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

Umbrella review of nonpharmacological interventions for intrinsic capacity in older adults

PURPOSE

This study aims to synthesize existing evidence on the effectiveness of nonpharmacological interventions designed to increase the intrinsic capacity (IC) of community-dwelling older adults.

METHODS

An umbrella review of systematic reviews from 2015 to October 31, 2024, with no language restrictions, was conducted. The review included five databases, including Embase, Ovid MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Joanna Briggs Institute (JBI) Library. Studies followed the preferred reporting items for overviews of reviews (PRIOR) statement. Eligible studies were systematic review and meta-analysis (SRMAs) that included any type of research aimed at enhancing IC in community-dwelling older adults (aged ≥60 years). The interventions covered seven domains: locomotion, vitality, cognitive function, psychological health, sensory function, sleep, and continence. Risk of bias and study quality were extracted via the AMSTAR tool, and GRADE approach was applied to assess the certainty of evidence.

FINDINGS

Out of 6407 initially identified articles, 29 SRMAs comprising 400 studies with a total sample size of 43,849 participants were included. Mobility-focused interventions were the most studied among the seven domains of IC. Moderate to low-quality evidence supports the effectiveness of intrinsic foot muscle strengthening and gait/muscle training for improving locomotor functions in older adults with frailty or acute functional decline. Nonpharmacological interventions targeting cognitive and psychological functions ranked second in the volume of available evidence. No effective sensory or continence interventions were identified. Overall, interventions have demonstrated varying effectiveness, with impacts ranging from moderate to very low across the domains of IC.

INTERPRETATIONS

This umbrella review provides a comprehensive assessment of nonpharmacological interventions for enhancing IC in older adults, highlighting the effectiveness of mobility/muscle strength training for improving locomotor function among frail older adult or those experiencing functional decline. However, the evidence for interventions targeting other IC domains remains limited, particularly for sensory function, and continence management. Future research should prioritize high-quality trials evaluating interventions in these areas to develop evidence-based guidelines for improving overall IC and promoting healthy aging in older adults.

Association of dietary health indices with frailty

BACKGROUND

The Healthy Eating Index (HEI-2015) assesses dietary quality, and lower scores may be associated with an increased risk of frailty. However, few epidemiological studies have examined the relationship between HEI-2015 and the Frailty Index (FI). This study explores the association between HEI-2015 and FI using data from the U.S. National Health and Nutrition Examination Survey (NHANES), analyzing how factors such as gender and age influence this relationship.

METHODS

TNHANES data (2007-2018) were analyzed using logistic regression models to assess the HEI-2015-frailty association. Frailty diagnosis was based on physical activity, strength, fatigue, weight change, and gait speed, with FI scores ranging from 0 to 1. A threshold of 0.21 classified frailty. The R package "DALEX" was used for feature importance analysis to enhance the prediction of frailty. From this analysis, we selected 10 key factors to further improve the accuracy of frailty prediction.

RESULT

Of 14,300 participants, 16.2% (2,322) were classified as frail. Frail participants had lower income, higher BMI, lower physical activity, and lower HEI-2015 scores. Higher HEI-2015 scores were associated with reduced frailty risk (adjusted OR: 0.69, 95% CI: 0.56-0.87, P < 0.01). The negative association was stronger in women, higher-income groups, and those with higher education (P < 0.01). Feature importance analysis showed HEI-2015 was the top predictor of frailty.

CONCLUSION

Higher HEI-2015 scores are linked to lower frailty risk. Promoting healthy eating may prevent frailty, especially in high-risk groups, with education and demographic factors influencing this relationship.

Retrospective observational study of the association between changes in physical activity and frailty in middle-aged and older adults: evidence from the Korean Longitudinal Study of Aging (2006-2022)

OBJECTIVES

This study aimed to investigate the relationship between changes in physical activity and frailty among middle-aged and older adults in Korea, using panel data from the 2006-2022 Korean Longitudinal Study of Aging (KLoSA).

DESIGN

Retrospective observational study.

SETTING

For this longitudinal panel study, data were sourced from the KLoSA dataset.

PARTICIPANTS

We analysed data from 5594 participants (2855 males and 2739 females) extracted from KLoSA data collected between 2006 and 2022.

