Frailty: understanding the difference between age and ageing

Outcomes of Octogenarians Undergoing Edge-to-Edge Transcatheter Valve Repair for Tricuspid Regurgitation: Inverse Propensity Score-Weighted Analysis

There is a scarcity of data for perioperative outcomes of octogenarians undergoing tricuspid transcatheter edge-to-edge repair (TEER), despite both the potential procedural effectiveness in treating tricuspid regurgitation and a low incidence of severe complications observed in the nonelderly population. We assessed the characteristics and outcomes of TEER in octogenarians compared to those in patients under 80 years old treated at a referral tertiary teaching hospital. We retrospectively enrolled all adult patients undergoing tricuspid TEER. The population was stratified based on age: ≥80 and <80 years. Inverse probability of treatment weighting (IPTW) propensity score was used to mitigate the risk of selection bias. Between January 2017 and September 2023, 101 patients underwent tricuspid TEER. Thirty-six (36%) were octogenarians. Crude treatment estimates indicated that preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) was significantly higher in octogenarians compared to younger patients (19 mm [IQR: 17 to 21] vs. 17 mm [IQR: 14-18]; p = 0.005). At discharge, octogenarians showed a TAPSE 2.71 mm higher than that observed in the <80 age group (95% CI: 0.79 to 4.62; p = 0.006) according to crude treatment estimates. After adjusting with IPTW-weighting, the TAPSE difference remained significant, with octogenarians having a 2.44 mm higher TAPSE (95% CI: 0.54 to 4.35; p = 0.012). IPTW-adjusted analyses indicated comparable clinical outcomes between the two groups. Adverse events and survival in octogenarians were similar to those observed in patients aged <80 years. Our findings indicate that age alone should not be the sole criterion to deny TEER.

Does frailty scoring help to predict outcomes in older patients with major trauma? A retrospective study at a major trauma centre

OBJECTIVE

The objective of the present study was to evaluate the impact of frailty on outcomes for older patients presenting with major trauma to a tertiary ED in Aotearoa New Zealand.

METHODS

A retrospective observational study of patients 65 years and older who presented to Christchurch ED, New Zealand, with major trauma between 1 January and 31 December 2022. The primary outcome was a composite of in-hospital mortality or increased care requirements on discharge from hospital. Demographic details, in-hospital management, and outcomes were retrieved. Clinical Frailty Scale scoring had prospectively been recorded at the time of admission. Univariable analysis of discrete dependent variables was carried out. Mediation analysis was undertaken, wherein frailty was the mediator between age and the primary outcome variable.

RESULTS

After exclusion criteria were applied, 134 patients were included for analysis. Even after controlling for age, for every additional point on the Clinical Frailty Scale, the odds of in-hospital mortality or increased care requirements on discharge increased by 36.4% (95% confidence interval: 9.4-85). Only 33% of these major trauma patients were appropriately identified at presentation and so received a trauma team activation, with worsened activation rates with increasing frailty.

CONCLUSIONS

The presence of significant injuries in older trauma patients is under-recognised. Frailty scoring could be used in the ED for early identification of those patients at high risk of poor outcomes, so that active management strategies can be put in place to optimise their care.

Association between relative fat mass and cognitive function among US older men: NHANES 2011-2014

BACKGROUND

Relative fat mass (RFM) is a new metric developed to assess the entire body fat proportion in adults. The objective of this study was to examine the correlation between cognitive performance and RFM in older American males.

METHODS

A total of 1,321 individuals were selected from the National Health and Nutrition Examination Survey (NHANES) that was carried out between the years 2011 and 2014. Specifically, the Consortium to Establish a Registry for Alzheimer's Disease Word Learning Test (CERAD-WL), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST) were used in order to achieve the objective of assessing cognitive function. The standardized scores of the three previously mentioned tests were averaged to create the Z-scores, a composite, generalized metric. RFM was ascertained by measuring waist circumference (WC) and height. The relationships that exist between RFM and cognitive performance were investigated using a variety of statistical methods, including multivariate linear regression, threshold effect analyses, smooth curve fitting, and subgroup analyses.

RESULTS

The study included 1,321 male volunteers aged 60 years or older, and comprehensive data was provided for each individual. Fully adjusted models indicated a negative correlation between RFM and CERAD-WL scores[-0.17, (-0.32,-0.01)], DSST scores[-0.83, (-1.16,-0.50)] and Z-scores[-0.03, (-0.05, -0.01)]. It was observed that the negative correlation that exists between RFM and Z-scores became more pronounced when RFM exceeded 35.78. Furthermore, subgroup analyses showed that the association between RFM and cognitive function was significantly impacted by education level, poverty-income ratio (PIR), smoking status, and drinking status.

CONCLUSIONS

A higher RFM was linked to lower cognitive function in older men, suggesting that management of RFM may prove advantageous in mitigating cognitive decline among older male populations.

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.

Construction and Evaluation of a Novel Nomogram for Predicting Dual Dimensional Frailty in Older Maintenance Haemodialysis Patients

OBJECTIVE

To construct and evaluate a novel nomogram for predicting the risk of dual dimensional frailty (comorbidity between physical frailty and social frailty) in older maintenance haemodialysis.

METHODS

A cross-sectional investigation was conducted. A total of 386 older MHD patients were recruited between September and December 2024 from four haemodialysis centres in four tertiary hospitals in Sichuan Province, China. LASSO regression and binary logistic regression were employed to determine the predictors of dual dimensional frailty. The prediction performance of the model was evaluated by discrimination and calibration. The decision curve was utilised to estimate the clinical utility. Internal validation with 1000 bootstrap samples was conducted to minimise overfitting.

RESULTS

In the overall sample (386 cases), a total of 92 (23.8%) of patients exhibited dual dimensional frailty. Five relevant predictors, including physical activity, self-perceived health status, ADL impairment, malnutrition, and self-perceptions of aging, were identified for constructing the nomogram. Internal validation indicated excellent discriminatory power and calibration of the model, while the clinical decision curve demonstrated its remarkable clinical utility.

CONCLUSIONS

The novel nomogram constructed in this study holds promise for aiding healthcare professionals in identifying physical and social frailty risks among older patients on maintenance haemodialysis, potentially informing early and targeted interventions.

RELEVANCE TO CLINICAL PRACTICE

This nomogram enables nurses to efficiently stratify dual-dimensional frailty risk during routine assessments, facilitating early identification of high-risk patients. Its visual output can guide tailored interventions, such as exercise programmes, nutritional support, and counselling, while optimising resource allocation.

PATIENT OR PUBLIC CONTRIBUTION

Data were collected from self-reported conditions and patients' clinical information.

REPORTING METHOD

STROBE checklist was employed.

Frailty and long-term survival of non-cancer patients admitted to intensive care after surgery: a retrospective multicentre cohort study

BACKGROUND

As the global population ages and older patients undergo surgery, understanding the association between frailty and postoperative outcomes is crucial to informed decision-making and patient care. There is a lack of research assessing the association between frailty and long-term outcomes in patients admitted to ICUs after surgery.

METHODS

We conducted a multicentre retrospective cohort study using Australian and New Zealand Intensive Care Society Adult Patient Database, linked with the Australian National Death Index. Adults aged ≥16 yr admitted to the 175 ICUs in Australia between January 1, 2018, and March 31, 2022, after surgery were included. We excluded patients with cancer or admission to ICU for palliation or organ donation purpose. Patients with Clinical Frailty Scale score 5-8 were considered frail. The primary outcome was survival time up to 4 yr after ICU admission. Survival analysis was performed using mixed-effects Cox regression models and adjusted for age, sex, comorbidities, acute illness severity, and hospital types.

RESULTS

We included 216 922 patients of whom 30 860 (14.2%) were frail. Patients with frailty had shorter overall survival time (median [IQR]: 16 [6-29] vs 21 [10-34] months; P<0.01) when compared with patients without frailty. After adjusting for confounders, frailty was associated with a shorter time to death (HR: 2.33, 95% CI: 2.26-2.40). This association was consistent across sensitivity analyses and subgroups. Of note, this association between frailty and shorter time to death was more pronounced in patients aged <65 yr, those undergoing elective surgery, and those without treatment limitations.

CONCLUSIONS

In this multicentre study, frailty was associated with shorter time to death amongst postoperative ICU patients without cancer. The association was concordant across all subgroups.

Development and validation of a prediction model of frailty risk in community-dwelling older adults: From a national longitudinal survey

OBJECTIVES

This study aimed to develop and validate a risk prediction model for frailty in elderly using a nationally representative longitudinal survey database.

