Trajectories of frailty among Chinese older people in Hong Kong between 2001 and 2012: an age-period-cohort analysis

An interactive dynamic online nomogram for predicting the frailty trajectories among older people with chronic heart failure

OBJECTIVES

To delineate the heterogeneous frailty trajectories in older people with chronic heart failure during one year after discharge, and further explore their predictors to construct a nomogram for prediction.

METHODS

Longitudinal data on 757 older chronic heart failure patients (CHF) over 60 years was used to delineate the heterogeneous frailty trajectories using a growth mixture model (GMM). The least absolute shrinkage and selection operator and logistic regression model was employed to determine their predictors and further construct a nomogram based on the predictors. A 1000-fold bootstrap resampling was used for internal validation of the nomogram, and its discrimination, calibration, and clinical values were evaluated by the area under the receiver operating characteristic curve (AUROC), calibration curves, and decision curve analysis (DCA), respectively.

RESULTS

GMM identified three heterogeneous frailty trajectories: "frailty deteriorating trajectory", "frailty moderately improving trajectory", and "frailty slightly improving trajectory". Logistic regression analysis showed 6 independent predictors of "frailty deteriorating trajectory", and a dynamic online nomogram was constructed. The AUROCs of the nomogram on the training and validation sets were 0.752 (95 %CI, 0.713-0.792) and 0.753 (95 %CI, 0.682-0.833), respectively. The calibration curves demonstrated that probabilities predicted by the nomogram had high consistency with the actual probability, and the DCA showed that the nomogram had excellent clinical utility on both the training and validation sets.

CONCLUSIONS

Older CHF patients have heterogeneous frailty trajectories, and the nomogram we constructed can serve as clinical tool for early identifying the high-risk groups, and promoting the personalized and precise frailty management.

Non-Communicable Diseases, Longevity, and Health Span: A Hong Kong Perspective

The health of different countries evolves in parallel with their economic development. Communicable diseases play a more prominent role in low-income countries compared with high-income countries, while non-communicable diseases (NCDs) have become dominant in developing and developed economies. This transition has been accompanied by public health efforts to prevent NCDs, resulting in improvements in total life expectancy at birth (TLE). It is recognized that health determinants are not confined to healthcare systems, but that social determinants play a key role in health inequalities. The rapid increase in life expectancy at birth has led to increasing numbers of older adults, where health inequalities are accentuated. The current UN Decade of Healthy Aging calls for a life-course approach to building intrinsic capacity, maintaining function, and avoiding dependency with age instead of avoiding mortality and morbidity. TLE in Hong Kong is one of the highest in the world as a result of public health preventive efforts and an essentially free hospital system. However, the increase in TLE has not been accompanied by the same magnitude of increase in health span, resulting in an increasing dependency burden. Geography, culture, dietary and smoking habits, physical activity, urban planning, and neighbourhood cohesion are some of the social determinants affecting TLE and also health inequalities. With population ageing, it would be appropriate to focus on the social determinants affecting health span to maintain functional independence rather than prolonging life. A whole-of-society response instead of relying solely on the adaptation of health and social care systems would be needed, together with more nuanced metrics to measure health span.

Frailty as an independent risk factor for sepsis-associated delirium: a cohort study of 11,740 older adult ICU patients

BACKGROUND

Sepsis-associated delirium (SAD) is a common complication in intensive care unit (ICU) patients and is associated with increased mortality. Frailty, characterized by diminished physiological reserves, may influence the development of SAD, but this relationship remains poorly understood.

AIMS

To comprehensively analyze the assessment of frailty as a predictive factor for sepsis-associated delirium in older adults.

METHODS

A retrospective cohort analysis was performed on sepsis patients aged ≥ 65 years admitted to the ICU. Frailty was assessed using the Modified Frailty Index based on 11 items including comorbidities and functional status. Patients were categorized into non-frail (MFI: 0-2) and frail (MFI ≥ 3) groups. Delirium was assessed using the ICU Confusion Assessment Method (CAM-ICU) and retrospective nursing notes. Logistic regression analysis was used to examine the relationship between frailty in older patients and the risk of delirium, and odds ratios (OR) and their 95% confidence intervals (CI) were calculated.

RESULTS

Among 11,740 patients (median age approximately 76 years [interquartile range: 70.47-83.14], 44.3% female), frail patients tended to have longer ICU stays, higher severity scores, and potentially worse clinical outcomes. The study found a significant positive association between MFI and the risk of developing SAD (OR: 1.13, 95% CI: 1.09-1.17, p < 0.001). Additionally, frail patients had a higher risk of developing SAD compared to non-frail patients (OR: 1.31, 95% CI: 1.20-1.43, p < 0.001).

CONCLUSIONS

Frailty independently predicts SAD development in older adults with sepsis in the ICU, emphasizing the importance of early recognition and prevention.

Frailty prevalence, invasive treatment frequency, and in-hospital outcome in patients hospitalized for acute coronary syndrome in Germany (2005-2022): a nationwide registry study

Background

Frailty is a significant predictor for adverse outcomes. Yet, data on prevalence and treatment of frail patients with acute coronary syndrome (ACS) remains limited. We aimed to investigate frailty prevalence, interventional treatment frequency, and in-hospital outcome for all patients hospitalized for ACS in Germany from 2005 to 2022 and validate the Hospital Frailty Risk Score (HFRS) in this population.

Methods

Data for 2005-2022 from the Statistical Federal Office included all cases with primary diagnosis of ACS treated in Germany. Patients were categorized into low, intermediate, and high frailty by HFRS. Diagnoses, procedures, and in-hospital outcomes were analyzed. Univariable and multivariable logistic regressions as well as sensitivity analyses were performed.

Findings

Between 2005 and 2022, 5,889,972 ACS patients were hospitalized in Germany. Mean age was 69 years (standard deviation (SD) ± 12.85 years) and 2,060,224 (34.98%) were female. In-hospital mortality was 6.2%. Among all, 5,001,812 (84.9%) had a low, 784,106 (13.3%) an intermediate, and 104,054 (1.8%) a high HFRS. High-frailty patients were less likely to undergo coronary intervention than low-frailty patients (47.0% vs. 70.6%, p < 0.001), had longer hospital stays (21.6 days SD 19.4 ± vs. 5.6 days SD ± 5.2, p < 0.001), and higher in-hospital mortality (adjusted odds ratio (OR) 3.34 [confidence interval (95% CI) 3.29-3.4]).

Interpretation

Nearly one-sixth of ACS-patients were frail according to HFRS. Frail patients had longer hospital stays, less often received interventional procedures, and showed substantially increased in-hospital mortality. In our aging population, frailty will play an increasing role in patient management. Frailty scores based on electronic patient records, like the HFRS, offer clinicians a tool for assessing in-hospital outcome in ACS patients, potentially enabling more individualized treatment approaches.

Funding

None.

Marital and living status and biological ageing trajectories: a longitudinal cohort study with a 20-year follow-up

Biomarkers of ageing (BA) can predict health risks beyond chronological age, but little is known about how marital/living status affects longitudinal changes in BA. We examined the association between marital/living status and BA over time using the-Swedish-Adoption/Twin-Study-of-Aging (SATSA) cohort. Four BAs were analyzed: telomere length (TL) (638 individuals; 1603 measurements), DNAmAge (535 individuals; 1392 measurements), cognition (823 individuals; 3218 measurements), and frailty index (FI) (1828 individuals; 9502 measurements). Individuals were born between 1900 and 1948, and data on marital/living status, BAs, and covariates were collected through nine waves of questionnaires and in-person testing from 1986 to 2014. Mixed linear regression with random effects at twin-pair and individual levels were used to assess BA changes for constant marital/living status. Conditional generalized estimating equation assessed within-individual BA changes for varying marital/living status. Results showed that individuals who were consistently unmarried/non-cohabiting (β = 0.291, 95%CI = 0.189-0.393) or living alone (β = 0.203, 95%CI = 0.090-0.316) were more frail, and experienced accelerated frailty (p-for-interaction with age < 0.001 for marital status; p-for-interaction = 0.002 for living status) and cognitive decline (p-for-interaction < 0.001), compared to those married/cohabiting or living with someone Among individuals whose marital/living status changed, frailty was higher when living alone (β = 0.089, 95%CI = 0.017-0.162) and frailty accelerated when they became unmarried/non-cohabiting or were living alone (p-for-interaction < 0.001). Cognitive decline also accelerated when living alone (p-for-interaction = 0.020). No associations were observed for TL and DNAmAge. In conclusion, being unmarried/non-cohabiting or living alone from mid-to-old age is linked to accelerated cognitive decline and frailty. These findings highlight the potential importance of social support networks and living arrangements for healthy ageing.

Genetically-predicted effects of lifestyle factors on frailty: Evidence from Mendelian randomization study

OBJECTIVE

To evaluate the causal relationships between genetically predicted lifestyle factors and frailty using Mendelian randomization(MR).