PRIMARY AND SECONDARY OUTCOME MEASURES

The frailty index was calculated based on 6 clinical domains comprising 34 age-related health deficits. Changes in physical activity were categorised as persistently inactive, decreased, increased or persistently active. Logistic regression analysis using generalised estimating equations was conducted to assess the association between changes in physical activity and frailty.

RESULTS

The persistently active group (OR=0.45, 95% CI: 0.40 to 0.50) showed a lower likelihood of frailty than did the persistently inactive group. In the group that increased their physical activity, the OR was 0.57 (95% CI: 0.52 to 0.63), and higher ORs were observed for current smokers and those residing in rural areas.

CONCLUSIONS

This study demonstrated that persistent and increased physical activity is associated with lower frailty in middle-aged and older adults in Korea. Therefore, participation in physical activity in the older adults is one of the important ways to prevent frailty.

Causal Associations of Cognitive Reserve and Hierarchical Aging-Related Outcomes: A Two-Sample Mendelian Randomization Study

PURPOSE

Two-sample Mendelian randomization methods were used to explore the causal effects of cognitive reserve proxies, such as educational attainment, occupational attainment, and physical activity (PA), on biological (leukocyte telomere length), phenotypic (sarcopenia-related features), and functional (frailty index and cognitive performance) aging levels.

RESULTS

Educational attainment had a potential protective effect on the telomere length (β = 0.10, 95% CI: 0.08-0.11), sarcopenia-related features (β = 0.04-0.24, 95% CI: 0.02-0.27), frailty risk (β = -0.31, 95% CI: -0.33 to -0.28), cognitive performance (β = 0.77, 95% CI: 0.75-0.80). Occupational attainment was causally related with sarcopenia-related features (β = 0.07-0.10, 95% CI: 0.05-0.14), and cognitive performance (β = 0.30, 95% CI: 0.24-0.36). Device-measured PA was potentially associated with one sarcopenia-related feature (β = 0.14, 95% CI: 0.03-0.25).

CONCLUSIONS

Our findings support the potential causality of educational attainment on biological, phenotypic, and functional aging outcomes, of occupational attainment on phenotypic and functional aging-related outcomes, and of PA on phenotypic aging-related outcomes.

Dynapenia-abdominal obesity and mortality risk, is independent effect obscured by age and frailty?:Birjand Longitudinal Aging Study (BLAS)

Background

Abdominal obesity and low muscle strength, known separately as risk factors for mortality, might have a synergistic effect when they co-occur. Dynapenic abdominal obesity (DAO) is a condition defined by the presence of both. However, DAO's independent and combined impact on mortality remains under investigation.

Objective

The objective of the present study was to evaluate the association of dynapenia, abdominal obesity, and dynapenic abdominal obesity with all-cause mortality among community-dwelling older adults.

Methods

This is a longitudinal study with a 5-year follow-up conducted involving 1,354 community-dwelling older adults (≥ 65 years) of the Birjand Longitudinal Aging Study (BLAS). Abdominal obesity and dynapenia were respectively defined based on waist circumference (> 102 cm for men and > 88 cm for women) and grip strength (< 26 kg for men and < 16 kg for women). The sample was divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), dynapenic/non-abdominal obesity (D/NAO), non-dynapenic/abdominal obesity (ND/AO), and dynapenic/abdominal obesity (D/AO). The outcome was all-cause mortality registered through four methods: 1- telephone interview with the family of the participants during September 2018 and February 2024, 2- hospital information systems, 3- death registry of the deputy of the Health of Birjand University of Medical Sciences 4- in a subject who died at home or out of hospital death registry was verified by a verbal autopsy performed by a clinician. Univariate and multiple Logistic regression models were used to estimate the risk of all-cause mortality as a function of dynapenia and abdominal obesity in competing events controlled by age, sex, multi-morbidity, and frailty.

Results

The mean age of the study participants was 69.77 ± 7.55 years, and about 703 (51.71%) were female. There was a statistical difference between the alive and the deceased groups in terms of sex, age, multimorbidity, and frailty. Mortality was statistically higher among dynapenic participants (P < 0.001). Unadjusted logistic regression analysis explored the relationship between D/NAO and mortality (OR = 2.18; CI 95% 1.25-3.78). In the adjusted models, no significant relationships were observed. Age and frailty had significant associations with mortality.

