Biomarkers of frailty

Several biomarkers have been proposed to identify frailty, a multisystemic age-related syndrome. However, the complex pathophysiology and the absence of a consensus on a comprehensive and universal definition make it challenging to pinpoint a singular biomarker or set of biomarkers that conclusively characterize frailty. This review delves into the main laboratory biomarkers, placing special emphasis on those associated with various pathways closely tied to the frailty condition, such as inflammation, oxidative stress, mitochondrial dysfunction, metabolic and endocrine alterations and microRNA. Additionally, we provide a summary of different clinical biomarkers encompassing different tools that have been proposed to assess frailty. We further address various imaging biomarkers such as Dual Energy X-ray Absorptiometry, Bioelectrical Impedance analysis, Computed Tomography and Magnetic Resonance Imaging, Ultrasound and D3 Creatine dilution. Intervention to treat frailty, including non-pharmacological ones, especially those involving physical exercise and nutrition, and pharmacological interventions, that include those targeting specific mechanisms such as myostatin inhibitors, insulin sensitizer metformin and with special relevance for hormonal treatments are mentioned. We further address the levels of different biomarkers in monitoring the potential positive effects of some of these interventions. Despite the availability of numerous biomarkers, their performance and usefulness in the clinical arena are far from being satisfactory. Considering the multicausality of frailty, there is an increasing need to assess the role of sets of biomarkers and the combination between laboratory, clinical and image biomarkers, in terms of sensitivity, specificity and predictive values for the diagnosis and prognosis of the different outcomes of frailty to improve detection and monitoring of older people with frailty or at risk of developing it, being this a need in the everyday clinical practice.

Pain Characteristics, Cardiovascular Risk Factors, and Cardiovascular Disease

BACKGROUND

There is unclear evidence that chronic pain may increase the risk of cardiovascular disease (CVD) incidence and mortality. This work evaluated the association between chronic pain, incidence of CVD and changes in CVD risk factors.

METHODS

Cohort of 1091 community-dwelling individuals ≥60years, free from CVD at baseline, followed up for 6 years. Data on psychosocial factors and CVD risk factors was obtained through validated questionnaires and laboratory measurements. A pain scale ranging from 0 (no pain) to 6 (worst pain) was created according to pain frequency, location and intensity.

RESULTS

The cumulative incidence of CVD was 4.2% at 3 years, and 7.7% at 5-years of follow-up. Compared to individuals without pain in the first 3 years (2012-2015), those with maintained scores ≥2 showed a mean reduction of 3.57 (-5.77,-1.37) METs-h/week in recreational physical activity; a 0.38-point (0.04,0.73) increase in psychological distress; and a 1.79 (1.03,3.11) higher odds of poor sleep. These associations held in the second follow-up period, when individuals with maintained pain also worsened their diet quality. A 1-point increase in the pain scale in 2012 was associated with a 1.21 (1.03,1.42) and 1.18 (0.97,1.44) increased CVD incidence in 2015 and 2017, respectively; none of the studied factors mediated this relationship.

CONCLUSIONS

Older adults with chronic pain show important reductions in recreational physical activity and deterioration in mental health, sleep and diet quality, which may well aggravate pain. Future studies should evaluate whether these factors mediate the increased risk of CVD observed in older adults with chronic pain.

Functional, Clinical, and Sociodemographic Variables Associated with Risk of In-Hospital Mortality by COVID-19 in People over 80 Years Old

OBJECTIVES

The objective is to assess the role of functional, clinical, and analytic parameters in predicting mortality in older patients hospitalized due to COVID-19.

DESIGN

Cohort study with a mean follow-up of 12.8 days.

SETTING

Public university hospital (Madrid, Spain).

PARTICIPANTS

499 patients 80 and above consecutively admitted to a Spanish public university hospital between 4 March 2020 and 16 May 2020.

MEASUREMENTS

Mortality was the main outcome. Data of sociodemographic variables (age, sex, living), comorbidities, polypharmacy, functional status, date of hospital admission and length of stay was recorded. Clinical symptoms, laboratory and X-ray findings were collected at time of admission. For multivariant analysis, logistic regressions were performed to identify risk factors for death.

RESULTS

Mean age was 86.7±4.4 with 37% of death. Mortality was associated with male gender [odds ratio (OR) 1.50; 95% confidence interval (CI) 1.01-2.24], with a 5-points increase on Barthel Index [OR 1.01 (95%CI 1.00-1.02)], higher Charlson Index score [OR 1.13 (95%CI 1.02-1.26)] and comorbidities [OR 1.28 (95%CI 1.06-1.53)], hyperpolipharmacy [OR 2.00 (95%CI 1.04-3.82)], unilateral pneumonia [OR 1.83 (95%CI 1.01-3.30)], higher levels of C-reactive protein [OR 1.09 (95%CI 1.06-1.12)] and creatine [OR 1.48 (95%CI 1.15-1.89)]. Higher oxygen levels were a protective factor [OR 0.92 (95%CI 0.89-0.95)].

CONCLUSIONS

Functional status, being male, a higher burden of comorbidities, hyperpolipharmacy, unilateral pneumonia and some laboratory parameters predict in-hospital mortality in this older population. The knowledge of these mortality risk factors should be used to improve the survival of older hospitalized patients.

