Long-term prediction of changes in health status, frailty, nursing care and mortality in community-dwelling senior citizens—results from the Longitudinal Urban Cohort Ageing Study (LUCAS)

Assessment of relationships between frailty and chronic pain: a bidirectional two-sample Mendelian randomisation study

BACKGROUND

Previous observational studies have indicated a complex association between chronic pain and frailty. This study aimed to examine the bidirectional causal relationship between frailty and chronic pain and to quantify mediating effects of known modifiable risk factors.

METHODS

A bidirectional two-sample Mendelian randomisation (MR) analysis was applied in this study. Summary genome-wide association statistics for frailty, as defined by both frailty index (FI) and Fried Frailty Score (FFS), pain at seven site-specific chronic pain (SSCP) (headache, facial, neck/shoulder, stomach/abdominal, back, hip and knee) and multisite chronic pain (MCP) were extracted from populations of European ancestry. Genetic instrumental variables strongly correlated with each exposure were selected. The inverse-variance-weighted method was the primary method used in the MR, supplemented by a range of sensitivity and validation analyses. Two-step MR analysis was undertaken to evaluate the mediating effects of several proposed confounders.

RESULTS

Genetically predicted higher FI and FFS were associated with an increased risk of MCP and specific types of SSCP, including neck/shoulder pain, stomach/abdominal pain, back pain, hip pain and knee pain. In the reverse direction analysis, genetic liability to MCP was found to be associated with increased FI and FFS. These results remained consistent across sensitivity and validation assessments. Two-step MR suggested a mediating role for body mass index, smoking initiation, physical inactivity, educational attainment and depression.

CONCLUSIONS

Our research provided genetic evidence that the association between frailty and chronic pain was bidirectional where the coexistence of both conditions will exacerbate each other.

Recruiting patients for falls prevention in the emergency department - worth the challenge

BACKGROUND

Severe falls escalate the risk of future falls and functional decline as indicated by recent global guidelines. To establish effective falls prevention, individuals at highest risk must be thoroughly studied and, therefore, successfully recruited.

OBJECTIVE

Recruiting from an emergency department (ED) may mitigate common selection biases, such as overrepresentation of individuals with a higher social status and healthier lifestyle. However, this approach presents unique challenges due to ED-specific conditions. Hence, we present the successes and challenges of an ED-based recruitment for an observational study.

METHODS

The SeFallED study targets older adults aged ≥60 years, who present to either of two hospitals in Oldenburg after a fall without subsequent admission. A study nurse addressed individuals in the EDs. Subsequently, potential participants were contacted by phone to arrange a home visit for obtaining written consent. Data of participants were compared with total admissions during the recruitment period to determine recruitment rate and compare patients' characteristics.

RESULTS

Over 1.500 individuals met the inclusion criteria. Of these, 288 participants were successfully recruited. Most patients presented to the ED outside of the study team's working hours, and some opted not to participate (main reason: too unwell (40%)). Compared to working hours, a participant was recruited every 14 h. Comparing characteristics, a trend towards better health and younger age was observed.

CONCLUSION

ED-based recruitment offers the opportunity to include more diverse individuals in falls prevention. To achieve adequate sample sizes, flexibility in working days and hours of the research team are obligatory.

TRIAL REGISTRATION

DRKS00025949.

[Reactive dynamic balance in the geriatric setting : Possibilities for evaluation and quantification in functionally heterogeneous persons]

BACKGROUND

Most falls in older persons occur during walking and are often due to maladaptation in response to gait perturbations. Therefore, the assessment of reactive dynamic balance is highly relevant for determining the individual risk of falling and could enable an early initiation of interventions.

OBJECTIVE

The methods available for perturbation of gait and for evaluating the corresponding reaction patterns are critically discussed in order to approach the assessment of reactive dynamic balance.

MATERIAL AND METHODS

A diagnostic protocol for perturbation of gait on a treadmill was developed based on the literature. The application of the protocol to map reactive dynamic balance as comprehensively as possible is presented.

RESULTS

After the initial determination of the individually preferred gait speed over ~ 6 min, the participant's gait is disrupted with 9 different types of perturbations over a time period of ~ 4:30 min. The evaluation options include spatiotemporal parameters and their variability, the margin of stability and the Lyapunov exponent.

CONCLUSION

Dynamic reactive balance is a promising and specific parameter for quantifying the risk of falling in older persons. The comprehensive evaluation of the documented parameters is currently insufficient because there are no established methods or references. The development of a unified method for the sensitive determination of reactive dynamic balance is essential for its use in assessment of the risk of falling in the clinical context and for measuring the success of training.

Co-Creating a Digital Life-Integrated Self-Assessment for Older Adults: User Experience Study

BACKGROUND

Older adults are at increased risk of developing health disorders and functional decline. However, owing to time constraints and considerable effort, physicians rarely conduct comprehensive assessments to detect early signs of negative trajectories. If designed properly, digital technologies could identify health risks already at a preclinical stage, thereby facilitating preventive efforts and targeted intervention. For this purpose, a Life-integrated Self-Assessment (LiSA) tablet system will be developed through a structured co-creation process.

OBJECTIVE

This study aims to investigate older adults' perceptions of different self-assessment domains, components affecting user experience, risks and benefits associated with LiSA, characteristics of potential LiSA users, and the LiSA concept in general.

METHODS

A total of 10 community-dwelling older adults aged ≥70 years were recruited. In total, 6 co-creation workshops were held and started with expert input followed by semistructured discussion rounds. Participants performed hands-on activities with a tablet, including testing of preinstalled self-assessment apps. All workshops were audio recorded and additionally documented by the researchers using flipcharts, notes, and photos. Qualitative content analysis was used to analyze the data following a deductive-inductive approach guided by the Optimized Honeycomb Model for user experience.

RESULTS

The group (mean age 77.8, SD 5.1 years) was heterogeneous in terms of previous technology experience and health status. The mean workshop duration was 2 hours (122.5, SD 4.43 min), and an average of 8 (SD 1.15) participants attended each workshop. A total of 11 thematic categories were identified, covering results on all research questions. Participants emphasized a strong interest in conducting a digital self-assessment of physical activity and function and sensory and cognitive functions and requested additional features such as recommendations for actions or reminders. LiSA was perceived as empowering and a motivator to engage in active health care planning as well as enabling shared and informed decision-making. Concerns and barriers included the lack of technical competence, feelings of frustration, and fear of being left alone, with negative assessment results. In essence, participants expressed a positive attitude toward using LiSA repeatedly and identified it as an option to increase the chances of maintaining independence when growing older.

CONCLUSIONS

The co-creation participants supported the LiSA approach and were interested in performing regular self-assessments on a long-term basis. In their opinion, LiSA should include relevant assessments capturing physical activity and function and sensory and cognitive functions as well as recommendations for actions. It should be customizable to individual needs. These results will form the basis for a prototype. Iterative development and validation will aim to make LiSA accessible in the public domain as a reliable tablet-based system for self-assessment.