Conclusion

While our study found an association between dynapenia without abdominal obesity and increased mortality risk, factors like age and frailty might play a stronger role. These require further investigation to understand the independent effect of dynapenia on mortality fully.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01501-8.

Feasibility, usability and acceptability of a lifestyle-integrated multicomponent exercise delivered via a mobile health platform in community-dwelling pre-frail older adults: a short-term, mixed-methods, prospective pilot study

BACKGROUND

Pre-frailty is a window of opportunity for frailty reversal and can be enhanced by multicomponent exercise. The Lifestyle-integrated Functional Exercise (LiFE) program may be a promising alternative to overcome traditional exercise barriers. The latest advancements in mobile health (mHealth) technology have enabled individuals to retain the advantages of supervised exercise training within group settings while providing exercise programs that can be accessed and completed at home. This study aims to assess the feasibility, acceptability, and primary efficacy of the PF-Life program, which is the Lifestyle-Integrated Functional Exercise program for Pre-Frail supported by an mHealth platform.

METHODS

Sixteen pre-frail adults aged ≥ 65 years were recruited from five community health centers in Fuzhou, China. All participants were prescribed the PF-Life program by geriatricians using the mhealth platform (web-based portal). Participants engaged in the customized exercises program following in-app video instructions and feedback on the mhealth platform (smartphone application). Physical activity (PA) and sedentary behavior (SB) were registered daily through wearable devices. Study endpoints were feasibility (retention rate, compliance rate, adverse events), usability (system usability scale), acceptability (qualitative interviews), changes in physical function (timed up and go (TUG), handgrip strength (HGS), and 30-second chair rise tests), PA and SB.

RESULTS

The intervention was feasible, 88% of participants adhered completely to the study protocol, and 95% had completed at least 75% of the prescribed experimental duration. System usability was high (85 out of 100 best imaginable). Changes were observed from baseline to follow-up for total HGS (21.41 ± 6.38 vs. 24.12 ± 6.62 kg, P < 0.05, d = 0.714), TUG (8.23 ± 1.33 vs. 7.48 ± 2.01 s, P < 0.01, d = 1.647) and 30-second chair rise test (17.13 ± 4.3 vs. 20.04 ± 4.54 repetitions, P < 0.01, d = 0.94). In addition, SB decreased by a mean of 33 min/day (P < 0.01), and low physical activity increased by 31 min/day (P < 0.01). No adverse events occurred. The majority of participants found the PF-Life program to be straightforward, adaptable, and easily integrable into their daily routines.

CONCLUSIONS

Preliminary studies have demonstrated that the PF-life program exhibits good compliance, safety, and usability for the pre-frail elderly population. Large-scale randomized controlled trials are required to ascertain its long-term effectiveness.

Effect of leisure activity on frailty trajectories among Chinese older adults: a 16-year longitudinal study

BACKGROUND

While the significant association between leisure activities and frailty risk among older adults is well-established, the impact of integrated leisure activity scores and different categories of them on frailty trajectories over time remains unclear.

METHODS

This study utilized longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which enrolled participants aged 65 years and older between 2002 and 2018. Frailty trajectories were derived using group-based trajectory modelling, and based on these trajectories, subjects were classified into various categories. Leisure activity was measured by integrated scores as well as three distinct categories: physically, cognitively, and socially stimulating activity. The effect of leisure activity on frailty trajectories was examined using multinomial logistic regression.

RESULTS

By analysing data from 2,299 older adults, three frailty trajectories were identified: non-frail, moderate progressive, and high progressive. The results indicated that an increase in the score of integrated leisure activity was associated with 11% (odds ratio [OR] 0.89; 95% Confidence Interval [CI] 0.85-0.93) and 14% (OR 0.86; 95% CI 0.80-0.91) decrease in the likelihood of being in the moderate and high progressive frailty trajectories, respectively. Engaging in physically stimulating activity lowered the odds of belonging to the moderate and high progressive trajectory by 43% (OR 0.57; 95% CI 0.40-0.81; OR 0.57; 95% CI 0.36-0.92, respectively). Participation in socially stimulating activity showed a lower odd of being in the moderate progressive trajectory (OR 0.68; 95% CI 0.49-0.93) and the high progressive trajectory (OR, 0.61; 95% CI, 0.39-0.95). The effects of leisure activities on frailty trajectories were observed not to vary by age, education level and retirement status.