METHODS

We extracted summary data from genome-wide association studies conducted among individuals of European ancestry, examining lifestyle factors such as smoking, alcohol consumption, physical activity, and sedentary behaviors. The outcomes were assessed using Fried Frailty Score (FFS) and Frailty Index (FI). We conducted 2-sample single-variable Mendelian randomization (SVMR) and multivariable Mendelian randomization (MVMR) to simultaneously assess the independent causal effects were primarily estimated using inverse variance weighted methods. Multiple sensitivity and validation analyzes were used.

RESULTS

The IVW analyzes indicated that smoking increased frailty risk (FFS: β = 0.107, 95 % CI = 0.057 to 0.156, P < 0.001; FI: β = 0.899, 95 % CI = 0.016 to 0.191, P = 0.020.), this effect was amplified in the MVMR analysis after adjusting for alcohol consumption. Strenuous sports or other exercise(SSOE) reduced frailty risk (FFS: β = -0.473, 95 % CI = -0.646 to -0.299, P < 0.001; FI: β = -0.423, 95 % CI = -0.692 to -0.154, P = 0.002). Vigorous and moderate-to-vigorous physical activities were significantly related to lower FFS, although no effects were observed on FI. Increased television watching was linked to higher frailty incidence (FFS: β = 0.227, 95 % CI = 0.197 to 0.257, P < 0.001; FI: β = 0.297, 95 % CI = 0.249 to 0.346, P < 0.001), the impact remained persistent in MVMR adjusting for driving and computer use.

CONCLUSION

This study suggests that modifications in smoking, alcohol consumption, and physical activity may help prevent or manage frailty.

Secular trends in frailty among community-dwelling 75-95-year-old cohorts over three decades in Helsinki, Finland

BACKGROUND

Frailty Index (FI) reflects health, functioning and well-being of older people. It is valuable to compare how frailty has changed over time in ageing cohorts. This study aims to examine trends in frailty among 75-95-year-old men and women over three decades.

METHODS

The Helsinki Ageing Study started in 1989 and includes repeated cross-sectional postal surveys every 10 years examining community-dwelling cohorts of older people (75, 80, 85, 90 and 95 years). FI comprises the same 36 items in each cohort.

RESULTS

The mean FI was 0.22 (SD 0.12), 0.25 (SD 0.15), 0.26 (SD 0.15) and 0.23 (SD 0.15) in 1989, 1999, 2009 and 2019, respectively (P for linearity for crude values .11). Adjusted for age and sex, the four cohorts differed in their frailty the 2019 cohort having the lowest FI. This sex-adjusted difference was seen among 75-, 80-, 85- and 90-year-olds but not among 95-year-olds. FI decreased more among men than women (P for cohort <.001, P for sex <.01, P for interaction = .19).

CONCLUSIONS

The prevalence of frailty among community-dwelling individuals aged 75, 80, 85 and 90 years-but not among those aged 95 years-has significantly decreased over the last decades. This positive trend may have important implications for health policies in societies with increasing longevity.

Glucose Targets Using Continuous Glucose Monitoring Metrics in Older Adults With Diabetes: Are We There Yet?

The older population is increasing worldwide and up to 30% of older adults have diabetes. Older adults with diabetes are at risk of glucose-related acute and chronic complications. Recently, mostly in type 1 diabetes (T1D), continuous glucose monitoring (CGM) devices have proven beneficial in improving time in range (TIR glucose, 70-180 mg/dL or glucose 3.9-10 mmol/L), glycated hemoglobin (HbA1c), and in lowering hypoglycemia (time below range [TBR] glucose <70 mg/dL or glucose <3.9 mmol/L). The international consensus group formulated CGM glycemic targets relating to older adults with diabetes based on very limited data. Their recommendations, based on expert opinion, were aimed at mitigating hypoglycemia in all older adults. However, older adults with diabetes are a heterogeneous group, ranging from healthy to very complex frail individuals based on chronological, biological, and functional aging. Recent clinical trial and real-world data, mostly from healthy older adults with T1D, demonstrated that older adults often achieve CGM targets, including TIR recommended for non-vulnerable groups, but less often meet the recommended TBR <1%. Existing data also support that hypoglycemia avoidance may be more strongly related to minimization of glucose variability (coefficient of variation [CV]) rather than lower TIR. Very limited data are available for glucose goals in older adults adjusted for the complexity of their health status. Herein, we review the bidirectional associations between glucose and health status in older adults with diabetes; use of diabetes technologies, and their impact on glucose control; discuss current guidelines; and propose a new set of CGM targets for older adults with insulin-treated diabetes that are individualized for health and living status.

Effects of cognitive reserve on cognitive frailty among older adults: A population-based prospective cohort study

AIM

We investigated the effect of lifespan cognitive reserve and its components on cognitive frailty among older adults.

METHODS

A total of 4922 participants aged ≥65 years were recruited in 2008 and were followed up in 2011 from the Chinese Longitudinal Healthy Longevity Survey. Cognitive frailty was determined through the simultaneous presence of physical frailty (pre-frailty or frailty) and mild cognitive impairment, excluding concurrent dementia. The assessment of physical frailty and mild cognitive impairment was based on the Fatigue, Resistence, Ambulation, Illness, Loss of weight (FRAIL) (Fatigue, Resistence, Ambulation, Illness, Loss) and Mini-Mental State Examination scale, respectively. The lifespan cognitive reserve consisted of education attainment, occupational complexity and later-life leisure activities. We used logistic regression models to estimate the risk of cognitive frailty associated with the lifespan cognitive reserve and its components.

RESULTS

A higher level of lifespan cognitive reserve, higher educational attainment or leisure activities engagement, but not occupational complexity, were associated with lower risk of incident cognitive frailty. Furthermore, cognitive, social and physical activities were associated with lower risk of incident cognitive frailty.

CONCLUSION

Cognitive reserve, particularly educational attainment and leisure activities, can protect from cognitive frailty. This implicates that individuals should accumulate cognitive reserve in their lifespan, and older adults should actively participate in leisure activities to prevent cognitive frailty. Geriatr Gerontol Int 2024; 24: 398-403.

Correlation of preoperative frailty with postoperative delirium and one-year mortality in Chinese geriatric patients undergoing noncardiac surgery: Study protocol for a prospective observational cohort study

BACKGROUND

To Frailty is associated with postoperative delirium (POD) but is rarely assessed in patients undergoing noncardiac surgery. In this study, the correlation between preoperative frailty and POD, one-year mortality will be investigated in noncardiac Chinese geriatric surgery patients.

METHODS

This study is a prospective, observational, cohort study conducted at a single center with Chinese geriatric patients. Patients who undergo noncardiac surgery and are older than 70 years will be included. A total of 536 noncardiac surgery patients will be recruited from the First Affiliated Hospital of Shandong First Medical University for this study. The Barthel Index (BI) rating will be used to assess the patient's ability to carry out everyday activities on the 1st preoperative day. The modified frailty index (mFI) will be used to assess frailty. Patients in the nonfrailty group will have an mFI < 0.21, and patients in the frailty group will have an mFI ≥ 0.21. The primary outcome is the incidence of POD. Three-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM) will be conducted twice daily during the 1st-7th postoperative days, or just before discharge. The secondary outcomes will include one-year mortality, in-hospital cardiopulmonary events, infections, acute renal injury, and cerebrovascular events.

DISCUSSION

This study will clarify the correlation of preoperative frailty with POD and one-year all-cause mortality in Chinese geriatric patients undergoing noncardiac surgery. Can preoperative frailty predict POD or one-year mortality? In the face of China's serious aging social problems, this result may have important clinical value for the surgical treatment of geriatric patients.

TRIAL REGISTRATION

This protocol has been registered with ClinicalTrials. Gov on 12 January 2022 (https://clinicaltrials.gov/ct2/show/NCT05189678).

Physical Function Trajectories and Mortality in Older Adults With Multisensory Impairment

Importance

Single sensory impairment is associated with reduced functional resilience and increased mortality, though the effects of multiple sensory deficits are not known.

Objective

To investigate longitudinal associations of the type, severity, and number of sensory impairments with physical function trajectories and mortality in older adults.

Design, Setting, and Participants

This retrospective analysis of a longitudinal cohort study, the Health, Aging, and Body Composition (Health ABC) study, incorporated data from April 1997 to July 2013, featuring a 16-year follow-up with annual examinations and questionnaires. The cohort comprised 3075 men and women, aged 70 to 79 years at baseline, residing in Memphis, Tennessee, and Pittsburgh, Pennsylvania. All participants with complete sensory testing and covariate data at analytical baseline (year 5, 2002) were included. The data were analyzed September 1, 2022.

Exposures

Visual, olfactory, auditory, and touch sensory functions were assessed between 2000 and 2002.

Main Outcomes

The main outcomes included physical functioning trajectories and mortality risk. Physical function was assessed longitudinally using the Health ABC physical performance battery (HABCPPB).