Leisure time physical activity and exercise performance in active older people in rural areas-Comparison of the first and second COVID-19 related lockdown in Germany

The closure of all sports facilities during the two lockdowns in Germany favoured a reduction of leisure time physical activity during the COVID-19 pandemic. The aim of this study was to compare leisure time physical activity during the 1st and 2nd lockdown and to examine exercise performance before and after resumption of exercise. Leisure time physical activity was measured by the Longitudinal Urban Cohort Ageing Study (LUCAS) functional ability index and energy expenditure in the Minnesota Leisure Time Physical Activity Questionnaire. Participants' exercise performance was extracted from a chip-controlled fitness circuit. Differences were tested for statistical significance using Friedman tests. 35 participants above 60 years were included from the Oldenburg area (20 women, 15 men, mean age and standard deviation 71±6 years). The decline in energy expenditure was higher during the 2nd lockdown (1st lockdown: Median -55.7 kcal.day-1, Q0.25-121.3 kcal.day-1, Q0.75 132.9 kcal.day-1; 2nd lockdown: Median -119.7 kcal.day-1, Q0.25-255.6 kcal.day-1, Q0.75-65.1 kcal.day-1; Friedman test: p<0.001, n = 35, W = 0.262). The time spent in the fitness circuit decreased from lockdown to lockdown as well as the number of participants exercising there. Intense activities were performed during the two lockdowns by only 7 and 3 participants, respectively, and were not resumed by two-thirds of the participants after the 2nd lockdown. During the 1st lockdown, exercise performance on resistance exercise devices increased in most of them, while it decreased by 1 to 7% during the 2nd lockdown. The lockdowns limited leisure time physical activity in older adults. This was more pronounced during the lockdown in winter 2020/2021, when participants engaged less in outdoor activities. Therefore, measures should be taken to maintain physical activity and muscle strength, especially during winter months, with a home-based training, if visiting gyms is not possible.

A review of frailty instruments in human medicine and proposal of a frailty instrument for dogs

Over the last few decades, frailty has become a pillar of research and clinical assessment in human gerontology. This complex syndrome, characterized by loss of physiologic reserves leading to decreased resilience to stressors, is of critical importance because it predicts higher risks of poor health outcomes, including mortality. Thus, identifying frailty among the elderly human population has become a key focus of gerontology. This narrative review presents current scientific literature on frailty in both humans and animals. The authors discuss the need for an accessible frailty instrument for companion dogs suitable for general use in veterinary medicine and the advances that would be facilitated by this instrument. A phenotypic frailty instrument for companion dogs, utilizing components that are easily collected by owners, or in the general practice setting, is proposed. The authors elaborate on the domains (physical condition, physical activity, mobility, strength, cognitive task performance, and social behavior), factors that will be included, and the data from the Dog Aging Project that inform each domain.

Multisystem physiological perspective of human frailty and its modulation by physical activity

"Frailty" is a term used to refer to a state characterized by enhanced vulnerability to, and impaired recovery from, stressors compared with a nonfrail state, which is increasingly viewed as a loss of resilience. With increasing life expectancy and the associated rise in years spent with physical frailty, there is a need to understand the clinical and physiological features of frailty and the factors driving it. We describe the clinical definitions of age-related frailty and their limitations in allowing us to understand the pathogenesis of this prevalent condition. Given that age-related frailty manifests in the form of functional declines such as poor balance, falls, and immobility, as an alternative we view frailty from a physiological viewpoint and describe what is known of the organ-based components of frailty, including adiposity, the brain, and neuromuscular, skeletal muscle, immune, and cardiovascular systems, as individual systems and as components in multisystem dysregulation. By doing so we aim to highlight current understanding of the physiological phenotype of frailty and reveal key knowledge gaps and potential mechanistic drivers of the trajectory to frailty. We also review the studies in humans that have intervened with exercise to reduce frailty. We conclude that more longitudinal and interventional clinical studies are required in older adults. Such observational studies should interrogate the progression from a nonfrail to a frail state, assessing individual elements of frailty to produce a deep physiological phenotype of the syndrome. The findings will identify mechanistic drivers of frailty and allow targeted interventions to diminish frailty progression.

Funktionale Krankheitsfolgen von Menschen im Alter ab 70 Jahren und die Akzeptanz eines neuen Unterstützungs-Netzwerkes, das NetzWerk GesundAktiv (NWGA)

Einleitung  Häufigere Pflegebedürftigkeit bei steigender Lebenserwartung ist problematisch. Das NetzWerk GesundAktiv (NWGA) nimmt positive Beeinflussbarkeit der Entwicklung von Pflegebedürftigkeit an. In einer Pilotregion Hamburgs luden gesetzliche Krankenversicherungen ihre Versicherten im Alter ab 70 Jahren zur Teilnahme am NWGA Hilfs- und Betreuungsnetzwerk ein. Hier werden die Ergebnisse der Akzeptanzanalyse dargestellt.

Methoden  Zur Fokussierung auf die Zielgruppe der für die Entwicklung von Pflegebedürftigkeit gefährdeten Personen wurde der LUCAS Funktions-Index (Selbstausfüll-Fragebogen) als Screening für den Grad funktionaler Kompetenz verwendet. Die retrospektive Beobachtungsstudie untersuchte explorativ NWGA Teilnehmende, Ablehnende, Interessenten (Ausschluss, da funktional kompetent) und Non-Responder anhand sozio-demografischer sowie Morbiditätsbezogener Routinedaten. Dafür wurden ICD-Diagnosen anlässlich stationärer Krankenhausaufenthalte, die Anzahl ambulanter Arztkontakte sowie Pflegegrade innerhalb 12 Monaten vor Rekrutierung verwendet.

Ergebnisse  Von 13 100 angeschriebenen Versicherten waren 962 Teilnehmende (7,4 %), 948 Ablehnende (7,2 %), 2437 Interessenten (18,6 %) und 8753 Non-Responder (66,8 %). Bezüglich soziodemografischer Merkmale unterschieden sich diese Gruppen. Die Diagnosen von 5422 Krankenhausaufenthalten zeigten unterschiedlich häufige ICD-Codes funktionaler Beeinträchtigungen. Interessenten waren praktisch nicht pflegebedürftig und wiesen die niedrigste Morbidität auf.

Diskussion  Die Ergebnisse weisen darauf hin, dass Beeinträchtigungen insbesondere motorischer und kognitiver Funktionen sowie soziodemografische Merkmale die NWGA-Akzeptanz beeinflussen. Die Ansprache zur Teilnahme sollte entsprechend differenziert verbessert werden. Die Berücksichtigung funktionaler Störungen als Krankheitsfolgen und Schrittmacher von Pflegebedürftigkeit könnte Gesundheitsförderung und Prävention im Alter generell stärken. Das Interesse für präventive Aktivitäten war unter den 70-jährigen und älteren Menschen nennenswert häufig.

Individual characteristics associated with the utilization of nursing care in the very old population: a cross-sectional study

BACKGROUND

As older adults ≥80 years are often underrepresented in previous studies, little is known about their characteristics associated with the utilization of nursing care services. Therefore, this study examined individual (predisposing, enabling, and need) predictors of nursing care utilization in the very old population of North Rhine-Westphalia (NRW) in Germany.

METHODS

Data from a representative cross-sectional study included 1531 community-dwelling individuals and nursing home residents aged ≥80 years. Multinomial regression was applied to investigate the factors that explain the use of outpatient care services, day care, and/or private care (odpNCU), and inpatient nursing care (inpNCU).