CONCLUSIONS

This study suggests that older adults should be encouraged to increase both the amount and variety of their leisure activities. Physically stimulating activities should be considered the primary choice, followed by socially and cognitively stimulating activities.

Common Characteristics Between Frailty and Myotonic Dystrophy Type 1: A Narrative Review

Myotonic dystrophy type 1 (DM1) is an inherited neuromuscular disorder often considered a model of accelerated aging due to the early appearance of certain age-related clinical manifestations and cellular and molecular aging markers. Frailty, a state of vulnerability related to aging, has been recently studied in neurological conditions but has received considerably less attention in neuromuscular disorders. This narrative review aims to describe 1) the common characteristics between Fried's frailty phenotype criteria (muscular weakness, slow gait speed, weight loss, exhaustion/fatigue, and low physical activity) and DM1, and 2) the psychological and social factors potentially contributing to frailty in DM1. This review gathered evidence suggesting that DM1 patients meet four of the five frailty phenotype criteria. Additionally, longitudinal studies report the deterioration of these criteria over time in DM1. Patients also exhibit psychological/cognitive and social factors that might contribute to frailty. Monitoring frailty criteria in the DM1 population could help to implement timely preventions and interventions to reduce the disease burden and severity of frailty symptoms.

Nutritional care in older adults: are we doing everything? An expert opinion review

Malnutrition is a prevalent, yet often underdiagnosed and undertreated, condition in older adults. It is characterized by weight loss and/or reduced muscle mass due to diminished caloric intake, inflammation, and/or disease burden. In return, malnutrition can lead to diminished skeletal muscle functionality and disability, among others. Malnutrition plays a crucial role in the pathogenesis of two prevalent geriatric syndromes, namely sarcopenia and frailty. The complex interplay between malnutrition, sarcopenia, and frailty significantly impacts the older population, leading to increased morbidity, mortality, hospitalization rates, quality-of-life, and healthcare costs. Given the prognostic significance of malnutrition in geriatric care, recent guidelines emphasized the role of nutritional support in vulnerable populations. A group of vulnerable populations to malnutrition, sarcopenia, and frailty are older patients with hip fractures, cancer patients, and those with sarcopenic dysphagia. This article highlights the importance of individualized nutritional assessment and treatment in the management of vulnerable populations such as older patients with hip fractures, cancer, and those suffering from sarcopenic dysphagia. It presents practical protocols and guidelines that can be instrumental in enhancing the nutritional care of these groups, thereby improving their overall health outcomes.

The relationship between health behaviors and quality of life: the mediating roles of activities of daily living and psychological distress

Objective

The aim of this study is to examine the role of activities of daily living performance (ADLs) and psychological distress in mediating the process by which health behaviors affect QOL.

Methods

A non-probabilistic study was conducted among 1,065 older adult people older than 60 years. Participants were assessed using the Barthel Index, Functional Activities Questionnaire (FAQ), Kessler Psychological Distress Scale (K10), Australian Active Survey, and EQ-VAS score. The SPSS22.0 software was used to analyze the differences in QOL scores among older adults with different demographic characteristics. Pearson correlation analysis was used to analyze the correlation between health behaviors, psychological distress, ADLs, and QOL. Amos23.0 software was used to construct structural equation model (SEM) to analyze the path of health behavior affecting QOL and the mediating role of BADLs, IADLs and psychological distress.

Results

(1) The direct effect of health behaviors on QOL was not significant in the model; (2) ADLs had multiple mediating effects on the relationship between health behaviors and QOL, and the incidence of ADL limitation was negatively correlated with the reported QOL in the older adult; (3) Psychological distress had a significant mediating effect on the relationship between health behaviors and QOL.