Results

A total of 1825 individuals (mean [SD] age, 77.4 [3.2] years; 957 [52%] female) were included in this study. Multivariable analysis of HABCPPB decline indicated that having 1 sensory impairment (β estimate, -0.01 [95% CI, -0.02 to -0.001]); 2 sensory impairments (β estimate, -0.01 [95% CI, -0.02 to -0.01]); 3 sensory impairments (β estimate, -0.03 [95% CI, -0.04 to -0.02]); or 4 sensory impairments (β estimate, -0.04 [95% CI, -0.05,-0.03]) was significantly associated with a steeper HABCPPB score decline in a dose-dependent manner. Adjusted Cox proportional hazards models indicated that having 1 sensory impairment (hazard ratio [HR], 1.35 [95% CI, 1.01-1.81]), 2 sensory impairments (HR, 1.58 [95% CI, 1.19-2.11]), 3 sensory impairments (HR, 1.79 [95% CI, 1.33-2.42]), or 4 sensory impairments (HR, 1.97 [95% CI, 1.39-2.79]) was significantly associated with increased mortality risk in a similarly dose-dependent manner.

Conclusion

In this retrospective cohort study, the degree and number of multiple sensory impairments were associated with worse physical functioning and increased mortality risk. These findings represent an opportunity for further investigation into the value of screening, prevention, and treatment of sensory impairments to reduce morbidity and mortality in older adults.

Moving towards the detection of frailty with biomarkers: A population health study

Aging adults experience increased health vulnerability and compromised abilities to cope with stressors, which are the clinical manifestations of frailty. Frailty is complex, and efforts to identify biomarkers to detect frailty and pre-frailty in the clinical setting are rarely reproduced across cohorts. We developed a predictive model incorporating biological and clinical frailty measures to identify robust biomarkers across data sets. Data were from two large cohorts of older adults: "Invecchiare in Chianti (Aging in Chianti, InCHIANTI Study") (n = 1453) from two small towns in Tuscany, Italy, and replicated in the Atherosclerosis Risk in Communities Study (ARIC) (n = 6508) from four U.S. communities. A complex systems approach to biomarker selection with a tree-boosting machine learning (ML) technique for supervised learning analysis was used to examine biomarker population differences across both datasets. Our approach compared predictors with robust, pre-frail, and frail participants and examined the ability to detect frailty status by race. Unique biomarker features identified in the InCHIANTI study allowed us to predict frailty with a model accuracy of 0.72 (95% confidence interval (CI) 0.66-0.80). Replication models in ARIC maintained a model accuracy of 0.64 (95% CI 0.66-0.72). Frail and pre-frail Black participant models maintained a lower model accuracy. The predictive panel of biomarkers identified in this study may improve the ability to detect frailty as a complex aging syndrome in the clinical setting. We propose several concrete next steps to keep research moving toward detecting frailty with biomarker-based detection methods.

Development and validation of prediction model for older adults with cognitive frailty

OBJECTIVE

This study sought to develop and validate a 6-year risk prediction model in older adults with cognitive frailty (CF).

METHODS

In the secondary analysis of Chinese Longitudinal Healthy Longevity Survey (CLHLS), participants from the 2011-2018 cohort were included to develop the prediction model. The CF was assessed by the Chinese version of Mini-Mental State Exam (CMMSE) and the modified Fried criteria. The stepwise regression was used to select predictors, and the logistic regression analysis was conducted to construct the model. The model was externally validated using the temporal validation method via the 2005-2011 cohort. The discrimination was measured by the area under the curve (AUC), and the calibration was measured by the calibration plot. A nomogram was conducted to vividly present the prediction model.

RESULTS

The development dataset included 2420 participants aged 60 years or above, and 243 participants suffered from CF during a median follow-up period of 6.91 years (interquartile range 5.47-7.10 years). Six predictors, namely, age, sex, residence, body mass index (BMI), exercise, and physical disability, were finally used to develop the model. The model performed well with the AUC of 0.830 and 0.840 in the development and external validation datasets, respectively.

CONCLUSION

The study could provide a practical tool to identify older adults with a high risk of CF early. Furthermore, targeting modifiable factors could prevent about half of the new-onset CF during a 6-year follow-up.

Accelerometer-measured physical activity and sample-based frailty in older women: does pattern really matter?

Background

The relationship between the patterns of physical activity (PA) and frailty, including its various subdomains, remains poorly understood. Therefore, this study aims to investigate the correlations between the patterns of physical activity and frailty and its various subdomains in community-dwelling older women.

Methods

A cross-sectional study investigated the association between physical activity and frailty in 1,099 women aged between 60 to 70 years. Triaxial accelerometers were used to measure bouted PA (a minimum duration of 10 min) and sporadic PA (a duration of <10 min). Fried's frailty phenotype was utilized to evaluate the status of frailty. Data were analyzed using logistic regression and the receiver operating characteristic (ROC) curve.

Results

Bouted moderate-to-vigorous PA (MVPA) and sporadic MVPA were associated with decreased odds of being prefrail and frail, and the optimal cutoff values were 6 and 19.7 for the prefrail stage and 6.6 and 19.4 min/day for the frail stage, respectively. Bouted light PA (LPA) was associated with decreased odds of being prefrail, and the optimal cutoff value was 170.2 min/day. Additionally, bouted and sporadic MVPA were associated with decreased odds of being slow and their optimal cutoff values were 5 and 19.1 min/day, respectively. Sporadic MVPA was associated with decreased odds of exhaustion, and the cutoff was 19.7 min/day. Bouted MVPA and LPA were associated with decreased odds of having low PA, and the cutoff values were 4.4 and 163.2 min/day, respectively.

Conclusion

Any MVPA, regardless of bout duration, could be used as a suitable PA program to improve and prevent frailty in older women, such as bouted MVPA (4-5 times/week) or sporadic MVPA (20 min/day). The improvement effect of bouted and sporadic MVPA on the frailty of older people may not be affected by the subdomain. Additionally, bouted LPA was suitable for the management of prefrailty.

Application of the (fr)AGILE scale in the evaluation of multidimensional frailty in elderly inpatients from internal medicine wards: a cross-sectional observational study

Background

With the rapid growth of an aging global population and proportion, the prevalence of frailty is constantly increasing. Therefore, finding a frailty assessment tool suitable for clinical application by physicians has become the primary link in the comprehensive management of frailty in elderly patients. This study used the (fr)AGILE scale to investigate the frailty status of elderly patients from internal medicine wards and identified relevant factors that affect the severity of frailty.

Method

In this study, 408 elderly inpatients in internal medicine departments of Qilu Hospital of Shandong University from May 2021 to August 2022 were enrolled as research subjects, and a cross-sectional observational study was conducted. Researchers evaluated the frailty based on the (fr)AGILE scale score. The general condition, past medical history, physical examination, laboratory examination, nutrition control score, intervention and treatment measures and other elderly patient information was collected. Logistic regression analysis was used to analyze the relevant factors that affect the severity of frailty and hospitalization costs.

Results

According to the (fr)AGILE scale score, the elderly patients were divided into groups to determine whether they were frail and the severity of the frailty. Among them, 164 patients were in the prefrailty stage, which accounted for 40.2%. There were 188 cases of mild frailty that accounted for 46.1%, and 56 cases of moderate to severe frailty that accounted for 13.7%. Decreased grip strength, elevated white blood cell levels, and low sodium and potassium are independent risk factors affecting the severity of frailty. As the severity of frailty increases, the proportion of sodium, potassium, albumin supplementation as well as anti-infection gradually increases.

Conclusion

Frailty is a common elderly syndrome with a high incidence among elderly patients in internal medicine departments. The main manifestations of frailty vary with different severity levels. Inflammation, anemia, and poor nutritional status can lead to an increase in the severity of frailty as well as blood hypercoagulability, myocardial damage, and additional supportive interventions. This ultimately leads to prolonged hospitalization and increased hospitalization costs.

Plasma Androstenedione Concentration Can Discriminate Frail versus Non-Frail Men with Prostate Cancer under Androgen Deprivation Therapy

BACKGROUND

Androgen deprivation therapy (ADT) is a mainstay of prostate cancer in both adjuvant and palliative settings. Since androgens are crucial for functional status and psychological functions, we evaluated whether blood testosterone, androstenedione, or DHEA concentrations were associated with functional status and psychological alterations in patients with localised (PCa) or metastatic prostate cancer (mPCa) receiving ADT with analogues of luteinising hormone-releasing hormone (LHRH).

METHODS

The five Fried criteria were considered to identify frailty syndrome. In addition, complementary evaluations were carried out to measure other variables of interest. Sleep quality was assessed using the Athens Insomnia Scale, cognitive functions were assessed using the Mini-Mental State Examination, and symptoms of depression were measured using the Yesavage Geriatric Depression Scale. Logistic regression analysis was performed to determine if the androgens level could be related to frailty syndrome, sleep impairment, depressive symptoms, and cognitive functions.