STUDY DESIGN

Longitudinal study based on public databases.

METHODS

Three continuous cohorts of elderly aged 65 years or older from the Chinese Longitudinal Healthy Longevity Survey, with the 2008-2018 cohort as the development cohort. 2005-2014 and 2002-2011 cohort as validation sets. Frailty was assessed using the FI constructed from 46 indicators of health deficits, with FI ≥ 0.25 considered frailty. Prediction models were constructed using Cox regression model. We assessed the predictive performance of the models using the concordance statistic and calibration accuracy.

RESULTS

4,878 participants from the development cohort were enrolled with a median follow-up of 65 months. The prediction model contained 9 predictors: age, BMI, cognitive function, gender, ethnicity, education, natural teeth status, smoking status, and occupation. In the development cohort, the AUCs were 0.74, 0.78, and 0.80 at 36, 60, and 96 months. The AUCs were 0.68, 0.84, 0.85, and 0.70, 0.72, and 0.76 for two validation sets, respectively. Calibration performed well in the development and two validation sets, with a Brier score of <0.25. The prediction models constructed using machine learning algorithms showed similar predictive performance.

CONCLUSIONS

We developed and validated a model to predict the risk of incident frailty in elderly. The model provides insights to enable early screening and risk stratification for frailty in elderly, and to frame the development of individualized prevention of frailty.

Frailty Influence on Postoperative Surgical Site Infections After Surgery for Degenerative Spine Disease and Adult Spine Deformity. Can a Frailty Index be a Valuable Summary Risk Indicator? A Systematic Review and Metanalysis of the Current Literature

STUDY DESIGN

Metanalysis.

OBJECTIVE

Surgical site infections (SSI) is one of the commonest postoperative adverse events after spine surgery. Frailty has been described as a valuable summary risk indicator for SSI in spine surgery. The aim of this metanalysis is to evaluate the influence of frailty on postoperative SSI in this cohort and provide hints on which index can predict the risk of SSI.

METHODS

Papers describing the postoperative SSI rate in adult degenerative spine disease or adult spine deformity patients with varying degrees of frailty were included in the analysis. The SSI rate in different grades of frailty was considered for outcome measure. Meta-analysis was performed on studies in whom data regarding patients with different levels of frailty and occurrence of postoperative SSI could be pooled. P < .05 was considered significant.

RESULTS

16 studies were included. The frailty prevalence measured using mFI-11 ranged from 3% to 17.9%, these values were inferior to those measured with mFI-5. Significant difference was found between frail and non-frail patients in postoperative SSI rate at metanalysis (z = 5.9547, P < .0001 for mFI-5 and z = 3.8334, P = .0001 for mFI-11).

CONCLUSION

This is the first meta-analysis to specifically investigate the impact of frailty, on occurrence of SSI. We found a relevant statistical difference between frail and non-frail patients in SSI occurrence rate. This is a relevant finding, as the ageing of population increases alongside with spine surgery procedures, a better understanding of risk factors may advance our ability to treat patients while minimizing the occurrence of SSI.

Is meeting 24-hour movement guidelines associated with a lower risk of frailty among adults?

BACKGROUND

The relationship between 24-hour (24-h) movement guidelines and frailty remains unclear. We aimed to investigate the associations between meeting 24-h movement guidelines and frailty and to conduct secondary analyses by age, gender, and ethnicity.

METHODS

In this study, we extracted data from the National Health and Nutrition Examination Survey (2007-2018) database. A total of 5,726 participants (50.25 ± 0.31 years) were included in this analysis, representing 38,240,356 noninstitutionalized U.S.

INDIVIDUALS

Three 24-h movement behaviors, namely, physical activity, sedentary behavior (SB), and sleep, were self-reported using the standardized questionnaires. The 49-item frailty index was used to measure frailty. Multivariable logistic regression models and trend tests were used to examine the associations between meeting 24-h movement guidelines and frailty. Sensitivity analyses were also conducted to ensure the robustness of our results.

RESULTS

The total age-adjusted prevalence of frailty was 30.5%. In the fully adjusted model, compared with not meeting any of the 24-h movement guidelines, the adjusted odds ratios (AORs) of frailty were 0.786 (95% CI: 0.545, 1.133), 1.161 (95% CI: 0.787, 1.711), and 0.915 (95% CI: 0.616, 1.358) for participants meeting only moderate to vigorous physical activity (MVPA), only SB, and only sleep guidelines, respectively, but no statistically significant differences were observed (all P values > 0.05). Participants who met the SB + sleep guidelines (AOR = 0.613, 95% CI: 0.423, 0.887), MVPA + sleep guidelines (AOR = 0.389, 95% CI: 0.255, 0.593), and MVPA + SB guidelines (AOR = 0.555, 95% CI: 0.383, 0.806) presented a significantly lower risk of frailty by 39%, 61%, and 45%, respectively. Meeting all 3 guidelines (AOR = 0.377, 95% CI: 0.264, 0.539) and meeting 2 guidelines (AOR = 0.527, 95% CI: 0.377, 0.736) were associated with a lower risk of frailty (P value < 0.001), showing a linear trend (P for trend < 0.001). The strength of these associations varied somewhat by age, gender, and ethnicity.

CONCLUSIONS

Significant associations between the 24-h movement guidelines and frailty were observed among U.S. adults. Future studies are warranted to examine the causality and trajectory of these associations.

Predicting grip strength-related frailty in middle-aged and older Chinese adults using interpretable machine learning models: a prospective cohort study

Introduction

Frailty is an emerging global health burden, and there is no consensus on the precise prediction of frailty. We aimed to explore the association between grip strength and frailty and interpret the optimal machine learning (ML) model using the SHapley Additive exPlanation (SHAP) to predict the risk of frailty.

Methods

Data for the study were extracted from the China Health and Retirement Longitudinal Study (CHARLS) database. Socio-demographic, medical history, anthropometric, psychological, and sleep parameters were analyzed in this study. We used the least absolute shrinkage and selection operator (LASSO) regression to filter the model for the best predictor variables and constructed six ML models for predicting frailty. The feature performance of six ML models was compared based on the area under the receiver operating characteristic curve (AUROC) and the light gradient boosting machine (LightGBM) model was selected as the best predictive frailty model. We used SHAP to interpret the LightGBM model and to reveal the decision-making process by which the model predicts frailty.

Results

A total of 10,834 eligible participants were included in the study. Using the lowest quartile of grip strength as a reference, grip strength was negatively associated with the risk of frailty when grip strength was >29.00 kg for males or >19.00 kg for females (p < 0.001). The LightGBM model predicted frailty with optimal performance with an AUROC of 0.768 (95% CI 0.741 ~ 0.795). The SHAP summary plot showed that all features predicted frailty in order of importance, with cognitive function being considered the most important predictive feature. The poorer the cognitive function, nighttime sleep duration, body mass index (BMI), and grip strength, the higher the risk of frailty in middle-aged and older adults. The SHAP individual force plot clearly shows that the LightGBM model predicts frailty in the individual decision-making process.

Conclusion

The grip strength-related LightGBM prediction model based on SHAP has high accuracy and robustness in predicting the risk of frailty. Increasing grip strength, cognitive function, nighttime sleep duration, and BMI reduce the risk of frailty and may provide strategies for individualized management of frailty.

The Safety of Spinal Surgery in Patients over 80 Years of Age: Propensity Score Matching Study

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

Using propensity match score to remove those confounding bias and focuses on age factor to compare clinical outcomes and perioperative complications following spinal surgery in cohort of Korean octogenarians treated at a single tertiary hospital.

METHODS

We classified patients of 80s as the octogenarian group (group O), those 65 and older, and under 80 as the elderly group (group E). We strategically employed the Propensity Score Matching (PSM) analysis as a method to counteract potential confounding variables. 1: 1 nearest-neighbor PSM for fusion level, estimated blood loss (EBL), transfusion, body mass index (BMI), American society of anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI) surgical method and operation time was performed. After PSM, 98 patients are categorized each group evenly (group O, n = 49 vs group E, n = 49). Demographics, clinical, radiologic and postoperative complications were analyzed.

RESULTS

The clinical outcomes showed no significant differences in the VAS and ODI preoperatively or postoperatively. And most of hospitalization related factors shows no differences between 2 groups. However, follow-up period was longer in group E (1053.37 ± 684.14 days) than group O (640.29 ± 496.68, P = 0.001) and group O has higher incidences of medical complication (38.77% vs 16.32%, P = 0.013), especially in delirium (34.69% vs 6.12%, P = 0.001) than group E.