Conclusion

The results of this study elucidated the mechanisms of the correlation between health behaviors and QOL, and added to the existing literature. In addition, these mediating factors and indirect pathways have been identified as targets for intervention to improve the QOL of older adult individuals, which is important for achieving healthy aging.

The bidirectional relationship between activities of daily living and frailty during short-and long-term follow-up period among the middle-aged and older population: findings from the Chinese nationwide cohort study

Objective

Frailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals.

Methods

The data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs.

Results

In cross-sectional analysis, BADL [OR = 6.660 (4.519-9.815)], IADL [OR = 5.950 (4.490-7.866)], and ADL [OR = 5.658 (4.278-7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574-9.933)], IADL [OR = 6.042 (4.555-8.016)] and ADL [OR = 5.735 (4.333-7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150-3.379), ADL: HR = 1.920 (1.146-3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085-3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126-2.939)] and IADL [HR = 1.724 (1.103-2.694)].

Conclusion

In middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up.

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

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

Demographic and biological factors in interrelationships between physical, cognitive, psychological, and social frailty in community-dwelling older adults: Data from the Birjand Longitudinal Aging Study (BLAS)

Complex interrelationships may exist among different types of frailty. This study aimed to evaluate the demographic and biological factors that influence the different types of frailty in community-dwelling older adults in Iran through a cross-sectional analysis of data obtained from the Birjand Longitudinal Aging Study. This study is an ongoing cohort study of people aged 60 years and over and employed a multistage stratified cluster random sampling. Anthropometric measures were obtained by nurses. The "Fried frailty phenotype" was defined as physical frailty. Cognitive frailty was assessed using the Mini-Mental State Examination. Social frailty was evaluated by some questions, and psychological frailty was assessed using a patient health questionnaire. Blood samples were taken after overnight fasting. All statistical analyses were performed using Stata12 (Texas, USA) and Python. Some type of frailty had been experienced by 62.27 % of the older adults. Cognitive frailty was the dominant type of frailty (55.69 %). Based on multivariate regression analysis, age, sex, education, and marital status were the influencing factors in all types of frailty. Network analysis revealed that physical, cognitive, psychological, and social frailty had synergistic effects on each other, and age and sex had dominant interactions with frailty types. Cognitive frailty was dominant compared with other types of frailty, indicating the need to detect cognitive frailty at the earliest stage and to implement an appropriate program to manage cognitive frailty in older adults.

Low physical activity and depression are the prominent predictive factors for falling in older adults: the Birjand Longitudinal Aging Study (BLAS)

BACKGROUND

Falling in the older adults has many irreparable consequences, including hospitalization to long-term care centers and loss of independence, depression and social isolation, financial burden, and death. The present study was conducted to estimate the incidence of falls and their associated factors among community-dwelling older adults.

METHODS

This program is a population-based prospective cohort study (≥ 60 years) in Birjand City from 2019 to 2020. A total of 1418 participants were included in the study, and 1344 participants were analyzed according to the inclusion criteria. Thirty-nine risk factors were evaluated. Basic information included demographic information, lifestyle factors, general health and medical history, and mental and functional health.

RESULT

The incidence of falls among community-dwelling older adults in the previous approximately 24 months in the present study was 9.26% in women and 2.65% in men. In the multiple Cox proportional regression model based on fall risk factors, there was a strong significant relationship between male sex (HR = 0.37, CI = 0.21 to 0.64), being physically active (HR = 0.59, CI = 0.36 to 0.96), moderate-to-severe depression (HR = 2.97, CI = 1.47 to 6.01), severe depression (HR = 3.26, CI = 1.24 to 8.54), and high risk of falls according to the TUG test (HR = 1.73, CI = 1.10 to 2.72).

CONCLUSIONS

Inactivity and depression were recognized as important factors in falls in older adults. It is recommended for older adults to have an active lifestyle to prevent falls and to prioritize the diagnosis and treatment of depression in older adults. Women as a group at higher risk should be considered in prevention programs. In addition, the use of the TUG test to identify high-risk older adults should be considered.

Healthy Aging and its Determinants Among Community-dwelling Older Persons in East Coast, Malaysia: A Multidimensional Assessment

Objectives

Exploring the possibility of healthy aging among older persons is crucial for achieving optimal health in the growing older population. This study aimed to determine the prevalence, pattern, and determinants of healthy aging among older persons in Terengganu, Malaysia.