RESULTS

Overall, 1083 (69.9%) participants did not use nursing care services (noNCU), 339 (21.9%) used outpatient, day, and/or private care, and 127 (8.2%) used inpatient nursing care. Compared to noNCU, odpNCU was associated with a higher likelihood of being older [odds ratio (OR) = 1.06, 95% confidence interval (CI): 1.01-1.11], having no partner (OR = 0.58, 95%CI: 0.37-0.91), experiencing higher functional (basic activities of daily living, OR = 0.02, 95%CI: 0.01-0.04; instrumental activities of daily living, OR = 0.18, 95%CI: 0.11-0.30) and cognitive disabilities (OR = 0.63, 95%CI: 0.44-0.89). Compared to noNCU, nursing home residents were more likely older (OR = 1.14, 95%CI: 1.07-1.22), had lower socioeconomic status (OR = 0.98, 95%CI: 0.97-1.00), were childless (OR = 3.83, 95%CI: 1.71-8.56) and without partners (OR = 0.43, 95%CI: 0.20-0.96), socially isolated (OR = 3.94, 95%CI: 2.06-7.55), were more likely to be lonely (OR = 2.94, 95%CI: 1.58-7.89), more functionally (basic activities of daily living, OR = 0.01, 95%CI: 0.00-0.03; instrumental activities of daily living, OR = 0.04, 95%CI: 0.02-0.09) and cognitively impaired (OR = 0.48, 95%CI: 0.31-0.74), but they were less likely to experience five or more chronic conditions (OR = 0.42, 95%CI: 0.20-0.88) and less likely to be physically pre-frail (OR = 0.24, 95%CI: 0.10-0.58) and frail (OR = 0.09, 95%CI: 0.03-0.27).

CONCLUSIONS

Individual need factors dominated in explaining odpNCU, suggesting that the very old population in NRW may have equitable access to these services. As social structure, region, and social resources explain inpNCU, this type of care may be inequitably accessible.

Reference values of gait characteristics in community-dwelling older persons with different physical functional levels

Background

Mobility is one major component of healthy ageing of older persons. It includes gait speed, nowadays valued as the sixth vital sign of ageing. Quantitative gait analysis can support clinical diagnostics, monitor progression of diseases and provide information about the efficacy of interventions. Fast gait speed is an additional marker in the area of functional ability. Our aim was to contribute reference values of gait parameters of older persons based on their functional ability.

Methods

We visualised and combined three different established frameworks that assess gait characteristics into a new framework based approach that comprises eight gait parameters: gait speed, stride length, walk ratio, single and double support time, step width, step width CV (coefficient of variance), stride length CV. Gait parameters were stratified by two instruments that indicate levels of functional ability: First, the LUCAS Functional Ability Index (FAI), a self-administered screening tool easy to apply to a public-health orientated approach and second the Short Physical Performance Battery (SPPB), an established performance test widely used in comprehensive geriatric assessments (CGA). Gait parameters of older community-dwelling persons were measured with an objective Gait system (GAITRite) across differing functional ability ranging from robust to transient (postrobust and prefrail) to frail physical status.

Results

Of 642 community-dwelling participants (age 78.5 ± 4.8; n = 233 male, n = 409 female) categorisations by SPPB were 27.1% for robust (11–12 points), 44.2% for transient (8–10 points), 28.7% for frail (0–7 points), and 16.2, 50.3, 33.5% for robust, transient, frail by LUCAS FAI. Overall, our results showed that distinction by functional level only uncovers a wide spectrum of functional decline for all investigated gait parameters. Stratification by functional ability (biological age) revealed a greater range of differentiation than chronological age.

Conclusions

Gait parameters, carefully selected by literature, showed clinically meaningful differences between the functional featuring a gradient declining from robust over transient to frail in most gait parameters. We found discriminative power of stratifications by SPPB to be the highest, closely followed by LUCAS FAI, age groups and dichotomous age making the application of the LUCAS FAI more cost and time effective than conducting SPPB.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03373-0.

Sentinel fall presenting to the emergency department (SeFallED) - protocol of a complex study including long-term observation of functional trajectories after a fall, exploration of specific fall risk factors, and patients' views on falls prevention

BACKGROUND

Falls are a leading cause for emergency department (ED) visits in older adults. As a fall is associated with a high risk of functional decline and further falls and many falls do not receive medical attention, the ED is ideal to initiate secondary prevention, an opportunity generally not taken. Data on trajectories to identify patients, who would profit the most form early intervention and to examine the impact of a fall event, are lacking. To tailor interventions to the individual's needs and preferences, and to address the whole scope of fall risks, we developed this longitudinal study using an extensive assessment battery including dynamic balance and aerobic fitness, but also sensor-based data. Additionally, participative research will contribute valuable qualitative data, and machine learning will be used to identify trips, slips, and falls in sensor data during daily life.

METHODS

This is a mixed-methods study consisting of four parts: (1) an observational prospective study, (2) a randomized controlled trial (RCT) to explore whether a diagnostic to measure reactive dynamic balance influences fall risk, (3) machine learning approaches and (4) a qualitative study to explore patients' and their caregivers' views. We will target a sample size of 450 adults of 60 years and older, who presented to the ED of the Klinikum Oldenburg after a fall and are not hospitalized. The participants will be followed up over 24 months (within four weeks after the ED, after 6, 12 and 24 months). We will assess functional abilities, fall risk factors, participation, quality of life, falls incidence, and physical activity using validated instruments, including sensor-data. Additionally, two thirds of the patients will undergo intensive testing in the gait laboratory and 72 participants will partake in focus group interviews.

DISCUSSION

The results of the SeFallED study will be used to identify risk factors with high predictive value for functional outcome after a sentinel fall. This will help to (1) establish a protocol adapted to the situation in the ED to identify patients at risk and (2) to initiate an appropriate care pathway, which will be developed based on the results of this study.

TRIAL REGISTRATION

DRKS (Deutsches Register für klinische Studien, DRKS00025949 ). Prospectively registered on 4^th November, 2021.

Effectiveness of a multi-component community-based care approach for older people at risk of care dependency - results of a prospective quasi-experimental study

Background

Due to demographic changes, the elderly population in western countries is constantly growing. As the risk of functional decline and multimorbidity increases with age, health care systems need to face the challenge of high demand for health care services and related costs. Therefore, innovative health care approaches and geriatric screenings are needed to provide individualised care. This study aims to expand the state of research by investigating the effectiveness of a multi-component care approach for the elderly in a German community setting.

Methods

A prospective, quasi-experimental study was initiated by statutory health insurance (SHI) companies. The innovative care approach includes a geriatric assessment, a case and network management as well as digital supporting tools and was implemented at the Center for Geriatrics and Gerontology (Albertinen Haus, Hamburg-Eimsbuettel). Participants of the intervention were compared to matched controls recruited in comparable urban areas. The primary outcome measure was the progression in long-term care grade during the period of observation (21 months), which was analysed on the basis of SHI claims data. Secondary endpoints were morbidity, mortality and self-reported health-related quality of life (HRQoL) measured by SF-36.

Results

Overall, 2,670 patients (intervention group (IG) n=873; control group (CG) n=1,797) were analysed. Logistic regression analysis showed no statistically significant difference in progression of long-term care grade between IG and CG (Odds Ratio (OR)=1.054; 95% confidence interval (CI) 0.856-1.296; p-value=0.616). Differentiated analyses indicated an initial effect, which might be attributable to the geriatric assessment. However, an adapted regression model resulted in a reversed but even non-significant effect (OR=0.945; 95% CI 0.757-1.177; p-value=0.619). While secondary analyses of long-term care grade, mortality and HRQoL did not show intervention effects, a statistically significant relative change of 0.865 (95% CI 0.780, 0.960; p-value=0.006) in morbidity indicated a potential benefit for the IG.

Conclusions

The analyses did not reveal a significant effect of the community-based intervention on the primary outcome and thus we are not able to recommend a transfer into SHI standard care. Tendencies in secondary analyses need to be proved in further research.

Trial registration

German Clinical Trials Register, retrospective registration on February 01, 2022 (DRKS00027866).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02923-w.