CONCLUSIONS

With the preparation for the prevention and treatment of postoperative delirium, age itself should not be a reason to hesitate in performing the spinal surgery.

Association between stroke and relative fat mass: a cross-sectional study based on NHANES

BACKGROUND

This study was aimed at investigating the correlation between the occurrence of stroke and relative fat mass (RFM), a novel metric for determining total body fat.

METHODS

This cross-sectional study employed the National Health and Nutrition Examination Survey (NHANES) dataset, which encompassed the years 2005 to 2018 to assess the independent relationship between RFM and stroke. Moreover, multinomial logistic regression, subgroup analysis, smooth curve fitting, and interaction testing were also used.

RESULTS

This study included 35,842 participants and 1,267 (3.53%) of them were diagnosed with stroke. Fully adjusted Models showed that RFM was positively associated with stroke (odds ratio [OR] = 1.02; 95% confidence interval [CI] = 1.01-1.03). The odds of having a stroke in quartile 4 were significantly elevated by 44%, compared to quartile 1 (OR = 1.44,95%CI:1.09-1.90). In addition, a subgroup analysis also demonstrated that age and BMI significantly impacted the association between RFM and stroke (P for interaction<0.01).

CONCLUSIONS

Elevated RFM is associated with increased odds of stroke, suggesting that RFM may have potential value in the prevention and management of stroke.

Modified frailty index effectively predicts adverse outcomes in sepsis patients in the intensive care unit

BACKGROUND

Frailty and sepsis have a significant impact on patient prognosis. However, research into the relationship between frailty and sepsis in the general adult population remains inadequate. This paper aims to investigate the association between frailty and adverse outcomes in this population.

METHOD

This retrospective analysis investigated sepsis patients who were initially admitted to the intensive care unit (ICU). The Modified Frailty Index (MFI) was derived by tracking patients' International Classification of Diseases (ICD) codes during their hospitalization. Patients were classified into two groups based on their MFI scores: a frail group (MFI ≥ 3) and a non-frail group (MFI = 0-2). The key outcomes were mortality rates at 90 and 180 days, with secondary outcomes including the incidence of delirium and pressure injury.

RESULT

Of the 21,338 patients who were recruited for this study (median age about 68 years, 41.8 % female), 5,507 were classified as frail and 15,831 were classified as non-frail. Frail patients were significantly more likely to have delirium (48.9 % vs. 36.1 %, p < 0.001) and pressure injury (60.5 % vs. 51.4 %, p < 0.001). After controlling for confounding variables, the multifactorial Cox proportional hazard regression analyses revealed a significantly elevated mortality rate at 90 days (adjusted HR: 1.58, 95 % CI: 1.24-2.02, p < 0.001) and 180 days (adjusted HR: 1.47, 95 % CI: 1.18, 1.83, p < 0.001) in the frail group compared to their non-frail counterparts.

CONCLUSIONS

Frailty independently predisposes adult sepsis patients in the ICU to adverse outcomes. Future investigations should concentrate on evaluating frailty and developing targeted interventions to improve patient prognosis.

IMPLICATION FOR CLINICAL PRACTICE

The MFI provides a simple clinical assessment tool that can be integrated into electronic medical records for immediate calculation. This simplifies the assessment process and plays a key role in predicting patient outcomes.

The association between olfactory subdomains and frailty: A prospective case‒control study investigation

BACKGROUND

Amidst the rise of frailty among a globally aging population, olfactory decline has emerged as a harbinger of frailty and mortality in population-level studies. However, the relationships between frailty and the olfactory subdomains of identification (OI), discrimination (OD), and threshold (OT) remain unexplored. This study prospectively examined the association between olfactory subdomains and the physical frailty phenotype (PFP) to investigate olfactory evaluation as a means of frailty screening.

METHODS

A case‒control study of 45 frail and 45 non-frail individuals matched by age and sex. OT, OD, OI (range 0‒16), and composite sum (threshold, discrimination, and identification scores [TDI], range 0‒48) were measured with Sniffin' Sticks. PFP was defined by presence of three or more criteria: physical inactivity, self-reported exhaustion, muscle weakness, slow gait, and unintentional weight loss. Conditional logistic regression evaluated associations between olfactory subdomains and frailty.

RESULTS

Ninety individuals with mean age of 83.1 ± 4.9 years, 60% female (n = 54), and 87.8% white (n = 79) were included. Olfactory scores were significantly lower in the frail group for OI (9.2 vs. 12.1, p < 0.001), OD (8.1 vs. 11.6, p < 0.001), OT (4.4 vs. 8.5, p < 0.001), and TDI (21.7 vs. 32.2, p < 0.001) than in the non-frail group. A single-point decrease in olfactory score was associated with increased odds of frailty in OT (odds ratio [OR]: 2.21, 95% confidence interval: [1.22, 3.98]), OD (OR: 2.19, 95% CI: [1.32, 3.65]), OI (OR: 2.29, 95% CI: [1.19, 4.39]), and TDI (OR: 1.54, 95% CI: [1.14, 2.08]).

CONCLUSION

The robust association between olfactory subdomain scores and frailty suggests that olfaction may be an accessible signifier of frailty. Future studies should investigate this relationship longitudinally to assess predictive relationships.

Exploring Older Adults' Subjective Views on Aging Positively: Development and Validation of the Positive Aging Scale

BACKGROUND AND OBJECTIVES

Historically, aging research has focused primarily on health deterioration and negative aspects associated with aging. This has limited the scope of our understanding of the experience of aging and the relationships between aging and well-being from an integrative biopsychosocial perspective. In the same vein, there is a lack of reliable and valid assessments of aging that capture the positive aspects that characterize and improve the subjective experience of this period of life, particularly one that focuses on psychosocial well-being, including meaningful experiences and activities, group memberships, and general abilities. This study presents the development and validation of the Positive Aging Scale (PAS), a novel self-report assessment.

RESEARCH DESIGN AND METHODS

This was an online cross-sectional study conducted on 501 UK residents aged ≥60 years. A number of self-reported items and measures of positive aging, general health, well-being, and cognitive functioning were administered to the sample. We used exploratory and confirmatory factor analyses and assessed the dimensionality, reliability, and concurrent criterion-related validity of the PAS.

RESULTS

The results suggested that a unidimensional solution represents the data well, with the positive aging factor adequately loading on 8 items, and the solution showing factorial invariance between young-old and old participants (i.e., ≥75 years). Total PAS scores positively correlate with general health, well-being, and cognitive functioning.

DISCUSSION AND IMPLICATIONS

The PAS demonstrated strong psychometric properties and the findings highlight correlations between the PAS and key outcomes of positive aging, including general health. Implications for research and interventions are discussed.

Association of metabolic syndrome severity with frailty progression among Chinese middle and old-aged adults: a longitudinal study

BACKGROUND

The binary diagnosis of Metabolic Syndrome(MetS) fails to accurately evaluate its severity, and the association between MetS severity and frailty progression remains inadequately elucidated. This study aims to clarify the relationship between the severity of MetS and the progression of frailty among the middle-aged and elderly population in China.

METHOD

Participants from the 2011-2018 China Health and Retirement Longitudinal Study(CHARLS) were included for a longitudinal analysis. The study employs a frailty index(FI) based on 32 health deficits to diagnose frailty and to assess FI trajectories. An age-sex-ethnicity-specific MetS scoring model (MetS score) was used to assess metabolic syndrome severity in Chinese adults. The Cumulative MetS score from 2012 to 2015 was calculated using the formula: (MetS score in wave 1 + MetS score in wave 3) / 2 × time(2015 - 2012). The association between MetS score, Cumulative MetS score, and the risk and trajectory of frailty were evaluated using Cox regression/logistic regression, and linear mixed models. Restricted Cubic Splines(RCS) models were utilized to detect potential non-linear associations.

RESULTS

A higher MetS score was significantly associated with an increased risk of frailty(HR per 1 SD increase = 1.205; 95%CI: 1.14 to 1.273) and an accelerated FI trajectory(β per 1 SD increase = 0.113 per year; 95%CI: 0.075 to 0.15 per year). Evaluating changes in MetS score using a Cumulative MetS score indicated that each 1 SD increase in the Cumulative MetS score increased the risk of frailty by 22.2%(OR = 1.222; 95%CI: 1.133 to 1.319) and accelerated the rate of increase in FI(β = 0.098 per year; 95%CI: 0.058 to 0.138 per year). RCS model results demonstrated a dose-response curve relationship between MetS score and Cumulative MetS score with frailty risk. Stratified analysis showed consistency across subgroups. The interaction results indicate that in males and individuals under aged 60, MetS score may accelerate the increase in FI, a finding consistent across both models.