RESULTS

The results of the multivariate analyses show that high concentrations of androstenedione were significantly associated with frailty syndrome in both groups (p = 0.018; odds ratio = 4.66, 95% confidence interval [1.30-16.6]). There were significant relationships between frailty syndrome and the systemic concentration of androstenedione (p = 0.01), but not the concentration of testosterone (p = 0.60) or DHEA (p = 0.42). In addition, the results of the non-parametric tests show significant results between a decreased gait speed in the two groups (metastatic and localised) and the concentration of androstenedione (p = 0.015). High androstenedione levels were associated with a slow walking speed in the mCaP group (p = 0.016), while high testosterone levels were associated with a better walking speed in the localised CaP group (p = 0.03). For the concentration of androstenedione in plasma, the area under the curve was 0.72, with a 95% CI of 0.55-0.88 with acceptable values, and with a cut-off point of 4.51 pg/mL, a sensitivity of 82.9%, and specificity of 53.8%. No relationships between the concentration of androgens in plasma and sleep quality, cognitive functions, or symptoms of depression suggest that the changes were specific to frailty syndrome.

CONCLUSIONS

Further research into the role of androstenedione should be evaluated in follow-up studies in order to recommend its use as a suitable biomarker of frailty syndrome in prostate cancer patients.

Long-term trajectories of frailty phenotype in older cancer survivors: a nationally representative longitudinal cohort study

BACKGROUND

Frailty is a dynamic process associated with adverse health outcomes. However, little is known about the long-term trajectories of frailty in older cancer survivors.

OBJECTIVES

To describe the trajectories of frailty phenotype over time amongst older cancer survivors and examine the socio-demographic and health-related predictors of different trajectories.

DESIGN

Population-based longitudinal cohort study.

SETTING

Community-dwelling older adults in the United States.

SUBJECTS

1,763 older adults who were diagnosed with cancer from the National Health and Ageing Trends Study.

METHODS

Frailty was assessed by the Fried Frailty Phenotype. The group-based trajectory model was used to identify the trajectories of frailty. Multinomial logistic regression analyses were used to examine the socio-demographic and health-related predictors of different trajectories.

RESULTS

Three frailty trajectories were identified; 52.8% of older cancer survivors had a sustained low risk of frailty over time, 25.0% had a low frailty risk at baseline but the risk increased steadily, and 22.3% had a high frailty risk with a slight change in the observed period. Older cancer survivors were at a high-risk frailty trajectory if they were older, female, African American, had lower education status, had lower annual income, were underweight or obese, self-rated poorer health, had more chronic conditions and difficulties with activities of daily living (ADL), and had worse cognitive functions (P < 0.05).

CONCLUSIONS

Long-term frailty trajectories in older cancer survivors are heterogeneous. This study helps identify patients at high risk of sustained or deteriorating frailty and has the potential to inform targeted frailty management strategies addressing modifiable factors identified (e.g. body mass index, ADL).

Association between co-exposure to phenols, phthalates, and polycyclic aromatic hydrocarbons with the risk of frailty

The phenomenon of population aging has brought forth the challenge of frailty. Nevertheless, the contribution of environmental exposure to frailty remains ambiguous. Our objective was to investigate the association between phenols, phthalates (PAEs), and polycyclic aromatic hydrocarbons (PAHs) with frailty. We constructed a 48-item frailty index using data from the National Health and Nutrition Examination Survey (NHANES). The exposure levels of 20 organic contaminants were obtained from the survey circle between 2005 and 2016. The association between individual organic contaminants and the frailty index was assessed using negative binomial regression models. The combined effect of organic contaminants was examined using weighted quantile sum (WQS) regression. Dose-response patterns were modeled using generalized additive models (GAMs). Additionally, an interpretable machine learning approach was employed to develop a predictive model for the frailty index. A total of 1566 participants were included in the analysis. Positive associations were observed between exposure to MIB, P02, ECP, MBP, MHH, MOH, MZP, MC1, and P01 with the frailty index. WQS regression analysis revealed a significant increase in the frailty index with higher levels of the mixture of organic contaminants (aOR, 1.12; 95% CI, 1.05-1.20; p < 0.001), with MIB, ECP, COP, MBP, P02, and P01 identified as the major contributors. Dose-response relationships were observed between MIB, ECP, MBP, P02, and P01 exposure with an increased risk of frailty (both with p < 0.05). The developed predictive model based on organic contaminants exposure demonstrated high performance, with an R2 of 0.9634 and 0.9611 in the training and testing sets, respectively. Furthermore, the predictive model suggested potential synergistic effects in the MIB-MBP and P01-P02 pairs. Taken together, these findings suggest a significant association between exposure to phthalates and PAHs with an increased susceptibility to frailty.

Cholesterol alone or in combination is associated with frailty among community-dwelling older adults: A cross-sectional study

BACKGROUND

Biological markers contribute to the precise intervention across the continuum of frailty severity. Few studies have explored the advantages of biological markers collected as part of primary care data among community-dwelling older adult population and controversy remains regarding the classic biological markers for frailty.

METHODS

We recruited a total of 8791 adults with a mean age of 71.95 years who met the inclusion and exclusion criteria in Guancheng District and Dalang Town, Dongguan, China. Frailty was assessed by a Chinese frailty evaluation scale. Frailty status was classified with 33-item modified frailty index and latent class analysis was applied to explore the latent classes (subtypes) of frailty. We measured biological markers on blood samples collected. We identify association between specific biological markers or patterns and frailty by logistic regression and association rule mining (ARM) based on the Apriori algorithm.

RESULTS

Multivariable analysis of our data showed that an elevated white blood cell (WBC) count and high cholesterol (CHOL) level were associated with pre-frailty (adjusted odds ratio [aOR] = 1.231, 95 % confidence interval [CI] = 1.009-1.501; aOR = 0.703, 95 % CI = 0.623-0.793) and frailty (aOR = 1.500, 95 % CI = 1.130-1.993; aOR = 0.561, 95 % CI = 0.461-0.684) compared with the normal groups. Importantly, significantly high level of CHOL was associated with a lower risk of four frailty subtypes compared with relatively healthy participants with the most power of association in the multi-frail group (aOR = 0.182, 95 % CI = 0.086-0.386). Based on ARM technique to develop correlation analysis to identify important high-risk clusters among older adult transitions from non-frail to frailty, patterns for normal level of CHOL co-occurred with an elevated creatinine (CREA) level have a significant association with the risk of frailty (aOR = 7.787, 95 % CI = 1.978-30.648) after adjusting for targeted confounders.

CONCLUSIONS

Our study highlights the correlation between classic biological markers, especially CHOL and frailty status and subtypes among community-dwelling older adult, in the primary care setting. Further large-scale prospective studies are still needed to confirm the role of classic biological markers in frailty.

Frailty trajectory predicts subsequent cognitive decline: A 26-year population-based longitudinal cohort study

Frailty refers to a decline in the physiological functioning of one or more organ systems. It remained unclear whether variations in the trajectory of frailty over time were associated with subsequent cognitive change. The aim of the current study was to investigate the association between frailty trajectories and subsequent cognitive decline based on the Health and Retirement Study (HRS). A total of 15,454 participants were included. The frailty trajectory was assessed using the Paulson-Lichtenberg Frailty Index, while the cognitive function was evaluated using the Langa-Weir Classification. Results showed that severe frailty was significantly associated with the subsequent decline in cognitive function (β [95% CI] = -0.21 [-0.40, -0.03], p = 0.03). In the five identified frailty trajectories, participants with mild frailty (inverted U-shaped, β [95% CI] = -0.22 [-0.43, -0.02], p = 0.04), mild frailty (U-shaped, β [95% CI] = -0.22 [-0.39, -0.06], p = 0.01), and frailty (β [95% CI] = -0.34 [-0.62, -0.07], p = 0.01) were all significantly associated with the subsequent cognition decline in the elderly. The current study suggested that monitoring and addressing frailty trajectories in older adults may be a critical approach in preventing or mitigating cognitive decline, which had significant implications for healthcare.

Healthy Ageing Should Be a Key Component of Ageing in Place: Case Study from Hong Kong

As part of a knowledge-transfer project consisting of a series of three talks on the topic of healthy ageing and ageing in place, we explored what participants (older adults, students, the general public, as well as professionals in architecture, urban planning and property management) consider to be key requirements for ageing in place and healthy ageing. Feedback is captured using survey questionnaires and a post-talk discussion group. Safety, a comfortable and spacious environment, age-friendly facilities and meeting the needs of older adults, the availability of caring support and home maintenance services were the most frequently mentioned desirable features of ageing in place. Future models for different types of support for ageing in place may be explored by management companies working with the residents themselves, to develop a sustainable business model.

Association between diabetes complicated with comorbidities and frailty in older adults: A cross-sectional study

AIMS AND OBJECTIVES

This study investigated the relationship between frailty and diabetes complicated with comorbidities.

BACKGROUND

Frailty is a common geriatric syndrome, and older adults with diabetes are prone to frailty. Patients with diabetes and comorbidities might be at increased risk of developing frailty.

DESIGN

A multicenter cross-sectional study.

METHODS

A cross-sectional study was conducted to identify older patients with diabetes and comorbidities in the internal medicine departments of five tertiary general hospitals in Sichuan Province, China, from March 2020 to June 2021. We used the FRAIL scale to identify frailty, and multinomial logistic regression was used to compare sociodemographic characteristics and comorbidities of frail or pre-frail participants with robust participants. The STROBE checklist was used for this cross-sectional study.