Health economic perspective on a community-based intervention for older people at risk of care dependency – results of a prospective quasi-experimental study

This prospective, quasi-experimental study aims to compare healthcare resource utilization (HCRU) and costs of a multi-component care approach for older people in a community setting (intervention group (IG)) with usual care in a matched control group (CG) during a 21-month observation period. The reablement-oriented intervention included a geriatric assessment, a case and network management and digital supporting tools. Regression models were applied to determine intervention effects regarding hospitalization, total hospital length of stay (LOS), number of physician consultations, and healthcare costs using claims data. 872 subjects were included in the IG and 1,768 in the CG. The analyses showed that the intervention did not affect hospitalization ( OR = 1.153; 95% CI: 0.971–1.369, p = .105). However, participating in the IG lead to a small but significant increase of physician contacts by a factor of 1.078 (Exp( ß) = 1.078; 95% CI: 1.011–1.149; p = .022). A non-significant mean difference in costs of €1,183 (95% CI: €−261.6 to €2,627.6, p = .108) per participant was identified. Further research is needed to generate robust evidence on the optimal design of care approaches for older people and the health economic implications of such interventions to improve care and resource allocation decision-making.

Trial registration: The study was registered at the German Clinical Trials Register (DRKS00027866).

Frailty and Different Exercise Interventions to Improve Gait Speed in Older Adults after Acute Coronary Syndrome

Background and Objectives: The world’s population is rapidly aging, and it is estimated that, by 2050, every sixth person on earth will be older than 65 years. Around 30% of older adults entering cardiac rehabilitation (CR) meet the criteria of frailty. Frailty identification has not been included in the routine evaluation of CR patients yet, and there is a lack of evidence on what training regimen for improving physical performance in frail people is optimal. Therefore, the aim of our study was to determine the prevalence of frailty and to evaluate the effect of two different complementary training programs on the gait speed of older vulnerable and frail patients with acute coronary syndrome and mid-range-to-preserved left ventricular ejection fraction (≥40%) during short-term CR. Materials and Methods: This randomized controlled trial was conducted from January 2020 to September 2021. CR participants (n = 97) with a mean age of 73.1 ± 5.3 years were randomly allocated into three groups: control (CG, n = 32), intervention-1 (IG-1, n = 32) and intervention-2 (IG-2, n = 33). The patients of all three groups attended a usual inpatient CR program, and two intervention groups additionally received different resistance and balance training programs 3 days a week: the IG-1 underwent complementary training with traditional means of physical therapy, while the IG-2 underwent complementary training with mechanical devices. The mean CR duration was 18.9 ± 1.7 days. Frailty was assessed with the Edmonton Frail Scale, and the 5 m walk test was used to evaluate gait speed. Results: Frailty was determined in 37.1% of participants, and 42.3% met the criteria of being vulnerable. After CR, the gait speed of frail and vulnerable patients significantly improved in all three groups (p < 0.05). In the IG-2, slow gait speed was reversed to normal in the overwhelming majority of patients (p < 0.05), while the CG had the greatest proportion of patients who remained to be slow after CR (p < 0.05). Conclusions: A considerable part of patients entering CR are frail or vulnerable; therefore, it is of crucial importance to assess frailty status in all older people. All three CR programs improved gait speed in frail and vulnerable older patients with ischemic heart disease. Complementary resistance and balance training with mechanical devices more effectively reversed slow gait speed to normal during short-term CR.

Heat Perception and Coping Strategies: A Structured Interview-Based Study of Elderly People in Cologne, Germany

The transdisciplinary project “Heat-Health Action Plan for Elderly People in Cologne” addresses the most heat-vulnerable risk group, people over 65 years of age. A quantitative study aimed to better understand heat perception and coping strategies of elderly people during heat waves to inform heat-health action plans. We conducted a representative quantitative survey via structured interviews with 258 randomly chosen people over 65 years old, living in their own homes in four areas of Cologne, Germany. These areas varied, both in terms of social status and heat strain. Data regarding demographics, health status, coping strategies, and heat perception were collected in personal interviews from August to October 2019. The majority of the participants perceived heat strain as moderate to very challenging. Women, people with a lower monthly income, and those with a lower health status found the heat more challenging. We found that participants adapted to heat with a number of body-related, home-protective, and activity-related coping strategies. The number of coping strategies was associated with perceived personal heat strain. There is a definite underuse of water-related heat adaption strategies among the elderly. This is of increasing relevance, as rising heat impact will lead to more heat-related geriatric morbidity. Our results are seminal to inform elderly-specific, socio-adapted local heat-health action plans.

[The "Hamburg home visit for older citizens" : Development, execution and acceptance in 4716 older people in 15 months]

BACKGROUND

Preventive home visits are part of communal programs for older citizens. The city of Hamburg promoted the pilot project "The Hamburg home visit for older citizens" in two city districts. The voluntary program is offered to persons on their 80th birthday, without comprehensive assessment and is performed by visitors with a background in healthcare or social work. The aim is to provide information, to identify need of help and to initiate contact with officials for support if wanted.

METHODS

The structural and administrative prerequisites were defined together with officials of the city of Hamburg and the two city districts. The data safety concept, provision of addresses, birthday letter, information to be provided, recruitment, qualification and training of the visitors, timing and performance of visits, guiding how to communicate during the home visit, documentation and quarterly reports are described in detail.

RESULTS

From September 2018 to December 2019, 1636 (35%) out of 4716 persons contacted were visited by 59 visitors. The most frequent reasons for refusal were no need because of good health (40%) or satisfaction with existing support (14%). Most issues addressed were health situation (51%), mobility (43%), housing conditions (42%) and social contacts (41%). There was need of support as documented in 399 out of 1636 home visits, and contacts for support were initiated as required by 55 persons.

CONCLUSION

The acceptance of this new approach was 10% higher than 25% per month that had been expected in both the concentrated urban as well as the more rural city districts. Home visits on the 80th birthday appear to be feasible provided that structural and operational prerequisites are considered. In 2020, they were offered to all districts of the city, i.e. to about 15,000 persons per year.

Frailty inclusive care in acute and community-based settings: a systematic review protocol

BACKGROUND

Frailty is a known risk factor for an array of adverse outcomes including more frequent and prolonged health services use and high health care costs. Aging of the population has implications for care provision across the care continuum, particularly for people living with frailty. Despite known risks associated with frailty, there has been limited research on care pathways that address the needs of persons living with frailty. Our study aims to review and examine, in a rigorous way, the quality of evidence for multi-component interventions and care pathways focused on frailty.

METHODS

A comprehensive electronic search strategy will be used to identify studies that evaluate multi-component interventions or care pathways for persons living with frailty. The search strategy will include terms for frailty, multi-component interventions, effectiveness, and cost effectiveness applied to the following databases: MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews. An adapted search for Google Scholar and gray literature databases will also be used. References of included studies will be hand-searched for additional citations of frailty-inclusive care. Known experts and corresponding authors of identified articles will be contacted by email to identify further eligible studies. Risk of bias will be assessed using the Effective Public Health Practice Project Quality Assessment tool. Data will be extracted from eligible studies and it is anticipated that narrative analysis will be used. If studies with sufficient homogeneity are found, then pooled effects will be reported using meta-analysis.

DISCUSSION

This review will appraise the evidence currently available on multi-component frailty interventions. Results will inform on clinical pathway development for people living with frailty across the care continuum and will guide future research to address gaps in the literature and areas in need of further development.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020166733.