CONCLUSIONS

Our findings underscore the positive correlation between the severity of MetS and frailty progression in the middle-aged and elderly, highlighting the urgent need for early identification of MetS and targeted interventions to reduce the risk of frailty.

Frailty: a global health challenge in need of local action

Frailty is a complex, age-related clinical condition that involves multiple contributing factors and raises the risk of adverse outcomes in older people. Given global population ageing trends, the growing prevalence and incidence of frailty pose significant challenges to health and social care systems in both high-income and lower-income countries. In this review, we highlight the disproportionate representation of research on frailty screening and management from high-income countries, despite how lower-income countries are projected to have a larger share of older people aged ≥60. However, more frailty research has been emerging from lower-income countries in recent years, paving the way for more context-specific guidelines and studies that validate frailty assessment tools and evaluate frailty interventions in the population. We then present further considerations for contextualising frailty in research and practice in lower-income countries. First, the heterogeneous manifestations of frailty call for research that reflects different geographies, populations, health systems, community settings and policy priorities; this can be driven by supportive collaborative systems between high-income and lower-income countries. Second, the global narrative around frailty and ageing needs re-evaluation, given the negative connotations linked with frailty and the introduction of intrinsic capacity by the World Health Organization as a measure of functional reserves throughout the life course. Finally, the social determinants of health as possible risk factors for frailty in lower-income countries and global majority populations, and potential socioeconomic threats of frailty to national economies warrant proactive frailty screening in these populations.

The association between frailty and the risk of mortality in critically ill congestive heart failure patients: findings from the MIMIC-IV database

Background

Frailty is a severe, common co-morbidity associated with congestive heart failure (CHF). This retrospective cohort study assesses the association between frailty and the risk of mortality in critically ill CHF patients.

Methods

Eligible patients with CHF from the Medical Information Base for Intensive Care IV database were retrospectively analyzed. The frailty index based on laboratory tests (FI_Lab) index was calculated using 33 variables to assess frailty status. The primary outcomes were in-hospital mortality and one-year mortality. The secondary outcomes were the incidence of acute kidney injury (AKI) and the administration of renal replacement therapy (RRT) in patients with concurrent AKI. Survival disparities among the FI_Lab subgroups were estimated with Kaplan-Meier survival analysis. The association between the FI_Lab index and mortality was examined with Cox proportional risk modeling.

Results

A total of 3273 adult patients aged 18 years and older were enrolled in the study, with 1820 men and 1453 women included. The incidence rates of in-hospital mortality and one-year mortality rate were 0.96 per 1,000 person-days and 263.8 per 1,000 person-years, respectively. Multivariable regression analysis identified baseline FI_Lab > 0.45 as an independent risk factor predicting in-hospital mortality (odds ratio = 3.221, 95% CI 2.341-4.432, p < 0.001) and one-year mortality (hazard ratio=2.152, 95% CI: 1.730-2.678, p < 0.001). In terms of predicting mortality, adding FI_Lab to the six disease severity scores significantly improved the overall performance of the model (all p < 0.001).

Conclusions

We established a positive correlation between the baseline FI_Lab and the likelihood of adverse outcomes in critical CHF patients. Given its potential as a reliable prognostic tool for such patients, further validation of FI_Lab across multiple centers is recommended for future research.

Exercise as a Therapeutic Tool in Age-Related Frailty and Cardiovascular Disease: Challenges and Strategies

Understanding the link between heart disease and frailty in older adults is crucial. Although medical progress has extended life, it has not fully addressed the decline in function and quality of life in frail older people. Frailty is a state of vulnerability to health stressors that needs comprehensive solutions. Its assessment within health care, especially in cardiology, is important owing to its association with worse clinical outcomes. Recent evidence and guidelines suggest that the prescription of a comprehensive exercise regimen, tailored to progressively include strength, balance, mobility, and endurance training improves adherence, functionality, and health-related quality of life, in both acute and chronic cardiovascular diseases. In addition, exercise is a vital tool that improves function, targets frailty, and holistically affects the body's systems. Still, many frail people do not exercise enough, and when they do, they usually do not follow an appropriate plan tailored for better functional outcomes. Overcoming barriers and limitations in exercise enrollment and adherence through strategies such as automated cardiac rehabilitation referral, patient education, and eHealth tools can notably improve clinical outcomes.

Agreement and predictive value of the clinical frailty scale in hospitalized older patients

PURPOSE

Our objective was to perform an external validity study of the clinical frailty scale (CFS) classification tree by determining the agreement of the CFS when attributed by a senior geriatrician, a junior geriatrician, or using the classification tree. Additionally, we evaluated the predictive value of the CFS for 6-month mortality after admission to an acute geriatric unit.

METHODS

This prospective study was conducted in two acute geriatric units in Belgium. The premorbid CFS was determined by a senior and a junior geriatrician based on clinical judgment within the first 72 h of admission. Another junior geriatrician, who did not have a treatment relationship with the patient, scored the CFS using the classification tree. Intra-class correlation coefficient (ICC) was calculated to assess agreement. A ROC curve and Cox regression model determined prognostic value.

RESULTS

In total, 97 patients were included (mean age 86 ± 5.2; 66% female). Agreement of the CFS, when determined by the senior geriatrician and the classification tree, was moderate (ICC 0.526, 95% CI [0.366-0.656]). This is similar to the agreement between the senior and junior geriatricians' CFS (ICC 0.643, 95% CI [0.510-0.746]). The AUC for 6-month mortality based on the CFS by respectively the classification tree, the senior and junior geriatrician was 0.719, 95% CI [0.592-0.846]; 0.774, 95% CI [0.673-0.875]; 0.774, 95% CI [0.665-0.882]. Cox regression analysis indicated that severe or very severe frailty was associated with a higher risk of mortality compared to mild or moderate frailty (hazard ratio respectively 6.274, 95% CI [2.613-15.062] by the classification tree; 3.476, 95% CI [1.531-7.888] by the senior geriatrician; 4.851, 95% CI [1.891-12.442] by the junior geriatrician).

CONCLUSION

Interrater agreement in CFS scoring on clinical judgment without Comprehensive Geriatric Assessment is moderate. The CFS classification tree can help standardize CFS scoring.

Age Distribution and Clinical Results of Critically Ill Patients above 65-Year-Old in an Aging Society: A Retrospective Cohort Study

BACKGROUND

Increasing age has been observed among patients admitted to the intensive care unit (ICU). Age traditionally considered a risk factor for ICU mortality. We investigated how the epidemiology and clinical outcomes of older ICU patients have changed over a decade.

METHODS

We analyzed patients admitted to the ICU at a university hospital in Seoul, South Korea. We defined patients aged 65 and older as older patients. Changes in age groups and mortality risk factors over the study period were analyzed.

RESULTS

A total of 32,322 patients were enrolled who aged ≥65 years admitted to the ICUs between January 1, 2007, and December 31, 2017. Patients aged ≥65 years accounted for 35% and of these, the older (O, 65 to 74 years) comprised 19,630 (66.5%), very older (VO, 75 to 84 years) group 8,573 (29.1%), and very very older (VVO, ≥85 years) group 1,300 (4.4%). The mean age of ICU patients over the study period increased (71.9±5.6 years in 2007 vs. 73.2±6.1 years in 2017) and the proportions of the VO and VVO group both increased. Over the period, the proportion of female increased (37.9% in 2007 vs. 43.3% in 2017), and increased ICU admissions for medical reasons (39.7% in 2007 vs. 40.2% in 2017). In-hospital mortality declined across all older age groups, from 10.3% in 2007 to 7.6% in 2017. Hospital length of stay (LOS) decreased in all groups, but ICU LOS decreased only in the O and VO groups.

CONCLUSION

The study indicates a changing demographic in ICUs with an increase in older patients, and suggests a need for customized ICU treatment strategies and resources.

