the two measures was fair (κ = 0.26). Thirty-nine individuals died during the follow-up period. The FI showed a stronger association with mortality (HR 75.29, 95% CI 8.12-697.68, p < 0.001) compared to the FP (HR 3.3, 95% CI 1.45-7.51, p = 0.004). Individuals classified as frail by both definitions had the highest mortality risk and the highest FI scores (median 0.36).

Conclusion

Definitions of frailty identify different individuals as frail. The FI was more closely related to mortality than the FP. Individuals classified as frail according to both definitions displayed the highest complexity (corresponding also ho higher FI scores) and the greatest mortality. The FI demonstrated a more accurate ability to predict mortality due to its comprehensive nature.

The prevalence of frailty among older adults with maintenance hemodialysis: a systematic

BACKGROUND

To evaluate the epidemiological data on the prevalence of frailty and prefrailty in individuals aged 60 years or older on MHD patients.

METHODS

PubMed, Web of Science, Embase, CNKI, WanFang, CBM, and VIP were searched from inception to February 2023 using combinations of subject words and free words. The methodological quality of all the selected studies was assessed using the Joanna Briggs Institute Critical Appraisal of Epidemiological Studies Checklist and Newcastle‒Ottawa Cohort Quality Assessment Scale. Random effects meta-analysis was used to pool estimates from different studies. Subgroup analysis and meta-regression were performed to explore potential sources of heterogeneity.

RESULTS

Of the 4,190 documents retrieved, 16 observational studies involving 2,446 participants from 8 countries were included in this systematic review. Among older adults receiving MHD, the overall prevalence of frailty and prefrailty was 41% (95% CI = 34-49%) and 37% (95% CI = 26-48%), respectively, with considerable heterogeneity. The pooled prevalence of frailty was greater among individuals aged > 70 years (45%) than among those aged ≤ 70 years (37%). However, subgroup analyses indicated that the confidence intervals for the age group overlap substantially.

CONCLUSION

Our research showed that the prevalence of frailty and prefrailty in older patients with MHD are high.

TRIAL REGISTRATION

The PROSPERO registration number for this study was CRD42023442569.

Association between sarcopenic obesity and risk of frailty in older adults: a systematic review and meta-analysis

BACKGROUND

Age-related changes in body composition such as muscle loss can lead to sarcopenia, which is closely associated with frailty. However, the effect of body fat accumulation on frailty in old age remains unclear. In particular, the association between the combination of these two conditions, known as sarcopenic obesity, and frailty in older adults is unclear.

OBJECTIVE

To synthesise the association between sarcopenic obesity and the risk of frailty and to investigate the role of obesity in the risk of frailty in old age.

METHODS

Six databases were searched from inception to 29 September 2024. Two reviewers independently extracted the data and assessed the risk of bias for the included observational studies using the adapted Newcastle-Ottawa scale. The control groups consisted of robust, obese and sarcopenic individuals. Meta-analyses were performed to examine the risk of frailty due to sarcopenic obesity and the role of obesity in frailty amongst sarcopenic older adults.

RESULTS

Sixteen eligible studies were included in meta-analyses from 1098 records. Compared to robust individuals, older adults with sarcopenic obesity were more vulnerable to frailty [odds ratio (OR), 3.76; 95% confidence interval (CI), 2.62 to 5.39; I2 = 79.3%; P < .0001]. Obesity was not associated with the risk of frailty (OR, 1.23; 95% CI, 0.99 to 1.53; I2 = 0.0%; P = .501) in sarcopenic older adults.

CONCLUSIONS

Sarcopenic obesity is associated with a high risk of frailty. Sarcopenia and obesity may have synergistic effects on frailty in older adults.

Assessment of older persons with multimorbidity in Norwegian primary care: a qualitative study of healthcare professionals' experiences and preferences in fostering continuity of care

BACKGROUND

As the population ages, more people live longer with multimorbidity. Older people with multimorbidity face diverse needs and medical conditions, increasing the risk of adverse health outcomes, and often experience fragmented healthcare. Research has called for better ways to reach, understand and care for this group to enhance care continuity. This study aimed to examine healthcare professionals' experiences and preferences as they relate to assessments' role in promoting care continuity for home-dwelling older patients with multimorbidity in community-based healthcare.

METHODS

This qualitative study acquired qualitative data from 17 healthcare professionals from reablement teams, interdisciplinary teams, rehabilitation teams and home nursing in three Norwegian municipalities. Representing nursing, physiotherapy, occupational therapy and social work, all participants were experienced in assessing older home-dwelling patients with multimorbidity. Semi-structured focus group and individual interviews were conducted, then the interviews were transcribed and analysed using reflexive thematic analysis.

RESULTS

The analysis elicited three themes: gaining insight beyond diagnoses to promote relational continuity, facilitating interaction to ensure informational continuity, and linking patient journeys to facilitate managerial continuity. The themes underscore the significance of evaluating patients beyond their medical conditions, emphasising assessment's collaborative nature across disciplines. Healthcare professionals use diverse assessment methods and facilitate interaction to understand patients' needs. Working together across different healthcare professions is key for care that includes the whole patient, but challenges such as underutilisation of assessments and poor documentation still exist. Furthermore, linking patient journeys remains difficult due to fragmented services and limited resources. Despite these challenges, assessments were viewed as crucial to care continuity.

CONCLUSIONS

In this qualitative study, healthcare professionals emphasised that assessment is a complex, continuous process due to the fluctuating health of individuals with multimorbidity. Effective instruments and diverse assessment methods are essential to understanding all aspects of patients' health and well-being to ensure care continuity across individual, service, and system levels. Our findings highlight the need for systematic and structured use of assessments to improve interdisciplinary collaboration and personalised care for older individuals with multimorbidity. Understanding the patient journey is crucial for achieving these goals, potentially benefiting healthcare professionals, policymakers, and primary care providers.