RESULTS

A total of 1652 patients (883 males, 53.5%) were included, and the prevalence of frailty was 26.5%. Multinomial logistic regression analysis revealed that compared with robust patients, diabetic patients with hypertension, coronary heart disease, chronic cardiac failure, COPD, cerebrovascular diseases, osteoarticular diseases, chronic renal diseases, chronic gastrointestinal diseases and cancer were more likely to be frail. In addition, patients who engaged in less exercise, presented more comorbidities, were older and had lower education levels, were more prone to frailty.

CONCLUSION

There was a clear correlation between diabetes complicated with comorbidities and the development of frailty. Appropriate personalised care levels for patients with diabetes and comorbidities, and early screening for frailty might reduce the prevalence of frailty in these patients.

RELEVANCE TO CLINICAL PRACTICE

This study provided information for healthcare providers to identify circumstances that increase the risk of frailty and more effectively support patients with diabetes and comorbidities.

Differential utility of various frailty diagnostic tools in non-geriatric hospital departments of several countries: A longitudinal study

BACKGROUND

There is limited knowledge on the performance of different frailty scales in clinical settings. We sought to evaluate in non-geriatric hospital departments the feasibility, agreement and predictive ability for adverse events after 1 year follow-up of several frailty assessment tools.

METHODS

Longitudinal study with 667 older adults recruited from five hospitals in three different countries (Spain, Italy and United Kingdom). Participants were older than 75 years attending the emergency room, cardiology and surgery departments. Frailty scales used were Frailty Phenotype (FP), FRAIL scale, Tilburg and Groningen Frailty Indicators, and Clinical Frailty Scale (CFS). Analyses included the prevalence of frailty, degree of agreement between tools, feasibility and prognostic value for hospital readmission, worsening of disability and mortality, by tool and setting.

RESULTS

Emergency Room and cardiology were the settings with the highest frailty prevalence, varying by tool between 40.4% and 67.2%; elective surgery was the one with the lowest prevalence (between 13.2% and 38.2%). The tools showed a fair to moderate agreement. FP showed the lowest feasibility, especially in urgent surgery (35.6%). FRAIL, CFS and FP predicted mortality and readmissions in several settings, but disability worsening only in cardiology.

CONCLUSIONS

Frailty is a highly frequent condition in older people attending non-geriatric hospital departments. We recommend that based upon their current feasibility and predictive ability, the FRAIL scale, CFS and FP should be preferentially used in these settings. The low concordance among the tools and differences in prevalence reported and predictive ability suggest the existence of different subtypes of frailty.

Genetic predisposition to smoking in relation to the risk of frailty in ageing

Frailty causes emerging global health burden due to its high prevalence and mortality. In this study, we used Mendelian randomization (MR) approach to examine the potential causal relationship between smoking and frailty in ageing. Using inverse-variance weighted (IVW) method, genetically predicted smoking initiation was associated with an increased risk of frailty in ageing (odd ratio (OR) 1.23, 95% confidence interval (CI) 1.19-1.27, P = 3.21 × 10^-39). Similarly, per year increase in age of initiation of regular smoking was associated with a 25% decrease in the risk of frailty (95% CI 7-39%, P = 7.79 × 10^-3, per year), while higher number of cigarettes per day was associated with a 12% increased risk (95% CI 4-20%, P = 1.76 × 10^-3). Compared with former smokers, current smokers were associated with an increased risk of frailty (OR 1.12, 95% CI 1.02-1.22, P = 0.01). Lifetime smoking was associated with a 46% higher risk of frailty (95% CI 37-56%, P = 2.63 × 10^-29). Sensitivity analysis using alternative MR methods yielded similar results. Our study indicates that genetic predisposition to smoking is associated with the risk of frailty in ageing. Further studies are warranted to examine the exact role of smoking in the development of frailty.

Morphology of paraspinal muscles in frail and non-frail older adults evaluated through FRAIL scale

BACKGROUND

Frailty is a condition characterized by the progressive deterioration of physiological functioning, which is closely related to adverse events. Multiple previous investigations applied frailty scales for spine research, and the purpose of this study is to investigate the differences in the morphology of the paraspinal muscles in frail and non-frail older adults evaluated through FRAIL scale.

METHODS

The sample of this retrospectively cross-sectional study consisted of individuals who were ≥ 60 years of age and with lumbar degenerative disease. We divided patients into two groups (0-2 = non-Frail, 3-5 = Frail) according to the FRAIL scale. The cross-sectional area (CSA) and percentage of the fatty infiltration (FI%) of the paraspinal muscles were compared between the two groups.

RESULTS

The fCSA (functional cross-sectional area) of the non-Frail group (32.78 [28.52, 38.28]) (cm²) was significantly greater than that of the Frail group (28.50 [24.11, 34.77]) (p < 0.001). The ES FI% (erector spinae fatty infiltration rate) (24.83 ± 6.61 vs. 29.60 ± 7.92, p < 0.001) and MF FI% (multifidus fatty infiltration rate) (31.68 ± 5.63 vs. 41.12 ± 7.04, p < 0.001) of the non-Frail group were significantly lower than that of Frail group.

CONCLUSIONS

The paraspinal muscles of elderly Frail patients screened by the FRAIL scale are worse than those of the non-Frail patients, and the ability of the FRAIL scale to distinguish paraspinal muscle morphology has important clinical significance.

Plant-Based Diet and Risk of Frailty in Older Chinese Adults

OBJECTIVES

This study examined the relationship between the consumption of plant-based diet and frailty in older Chinese adults.

DESIGN

Prospective cohort study.

SETTING

Community-based setting in 22 provinces of China.

PARTICIPANTS

The final sample included data from 3990 older adults from 2011-2014 from the Chinese Longitudinal Healthy Longevity Survey.

MEASUREMENTS

A plant-based diet index (PDI) was calculated based on a qualitative food frequency questionnaire. Frailty was defined using modified Fried criteria. A Generalized Estimating Equation was used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for frailty. We further performed subgroup analyses stratified by sex and lifestyle factors.

RESULTS

557 cases of frailty were observed. After adjustment for covariates, the RR for frailty of a high PDI was 0.792 (95% CI: 0.644-0.973), relative to a low PDI. During follow-up, compared with respondents with a continually low PDI, the respondents with a continually high PDI had a significantly reduced risk of frailty (RR = 0.683, 95% CI: 0.514-0.908). In further subgroup analysis, a consistently high PDI over time resulted in a significantly reduced risk of frailty for male (RR = 0.591, 95% CI: 0.391-0.893); for never smokers (RR = 0.670, 95% CI: 0.458-0.979); for people who did never consume alcohol (RR = 0.654, 95% CI: 0.454-0.941); and for people with current or former exercise habits (RR = 0.488, 95% CI: 0.313-0.762).

CONCLUSION

Plant-based diet was associated with low risk of frailty in men and in older adults with healthy lifestyle. These findings stress that plant-based diet should be recommended as a dietary strategy to prevent and reduce frailty in older adults; in addition, more dietary interventions along with lifestyle modification should be adopted to promote successful ageing, especially for women.

Cross-cultural adaptation and validation of the geriatric 8 screening tool in Chinese hospitalized older adults with cancer

OBJECTIVES

To translate, cross-culturally adapt, and validate the Geriatric 8 (G8) questionnaire in Chinese hospitalized older adults with cancer.

METHODS

The Chinese version of the G8 (C-G8) was produced following Brislin's guidelines. The psychometric properties of the C-G8 were evaluated among 296 eligible patients.

RESULTS

The content validity index of the C-G8 was 0.8∼1 at the item level and 0.975 at the scale level. The C-G8 identified more frail individuals among these older (>75 years) participants compared to their younger (65∼75 years) counterparts (frailty prevalence: 87.1% vs. 70.9%, P=0.010). The convergent validity of the C-G8 was tested by correlating it with the FRAIL scale (r=-0.592, P<0.001). The C-G8 had a lower internal consistency (Cronbach's α coefficient=0.501) but higher test-retest reliability and inter-rater reliability (intraclass correlation coefficient=0.913 and 0.993, respectively, P<0.001).

CONCLUSIONS

The C-G8 questionnaire presented acceptable validity and reliability and could be used in Chinese hospitalized older adults with cancer.

Trajectories of Intrinsic Capacity: Determinants and Associations with Disability

OBJECTIVES

Intrinsic capacity (IC) declines progressively with age, thereby increasing the risk of disability. However, it is less known whether IC trajectories are associated with disability. This study aims to identify the different patterns of IC trajectories in older people, and examine their determinants and associations with Instrumental Activities of Daily Living (IADL).

DESIGN

Cohort study.

SETTING

Community centres in different regions in Hong Kong.

PARTICIPANTS AND MEASUREMENTS

Longitudinal data from community-dwelling older people aged 60 years or above (n = 1371) collected between 2016 and 2021 was analysed. Their mean age was 74.5 years, and 78.7% of them were female. Repeated measurements of a set of 14 self-reported items were used to generate IC scores at four time points using a bi-factor model. Latent class growth analysis was performed to identify classes with distinct IC trajectories. The association between class membership and IADL disability was then examined using logistic regression.