Methods

We conducted a community-based cross-sectional study involving older persons aged % 60 years. An interviewer-guided questionnaire, anthropometric measurements, and physical assessments were administered to operationalize healthy aging based on a multidimensional concept.

Results

Among the 765 older persons surveyed, only 14.1% (95% CI: 11.64?"16.59) were classified as healthy agers. Multiple logistic regression analysis revealed that superior intrinsic religiosity (odds ratio (OR) = 3.42; 95% CI: 1.34?"8.73), higher social interaction (OR = 2.82; 95% CI: 1.32?"6.04), larger calf circumference (OR = 2.05; 95% CI: 1.24?"3.38), taking water intake % 5 cups per day (OR = 2.01; 95% CI: 1.23?"3.30), better gait speed (OR = 1.71; 95% CI: 1.04?"2.80), having savings (OR = 1.71; 95% CI: 1.10?"2.66), and normal waist circumference (OR = 1.63; 95% CI: 1.04?"2.55) were found positively associated with healthy aging.

Conclusions

Only one in 10 older persons in the state met all the criteria for healthy aging. Specific aspects of religious status, social interaction, socioeconomic, behavioral, physical, and nutritional factors were found to predict healthy ageing in this population. These important determinants should be considered in developing a well-defined and comprehensive public health policy to promote healthy aging in the nation.

Implementation and Core Components of a Multimodal Program including Exercise and Nutrition in Prevention and Treatment of Frailty in Community-Dwelling Older Adults: A Narrative Review

Increasing disability-free life expectancy is a crucial issue to optimize active ageing and to reduce the burden of evitable medical costs. One of the main challenges is to develop pragmatic and personalized prevention strategies in order to prevent frailty, counteract adverse outcomes such as falls and mobility disability, and to improve quality of life. Strong evidence reports the effectiveness of exercise interventions to improve various physical parameters and muscle function that are cornerstones of frailty. Other findings also suggest that the interactions between nutrition and physical exercise with or without health behavior promotion prevent the development of frailty. Multimodal programs, including structured exercise, adequate dietary intervention and health behavior promotion, appear increasingly consensual. However, in order for implementation in real-life settings, some pitfalls need to be addressed. In this perspective, structuring and tailoring feasible, acceptable and sustainable interventions to optimize exercise training responses are essential conditions to warrant short, medium and long-term individual benefits. The different components of exercise programs appear to be fairly consensual and effective. However, specific composition of the programs proposed (frequency, intensity, type, time, volume and progressiveness) have to be tailored to individual characteristics and objectives in order to improve exercise responses. The intervention approaches, behavioral strategies and indications for these programs also need to be refined and framed. The main objective of this work is to guide the actions of healthcare professionals and enable them to widely and effectively implement multimodal programs including exercise, nutrition and behavioral strategies in real-life settings.

The mediating effects of social support and depressive symptoms on activities of daily living and social frailty in older patients with chronic heart failure

OBJECTIVES

To investigate the level of social frailty (SF) in older patients with chronic heart failure (CHF) and examine the mediating role of social support and depressive symptoms between activities of daily living and SF.

METHODS

Using a convenience sampling method, 205 older patients with CHF were recruited from China between November 2021 and May 2022. Activities of daily living, social support, depressive symptoms, and SF were assessed using a self-administered questionnaire. Data were analyzed using structural equation modeling.

RESULTS

The final model obtained a good fit. Activities of daily living in older patients with CHF were directly related to SF. The multiple mediation analysis revealed that the relationship between activities of daily living and SF was mediated by social support (effect: -0.010, 95% CI [-0.021, -0.003]) and depressive symptoms (effect: -0.011, 95% CI [-0.019, -0.005) separately, and serially (effect: -0.007, 95% CI [-0.012, -0.003).

CONCLUSIONS

Social support and depressive symptoms are multiple mediating variables in the relationship between activities of daily living and SF. Activities of daily living can improve patients' SF through social support and depressive symptoms.