Multi-polygenic prediction of frailty highlights chronic pain and educational attainment as key risk and protective factors

Frailty is a complex trait. Twin studies and recent Genome-Wide Association Studies have demonstrated a strong genetic basis of frailty but there remains a lack of genetic studies exploring genetic prediction of Frailty. Previous work has shown that a single polygenic predictor - represented by a Frailty polygenic score - predicts Frailty, measured via the frailty index, in independent samples within the United Kingdom. We extended this work, using a multi-polygenic score (MPS) approach to increase predictive power. Predictor variables - twenty-six polygenic scores (PGS) were modelled in regularised Elastic net regression models, with repeated cross-validation, to estimate joint prediction of the polygenic scores and order the predictions by their contributing strength to Frailty in two independent cohorts aged 65+ - the English Longitudinal Study of Ageing (ELSA) and Lothian Birth Cohort 1936 (LBC1936). Results showed that the MPS explained 3.6% and 4.7% of variance compared to the best single-score prediction of 2.6% and 2.2% of variance in ELSA and LBC1936 respectively. The strongest polygenic predictors of worsening frailty came from PGS for Chronic pain, Frailty and Waist circumference; whilst PGS for Parental Death, Educational attainment, and Rheumatoid Arthritis were found to be protective to frailty. Results from the predictors remaining in the final model were then validated using the longitudinal LBC1936, with equivalent PGS scores from the same GWAS summary statistics. Thus, this MPS approach provides new evidence for the genetic contributions to frailty in later life and sheds light on the complex structure of the Frailty Index measurement.

The association between oxidative balance score and frailty in adults across a wide age spectrum: NHANES 2007-2018

Background: Frailty has been one of the most serious global public health challenges we will ever face. Oxidative stress is associated with the pathogenesis of frailty, and may be accurately reflected by the oxidative balance score (OBS). However, there have been no studies examining the effect of OBS on frailty. Therefore, we aimed to explore the association between OBS and frailty and whether there was an interaction between the outcomes. Methods: 22 914 participants aged over 20 years taking part in the National Health and Nutrition Examination Survey (NHANES) in 2007-2018 were involved in the study. Sixteen dietary factors and four lifestyle factors were selected to score the OBS. A modified 36-item deficit cumulative frailty index (FI) was used to assess the degree of frailty. The association between OBS and frailty was analyzed using binary logistic regression. Subgroup analysis and interaction tests were used to investigate whether this association was stable across populations. Results: A negative association between OBS and the prevalence of frailty was found in this study. There was also an interaction between OBS and age in their association with frailty. High OBS was significantly and negatively associated with the prevalence of frailty in the 20-39 and 40-64 age groups. In addition, higher OBS combined with a population in the 20-39 age group resulted in a stronger negative association with frailty. Conclusion: High OBS was significantly associated with lower odds of frailty. An interaction existed between OBS and age. Individuals, especially in relatively young populations, are advised to increase OBS through greater intake of antioxidant nutrients and healthier lifestyles, thereby reducing the adverse effects of frailty.

Association Between Modified Frailty Index and Postoperative Outcomes of Tracheostomies

OBJECTIVE

The 5-item modified frailty index (mFI-5) has been used to stratify patients based on the risk of postoperative complications in several surgical procedures but has not yet been done in tracheostomies. This study investigates the association between the mFI-5 score and tracheostomy complications.

STUDY DESIGN

Retrospective database review.

SETTING

United States hospitals.

METHODS

The National Surgical Quality Improvement Program database was queried for tracheostomy patients between 2005 and 2018. The mFI-5 was calculated for each patient by assigning 1 point for each of the following comorbidities: diabetes mellitus, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functionally dependent health status. Univariate and multivariable analyses were conducted to determine associations between the mFI-5 score and postoperative complications.

RESULTS

A total of 4438 patients undergoing tracheostomies were queried and stratified into the following groups: mFI = 0 (N = 1741 [39.2%], mFI = 1 (N = 1720 [38.8%]), mFI = 2 (N = 726 [16.4%]), and mFI of 3 or higher (N = 251 [5.7%]). Univariate analysis showed that patients with higher mFI-5 scores had a greater proportion of smoking, dyspnea, obesity, steroid use, emergency cases, complications, reoperations, and mortality (P < .001). Multivariable analyses found associations between mFI-5 score and any complication (odds ratio [OR]: 1.49, 95% confidence interval [CI]: 1.03-2.16, P = .035), mortality (OR: 2.32, 95% CI: 1.15-4.68, P = .019), and any medical complication (OR: 2.75, 95% CI: 1.88-4.02, P < .001).

CONCLUSION

This study suggests an association between the mFI-5 score and postoperative complications in tracheostomies. mFI-5 score can be used to stratify tracheostomy patients by operative risk.

Diet and lifestyle behaviours simultaneously act on frailty: it is time to move the threshold of frailty prevention and control forward

BACKGROUND

To analyse the association among the simultaneous effects of dietary intake, daily life behavioural factors, and frailty outcomes in older Chinese women, we predicted the probability of maintaining physical robustness under a combination of different variables.

METHODS

The Fried frailty criterion was used to determine the three groups of "frailty", "pre-frailty", and "robust", and a national epidemiological survey was performed. The three-classification decision tree model was fitted, and the comprehensive performance of the model was evaluated to predict the probability of occurrence of different outcomes.

RESULTS

Among the 1,044 participants, 15.9% were frailty and 50.29% were pre-frailty; the overall prevalence first increased and then decreased with age, reaching a peak at 70-74 years of age. Through univariate analysis, filtering, and embedded screening, eight significant variables were identified: staple food, spices, exercise (frequency, intensity, and time), work frequency, self-feeling, and family emotions. In the three-classification decision tree, the values of each evaluation index of Model 3 were relatively average; the accuracy, recall, specificity, precision, and F1 score range were between 75% and 84%, and the AUC was also greater than 0.800, indicating excellent performance and the best interpretability of the results. Model 3 takes exercise time as the root node and contains 6 variables and 10 types, suggesting the impact of the comprehensive effect of these variables on robust and non-robust populations (the predicted probability range is 6.67-93.33%).

CONCLUSION

The combined effect of these factors (no exercise or less than 0.5 h of exercise per day, occasional exercise, exercise at low intensity, feeling more tired at work, and eating too many staple foods (> 450 g per day) are more detrimental to maintaining robustness.

Factors Associated with Frailty in Older Adults in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis

Background: Frailty is a globally recognized issue. However, there is a lack of evidence exploring factors associated with frailty among older residents in community and nursing-home settings. Methods: To explore the prevalence and factors associated with frailty among older adults in community and nursing-home settings, we conducted a systematic search following the PRISMA guidelines across Web of Science, MEDLINE, EMBASE, PubMed, and Cochrane databases up until January 2024, selecting 38 studies which encompassed 150,642 participants. Results: Our findings showed higher frailty prevalence in nursing homes compared to communities. Frailty was significantly associated with sociodemographic (living alone, poor self-reported health), physiological (poor sleep, low activity of daily living), behavioral (physical inactivity) and disease (chronic conditions, depression) factors in both community and nursing-home settings. Conclusions: There are numerous factors associated with frailty in older adults in nursing-home and community settings. These factors underscore the significance of promptly identifying high-risk individuals and devising appropriate interventions to mitigate frailty among them.

Predictive performance of different measures of frailty (CFS, mFI-11, mFI-5) on postoperative adverse outcomes among colorectal cancer patients: a diagnostic meta-analysis

PURPOSE

To clarify the predictive performance of different measures of frailty, including Clinical Frailty Scale (CFS), 11-factor modified Frailty Index (mFI-11), and 5-factor modified Frailty Index (mFI-5), on adverse outcomes.

METHODS

PubMed, Embase, Web of Science, and other databases were retrieved from the inception of each database to June 2023. The pooled sensitivity, specificity, and the area under the summary receiver operating curve (SROC) values were analyzed to determine the predictive power of CFS, mFI-11, and mFI-5 for adverse outcomes.

RESULTS

A total of 25 studies were included in quantitative synthesis. The pooled sensitivity values of CFS for predicting anastomotic leakage, total complications, and major complications were 0.39, 0.57, 0.45; pooled specificity values were 0.70, 0.58, 0.73; the area under SROC values were 0.58, 0.6, 0.66. The pooled sensitivity values of mFI-11 for predicting total complications and delirium were 0.38 and 0.64; pooled specificity values were 0.83 and 0.72; the area under SROC values were 0.64 and 0.74. The pooled sensitivity values of mFI-5 for predicting total complications, 30-day mortality, and major complications were 0.27, 0.54, 0.25; pooled specificity values were 0.82, 0.84, 0.81; the area under SROC values were 0.63, 0.82, 0.5.