The inter-relationship between depressed mood, functional decline and disability over a 10-year observational period within the Longitudinal Urban Cohort Ageing Study (LUCAS)

Background

The WHO defines ‘healthy ageing’ as ‘the process of developing and maintaining the functional ability’. Late-life depression and frailty compromise well-being and independence of older people. To date, there exists little research on the interaction of the dynamic processes of frailty and depression and only a few studies were longitudinal. Conclusions about the direction of effects remained uncertain.

Methods

Data were obtained from each of the last six biyearly waves (2007–2017) of the Longitudinal Urban Cohort Ageing Study (LUCAS) in Hamburg, Germany, a prospective observational cohort study of manifold aspects of ageing. Screening of predictor and event variables: depressed mood: one question from the 5-item Mental Health Inventory Screening Test; frailty: LUCAS Functional Ability Index, status ‘frail’; disability: one question on need for human help with basic activities of daily living. Kaplan-Meier curves and Cox’s proportional hazards regression were used for time-to-event analyses with shifting baseline.

Results

Sample size in 2007 was 2012, average age 76.2 years; ±6.5. Main results were as follows: (1) depression significantly increased the hazard of subsequent frailty (HR=1.581; 95% CI 1.257 to 1.988; p<0.001); (2) frailty significantly increased the hazard of subsequent depression (HR=2.324; 95% CI 1.703 to 3.172; p<0.001); (3) depression significantly increased the hazard of subsequent disability (HR=2.589; 95% CI 1.885 to 3.557; p<0.001) and (4) disability did not significantly increase the hazard of subsequent depression (HR=1.540; 95% CI 0.917 to 2.579; p=0.102).

Conclusion

Our results suggest an interdependence of the processes of depression and frailty/disability rather than unidirectional dependencies. These observable processes may be representative of underlying unobservable profound life changes. Obviously, there is a need for early screening to initiate appropriate interventions.

Pharmaceutical management of elderly high-risk patients in perioperative settings (PHAROS): protocol of a pilot sequential intervention study

INTRODUCTION

With increasing age, the risk of complications after surgery rises in elderly patients. Furthermore, the prevalence of multimorbidity and polypharmacy rises with age, making this elderly population especially vulnerable for drug-related problems and posing an additional risk for postoperative complications. Still, only few studies have concentrated on investigating how medication safety can be improved in these patients. The aim of this pilot study is to examine the impact of a comprehensive intervention (interprofessional systematic medication therapy management) on medication appropriateness in elderly polymedicated, multimorbid patients during hospital stay for elective surgery.

METHODS AND ANALYSIS

This pilot study will include a total number of 140 patients. Surgical high-risk patients ≥65 years taking more than five chronic systemic drugs will be recruited consecutively for 9 months in the control group capturing usual care regarding medication history and in-hospital medication therapy management without any study intervention. Recruitment of the intervention group will be conducted for another 9 months. The intervention consists of the following components: an additional medication history by a hospital pharmacist before admission, a subsequent medication review, optimisation of the long-term medication and recommendations to the patient's general practitioner. A follow-up will be performed 3 months after surgery. As the primary study outcome, medication appropriateness will be measured using the Medication Appropriateness Index.Secondary outcomes are postoperative complications, incidence and frequency of adverse drug reactions and potentially inappropriate medication in the elderly, satisfaction with inpatient and outpatient care, medication reconciliation and health-related quality of life. Multivariable analyses will be used to analyse all quantitative research questions.

ETHICS AND DISSEMINATION

Ethics approval was obtained by the medical ethics committee of the Medical Chamber of Hamburg (study ID: PV5754). Data will be published in peer-reviewed journals and presented at conferences.

TRIAL REGISTRATION NUMBER

The study is registered at www.drks.de: DRKS00014621.

Association between frailty and chronic pain among older adults: a systematic review and meta-analysis

PURPOSE

Frailty and chronic pain are prevalent among older adults. However, no study has systematically reviewed the association between frailty and chronic pain in older adults. Therefore, we aimed to estimate the prevalence of frailty and prefrailty among older adults with chronic pain and review the longitudinal association between frailty status and chronic pain.

METHODS

Embase, Medline, Pubmed, and Cochrane library were searched from inception to March 2020. The methodological quality of the studies was assessed using the Newcastle Ottawa Scale. Random effect models and Mantel-Haenszel weighting were adopted to synthesize the estimates.

RESULTS

Among the initial 846 articles retrieved, 24 were included in the review (12 cross-sectional, and 12 longitudinal). The pooled prevalence in persons with chronic pain was 18% (95% CI 14-23%; I² = 98.7%) for frailty and 43% (95% CI 36-51%; I² = 98.2%) for prefrailty. The pooled prevalence of chronic pain was 50% (95% CI 45-55%; I² = 88.3%) for individuals with frailty and 37% (95% CI 31-42%; I² = 97.1%) for individuals with prefrailty. Persons with chronic pain were 1.85 (95% CI 1.49-2.28; I² = 93.2%) times more likely to develop frailty after an average follow-up of 5.8 years compared to those without.

CONCLUSION

Frailty and prefrailty are common in persons with chronic pain. Chronic pain among non-frail older persons significantly predicts the incidence of frailty after an average follow-up of 5.8 years. Future studies should explore the efficacy of different pain management strategies in reducing physical frailty and clarify the association of other types of frailty (cognitive, social and psychological) with chronic pain.

The dynamics of frailty and change in socio-economic conditions: evidence for the 65+ in Europe

BACKGROUND

The frailty phenotype for older people is defined as an increased vulnerability to stressors, leading to adverse health outcomes. It is acknowledged as a specific precursor of disability besides chronic diseases that allows for some reversibility in the loss of autonomy. Although the literature on the socio-economic determinants of frailty is emerging in cross-sectional settings, little is known about the dynamics of this relationship over time. This article examines the joint evolution of frailty and change in economic conditions for the 65+ in Europe.

METHODS

Individual and longitudinal data from SHARE (Survey on Health, Ageing and Retirement in Europe) over the period 2004-12 has been used. The sample contains 31 044 observations from 12 002 respondents aged 65 or more. A fixed effect Poisson model is estimated in order to control for unobserved individual heterogeneity. Three types of explanative economic variables have been considered in turn: income, wealth and a subjective variable of deprivation.

RESULTS

Our results indicate that individuals with worsening economic conditions (wealth and subjective deprivation) over time simultaneously experience a rapid increase in the frailty symptoms. Results also show that the nature of economic variable does not affect the frailty process in the same way. Subjective measure of deprivation seems to better evaluate the household's financial difficulties than objective measure.

CONCLUSION

From a public policy perspective, these results show that policies fostering economic conditions of the elderly could have a significant impact on frailty and henceforth, could reduce the risks of disability.

The accumulation of deficits approach to describe frailty

The advancing age of the participants of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study was the incentive to investigate frailty as a major parameter of ageing. The aim of this study was to develop a multidimensional tool to measure frailty in an ageing, free-living study population. The "accumulation of deficits approach" was used to develop a frailty index (FI) to characterize a sub-sample (N = 815) of the EPIC-Potsdam (EPIC-P) study population regarding the aging phenomenon. The EPIC-P frailty index (EPIC-P-FI) included 32 variables from the following domains: health, physical ability, psychosocial and physiological aspects. P-values were calculated for the linear trend between sociodemographic and life style variables and the EPIC-P-FI was calculated using regression analysis adjusted for age. The relationship between the EPIC-P-FI and age was investigated using fractional polynomials. Some characteristics such as age, education, time spent watching TV, cycling and a biomarker of inflammation (C-reactive protein) were associated with frailty in men and women. Interestingly, living alone, having no partner and smoking status were only associated with frailty in men, and alcohol use and physical fitness (VO2max) only in women. The generated, multidimensional FI, adapted to the EPIC-P study, showed that this cohort is a valuable source for further exploration of factors that promote healthy ageing.