RESULTS

Three distinct IC trajectories were identified. The 1st class included those with the highest level of baseline IC and the least declining trajectory, whereas the 3rd class was composed by those with the lowest level of baseline IC and the most declining trajectory. Older age, female gender, lower perceived financial adequacy, living in public or subsidized housing, and chronic diseases were associated with the 3rd class. After adjusting for demographic factors, socioeconomic status, and the number of chronic diseases, the 1st class was more likely to preserve IADL when compared against the 2nd class, with OR being 3.179 (95% CI: 2.152-4.793), whereas for the 3rd class, the OR was 0.253 (95% CI: 0.178-0.359).

CONCLUSION

Monitoring IC trajectories is of relevance to clinical practice, as it helps shift the focus from treating acute episodes of illness to preserving the functional ability of older people.

Prediction model for cognitive frailty in older adults: A systematic review and critical appraisal

Background

Several prediction models for cognitive frailty (CF) in older adults have been developed. However, the existing models have varied in predictors and performances, and the methodological quality still needs to be determined.

Objectives

We aimed to summarize and critically appraise the reported multivariable prediction models in older adults with CF.

Methods

PubMed, Embase, Cochrane Library, Web of Science, Scopus, PsycINFO, CINAHL, China National Knowledge Infrastructure, and Wanfang Databases were searched from the inception to March 1, 2022. Included models were descriptively summarized and critically appraised by the Prediction Model Risk of Bias Assessment Tool (PROBAST).

Results

A total of 1,535 articles were screened, of which seven were included in the review, describing the development of eight models. Most models were developed in China (n = 4, 50.0%). The most common predictors were age (n = 8, 100%) and depression (n = 4, 50.0%). Seven models reported discrimination by the C-index or area under the receiver operating curve (AUC) ranging from 0.71 to 0.97, and four models reported the calibration using the Hosmer-Lemeshow test and calibration plot. All models were rated as high risk of bias. Two models were validated externally.

Conclusion

There are a few prediction models for CF. As a result of methodological shortcomings, incomplete presentation, and lack of external validation, the models' usefulness still needs to be determined. In the future, models with better prediction performance and methodological quality should be developed and validated externally.

Systematic review registration

www.crd.york.ac.uk/prospero, identifier CRD42022323591.

Frailty in community-dwelling older adults: reliability and validity of the Turkish version of the Gérontopôle frailty screening tool

BACKGROUND

Recognizing frailty had a great importance in countries with an increasing geriatric population. The study aims to evaluate the reliability and validation of the Gérontopôle frailty screening tool (GFST), which was developed to screen frailty in the community-dwelling older adults, for the Turkish population.

METHODS

In this crosssectional study, participants who applied to the geriatrics outpatient clinic of a university hospital were included. Comprehensive geriatric assessments of all patients were performed. The validity of the GFST was tested by its concordance with the FRAIL scale. Test-retest and interrater reliability analyses were made.

RESULTS

Ninety-six patients were included in the study. Sixty-one and five-tenths percent (n = 59) of them are females. The median age was 72.0 (IQR: 10.0). There was a moderate concordance between the GFST and the FRAIL scale (Cohen's kappa: 0.566, p < 0.001). The Gérontopôle frailty screening tool interrater and retest reliabilities were excellent (Cohen's kappa: 0.814, p < 0.001 and 1.0, p < 0.001; respectively). The sensitivity of the GFST determined according to the FRAIL scale is 69.39%, the specificity is 86.36%, the positive predictive value is 85.00%, and the negative predictive value is 71.70%.

DISCUSSION

The Gérontopôle frailty screening tool, which can be used by all healthcare professionals, is a valid and reliable tool for the Turkish geriatric population.

Childhood experiences and frailty trajectory among middle-aged and older adults in China

This study examined the associations between childhood experiences and frailty trajectory among middle-aged and older Chinese adults. Data were derived from the China Health and Retirement Longitudinal Study. We used data from all four waves (i.e., 2011, 2013, 2015, 2018) and the life history survey in 2014. Data for 10,963 respondents were included. Latent growth curve models were conducted to examine the proposed model. The results show that adverse childhood experiences, self-rated childhood socioeconomic status, and the objective indicators of childhood health and health care were associated with both the baseline level and change rate of frailty. The educational attainment of fathers and perceived childhood health and healthcare conditions were associated with baseline frailty only. Our findings highlight the crucial role of childhood antecedents in the progression of frailty in later life. We further found strong evidence that childhood is an essential life stage for human development. Future social policies and interventions should use childhood experiences as a screening tool and promote child protection, health education, and life course interventions.

Effects of age, period, and cohort on the prevalence of frailty in Chinese older adults from 2002 to 2014

Background

Currently, longitudinal studies on frailty are in an early stage, particularly in low- and middle-income countries. Only one study was conducted in Hong Kong to examine age-period-cohort effects on the prevalence of frailty among Chinese older adults.

Objectives

This study aims to shed light on the prevalence trajectory of frailty among older adults in mainland China through the APC model and to analyze the effects of age, period, and cohort on the prevalence trajectory.

Methods

The sample for this study was older adults aged 65-109 years old from the 2002 to 2014 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Frailty status was measured by Rockwood FI. An age-period-cohort model was used to describe the effects of age, period, and cohort on the prevalence trajectory of frailty.

Results

The prevalence of frailty among Chinese older adults changed significantly with age, period, and cohort. Furthermore, the effect of age was much stronger than the effect of period and cohort. The prevalence of frailty in the 101-103 and 104-106 age groups was 8.998 (95% CI 13.667-5.924) and 8.699 (95% CI 13.037-5.805) times higher than the in the 65-67 age group, respectively. The sensitivity analysis based on Fried's frailty phenotype showed similar results, confirming the robustness of our findings.

Conclusion

All of the age effect reflecting the individual aging process, period effect reflecting change in the social environment, and birth cohort effect reflecting different generations could influence the prevalence of frailty at the population level. In contrast, the age effect was the main effect.

Intrinsic capacity and 10-year mortality: Findings from a cohort of older people

BACKGROUND AND OBJECTIVES

Longitudinal data with regard to the association between intrinsic capacity (IC) and mortality is required for prevention efforts. We examined the association between IC and 10-year mortality among older people.

RESEARCH DESIGN AND METHODS

We recruited a cohort of 2032 Chinese people aged 70 years and older, 1371 of them could be traced over follow-up, of which 1096 died within 10 years. Of those who were traceable, 846 were complete cases regarding the data for the exposure, outcome and covariates. Multiple imputation was used to handle missing data. Nine indicators were included to represent the construct of IC. All-cause mortality was collected from the Death Registry. Multivariable Cox proportional hazard regression model and Kaplan-Meier estimator were used to assess the association between IC and mortality.

RESULTS

The mean age of the 2032 participants was 79.7 years and 51 % were female. Compared with those in the lowest (best) quartile of IC, those in the highest (worst) quartile were associated with 1.48-fold (95 % CI 1.21-1.82) higher risk of mortality, after adjustment for sociodemographic variables. When past medical illnesses were further adjusted, the hazard ratio was attenuated (1.41; 95 % CI 1.15-1.73). Kaplan-Meier estimator for survival probability similarly showed a graded mortality pattern. The association between IC and mortality remained similar when the analysis was confined to community-dwelling older people.

DISCUSSION AND IMPLICATIONS

IC is associated with mortality in a dose-response fashion. Assessment of IC should be instituted in community and institutional settings to enable formulation of early interventions.

Physiological Systems in Promoting Frailty

Frailty is a complex syndrome affecting a growing sector of the global population as medical developments have advanced human mortality rates across the world. Our current understanding of frailty is derived from studies conducted in the laboratory as well as the clinic, which have generated largely phenotypic information. Far fewer studies have uncovered biological underpinnings driving the onset and progression of frailty, but the stage is set to advance the field with preclinical and clinical assessment tools, multiomics approaches together with physiological and biochemical methodologies. In this article, we provide comprehensive coverage of topics regarding frailty assessment, preclinical models, interventions, and challenges as well as clinical frameworks and prevalence. We also identify central biological mechanisms that may be at play including mitochondrial dysfunction, epigenetic alterations, and oxidative stress that in turn, affect metabolism, stress responses, and endocrine and neuromuscular systems. We review the role of metabolic syndrome, insulin resistance and visceral obesity, focusing on glucose homeostasis, adenosine monophosphate-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR), and nicotinamide adenine dinucleotide (NAD+ ) as critical players influencing the age-related loss of health. We further focus on how immunometabolic dysfunction associates with oxidative stress in promoting sarcopenia, a key contributor to slowness, weakness, and fatigue. We explore the biological mechanisms involved in stem cell exhaustion that affect regeneration and may contribute to the frailty-associated decline in resilience and adaptation to stress. Together, an overview of the interplay of aging biology with genetic, lifestyle, and environmental factors that contribute to frailty, as well as potential therapeutic targets to lower risk and slow the progression of ongoing disease is covered. © 2022 American Physiological Society. Compr Physiol 12:1-46, 2022.