CONCLUSION

The results showed that CFS could predict anastomotic leakage, total complications, and major complications; mFI-11 could predict total complications and delirium; mFI-5 could predict total complications and 30-day mortality. More high-quality research is needed to support the conclusions of this study further.

The association of urinary heavy metal exposure with frailty susceptibility and mortality in middle-aged and older adults: a population-based study

Heavy metals' presence as environmental pollutants has a close link to adverse health effects. Frailty, a clinical syndrome hallmarked by elevated vulnerability to stressors, presents a substantial challenge in healthcare. However, the association between exposure to heavy metals and frailty largely remains unexplored. Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2003-2018 and correlated with the U.S. National Death Index (NDI) from 2019, we investigated mortality outcomes. Logistic regression, Cox regression, Kaplan-Meier survival curves, weighted quantile-sum (WQS) regression, and Bayesian kernel machine regression (BKMR) were employed to assess the association between heavy metal exposure and frailty incidence and mortality in the frail population. Eight metals were measured in urine using inductively coupled plasma mass spectrometry with values adjusted for urinary creatinine, which was used to reflect heavy metal exposure. The cohort incorporated 5370 female participants aged 45 and above, with 1518 diagnosed with frailty. The findings indicated a substantial correlation between exposure to specific heavy metals, namely tungsten (odds ratio [OR]: 1.94, 95% confidence interval [CI]: 1.31-2.89), cobalt (OR: 1.64, 95% CI: 1.40-1.93), cadmium (OR: 1.93, 95% CI: 1.52-2.43), and uranium (OR: 7.36, 95% CI: 1.53-35.28), and an elevated risk of frailty. WQS and BKMR regression models identified cadmium, cobalt, and tungsten as main contributors to frailty. Cox regression analysis, after adjustment for covariates, suggested that the higher the exposure levels to cadmium and lead, the higher the risk of death in frail patients, with associated hazard ratios (HR) of 95% CI: 1.96 (1.53, 2.52) and 1.30 (1.13, 1.49), respectively. Our study revealed a significant positive correlation between exposure to heavy metal mixtures and frailty onset in middle-aged and older adults, along with increased mortality in frail patients. Cobalt, cadmium, and tungsten emerged as prominent contributors to frailty, with cobalt and cadmium directly impacting the long-term life expectancy of frail patients.

The causal association between circulating cytokines with the risk of frailty and sarcopenia under the perspective of geroscience

Introduction

Circulating cytokines were considered to play a critical role in the initiation and propagation of sarcopenia and frailty from observational studies. This study aimed to find the casual association between circulating cytokines and sarcopenia and frailty from a genetic perspective by two-sample Mendelian randomization (MR) analysis.

Methods

Data for 41 circulating cytokines were extracted from the genome-wide association study dataset of 8,293 European participants. Inverse-variance weighted (IVW) method, MR-Egger, and weighted median method were applied to assess the relationship of circulating cytokines with the risk of aging-related syndromes and frailty. Furthermore, MR-Egger regression was used to indicate the directional pleiotropy, and Cochran's Q test was used to verify the potential heterogeneity. The "leave-one-out" method was applied to visualize whether there was a causal relationship affected by only one anomalous single-nucleotide polymorphisms.

Results

Genetic predisposition to increasing levels of interleukin-10 (IL-10), IL-12, and vascular endothelial growth factor (VEGF) was associated with the higher risk of low hand grip strength according to the IVW method [R = 1.05, 95% CI = 1.01-1.10, P = 0.028, false discovery rate (FDR)-adjusted P = 1.000; OR = 1.03, 95% CI = 1.00-1.07, P = 0.042, FDR-adjusted P = 0.784; OR = 1.02, 95% CI = 1.00-1.05, P = 0.038, FDR-adjusted P = 0.567]. Furthermore, genetically determined higher macrophage colony-stimulating factors (M-CSFs) were associated with a lower presence of appendicular lean mass (OR = 1.01, 95% CI = 1.00-1.02, P = 0.003, FDR-adjusted P = 0.103). Monokine induced by interferon-γ (MIG) and tumor necrosis factor-beta (TNF-β) were associated with a higher risk of frailty (OR = 1.03, 95% CI = 1.01-1.05, P < 0.0001, FDR-adjusted P = 0.012; OR = 1.01, 95% CI = 1.00-1.03, P = 0.013, FDR-adjusted P = 0.259). In this study, we did not find heterogeneity and horizontal pleiotropy between the circulating cytokines and the risk of frailty and sarcopenia.

Conclusion

Genetic predisposition to assess IL-10, IL-12, and VEGF levels was associated with a higher risk of low hand grip strength and M-CSF with the presence of appendicular lean mass. The high levels of TNF-β and MIG were associated with a higher risk of frailty. More studies will be required to explore the molecular biological mechanisms underlying the action of inflammatory factors.

Tertiary centre study highlights low inpatient deintensification and risks associated with adverse outcomes in frail people with diabetes

INTRODUCTION

The community deintensification rates in older people with diabetes are low and hospital admission presents an opportunity for medication review. We audited the inpatient assessment and deintensification rate in people with diabetes and frailty. We also identified factors associated with adverse inpatient outcomes.

METHODS

A retrospective review of electronic charts was conducted in all people with diabetes and clinical frailty score ≥6 who were discharged from the medical unit in 2022. Data on demographics, comorbidities and background glucose-lowering medications were collected.

RESULTS

Six-hundred-and-sixty-five people with diabetes and moderate/severe frailty were included in our analysis. For people with no HbA1c in the last six months preceding admission, only 9.0% had it assessed during inpatient. Deintensification rates were 19.1%. Factors that were associated with adverse inpatient outcomes included inpatient hypoglycaemia, non-White ethnicity, and being overtreated (HbA1c <7.0% [53 mmol/mol] with any glucose-lowering medication).

CONCLUSION

The assessment and deintensification rate in secondary care for people with diabetes and frailty is low. Inpatient hypoglycaemia, non-White ethnicity, and overtreatment are important factors in determining inpatient outcomes highlighting the importance of deintensification and the need for an evidence-based risk stratification tool.

Assessment of Bidirectional Relationships between Frailty and Mental Disorders: A Bidirectional Mendelian Randomization Study

OBJECTIVES

Although observational studies have reported the association between frailty and mental disorders, the causality remains unclear. We aimed to evaluate the bidirectional causal association between frailty levels and mental disorders using a 2-sample Mendelian randomization (MR) analysis.

DESIGN

A bidirectional, 2-sample Mendelian randomization (MR) analysis.

SETTING AND PARTICIPANTS

Instrumental variables were obtained from large-scale genome-wide association study (GWAS) of a European-descent population for frailty index (FI, n = 175,226), Fried Frailty Score (FFS, n = 386,565), major depressive disorder (MDD, n = 674,452), bipolar disorder (n = 353,899), anxiety and stress-related disorder (ASRD, n = 31,880), and schizophrenia (n = 127,906).

METHODS

Two-sample MR analyses were conducted using inverse variance-weighted method, with sensitivity analyses using MR-Egger, weighted median, and simple median methods.

RESULTS

Per SD increase in genetically predicted FI and FFS increased the risk of MDD [odds ratio (OR) 1.56, 95% CI 1.27-1.94, P = 3.65 × 10-5, and OR 1.67, 95% CI 1.26-2.20, P = 3.02 × 10-4, respectively]. Per-SD increase in genetically predicted FI also increased the risk of ASRD (OR 2.76, 95% CI 1.36-5.60, P = .005). No significant effect was observed for frailty levels on the risk of bipolar disorder and schizophrenia. In the reverse direction, genetically predicted MDD was associated with higher FI (β 0.182, 95% CI 0.087-0.277, P = 1.79 × 10-4) and FFS (β 0.121, 95% CI 0.087-0.155, P = 4.43 × 10-12). No reliable evidence supported the effects of genetically predicted bipolar disorder, ASRD, or schizophrenia on frailty levels.

CONCLUSIONS AND IMPLICATIONS

A bidirectionally causal association exists between frailty levels and MDD, and higher FI is associated with a higher risk of ASRD. No reliable evidence suggested the causal associations of other mental disorders with frailty. Our findings provided evidence for introduction of psychological-related strategies in management of frailty.