The Co-Occurrence Of Frailty (Accumulation Of Functional Deficits) And Depressive Symptoms, And Its Effect On Mortality In Older Adults: A Longitudinal Study

Purpose

The co-occurrence of frailty and depression in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality have rarely been investigated. We aimed to examine the co-occurrence of frailty and depressive symptoms in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality using all the information from a longitudinal study.

Patients and methods

We used the Taiwan Longitudinal Study of Aging (TLSA) for this study. TLSA was initiated in 1989 and followed periodically. We included participants from 1989 to 2007, who had data on frailty and depressive symptoms. Frailty was assessed by accumulation of functional deficits in 6 dimensions including disease status, sensory dysfunction, balance, functional limitations, health risk behaviors, and life satisfaction. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). A multistate model with interval censoring was used to examine the transition between states of frailty with or without depressive symptoms, and finally to death. A mixed model was used to examine the relationships between frailty and depressive symptoms.

Results

The coexistence of frailty and depressive symptoms was associated with higher mortality. Individuals with depressive symptom had a lower probability of reversal to a better state. Previous depression score predicted current frailty, but the coefficient was smaller than that of previous frailty. Previous frailty predicted current depression score, and the coefficient was stronger than that of previous depression.

Conclusion

Depressive symptoms increased the mortality and decreased the probability of reversal in the frail older adults.

Chronic Pain and Frailty in Community-Dwelling Older Adults: A Systematic Review

OBJECTIVE

Our aim was to examine the relationship between chronic pain and frailty in community-dwelling older adults.

DESIGN

A systematic review method following the Joanna Briggs Institute Reviewers' Manual 2015.

DATA SOURCES

MEDLINE, Cochrane Library Plus, Science Direct, Scielo, LILACS, and the Joanna Briggs Institute database of systematic reviews and implementation reports were searched using different combinations of the terms "frail," "frailty," and "pain."

REVIEW/ANALYSIS METHODS

Original publications of nononcologic chronic pain and frailty status in community-dwelling older adults published in English or Spanish were included. Because of the heterogeneity of the studies, a narrative approach was used to summarize the results.

RESULTS

A total of 23 studies were finally selected for the systematic review. Most of them (n = 14) were cross-sectional studies, and there were also longitudinal studies (n = 4), cohort studies (n = 3), and randomized controlled trials (n = 2). Most of the studies found an association between chronic pain and frailty in terms of prevalence; approximately 45% of frail patients had chronic pain, and prevalence can reach 70%.

CONCLUSIONS

The studies analyzed suggest that chronic pain has a predictive effect for frailty in older adults compared with those reporting no pain. Higher pain intensity, chronic widespread pain, and higher pain interference were also related to frailty status. No specific interventions for managing chronic pain in frail or prefrail older adults were found.

Predictors of developing a new need for long-term care of older adults aged ≥70 years: Results from a population-based cohort study in Taiwan

AIM

To determine the characteristics associated with developing a new need for long-term care among older Taiwanese adults.

METHODS

We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging. A total of 1986 persons who were aged ≥70 years and had no disability in activities of daily living or need for long-term care at the baseline served as the study participants. We first identified the potential variables associated with developing a need for long-term care in demographic, socioeconomic, anthropometric, functional status, mental health, medical and global domains based on the literature and our earlier studies. We then carried out univariable logistic regression analyses to identify the variables most strongly associated with developing a new need for long-term care within each domain. Variables showing the strongest association were further analyzed in a forward stepwise multivariable logistic regression model to determine the significant predictors.

RESULTS

The multivariable model identified age, sex, doing heavy housework, walking 200 m, carrying out calculation, appetite status, frequency of hospitalizations during the past 12 months, living arrangement and weight loss as significant (P < 0.05) predictors.

CONCLUSIONS

The present study identified nine characteristics that predict the subsequent 4-year new need for long-term care of ≥70-year-old Taiwanese adults. Age, sex and functional status are the most powerful predictors. The results are useful for identifying older individuals at risk of developing a new need for long-term care within the next 4 years, enabling implementation of preventive strategies or timely care planning. Geriatr Gerontol Int 2019; 19: 641-646.

Factors associated with changes of the frailty status after age 70: Findings in the MAPT study

PURPOSE

Frailty has become a major issue in the prevention of functional decline and disability in aged populations. Using repeated measurements of frailty over 3 years, this work aimed to describe transitions between frailty states and associated factors.

METHODS

This study used the data from the Multidomain Alzheimer Preventive Trial and included the 842 participants aged 70 and over who did not receive the multidomain intervention. Frailty was assessed using the phenotype proposed by Fried et al. at baseline and at 6, 12, 24, and 36 months. Factors influencing the transitions across frailty states were examined using multistate modeling.

RESULTS

The study population included 548 women and 294 men, mean age 75.4 ± 4.5 years. At baseline, 430 (53%) participants were nonfrail, 349 (43%) prefrail, and 28 (4%) frail. A total of 2271 pairs of consecutive measurements of frailty status were available over the 3 years of follow-up, with no change in frailty status in 1548 of them (68%), a worsening of frailty status in 426 of them (19%), and an improvement in frailty status in the remaining 297 (13%). Polypharmacy (i.e., ≥6 drugs) and probable depression were associated with incident prefrailty. Female gender was systematically associated with a lower probability of recovering from prefrailty and frailty. Older age, overweight, comorbidity, and abnormal C-reactive protein also reduced the probability of recovery from frailty or prefrailty.

CONCLUSIONS

This study sheds light on factors that should be further investigated in future research to help the prevention and management of frailty.

Modelling long-term cost-effectiveness of health promotion for community-dwelling older people

The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.

Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

OBJECTIVE

The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults.

METHODS

These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

Persistent pain is a risk factor for frailty: a systematic review and meta-analysis from prospective longitudinal studies

Background

pain is prevalent in frail older adults; however, the association of pain and frailty has not been evaluated yet by a systematic assessment of prospective longitudinal studies.

Objective

we aimed to assess the association of persistent pain as a risk factor for frailty incidence, using data from longitudinal studies in a systematic review and meta-analysis.

Methods

publications were identified using a systematic search on PubMed, Embase, Cochrane Library and clinicaltrials.gov databases from inception to October 2017. Since heterogeneity across studies was high, we used random-effects meta-analysis to calculate the pooled relative risk for the association between persistent pain and the incidence of frailty. We investigated sources of heterogeneity among studies using meta-regression and stratified analyses.

Results

we included five prospective longitudinal studies with 13,120 participants (46% women, mean age from 59 to 85 years old). Participants with persistent pain at baseline had twice the risk of developing frailty during the follow-up (pooled RR = 2.22, 95% CI = 1.14-4.29). No variables were related to study heterogeneity in sensitivity analyses.

Conclusion

persistent pain was a risk factor for the development of frailty in a meta-analysis of longitudinal studies. Better understanding of the association between pain and frailty with proper evaluation of potential confounders could allow the development of targeted interventions.

Effects of receiving and providing family support on mortality in non-frail, pre-frail and frail older adults in Taiwan: a 12-year follow-up longitudinal study

BACKGROUND

To investigate the association between providing or receiving family support and risk of mortality in non-frail, pre-frail and frail older people.

