The Aging Study of Pyeongchang Rural Area (ASPRA): Findings and Perspectives for Human Aging, Frailty, and Disability

Effect of Exercise and Nutrition Intervention for Older Adults with Impaired Physical Function with Preserved Muscle Mass (Functional Sarcopenia): A Randomized Controlled Trial

Background

Functional sarcopenia is characterized by decreased physical performance and grip strength despite preserved muscle mass. The effectiveness of a program combining exercise and nutritional support-known interventions for individuals with low muscle mass-was evaluated for its impact on older adults with functional sarcopenia.

Methods

An unblinded, parallel-group randomized controlled trial was conducted in a public medical center in a rural Korean community. Eligible older adults with functional sarcopenia were randomized into either the intervention group, receiving a 12-week program of group exercises and nutritional support, or the control group, receiving education on lifestyle management. Outcomes measured included changes in gait speed, grip strength, physical performance, and quality of life indices.

Results

The study enrolled 42 participants, with 21 allocated to each group. Compared with the control group, the intervention group showed significant improvements in the primary outcome of gait speed (mean change (m/s) 0.24 vs 0.00, p<0.001) and secondary outcomes, such as Short Physical Performance Battery scores, grip strength, and quality of life. No significant adverse events were reported.

Conclusion

The 12-week exercise and nutritional intervention significantly enhanced physical performance, grip strength, and quality of life among community-dwelling older adults with functional sarcopenia. This suggests that strategies commonly recommended for sarcopenia, including exercise and nutritional support, are also beneficial for individuals with functional sarcopenia, indicating the potential for broader application of such interventions.

Breathlessness, Frailty, and Sarcopenia in Older Adults

BACKGROUND

Breathlessness shares aging mechanisms with frailty and sarcopenia.

RESEARCH QUESTION

Are frailty and sarcopenia associated with breathlessness itself?

STUDY DESIGN AND METHODS

We analyzed data from a population-based, prospective cohort study of 780 community-dwelling older adults. Breathlessness was defined using the modified Medical Research Council dyspnea scale (≥ 2 points) and the COPD Assessment Test (≥ 10 points). Frailty was defined by frailty index (FI); frailty phenotype; and fatigue, resistance, ambulation, illness, and weight loss (FRAIL) questionnaire results. Sarcopenia was defined by the Asian Working Group for Sarcopenia in 2019. Sarcopenia phenotype score quantified the number of criteria met. The associations of frailty and sarcopenia with breathlessness were evaluated by logistic regression analyses. Adjusted ORs (aORs) were calculated, accounting for age, sex, chronic airway disease, smoking status, BMI, lung functions, socioeconomic status (living alone, income, education), comorbid conditions (hypertension, diabetes, malignancy, myocardial infarction, heart failure), and other geriatric contributors (cognitive dysfunction, depression, malnutrition, polypharmacy, fall history in the past year). Institutionalization-free survival was compared by log-rank test.

RESULTS

The prevalence of frailty was higher in the breathlessness group compared with the group without breathlessness (42.6% vs 10.5% by FI, 26.1% vs 8.9% by frailty phenotype, and 23.0% vs 4.2% by FRAIL questionnaire) and sarcopenia (38.3% vs 26.9%), with P < .01 for all comparisons. The multivariable logistic regression analyses showed that frailty (FI [aOR, 9.29], FRAIL questionnaire [aOR, 5.21], and frailty phenotype [aOR, 3.09]) and sarcopenia phenotype score (2 [aOR, 2.00] and 3 [aOR, 2.04] compared with 0) were associated with breathlessness. The cumulative incidence of institutionalization-free survival was higher in the breathlessness group than its counterparts (P = .02).

INTERPRETATION

These findings suggest that frailty and sarcopenia strongly contribute to breathlessness in community-dwelling older adults. Measuring sarcopenia and frailty in older adults may offer opportunities to prevent age-related breathlessness.

The antioxidant effects of hedysarum polybotrys polysaccharide in extending lifespan and ameliorating aging-related diseases in Drosophila melanogaster

Hedysarum polybotrys polysaccharide (HPS) is one of the main active ingredients of Hedysarum with many health-beneficial properties, including antioxidant property, immunomodulatory, anti-inflammatory, and anti-tumor. However, the effect of HPS on anti-aging is still unclear. This study was to explore the protective function of HPS on aging and age-related diseases using Drosophila melanogaster. The results demonstrated that HPS supplementation promoted hatchability and prolonged lifespan by enhancing the antioxidative capacity. Administraction of HPS ameliorated age-related symptoms such as imbalanced intestinal homeostasis, sleep disturbances, and beta-amyloid (Aβ) induced Alzheimer's disease (AD) in flies, but did not modulate neurobehavioral deficits in the AD model of tauopathy and the Parkinson's disease (PD) model of Pink1 mutation. Overall, this study reveals that HPS has strong potential in the prevention of aging and age-related diseases, and provided a new candidate for the development of anti-aging drugs.

Height loss as an indicator of ageing through its association with frailty and sarcopenia: An observational cohort study

BACKGROUND

Height loss is associated with various health-related variables such as cardiovascular disease, osteoporosis, cognitive function, and mortality. We hypothesized that height loss can be used as an indicator of aging, and we assessed whether the degree of height loss for 2 years was associated with frailty and sarcopenia.