The Limited Utility of the Hospital Frailty Risk Score as a Frailty Assessment Tool in Neurosurgery: A Systematic Review

BACKGROUND AND OBJECTIVES

The Hospital Frailty Risk Score (HFRS) is an International Classification of Disease 10th Revision-based scale that was originally designed for, and validated in, the assessment of patients 75 years or older presenting in an acute care setting. This study highlights central tenets inherent to the concept of frailty; questions the logic behind, and utility of, HFRS' recent implementation in the neurosurgical literature; and discusses why there is no useful role for HFRS as a frailty-based neurosurgical risk assessment (FBNRA) tool.

METHODS

The authors performed a systematic review of the literature per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including all cranial and spinal studies that used HFRS as their primary frailty tool. Seventeen (N = 17) studies used HFRS to assess frailty's impact on neurosurgical outcomes. Thirteen total journals, 10 of which were neurosurgical journals, including the highest impact factor journals, published the 17 papers.

RESULTS

Increasing HFRS score was associated with adverse outcomes, including prolonged length of stay (11 of 17 studies), nonroutine discharge (10 of 17 studies), and increased hospital costs (9 of 17 studies). Four different HFRS studies, of the 17, predicted one of the following 4 adverse outcomes: worse quality of life, worse functional outcomes, reoperation, or in-hospital mortality.

CONCLUSION

Despite its rapid acceptance and widespread proliferation through the leading neurosurgical journals, HFRS lacks any conceptual relationship to the frailty syndrome or FBNRA for individual patients. HFRS measures acute conditions using International Classification of Disease 10th Revision codes and awards "frailty" points for symptoms and examination findings unrelated to the impaired baseline physiological reserve inherent to the very definition of frailty. HFRS lacks clinical utility as it cannot be deployed point-of-care at the bedside to risk stratify patients. HFRS has never been validated in any patient population younger than 75 years or in any nonacute care setting. We recommend HFRS be discontinued as an individual FBNRA tool.

How is complexity measured and detected among community dwelling older people aged 65 years and over? A scoping review

AIM

To identify and explore tools that measured and detected complexity of care among community dwelling people aged 65 years and older.

DATA SOURCES

Databases were searched for articles published up to 23 September 2022 including CINAHL, EMBASE and MEDLINE, Cochrane database for trials and grey literature.

METHODS

A scoping review was conducted and reported in accordance with the PRISMA guidelines. Eligible articles included those with participants aged over 65 years, living in the community and studies that included care complexity detection or assessment and how this related to care delivered. Covidence was used to screen titles, abstracts and full-text articles.

RESULTS

Eighteen full texts were reviewed; four studies were included in the final review. All selected studies included people aged over 65 years living in the community. A high level of reliability for the items included in the interventions was found. The selected studies included tools for assessing older person's needs with nurses involved in the assessment.

CONCLUSION

The review identified four tools for measuring complexity in community dwelling older people. Two tools have the capacity to objectively measure complexity due to the holistic nature of items included and appear easy to use to support clinical judgement decisions.

IMPACT

The review places a spotlight on the concept of complexity and highlights the lack of definition of care complexity. The synthesized result highlights the need to explore detection of care complexity of older people further and consider ways of supporting clinical judgement and decision making of community nurses. The use of a validated tool may enhance clinical judgement regarding care complexity and may lead to a more consistent and timely approach to care.

PATIENT OR PUBLIC CONTRIBUTION

During the development phase, the study was presented to a consumer group from the researcher's workplace.

PROSPERO REGISTRATION

CRD42022299336.

Development and Validation of a Risk Prediction Model for Frailty in Patients with Chronic Diseases

The occurrence rate of frailty is high among patients with chronic diseases. However, the assessment of frailty among these patients is still far from being a routine part of clinical practice. The aim of this study is to develop a validated predictive model for assessing frailty risk in patients with chronic illnesses. This study recruited 543 patients with chronic diseases, and 237 were included in the development and validation of the predictive model. A total of 57 frailty related indicators were analyzed, encompassing sociodemographic variables, health status, physical measurements, nutritional assessment, physical activity levels, and blood biomarkers. There were 100 cases (42.2%) presenting frailty symptoms. Multivariate logistic regression analysis revealed that gender, age, chronic diseases, Mini Nutritional Assessment score, and Clinical Frailty Scale score were predictive factors for frailty in chronic disease patients. Utilizing these factors, a nomogram model demonstrated good consistency and accuracy. The AUC values for the predictive model and validation set were 0.946 and 0.945, respectively. Calibration curves, ROC, and DCA indicated the nomogram had favorable predictive performance. Altogether, the comprehensive nomogram developed here is a promising and convenient tool for assessing frailty risk in patients with chronic diseases, aiding clinical practitioners in screening high-risk populations.

Putting Guidelines Into Practice: Is Frailty Measurement at the Time of Kidney Transplant Eligibility Assessment Valid, Feasible, and Acceptable to Patients?

Background

Clinical Practice Guidelines suggest that frailty be measured during kidney transplant eligibility assessments. Yet it is not known how frailty is best assessed in this setting or whether its assessment is acceptable to patients. We aimed to examine the construct validity and feasibility of Frailty Index (FI) assessment among patients attending a kidney transplant assessment clinic and to explore patients' perspectives on frailty and the acceptability of its routine assessment.

Methods

A 58-item FI was calculated for 147 clinic patients. Semistructured interviews were conducted with a subgroup of 29 patients. The FI was validated against normative FI characteristics (mean, distribution, limit), age, and the Estimated Post-Transplant Survival Score. Feasibility was assessed using descriptive statistics. Qualitative data were analyzed using reflexive thematic analysis.

Results

The mean FI was 0.23 (±0.10, normal distribution, limit 0.53). FI increased with age and Estimated Post-Transplant Survival score. The FI was completed for 62.8% of eligible patients (147/234). The median completion time was 10 min, and completion rate (with no missing data) was 100%. Four themes were identified: perceptions of frailty, acceptability, perceived benefits, and risks of frailty measurement. Patients linked frailty with age and adverse outcomes, and most did not consider themselves frail. Patients reported that the FI was quick, simple, and efficient. They felt that frailty assessment is relevant to transplant eligibility and should be used to address potentially reversible factors.

Conclusions

The FI demonstrated construct validity and was feasible and acceptable in this clinic setting. The challenge is ensuring that routine assessments lead to better care.

Frailty in younger adults in hospital

BACKGROUND

Even though frailty has been extensively measured in the acute care setting, relatively little is known about the frailty of younger adult inpatients.

AIM

This study aimed to measure frailty in a sample of hospitalized adults aged 18 years and over and to examine how frailty in younger adult inpatients differs from middle-aged and older adult inpatients.

DESIGN

Secondary analyses of prospectively collected cohort data.

METHODS

Research nurses assessed 910 patients at admission to four Australian hospitals using the interRAI Acute Care instrument. Comparison of frailty index (FI) scores and domains was conducted across three age groups: younger (18-49 years), middle-aged (50-69 years) and older adults (≥70 years). Multivariable logistic regression examined risk of prolonged length of stay and unfavourable discharge destination.

RESULTS

Younger adults (n = 214; 23.5%) had a mean (SD) FI of 0.19 (0.10). Approximately 27% (n = 57) of younger adults were frail (FI > 0.25). Mood and behaviour, health symptoms and syndromes, nutrition and pain were the most frequently affected domains in younger adults and 50% had ≥3 comorbidities. Frailty increased the risk of long length of stay (odds ratio (OR) = 1.77, P < 0.001) but not the risk of an unfavourable discharge (OR = 1.40, P = 0.20) in younger adults.

CONCLUSIONS

This study showed that frailty is prevalent in younger patients admitted to acute care and is associated with adverse outcomes. This study was a critical first step towards establishing an understanding of frailty in younger hospitalized adults.

U-shaped association of systemic immune-inflammation index levels with cancer-related and all-cause mortality in middle-aged and older individuals with frailty

PURPOSE

Frailty is a state of heightened vulnerability to stress, whether from within the body or external factors. We aim to assess the prognostic value of the Systemic Immune-Inflammation Index (SII) in middle-aged and older frail adults.

METHODS

We used data from the 2003-2018 National Health and Nutrition Examination Survey (NHANES) linked to the 2019 National Death Index (NDI) to study mortality. Cox proportional hazards model and two-piecewise Cox proportional hazards model were used to elucidate the nonlinear relationship between SII level and mortality.