METHODS

Data were obtained from Taiwan's Longitudinal Study on Aging (TLSA) from 1996 to 2007 for 2186 people (1207 males; 979 females) aged ≥ 67 years at the time of 1996 follow-up survey. These older adults were categorized as being non-frail (normal), pre-frail, and frail, with frailty defined as the presence of three or more of the following criteria: shrinking, weakness, exhaustion, slowness, and low physical activity. Cox regression analysis was used to examine the association between the people's providing family support or their receiving family support on mortality, after adjustment for several demographic and health status covariates.

RESULTS

The participants (55.9% male) had an average age of 73.8 (SD 5.5) years. In total, 886 (40.5%) were classified as non-frail, 886 (40.5%) as pre-frail and 414 (19.9%) as frail. Multivariate Cox regression analysis revealed a significant association between providing family support and lower mortality rates in the non-frail older adults (hazard ratio 0.913; 95% confidence interval 0.855-0.975; p = 0.0063). This association was also significant in the younger (67-74 years old) pre-frail males but not females after adjustment. No significant association was found between receiving family support and mortality risk regardless of the frailty status, age, or gender.

CONCLUSIONS

Providing family support to others may prolong life expectancy of the pre-frail older adults.

[Effectiveness of "Active health promotion in old age" : Results regarding compression of morbidity by target groups in 13.8 years of observation in LUCAS]

BACKGROUND AND OBJECTIVE

Healthy ageing as defined by the World Health Organization (WHO) is the development and maintenance of functional competence. Unfavourable ageing is described by the term frailty and is characterised by a decline in functional reserves. The frailty process can be influenced in a positive way. Previous interventions concerned mostly hospital patients and residents of nursing homes. In this study we examined the maintenance of functional competence in an urban community setting.

MATERIAL AND METHODS

The programme "Active health promotion in old age" was carried out by a health advisory team with geriatric expertise for independent persons 60 years and older without disabilities. Its effectiveness was evaluated in the Longitudinal Urban Cohort Ageing Study (LUCAS) over a period of 13.8 years. Survival and disability-free survival were calculated separately for persons with a high level of functional competence (many reserves) and persons with few functional reserves, using Kaplan-Meier curves. Adjustments were made for unequal distribution of age, gender, educational level, chronic diseases and functional status using multivariate Cox regressions. This methodology facilitates the study of interrelationships between mortality and morbidity (compression of morbidity) including an impact from life style interventions.

RESULTS

Participants with a high level of functional competence had longer disability-free lifes (p < 0.001), and their average proportion of life time with disability was shorter than either for non-participants, or those with low functional competence.

CONCLUSION

There is evidence from these analyses on compression of morbidity that the health promotion programme had its strongest effects in persons with high functional competence, exactly those people for whom it has been developed.

The MINDMAP project: mental well-being in urban environments : Design and first results of a survey on healthcare planning policies, strategies and programmes that address mental health promotion and mental disorder prevention for older people in Europe

Background

The MINDMAP consortium (2016–2019) aims to identify opportunities provided by the urban environment for the promotion of mental well-being and functioning of older people in Europe by bringing together European cities with urban longitudinal ageing studies: GLOBE, HAPIEE, HUNT, LASA, LUCAS, RECORD, Rotterdam Study, Turin Study. A survey on mental healthcare planning policies and programmes dedicated to older persons covering the range from health promotion to need of nursing care was performed for profound data interpretation in Amsterdam, Eindhoven, Hamburg, Helsinki, Kaunas, Krakow, London, Nord-Trøndelag, Paris, Prague, Rotterdam and Turin.

Objectives

To collect detailed information on healthcare planning policies and programmes across these European cities to evaluate variations and to delineate recommendations for sciences, policies and planners using experience from evidence-based practice feedback from the MINDMAP cities.

Materials and methods

The MINDMAP partners identified experts in the 12 cities with the best background knowledge of the mental health sector. After pretesting, semi-structured telephone interviews (1–2 h) were performed always by the same person. A structured evaluation matrix based on the geriatric functioning continuum and the World Health Organization (WHO) Public Health Framework for Healthy Ageing was applied.

Results

A complete survey (12 out of 12) was performed reporting on 41 policies and 280 programmes on the city level. It appeared from extensive analyses that the focus on older citizens, specific target groups, and multidimensional programmes could be intensified.

Conclusion

There is a broad variety to cope with the challenges of ageing in health, and to address both physical and mental capacities in older individuals and their dynamic interactions in urban environments.

What is the duration of life expectancy in the state of frailty? Estimates in the SIPAF study

The screening of frailty can trigger interventions aiming to delay disability in older people. Whereas the prevalence, the consequences, and the factors associated with frailty are well described, little is known about the duration of the state of frailty. This study aimed to estimate the time spent in the state of frailty in men and women using the Sullivan method. Data used were the age- and sex-specific prevalence of frailty found in SIPAF study ("Système d'Information sur la Perte d'Autonomie Fonctionnelle de la personne âgée") and statistics of mortality from the Human Mortality Database. The SIPAF study included 2350 individuals aged 70 and over and living in France. Participants were interviewed at home by trained nurses. Frailty was defined as impairment in three domains or more among nutrition, energy, physical activity, strength, and mobility. People requiring assistance in basic activities of daily living were considered in a separate category. Mean age of the study sample was 83.3 ± 7.5 years, with 59.4% of women. Overall, the prevalence of pre-frailty, frailty, and dependency was 39.1, 17.0, and 15.4%, respectively. Life expectancy at age 70 was 18.3 years for women, of which 7.4 years (95% CI 6.9-7.9) were pre-frail, 3.4 years (95% CI 3.0-3.8) frail, and 2.4 (95% CI 2.1-2.7) with disability. In contrast, LE for men at 70 was 14.8 years, of which pre-frail, frail, and disabled years were 6.0 years (95% CI 5.5-6.5), 1.2 years (95% CI 1.0-1.5), and 1.2 (95% CI 1.0-1.5), respectively. In conclusion, frailty is a transition state that is relatively limited in time compared to pre-frailty that may represent a larger time window for prevention.

Sociodemographic and health factors associated with mortality in community-dwelling elderly

OBJECTIVE

The objective of this study is to identify factors associated with mortality, with emphasis on gender and age differences.

METHODS

This is a cross-sectional study, which uses data from the FIBRA-2008-2009 network in Campinas, State of São Paulo, Brazil, with information on non-institutionalized residents of the urban area and the Mortality Information System. The dependent variable has been death, in 2013. The associations have been tested by odds ratio (OR) and their 95% confidence intervals, and the analyses have been conducted using the program Stata 12.0.

RESULTS

Average age has been 72.3 years, 69.3% have been women, and 8.9% have died. We have found greater OR for mortality in individuals aged ≥ 75 years, classified as pre-frail or frail, and in those who have reported heart disease.

CONCLUSIONS

In this study, the analysis of specific subgroups has allowed us to better understand the relationship between the factors associated with death in the elderly. With the exception of age, strategies based on primary and secondary care, focused on priority groups, can have a positive impact on the reduction of mortality among the elderly.

OBJETIVO

Identificar fatores associados à mortalidade, com ênfase nas diferenças de gênero e idade.

MÉTODOS

Trata-se de estudo transversal, utilizando dados provenientes da rede FIBRA-2008-2009 em Campinas, SP, com informações de pessoas não institucionalizadas residentes na área urbana e pelo Sistema de Informações de Mortalidade. A variável dependente foi a ocorrência de óbito, verificada em 2013. As associações foram testadas pelas razões de chances (OR) e respectivos intervalos de confiança de 95%, e as análises conduzidas no programa Stata 12.0.