Effects of High-Intensity Functional Training (HIFT) on the Functional Capacity, Frailty, and Physical Condition of Older Adults with Mild Cognitive Impairment: A Blind Randomized Controlled Clinical Trial

Physical exercise has been established as an intervention in the integral approach for the physical, functional, and social health of older adults. The objective of this study was to determine the effects of a high-intensity functional training (HIFT) program on the physical condition and functional capacity of an elderly Colombian population with mild cognitive impairment. This research corresponds to a blind randomized controlled clinical trial. A total of 169 men and women aged over 65 years were evaluated and distributed in two groups: the experimental group that received a 12-week HIFT intervention (n = 82) and the control group (n = 87) that received general recommendations on the benefits of physical exercise. The outcome variables included physical condition, assessed using the Senior Fitness battery (SNB); Fried's frailty phenotype was applied, and gait and balance were assessed using the Tinetti scale. For the functional variables, activities of daily living, instrumental activities of daily living, and advanced activities of daily living were evaluated. All variables were measured pre- and post-intervention. Statistically significant improvements were observed in the IG for gait stability and balance (p < 0.001), as well as for independence in activities of daily living (p = 0.003), and instrumental and advanced activities (p < 0.001). Likewise, greater functionality was found when assessed with the SNB (p < 0.001), except for upper limb strength. The frailty classification did not show changes post-intervention (p = 0.170) nor in the group x time interaction. MANCOVA analysis showed that regardless of gender, health level, age, BMI, cognition, and health level, the HIFT intervention produced better results in functional capacity, balance, and gait (F = 0.173, p < 0.001, Wilks' λ = 88.231).

Effect of a physical therapeutic intervention on locomotive syndrome in the elderly patients with Parkinson’s disease and sarcopenia

Purpose: to evaluate the effectiveness of the effect of physical therapy on the indicators and severity of locomotive syndrome in elderly patients with Parkinson’s disease and sarcopenia. Material and methods: 57 elderly people with Parkinson’s disease in combination with sarcopenia were examined. They were divided into two groups: group 1 (followed the principles of standard protocols of outpatient rehabilitation) and group 2 (followed the physical therapy program, which was developed in terms of patient-centered model of rehabilitation taking into account the specifics of each comorbid condition with the use of functional training on the «Prosedos» platform, therapeutic exercises, massage, occupational therapy, nutrition correction, and patient education). The control group consisted of 24 elderly people without signs of sarcopenia and Parkinson’s disease. The effectiveness of the program was evaluated by the dynamics of 25-question Geriatric Locomotive Function Scale, Dynamic Gait Index, Functional Gait Assessment, Activities Balance Confidence Scale, Modified Parkinson Activity Scale. Results: Elderly patients with Parkinson’s disease and sarcopenia were diagnosed with locomotive syndrome stage 2 (according to the 25-question Geriatric Locomotive Function Scale), which manifested itself as a high risk of falling and deteriorating dynamic balance (according to Dynamic Gait Index, Functional Gait Assessment), decreased confidence in maintaining balance during activities (according to Activities Balance Confidence Scale), violation of activities of daily living (according to Modified Parkinson Activity Scale); it was statistically significantly worse than in their peers (p<0.05). The developed program of physical therapy led to a statistically significant (p<0.05) improvement of all studied parameters of locomotive syndrome in comparison with baseline and the condition of patients who received standard restorative correction. Conclusions: Elderly patients with comorbid pathology (Parkinson’s disease and sarcopenia) need new physical therapy programs considering the specifics of each disease and its correcting, the presence of locomotive syndrome to improve social and domestic activity of patients and reduce health risks associated with geriatric syndromes – falls and frailty.

Adherence to the Mediterranean diet and risk of frailty and pre-frailty in elderly adults: A systematic review and dose-response meta-analysis with GRADE assessment

BACKGROUND

Several studies have explored the association between Mediterranean diet and frailty, but reported inconsistent results. This systematic review and dose-response meta-analysis summarized the existing evidence on the relationship between Mediterranean diet and risk of frailty and pre-frailty in elderly adults.