RESULTS

Our study included 7,446 frail patients (mean age 65.6) with 2,524 deaths (726 from cardiovascular disease and 458 from cancer) over 49,565 person-years. Elevated SII levels were associated with an increased risk of all-cause, cardiovascular disease (CVD)-related and cancer-related mortality, even after adjusting for potential confounders (adjusted HR (95 % CI) = 1.35 (1.25, 1.46), 1.42 (1.22, 1.65) and 1.26 (1.05, 1.51), respectively). Moreover, a U-shaped correlation was discerned between SII levels and the risks of all-cause and cancer-related mortality, with respective thresholds identified at 334.96 and 348.28.

CONCLUSION

Our findings reveal SII levels positively correlate with frailty, all-cause mortality, CVD-related mortality, and cancer-related mortality in middle-aged and elderly frail individuals in the U.S. The critical thresholds for SII index were 334.96 for all-cause mortality and 348.28 for cancer-related mortality. This study underscores the potential benefits of maintaining a certain low level of SII to effectively mitigate the incidence of frailty and mortality among frail patients.

Neurosurgical perioperative management of frail elderly patients

With the rapid increase in global aging, the prevalence of frailty is increasing and frailty has emerged as an emerging public health burden. Frail elderly patients suffer from reduced homeostatic reserve capacity, which is associated with a disproportionate decline in physical status after exposure to stress and an increased risk of adverse events. Frailty is closely associated with changes in the volume of the white and gray matter of the brain. Sarcopenia has been suggested to be an important component of frailty, and reductions in muscle strength and muscle mass lead to reductions in physical function and independence, which are critical factors contributing to poor prognosis. Approximately 10-32% of patients undergoing neurological surgery are frail, and the risk of frailty increases with age, which is significantly associated with the occurrence of adverse postoperative events (major complications, total duration of hospitalization, and need for discharge to a nursing facility). The postoperative mortality rate in severely frail patients is 9-11 times higher than that in non-frail individuals. Therefore, due attention must be paid to neurosurgical frailty and muscle assessment in elderly patients. Specialized interventions in the perioperative period of neurosurgery in frail elderly patients may improve their postoperative prognosis.

Correlation between preoperative frailty and postoperative delirium in elderly patients undergoing hip arthroplasty

BACKGROUND

Postoperative delirium (POD) refers to acute brain dysfunction occurring within 7 days after operation or before discharge. Frailty refers to the state that the body's physiological reserve is insufficient, so that the compensative capacity to endogenous and exogenous stress stimuli decreases. The purpose of this study is to explore the association of preoperative frailty (PF) with POD in elderly patients undergoing hip arthroplasty.

METHODS

Totally 228 elderly patients (age ≥ 65 years) who received elective hip arthroplasty in the Ningbo No. 6 Hospital between December 2021 and June 2022 were enrolled. One day before surgery, the frailty phenotype scale was adopted for evaluation of patients' frailty. On the 1st-3rd day after operation, the confusion assessment method was adopted for evaluation of delirium, and the patients were grouped into a POD group and non-POD group. Logistic regression was conducted to analyze the correlation between PF and POD.

RESULTS

Among the patients, the incidence of PF was 30.70% (70/228), and the incidence of delirium within 3 days after operation was 25.88% (59/228). According to binary logistic regression analysis, PF, age, hypertension, diabetes mellitus, and preoperative sleep disorder were independent risk factors for POD in elderly patients undergoing hip arthroplasty (all P < .05).

CONCLUSION

PF is a crucial risk factor for POD in elderly patients undergoing hip arthroplasty.

'Frailty as an adjective rather than a diagnosis'-identification of frailty in primary care: a qualitative interview study

INTRODUCTION

In 2017, NHS England introduced proactive identification of frailty into the General Practitioners (GP) contract. There is currently little information as to how this policy has been operationalised by front-line clinicians, their working understanding of frailty and impact of recognition on patient care. We aimed to explore the conceptualisation and identification of frailty by multidisciplinary primary care clinicians in England.

METHODS

Qualitative semi-structured interviews were conducted with primary care staff across England including GPs, physician associates, nurse practitioners, paramedics and pharmacists. Thematic analysis was facilitated through NVivo (Version 12).

RESULTS

Totally, 31 clinicians participated. Frailty was seen as difficult to define, with uncertainty about its value as a medical diagnosis. Clinicians conceptualised frailty differently, dependant on job-role, experience and training. Identification of frailty was most commonly informal and opportunistic, through pattern recognition of a frailty phenotype. Some practices had embedded population screening and structured reviews. Visual assessment and continuity of care were important factors in recognition. Most clinicians were familiar with the electronic frailty index, but described poor accuracy and uncertainty as to how to interpret and use this tool. There were different perspectives amongst professional groups as to whether frailty should be more routinely identified, with concerns of capacity and feasibility in the current climate of primary care workload.

CONCLUSIONS

Concepts of frailty in primary care differ. Identification is predominantly ad hoc and opportunistic. A more cohesive approach to frailty, relevant to primary care, together with better diagnostic tools and resource allocation, may encourage wider recognition.

Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review

Residential care facility may provide a transition between living at home and a nursing home for dependent older people or an alternative to nursing homes. The objective of this review was to compare mortality and hospitalizations of older adults living in residential care facilities with those living in nursing homes or in the community. We searched Medline, Scopus and Web of Science from inception to December 2022. Fifteen cohort studies with 6 months to 10 years of follow-up were included. The unadjusted relative risk (RR) of mortality was superior in nursing homes than in residential care facilities in 6 of 7 studies (from 1.3 to 1.68). Conversely, the unadjusted relative risk of hospitalizations was higher in residential care facilities in 6 studies (from 1.3 to 3.37). Studies conducted on persons with dementia found mixed results, the only study adjusted for co-morbidities observing no difference on these two endpoints. Compared with home, unadjusted relative risks were higher in residential care facilities for mortality in 4 studies (from 1.34 à 10.1) and hospitalizations in 3 studies (from 1.12 to 1.62). Conversely, the only study that followed older adults initially living at home over a 10-year period found a reduced risk of heavy hospital use (RR = 0.68) for those who temporarily resided in a residential care facilities. There is insufficient evidence to determine whether residential care facilities might be an alternative to nursing homes for older people with similar clinical characteristics (co-morbidities and dementia). Nevertheless, given the high rate of hospitalizations observed in residential care facilities, the medical needs of residents should be better explored.

Validation of a polygenic risk score for Frailty in the Lothian Birth Cohort and English Longitudinal Study of Ageing

Frailty is a complex trait. Twin studies and a high-powered Genome Wide Association Study (GWAS) conducted in the UK Biobank have demonstrated a strong genetic basis of frailty. The present study utilized summary statistics from this GWAS to create and test the predictive power of frailty polygenic risk scores (PRS) in two independent samples - the Lothian Birth Cohort 1936 (LBC1936) and the English Longitudinal Study of Ageing (ELSA) aged 67-84 years. Multiple regression models were built to test the predictive power of frailty PRS at five time points. Frailty PRS significantly predicted frailty at all-time points in LBC1936 and ELSA, explaining 2.1% (β = 0.15, 95%CI, 0.085-0.21) and 1.6% (β = 0.14, 95%CI, 0.10-0.17) of the variance, respectively, at age ~68/~70 years (p < 0.001). This work demonstrates that frailty PRS can predict frailty in two independent cohorts, particularly at early ages (~68/~70). PRS have the potential to be valuable instruments for identifying those at risk for frailty and could be important for controlling for genetic confounders in epidemiological studies.

Intrinsic Capacities, Functional Ability, Physiological Systems, and Caregiver Support: A Targeted Synthesis of Effective Interventions and International Recommendations for Older Adults

The ageing population calls for interventions that can assist older people to age healthily. This study aimed to provide a targeted synthesis of high-level research and current evidence-based recommendations on effective interventions for maintaining or preventing the decline in intrinsic capacity, functional ability, and physiological systems, or for caregiver support. Nestled within the healthy ageing framework by the World Health Organization, available evidence was selected in a targeted manner, with the purpose of providing a synthesis that would allow the application of this knowledge in real life. As such, the outcome variables were examined through an Evidence and Gap Map of interventions for functional ability and through guidelines from leading institutions. Systematic reviews, meta-analyses, and guidelines on community-dwelling older adults with or without minor health limitations were considered. Thirty-eight documents were included and over fifty interventions identified. Physical activity interventions were consistently effective across several domains. Recommendations point to screening, whilst highlighting the importance of behavioural factors in the endeavour to age healthily. There is a wide range of activities which are likely to foster healthy ageing. To encourage their uptake, it is important for communities to offer suitable promotion and support, and to make these accessible to the public.