RESULTADOS

A média de idade foi 72,3 anos, 69,3% eram mulheres e 8,9% foram a óbito. Encontrou-se maior OR para mortalidade nos indivíduos com idade ≥ 75 anos, nos classificados como pré-frágil ou frágil e naqueles que referiram doença do coração.

CONCLUSÕES

Neste estudo, a análise para os subgrupos específicos permitiu melhor compreender a relação entre fatores que se associam ao óbito no idoso. Com exceção da idade, estratégias baseadas no cuidado específico de atenção primária e secundária, direcionadas a grupos prioritários, podem ter um impacto positivo na redução da mortalidade entre os idosos.

Health Promotion and Preventive Care Intervention for Older Community-Dwelling People: Long-Term Effects of a Randomised Controlled Trial (RCT) within the LUCAS Cohort

OBJECTIVES

An RCT of a health promotion and preventive care intervention was done in 2001-2002. Here, long-term analyses based on 12 years of follow-up of survival and of change in functional competence between intervention and control group are presented. Positive 1-year results (significantly higher use of preventive services and better health behaviour) were presented earlier.

DESIGN

Parallel group randomised controlled trial (RCT) with 878 participants in the intervention and 1,702 participants in the control group.

SETTING

The study took place in Hamburg, Germany and made use of health care structures and professionals of a geriatrics centre.

PARTICIPANTS

Study participants were initially community-dwelling, aged 60 years and older and without B-ADL-restrictions, cognitive impairment, or need of nursing care, with sufficient command of the German language.

INTERVENTIONS

Health promotion and preventive care interventions relied on an extensive health questionnaire and the subsequent offer to participate in multi-topic personal reinforcement performed in small group sessions or at preventive home visits.

MEASUREMENTS

Primary outcome: Survival time; in some analyses, adjustments were made for gender, age and self-perceived health. Secondary outcome: Functional competence (LUCAS Functional Ability Index) based on responses to self-administered questionnaires at 1-year follow-up and 12 years after 1-year follow-up (2013/2014).

RESULTS

Mean time under observation was 10.3 years. 38.3% (987/2,580) of the participants died; intervention group (IG): 35.7% (313/878), control group (CG): 39.6% (674/1,702); HR=0.89; p=0.09. Functional competence at 1-year follow-up: IG: ROBUST 67.4% (391/580), FRAIL 11.9% (69/580) vs. CG: ROBUST 62.9% (861/1,368), FRAIL 14.8% (203/1,368); p=0.12. 12-years after 1-year follow-up: IG: ROBUST 50.0% (160/320), FRAIL 30.9% (99/320) vs. CG: ROBUST 48.9% (307/628), FRAIL 34.1% (214/628); p=0.56.

CONCLUSIONS

Insignificant but consistent effects on survival and the dynamics of functional competence suggest effectivity of the complex intervention. We plan to take a closer look at the effect of each reinforcement separately.

Use of the frailty index in evaluating the prognosis of older people in Beijing: A cohort study with an 8-year follow-up

OBJECTIVE

Frailty is a significant healthcare challenge in China. However, the relationship between frailty and the prognosis of older people in China remains unclear. The present study aimed to evaluate the prevalence of frailty and determine if the frailty index, a comprehensive geriatric assessment, was associated with the prognosis of older people in a Chinese population.

METHODS

Data were drawn from the Beijing Longitudinal Study of Aging, a representative cohort study with an 8-year follow-up. Evaluations based on the use of the frailty index were performed in a cohort of 1808 people aged 60 years and over residing in Beijing urban and rural areas. The initial survey was conducted in 2004, with follow-up surveys at 3, 5, and 8 years. Mortality data for all individuals were collected and analyzed.

RESULTS

The frailty index and the age of individuals showed the same trend, with a higher frailty index expected as age increased. Respondents with the same frailty index level differed across factors such as sex and location. Male individuals, rural dwellers, and older individuals showed higher frailty rates than female individuals, urban dwellers, and younger individuals.

CONCLUSIONS

Frailty is a condition associated with problems across multiple physiological systems. The frailty index increases with age, and may be a significant tool for evaluation of the prognosis of older people in China.

Pre-Frailty, Frailty, and Multimorbidity: Prevalences and Associated Characteristics from Two French National Surveys

OBJECTIVE

To estimate the prevalence of pre-frailty, frailty and multimorbidity in individuals without disability in France. To describe independent determinants of each indicators.

DESIGN

Two nationally representative cross-sectional French surveys.

SETTINGS

Wave 2012 of the Health, Health Care and Insurance Survey (Enquête Santé et Protection Sociale, ESPS) and data from the Disability Healthcare Household section Survey (Enquête Handicap Santé - Ménages, HSM) from 2008.

PARTICIPANTS

Two representative samples of the French population aged 55 and older (n=4,328 and n=12,295).

MEASUREMENTS

Frailty was assessed using Fried's frailty phenotype and multimorbidity was defined as having had at least two groups of the following groups of comorbidities in the last 12 months (cardio or cerebrovascular disease, diabetes, chronic respiratory disease, arthralgia, depression). Independent determinants were studied using weighted logistic regressions.

RESULTS

In the French population over 55 and free of disability, 55 to 62% of individuals were either frail, pre-frail or multimorbid, 22 to 25% being frail or multimorbid. ESPS and HSM prevalences for frailty (11.1% [9.3%-12.1%] and 12.3% [11.5%-13.0%]) and multimorbidity (14.9% [13.6%-16.2%] and 16.8% [15.9%-17.7%]) were consistent across studies. Both frailty and multimorbidity prevalences were associated with age. On the other hand, pre-frailty prevalence varied consistently between studies (from 38 to 48%) and was not significantly associated with age. We found that more than 60% of frail subjects did not present with multimorbidity and around 70% of subjects with multimorbidity were not frail. Determinants of pre-frailty and multimorbidity but not frailty depended on sex. Similar factors were associated with frailty and multimorbidity in women (older age, functional decline, poor mental health, financial difficulties) while only poor mental health was independently associated with both indicators in men.

CONCLUSION

Our study highlights that in France, among individuals older than 55 years-old and free of disability, around 25% are either frail or multimorbid; another 30% to 40% being pre-frail. Pre-frailty, frailty and multimorbidity are known to be associated with adverse health outcomes and important economic costs. The health system must adapt to respond to the needs of its aging population. In addition, given the efficient impact of prevention actions, our findings emphasize the need to implement prevention strategies against Frailty and multimorbidity in France.

[Frailty in Germany: status and perspectives : Results from a workshop of the German Society for Epidemiology]

BACKGROUND

A standardized, valid and comparable operationalization and assessment of frailty in population-based studies is essential in order to describe the prevalence and determinants of frailty in the population.

AIM

After an introduction to the subject the main goal of a workshop at the 9th annual meeting of the German Society for Epidemiology (DGEpi) was to present approaches and results from four different studies in Germany.

MATERIAL AND METHODS

The following four population-based studies were used to describe frailty in Germany: the German health interview and examination survey for adults (DEGS1), the epidemiological study on the chances of prevention, early recognition and optimized treatment of chronic diseases in the older population (ESTHER), the cooperative health research in the region Augsburg (KORA Age) study and the longitudinal urban cohort ageing study (LUCAS) in Hamburg.

RESULTS

The four studies consistently showed that frailty is widespread in older and oldest-old persons in Germany. It is obvious that frailty represents a relevant concept in Germany even if there is currently no uniform basis for operationalization.

CONCLUSION

Concepts and instruments for the collation of frailty should be included in future population-based studies in order to make a better assessment of older people's health situation and to describe the unused potential for prevention in an aging society.