METHODS

This study was based on a longitudinal cohort, the Pyeongchang Rural Area cohort. The cohort included people aged 65 years or older, ambulatory, and living at home. We divided individuals according to the ratio of height change (height change for 2 years divided by height at 2 years from baseline): HL2 (<-2%), HL1 (-2%--1%), and REF (-1%≤). We compared the frailty index, diagnosis of sarcopenia after 2 years from baseline, and the incidence of a composite outcome (mortality and institutionalization).

RESULTS

In total, 59 (6.9%), 116 (13.5%), and 686 (79.7%) were included in the HL2, HL1, and REF groups, respectively. Compared with the REF group, groups HL2 and HL1 had a higher frailty index, and higher risks of sarcopenia and composite outcome. When groups HL2 and HL1 were merged, the merged group had higher frailty index (standardized B, 0.06; p = 0.049), a higher risk of sarcopenia (OR, 2.30; p = 0.006), and a higher risk of composite outcome (HR, 1.78; p = 0.017) after adjusting for age and sex.

CONCLUSIONS

Individuals with greater height loss were frailer, more likely to be diagnosed with sarcopenia and had worse outcomes regardless of age and sex.

Effects of Muscles on Bone Metabolism—with a Focus on Myokines

Skeletal muscles and bones, the largest tissues in the body of a non-obese person, comprise the musculoskeletal system, which allows mobility and protects internal organs. Although muscles and bones are closely related throughout life, observations during development and aging and in human and animal disuse models have revealed the synchronization of tissue mass such that muscle phenotype changes precede alterations in bone mineral density and strength. This review discussed that mechanical forces, which have been the traditional research focus, are not the only mechanism by which muscle-derived signals may affect bone metabolism and emphasized the significance of skeletal muscles as an endocrine organ that secretes bone-regulatory factors. Consequently, both mechanical and biochemical aspects should be considered to fully understand muscle–bone crosstalk. This review also suggested that specific myokines could be ideal therapeutic targets for osteoporosis to both increase bone formation and reduce bone resorption; moreover, these myokines could also be potential circulating biomarkers to predict musculoskeletal health.

Operationalization of the Clinical Frailty Scale in Korean Community-Dwelling Older People

Background

The Clinical Frailty Scale (CFS) is a simple measure of global fitness validated in various populations in real-world settings. In this study, we aimed to assess the characteristics and validities of the CFS in community-dwelling older people in Korea, with the original classification tree (oCFS) and a culturally modified tree (mCFS).

Methods

The comprehensive geriatric assessment records of 1,064 individuals of the Aging Study of the Pyeongchang Rural Area were used for this study. For mCFS, we considered the dependency of the food preparations and household chores not to be deficits in the male population. The frailty index was used as a reference for construct validity. We used a composite outcome of death and institutionalization for outcome validity.

Results

The correlation coefficients with frailty index were higher in mCFS (.535) than in oCFS (.468). The mean frailty index was lower in individuals reclassified by mCFS (5 to 4) than people who stayed in mCFS 5. The classification coefficient of mCFS was significantly higher than that of oCFS (p <0.001) in determining people with frailty (frailty index.25 or higher). Trends of a higher incidence of the composite outcome were observed in both higher oCFS and mCFS, in which oCFS and mCFS did not differ significantly in predicting the risk of the outcome.

Conclusion

The classification tree of CFS could be culturally adopted in a community-dwelling population of Korea and considered valid in detecting the vulnerable population.

Association Between Changes in Frailty Index and Clinical Outcomes: An Observational Cohort Study

Purpose

Although the association between a single assessment of frailty index (FI) and clinical outcomes has been revealed in prior studies, there is a lack of knowledge about the prognostic value of FI at different time points and the changes in repeated measurements of FI. Hence, we sought to determine the clinically meaningful changes in FI and reveal the association with the changes and a composite outcome of mortality and institutionalization.

Participants and Methods

This study was based on a longitudinal study of the Pyeongchang Rural Area cohort that included people aged 65 years or older, ambulatory and living at home. Individuals were divided into the worsened group (changes in FI ≥ 0.03 during 2 years) and the stable group (changes in FI < 0.03 during 2 years). The incidence of a composite outcome was compared between the two groups and the relationship was adjusted for age, sex, baseline FI, and follow-up FI.

Results

Of the 953 participants, 403 (42.3%) and 550 (57.7%) were included in the worsened group and the stable group, respectively. The worsened group had a significantly higher risk of the composite outcome than the stable group (HR, 2.37 [95% CI, 1.54-3.67]; p < 0.001). Although the higher risk remained significant after adjusting for age, sex, and baseline FI, the statistical significance disappeared after adjusting for follow-up FI (p = 0.614). The aggravation of FI in the worsened group was predominantly due to aggravation of FI domains, such as activities in daily living, cognitive function and mood, and mobility rather than comorbidity burden.

Conclusion

Aggravation of FI was associated with a composite outcome regardless of baseline FI, and the association was significantly reflected in the follow-up measurement of FI. The worsening FI was mainly attributable to functional geriatric domains.