A Path Analysis of the Effect of Neighborhood Built Environment on Public Health of Older Adults: A Hong Kong Study

Introduction

Health deterioration among frail older adults is a public health concern. Among the multi-dimensional factors, the neighborhood built environment is crucial for one's health. Although the relationship between the built environment and health in the general population has been thoroughly investigated, it has been ignored in the case of frail older adults, who may have difficulties in their daily basic living skills. A path analysis is constructed to model the proposed theoretical framework involving the neighborhood built environment and health among frail older adults. This study thus aims to investigate the environmental influences on health, and to validate the theoretical framework proposed for health and social services.

Methods

This study used secondary data collected in Hong Kong. A sample of 969 older community dwellers aged 60 or above were frail with at least one activity of daily living. Demographic information, neighborhood built environment data, service utilization, and health conditions were collected from these participants and their caregivers. A path analysis was performed to examine the proposed theoretical framework.

Results

The health condition was of general concern, including frailty and incapacities in daily activities in frail older adults. Besides psychosocial factors, service use, and caregivers' care quality, the built environment had a significant impact on the health of older adults as well. Specifically, more facilities offering services and groceries, a shorter distance to the nearest metro station, and more greenery exposure are associated with a better-expected health condition among frail older adults.

Discussion

The proposed theoretical framework successfully supplements past negligence on the relationship between the built environment and the health of frail older adults. The findings further imply that policymakers should promote the usability of transit and greenery in neighborhoods and communities. In addition, service utilization should be improved to meet the basic needs of frail older adults in the communities.

Age and Ageing journal 50th anniversary commentary seriesHealthcare for older people in Asia

Populations in Asian developed economies are rapidly ageing, such that, currently, Hong Kong and Japan have the longest life expectancy at birth for both men and women. However, extended lifespan is not necessarily accompanied by prolongation of health span, such that there is increasing prevalence of frailty and dependency, which translates into increase in complex health and social needs as well as increase in absolute numbers of older adults that require such needs. Consideration of social determinants of healthy ageing would be important in the design of equitable health and social care systems. There is a trend towards development of integrated medical social care in the community in Asian countries. Long-term care insurance and also philanthropic support play a role in the financing of such care models.

Association between Ultra-Processed Food Consumption and Frailty in American Elder People: Evidence from a Cross-Sectional Study

OBJECTIVES

Our study aims to explore the association between ultra-processed foods (UPFs) and frailty in participants with different body mass indexes (BMIs).

DESIGN

A cross-sectional study.

SETTING

Data were collected from the National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2001-2002.

PARTICIPANTS

We analyzed data from 2,329 participants.

MEASUREMENTS

Dietary data were obtained using 24-h dietary recall method. Frail status was assessed by modified Fried frailty phenotype. The association between the grams, energy, and energy proportion of UPFs and the risk of pre-frailty/frailty was estimated using logistic regression analysis, and odds ratio (OR) with 95% confidence intervals (CIs) were calculated. Participants were categorized into underweight-normal weight (BMI <25 kg/m2), overweight (25 kg/m2 ≤ BMI < 30 kg/m2), and obesity (BMI ≥ 30 kg/m2) groups. The multiplicative interaction between BMIs and UPFs on pre-frailty/frailty was assessed using the logistic regression analysis.

RESULTS

We analyzed data from 2,329 participants, and 2,267 (97.77%) of whom consumed UPFs. There were 1,063 participants in pre-frailty or frailty group and 1,266 participants in non-frailty group. In underweight-normal weight participants, every 100 kcal increase in energy of UPFs intake was associated with increased 0.08 times of pre-frailty or frailty risk (OR: 1.08, 95%CI: 1.00-1.16, P = 0.045), and every 10% increase in energy proportion of UPFs intake was correlated with a 0.02-fold increase in pre-frailty or frailty risk (OR: 1.02, 95%CI: 1.00-1.03, P = 0.018). Similar results were found in overweight participants, with OR of 1.06 (95%CI: 1.01-1.10) and 1.01 (95%CI: 1.00-1.02) for energy and energy proportion, respectively (both P < 0.05). This association was not found in obesity participants.

CONCLUSION

The energy and energy proportion of UPFs intake was positively associated with the frailty risk in underweight-normal weight and overweight people, indicating that population with BMI less than 30 kg/m2 should pay more attention to reasonable diet and balanced source of energy intake.

Nutritional Status and Renal Function in Relation to Frailty among the Community-Dwelling Elderly Taiwanese Population

OBJECTIVES

Frailty is a significant public health and clinical issue among the elder population. This study aimed to evaluate the nutritional status and renal function in relation to frailty among elderly Taiwanese.

DESIGN

We administered community-based health surveys to the elder population in Chiayi County, Taiwan, from 2017 to 2019.

MEASUREMENTS

We measured nutritional status (including serum albumin and total protein levels), renal function (including serum blood urea nitrogen, creatinine, urine protein, and urine creatinine levels), hand grip strength (GS) and calculated appendicular muscle mass (AMM).

RESULTS

The study recruited 3739 participants (2139 women). Participants of both sexes with normal GS had higher serum albumin levels and lower urine protein/creatinine ratios (UPCRs). For the men with normal and weak GS, serum albumin levels were 4.15 ± 0.2 and 4.10 ± 0.2 g/dL (p < 0.01), and UPCRs were 123.1 ± 219.6 and 188.7 ± 366.2 (p < 0.001), respectively. GS was positively correlated with serum albumin and urine creatinine levels (r = 0.136 and 0.177, both p < 0.001). AMM was also positively correlated with serum albumin and urine creatinine levels (r = 0.078 and 0.091, both p < 0.001). In the multivariate regression model, for every 1 g/dL increase in serum albumin level, there was a 1.9 and 1.7-kg increase in GS for men and women (p < 0.05 and p < 0.01), respectively. The final model for predicting GS included age, albumin, BUN, and UPCR (urine creatinine for women) which presented a variance of 22.1% and 13.8%, respectively.

CONCLUSION

Proper dietary nutritional intake and maintaining renal function are key elements for preventing frailty among elder population in Taiwan.

Age-related changes in physiology in individuals with bipolar disorder

BACKGROUND

Individuals with bipolar disorder have a reduced life expectancy and may experience accelerated biological ageing. In individuals with bipolar disorder and healthy controls, we examined differences in age-related changes in physiology.

METHODS

UK Biobank recruited more than 500,000 participants, aged 37-73, between 2006 and 2010. Generalised additive models were used to examine associations between age and grip strength, cardiovascular function, body composition, lung function and heel bone mineral density.

RESULTS

The main dataset included 271,118 adults (mean age = 56.04 years; 49.60% females). We found statistically significant differences between cases and controls for grip strength, blood pressure, pulse rate and body composition, with standardised mean differences of up to -0.24 (95% CI -0.28 to -0.19). Evidence of differences in lung function, heel bone mineral density or arterial stiffness was limited. Case-control differences were most evident for age-related changes in cardiovascular function (both sexes) and body composition (females). Differences did not uniformly narrow or widen with age and differed by sex. For example, the difference in systolic blood pressure between male cases and controls was -1.3 mmHg at age 50 and widened to -4.7 mmHg at age 65. Diastolic blood pressure in female cases was 1.2 mmHg higher at age 40 and -1.2 mmHg lower at age 65.

LIMITATIONS

Analyses did not distinguish between bipolar disorder subtypes. Results may not generalise to other age groups.

CONCLUSIONS

Differences between bipolar disorder cases and controls were most evident for cardiovascular and body composition measures. Targeted screening for cardiovascular and metabolic health in middle age is warranted to potentially mitigate excess mortality.

Trajectories of phenotypical frailty over a decade in young-old community-dwelling adults: results from the Lc65+ study

BACKGROUND

Few studies have examined the frailty trajectories of young-old adults using Fried frailty phenotype. Dropouts due to death were rarely taken into account. This longitudinal study aimed to identify trajectories with and without adjustment for non-random attrition and to analyse related factors.

METHODS

We used the first two samples of community-dwelling people in the Lausanne cohort 65+. Frailty phenotype was assessed at age 66-71 years and every third year over 10 years. A group-based trajectory modelling-first without and then with adjustment for non-random attrition-identified trajectories among all individuals with at least two observations (n=2286), excluding dropouts for reasons other than death. Multinomial logistic regressions estimated independent effects of participants' baseline characteristics.

RESULTS

We identified three frailty trajectories (low, medium and high). Participants in the highest trajectory had a higher mortality over 10 years. (Pre)frailty at baseline was the main factor associated with adverse trajectories. Smoking, obesity, comorbidity and negative self-perceived health were associated with unfavourable trajectories independently of baseline frailty, while social engagement was related to the lowest frailty trajectory. Ignoring transitions to death attenuated the estimated effects of age on trajectories.