Frailty Risk Patterns and Mortality Prediction in Community-Dwelling Older Adults: A 3-Year Longitudinal Study

OBJECTIVES

Frailty is a heterogeneous syndrome with distinct patterns. This study aimed to identify frailty risk patterns and their predictive value for mortality in older adults.

DESIGN

Prospective longitudinal study.

SETTING AND PARTICIPANTS

Data were obtained from a 2017 survey of 609 independently mobile adults aged 65 years and older in suburban Japan, focusing on those at risk for at least 1 frailty dimension.

METHODS

Frailty assessments were extracted from the Kihon checklist, and subgroups were identified using latent class analysis. Associations between frailty patterns and 3-year mortality were assessed using Kaplan-Meier survival analysis and Cox proportional hazards modeling.

RESULTS

Three frailty patterns were identified: "high risk of cognitive impairment" (76.0%), "moderate risk of cognitive, physical, and oral dysfunction" (14.3%), and "high risk of cognitive, physical, and functional decline" (9.7%). We recorded 52 deaths during a mean follow-up time of 25.7 months (standard deviation: 12.6) and a median follow-up time of 26.5 months. Kaplan-Meier analysis showed significant survival differences among the groups (log-rank: P < .001). Compared with the high risk of cognitive impairment group, the moderate risk of cognitive, physical, and oral dysfunction group had a 145% higher mortality risk (adjusted hazard ratio, 2.45; 95% confidence interval, 1.22-4.90), while the high risk of cognitive, physical, and functional decline group exhibited a 220% higher risk of mortality (adjusted hazard ratio, 3.20; 95% confidence interval, 1.53-6.70).

CONCLUSIONS AND IMPLICATIONS

The findings reveal the heterogeneity of frailty among community-dwelling Japanese older adults, with a high prevalence of cognitive impairment risk. The subgroup with risk of cognitive, physical, and functional decline had the highest mortality risk, highlighting the need for multidimensional assessment and intervention.

Frailty and comorbidity in older adults with and without diabetes and chronic leg ulcer: A cross-sectional study

This descriptive, cross-sectional study aimed to identify whether having a chronic leg ulcer (CLU), in addition to diabetes, contributed to frailty in individuals ≥65 years old. It also explored the associations between frailty, pre-frailty and other factors. 125 participants aged ≥65 attending outpatient clinics in Ireland were categorised into three groups: (1) diabetes-only and no CLU, (2) CLU-only and no diabetes, and (3) diabetes and CLU. Frailty status was identified using the Groningen Frailty Indicator (GFI) and the Physical Frailty Phenotype (PFP). The mean age was 76.09 ± 7.31. Overall, 90 (72%) had diabetes, and 89 (71.2%) had CLU in the past 6 months. While 124 (99.2%) were frail according to the GFI, 122 (97.6%) were either physically frail (n = 40, 32%) or pre-frail (n = 82, 65.6%) based on the PFP. There was no difference between the three groups regarding general frailty status (p > 0.05). However, being aged ≥75, having CLU and having CLU in addition to diabetes were associated with frailty severity (p < 0.05). Slow gait, inability to go to the toilet and dress/undress independently were the common factors contributing to frailty. Age, comorbidities and CLU were associated with frailty severity. Incorporating multidimensional frailty screening into regular clinic visits for older adults with CLU is recommended.

Navigating the Surgical Pathway for Frail, Older Adults Undergoing Colorectal Surgery

Adults ≥ 65 years of age comprise nearly 20% of the U.S. population and over half of surgical patients. Older adults, particularly when frail, may require additional preoperative evaluation and counseling, specialized hospital care, and may experience more noticeable physical and cognitive changes than younger or healthier patients. Surgeons can assess frailty and risk using several frailty measures, as data exist demonstrating worse perioperative outcomes among patients undergoing colorectal surgery. Prehabilitation programs have not been shown to improve surgical outcomes for colorectal surgery patients but may help maintain physical function or hasten recovery to baseline around the time of surgery, particularly for frail patients. Functional decline and delirium are common postoperatively in older adult patients, particularly those who are frail at baseline, and should be discussed with at-risk older adults. Primary care physicians and geriatricians can help with in-depth evaluation of frailty and geriatric syndromes. Special attention to the risks, outcomes, and care of older adults considering or undergoing colorectal surgery can help inform decision-making, which may facilitate goal-concordant care.

Frailty Modeling Using Machine Learning Methodologies: A Systematic Review With Discussions on Outstanding Questions

Studying frailty is crucial for enhancing the health and quality of life among older adults, refining healthcare delivery methods, and tackling the obstacles linked to an aging demographic. Approaches to frailty modeling often utilise simple analytic techniques rather than available advanced machine learning methods, which may be sub-optimal. There is no large-scale systematic review on applications of machine learning methods on frailty modeling. In this study we explore the use of machine learning methods to predict or classify frailty in older persons in routinely collected data. We reviewed 181 research articles, and categorised analytic methods into three categories: generalised linear models, survival models, and non-linear models. These methods have a moderate agreement with existing frailty scores and predictive validity for adverse outcomes. Limited evidence suggests that non-linear methods outperform generalised linear methods. The top-three predictor/input variables are specific diagnosis or groups of diagnoses, functional performance (e.g., ADLs), and impaired cognition. Mortality, hospital admissions and prolonged hospital stay are the mainly predicted outcomes. Most studies utilise classical machine learning methods with cross-sectional data. Longitudinal data collected by wearable sensors have been used for frailty modeling. We also discuss the opportunities to use more advanced machine learning methods with high dimensional longitudinal data for more personalised and accessible frailty tools.