METHODS

A systematic search on MEDLINE (PubMed), Scopus, Institute for Scientific Information (ISI) Web of Science and Google Scholar was conducted up to January 2023. Study selection and data extraction were performed by two reviewers working in parallel. Epidemiologic studies reporting relative risks (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) for frailty/pre-frailty in relation to Mediterranean diet (as a priori dietary pattern) were considered. The overall effect size was determined using a random effects model. The body of evidence was assessed by the GRADE approach.

RESULTS

A total of 19 studies (12 cohorts and 7 cross-sectionals) were included. In cohort studies (89,608 participants/ 12,866 cases), the highest versus lowest category of Mediterranean diet was inversely associated with frailty (RR: 0.66; 95%CI: 0.55, 0.78; I²:52.4%, P_Q-test=0.02). This association was also significant in cross-sectional studies with 1093 cases among 13,581 participants (OR: 0.44; 95%CI: 0.28, 0.70; I²:81.8%, P_Q-test<0.001). Moreover, each 2-point increase in Mediterranean diet score was related to decreased risk of frailty in cohort (RR: 0.86; 95%CI: 0.80, 0.93) and cross-sectional (OR: 0.79; 95%CI: 0.65, 0.95) studies. Nonlinear association showed a decreasing slope in curve, sharper at high scores for cohort studies and a steadily reduction for cross-sectional studies. The certainty of the evidence was graded as high in both cohort and cross-sectional studies. Combining 4 effect sizes of 4 studies (12,745 participants/ 4363 cases), the highest adherence to Mediterranean diet was linked to a lower risk of pre-frailty, as well (pooled OR: 0.73; 95%CI: 0.61, 0.86; I²:40.9%, P_Q-test=0.17).

CONCLUSION

Adherence to Mediterranean diet is inversely associated with risk of frailty and pre-frailty in older adults and thus, has a considerable impact on health of this population.

Gender Differences in Determinants of the Components of the Frailty Phenotype among Older Adults in India: Findings from LASI Wave-1

This study examines the gender-specific determinants of the components of frailty in a community-dwelling setting in India. Using data from the Longitudinal Ageing Study in India (LASI) Wave-1, this study employed 30,978 (14,885 male and 16,093 female) older adults (aged 60+) to fulfil the study objective. The modified Fried frailty phenotype criteria defines frailty by the five components: exhaustion, weak grip strength, slow walking speed, unintentional weight loss, and low physical activity. The result showed grip strength (79.1%) as the most discriminant component among males, and physical activity (81.6%) as the most discriminant component among females. The results also indicated that grip strength (male: 98.0%, female: 93.5%) and physical activity (male: 94.8%, female: 96.9%) showed a sensitivity of more than 90%, which appears to be a good indicator of frailty. Combining this dual marker increased the accuracy to 99.97% among male and 99.98% among female samples. The findings suggested adding grip strength and physical activity as a proxy measure of frailty, which can increase the precision of screening without a large additional investment of time, training, or cost.

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.

Multidimensional Frailty and Lifestyles of Community-Dwelling Older Portuguese Adults

(1) Background: Lifestyles are referred to as conditioning factors for the frailty of older adults. However, there are few studies that explore its association. The objective of the present study is to analyze the association between sociodemographic, clinical, and lifestyle factors of older adults people with multidimensional frailty. (2) Methods: Descriptive and correlational study carried out with older adults people registered in a Health Unit in Portugal. Data were collected through a sociodemographic and clinical questionnaire and application of the Individual Lifestyle Profile and Tilburg Frailty Index to assess the lifestyles and multidimensional frailty of older adults, respectively. This last instrument, being of a multidimensional nature, assesses not only physical, but also psychological and social frailty, with a cut-off point of 6. (3) Results: Of the 300 older adults who participated, most were female (60.3%) and had a mean age of 81.34 ± 6.75 years. Moreover, 60.3% of the sample were frail older adults. Gender, marital status, number of household members, number of chronic diseases, number of daily medications, self-perception of health status and lifestyle and use of a walking device were associated with multidimensional frailty (p ≤ 0.001). Healthy eating habits, physical activity, relational behaviour, preventive behaviour, and stress management were significantly associated with lower physical, psychological, and social frailty (p ≤ 0.001). (4) Conclusions: When community health workers are aware of multidimensional frailty predictors and their components, they can intervene early and, consequently, delay the onset and progression of frailty in older adults.