CONCLUSIONS

Fried frailty phenotype should be assessed in individuals aged late 60s as it is strongly associated with frailty trajectories in the following decade of their life. Lifetime prevention of behavioural risk factors such as smoking and obesity is the strategy most likely to influence the development of frailty in older populations. Furthermore, our results underline social engagement as an important area of interest for future research.

The Association of White Matter Hyperintensities with Frailty in Patients with Very Mild to Moderate Alzheimer's Disease

BACKGROUND

Frailty, one of serious global health problems in the elderly, is a growing concern in patients with Alzheimer's disease (AD) because of its high prevalence in AD and its impact on the prognosis.

OBJECTIVE

To investigate the quantitative association between white matter hyperintensities (WMH) and frailty in AD.

METHODS

A total of 144 outpatients were included. All subjects were evaluated by using Korean version of the CERAD assessment battery and diagnosed very mild to moderate AD. WMH volume was calculated using automated segmentation analysis from the 3D MRI image and further partitioned according to the distance from the ventricular surface. Using the Korean Frailty Index, prefrailty was defined by the scores of 3 and 4 and frailty by the score of 5 and higher.

RESULTS

In total, 23.6%were frailty, 32.6%were pre-frailty, and 43.8%were classified as a robust group. The frailty group had higher WMH volume compared to the robust group (p = 0.02), and these trends remained significant after linear regression analyses. According to the subclassification of WMH, using the robust group as a reference, total WMH (OR = 6.297, p = 0.013, 95%CI = 1.463-27.114), juxtaventricular WMH (OR = 12.955, p = 0.014, 95%CI = 1.687-99.509), and periventricular WMH (OR = 3.382, p = 0.025, 95%CI = 1.163-9.8531) volumes were associated with frailty, but deep WMH volume was not.

CONCLUSIONS

A quarter of patients with very mild to moderate AD is suffering from frailty. Our study provides the evidence of a cross-sectional relationship between WMH volume and frailty, and there is a difference in the association between the subclassification of WMH volume and frailty.

The degree of frailty as a translational measure of health in aging

Frailty is a multiply determined, age-related state of increased risk for adverse health outcomes. We review how the degree of frailty conditions the development of late-life diseases and modifies their expression. The risks for frailty range from subcellular damage to social determinants. These risks are often synergistic-circumstances that favor damage also make repair less likely. We explore how age-related damage and decline in repair result in cellular and molecular deficits that scale up to tissue, organ and system levels, where they are jointly expressed as frailty. The degree of frailty can help to explain the distinction between carrying damage and expressing its usual clinical manifestations. Studying people-and animals-who live with frailty, including them in clinical trials and measuring the impact of the degree of frailty are ways to better understand the diseases of old age and to establish best practices for the care of older adults.

Lifetime depression and age-related changes in body composition, cardiovascular function, grip strength and lung function: sex-specific analyses in the UK Biobank

Individuals with depression, on average, die prematurely, have high levels of physical comorbidities and may experience accelerated biological ageing. A greater understanding of age-related changes in physiology could provide novel biological insights that may help inform strategies to mitigate excess mortality in depression. We used generalised additive models to examine age-related changes in 15 cardiovascular, body composition, grip strength and lung function measures, comparing males and females with a lifetime history of depression to healthy controls. The main dataset included 342,393 adults (mean age = 55.87 years, SD = 8.09; 52.61% females). We found statistically significant case-control differences for most physiological measures. There was some evidence that age-related changes in body composition, cardiovascular function, lung function and heel bone mineral density followed different trajectories in depression. These differences did not uniformly narrow or widen with age and differed by sex. For example, BMI in female cases was 1.1 kg/m2 higher at age 40 and this difference narrowed to 0.4 kg/m2 at age 70. In males, systolic blood pressure was 1 mmHg lower in depression cases at age 45 and this difference widened to 2.5 mmHg at age 65. These findings suggest that targeted screening for physiological function in middle-aged and older adults with depression is warranted to potentially mitigate excess mortality.

Spousal concordance in frailty predicting mental and functional health decline: A four-year follow-up study of older couples in urban and rural China

AIMS AND OBJECTIVES

To examine the joint effects of self and spousal frailty status on functional and mental health in Chinese older adults and determine whether such effects vary by urban versus rural residency.

BACKGROUND

Frailty is a clinical syndrome among old adults and would lead to adverse outcomes. However, studies on the interactive patterns of frailty status between spouses and the joint effects of such patterns on health outcomes are scarce.

DESIGN

Data were from the China Health and Retirement Longitudinal Study (CHARLS). A total of 2,581 married seniors who participated both 2011 and 2015 waves of the CHARLS were categorised into four groups: robust self-robust spouse (RR), robust self-frail spouse (RF), frail self-robust spouse (FR) and frail self-frail spouse (FF).

METHODS

Frailty was measured using the physical frailty phenotype scale. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CESD). Functional health was measured by difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL). The generalised estimating equation was used to estimate the effects of concordant frailty on mental and functional outcomes, stratified by rural/urban residency. This study followed the STROBE checklist.

RESULTS

The FF group reported higher levels of ADL/IADL difficulties and depressive symptoms at follow-up than the RR group; urban individuals in the RF group reported higher follow-up depression than the RR group; and rural individuals from the FR or RF groups reported more follow-up ADL/IADL difficulties than the RR group.

CONCLUSION

Frailty and subsequent health decline are interdependent in older couples, and the rural/urban context is important for understanding this interdependence in the older Chinese population.

RELEVANCE TO CLINICAL PRACTICE

Couples-based intervention strategies are needed to tackle situations in which one or both spouses are concurrently facing frailty.

Trends in Frailty and Its Association With Mortality: Results From the Longitudinal Aging Study Amsterdam, 1995-2016

The aim of this study was to investigate trends in frailty and its relationship with mortality among older adults aged 64–84 years across a period of 21 years. We used data from 1995 to 2016 from the Longitudinal Aging Study Amsterdam. A total of 7,742 observations of 2,874 respondents in the same age range (64–84 years) across 6 measurement waves were included. Frailty was measured with a 32-item frailty index, with a cutpoint of ≥0.25 to indicate frailty. The outcome measure was 4-year mortality. Generalized estimating equation analyses showed that among older adults aged 64–84 years the 4-year mortality rate declined between 1995 and 2016, while the prevalence of frailty increased. Across all measurement waves, frailty was associated with 4-year mortality (odds ratio = 2.79, 95% confidence interval: 2.39, 3.26). There was no statistically significant interaction effect between frailty and time on 4-year mortality, indicating a stable association between frailty and mortality. In more recent generations of older adults, frailty prevalence rates were higher, while excess mortality rates of frailty remained the same. This is important information for health policy-makers and clinical practitioners, showing that continued efforts are needed to reduce frailty and its negative health consequences.

Effectiveness of Nutritional Advice for Community-Dwelling Obese Older Adults With Frailty: A Systematic Review and Meta-Analysis

Objectives: This systematic review was aimed to examine the effectiveness of nutritional advise interventions compared with usual care, or exercise, or exercise combined with nutritional advice as a means of improving the body weight, body composition, physical function, and psychosocial well-being of frail, obese older adults. Methods: CINAHL, Cochrane Library, Embase, MEDLINE, PsycINFO, and Scopus databases were searched to identify relevant studies. The quality of the included studies was assessed using Cochrane's risk of bias tool 2. Meta-analysis was performed with respect to body weight and fat mass. Other outcomes were synthesized narratively. Results: Eight articles (from two studies) with a total of 137 participants were included in the review. The results revealed that nutritional advice was more effective than exercise in reducing body weight and fat mass. The nutritional advice was also beneficial in enhancing physical function and psychosocial well-being. However, it was less effective than exercise or combined interventions in increasing muscle strength and preventing lean mass loss. Conclusions: Nutritional advice is an essential intervention for reducing body weight and fat mass, for enhancing physical function, and for improving the psychosocial well-being of obese older adults experiencing frailty. The limited number of studies included in this review suggests that there is a need for more well-designed interventional studies in order to confirm these findings.

Factors Affecting Trends in Societal Indicators of Ageing Well in Hong Kong: Policies, Politics and Pandemics

OBJECTIVES

To document the trend in a quality of life indicator for the older Hong Kong population as an assessment of the impact of age friendly city policies, political conflicts and the covid-19 pandemic.

DESIGN

Random telephone survey and collection of government data over four years (2017-2020).

SETTING

Community living older people.

PARTICIPANTS

People aged 50 years and over.

MEASUREMENTS

The Hong Kong Quality of Life Index covering four domains of in income security, health status, capability and enabling environment.

RESULTS

From 2017-9, improvements were seen in various domains in parallel with the adoption of the World Health Organization's Age Friendly City concept by government policy together with a territory wide initiative supported by a major philanthropic organization. However scores of all domains dropped markedly as a result of political conflicts as well as the onset of the pandemic.

CONCLUSION

The documentation of the trend in HKEQOL shows that while it may be used as a macro indicator that is able to reflect policies affecting the well-being of older people, it is also able to reflect the impact of societal unrest and pandemics, and that the latter may override the effect of existing ageing policies. It also follows that during social unrest and pandemics, specific policies targeting older people may be needed to maintain well-being.