Impact of Social Isolation Due to COVID-19 on Health in Older People: Mental and Physical Effects and Recommendations

OBJECTIVES

To review the impact of social isolation during COVID-19 pandemic on mental and physical health of older people and the recommendations for patients, caregivers and health professionals.

DESIGN

Narrative review.

SETTING

Non-institutionalized community-living people.

PARTICIPANTS

20.069 individuals from ten descriptive cross-sectional papers.

MEASUREMENTS

Articles since 2019 to 2020 published on Pubmed, Scielo and Google Scholar databases with the following MeSh terms ('COVID-19', 'coronavirus', 'aging', 'older people', 'elderly', 'social isolation' and 'quarantine') in English, Spanish or Portuguese were included. The studies not including people over 60 were excluded. Guidelines, recommendations, and update documents from different international organizations related to mental and physical activity were also analysed.

RESULTS

41 documents have been included in this narrative review, involving a total of 20.069 individuals (58% women), from Asia, Europe and America. 31 articles included recommendations and 10 addressed the impact of social distancing on mental or physical health. The main outcomes reported were anxiety, depression, poor sleep quality and physical inactivity during the isolation period. Cognitive strategies and increasing physical activity levels using apps, online videos, telehealth, are the main international recommendations.

CONCLUSION

Mental and physical health in older people are negatively affected during the social distancing for COVID-19. Therefore, a multicomponent program with exercise and psychological strategies are highly recommended for this population during the confinement. Future investigations are necessary in this field.

Gender Differences in Pain Risk in Old Age: Magnitude and Contributors

OBJECTIVES

To identify the factors associated with the excess risk of pain observed among older women compared with men.

PATIENTS AND METHODS

We used information from a cohort of 851 women and men age 63 years and older who were free of pain during 2012 and were followed up to December 31, 2015. Sociodemographic variables, health behaviors, psychosocial factors, morbidity, and functional limitations were assessed in 2012 during home visits. Incident pain in 2015 was classified according to its frequency, intensity, and number of localizations into lowest, middle, and highest categories.

RESULTS

During a mean follow-up of 2.8 years, the incidence of middle and highest pain was 12.5% and 22.6% in women and 12.4% and 12.6% in men, respectively. The age-adjusted relative risk ratios and 95% CIs of middle and highest pain in women versus men were 1.20 (0.79-1.83) and 2.03 (1.40-2.94), respectively. In a mediation analysis, a higher frequency in women than men of osteomuscular disease, impaired mobility, and impaired agility accounted, respectively, for 31.1%, 46.6%, and 32.0% of the excess risk of highest pain in women compared with men. Other relevant mediators were psychological distress (25.2%), depression (8.7%), poor sleep quality (10.7%), and lower recreational physical activity (12.6%).

CONCLUSION

A greater frequency of some chronic diseases, worse functional status, psychological distress, and lower physical activity can mediate the excess risk of pain in older women compared with men.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT02804672.

Frequency, intensity and localization of pain as risk factors for frailty in older adults

Background

the association between pain characteristics and frailty risk is uncertain.

Objective

to investigate the separate impact of the frequency, intensity and location of pain on frailty risk and its possible mechanisms.

Methods

prospective cohort of 1505 individuals ≥63 years followed between 2012 and 2015 in Spain. In 2012, pain was classified into: lowest pain (Score 0), middle pain (Score 1-4) and highest pain (Score 5-6). Incident frailty was assessed in 2015 as having ≥3 Fried criteria or a Frailty Index (FI) ≥0.30.

Results

in multivariate analyses, the risk of frailty (measured with the Fried criteria or the FI) increased progressively with the frequency of pain, its intensity and the number of pain locations. Compared with those having the lowest pain score, the odds ratio (95% confidence interval) of Fried-based frailty was 1.24 (0.56-2.75) in the middle score and 2.39 (1.34-4.27; P-trend <0.01) in the highest score. Corresponding values for frailty as FI ≥0.30 were 1.39 (0.80-2.42) and 2.77 (1.81-4.24; P-trend <0.01). Odds ratios did not change after adjustment for alcohol intake, Mediterranean diet adherence or sedentary time, but were reduced with adjustment for pain-associated chronic diseases (cardiovascular disease, diabetes, chronic lung disease, osteomuscular disease and depression). A higher pain score was linked to higher risk of exhaustion and low physical activity (two out of five Fried criteria) and to a worse score in all FI domains.

Conclusion

frequency, intensity and location of pain were associated with higher risk of frailty. Study associations were partly explained by pain-associated morbidity.

[Functional consequences of fragile pelvis fracture. Description of several cases attended by a consultation Geriatrics team]

INTRODUCTION

The prevalence of pelvic fracture (PF) due to frailty is increasing, leading to an increase in functional impairment in the patient, as well as increasing morbidity and mortality. The aim of the present study is to gain knowledge about the sociodemographic characteristics, as well as the functional features, of patients admitted to hospital with PF and evaluated by a Geriatrics department. The functional burden of PF and the potential influence of geriatric interventions are also assessed.

MATERIAL AND METHODS

A retrospective study conducted between 1995 and 2015 on all patients older than 65 years old with PF admitted to the Traumatology department, and then assessed in the Geriatrics Department. Sociodemographic information was also collected (age, gender and place of residence), as well as data from the geriatric assessment (baseline situation and at hospital admission), hospital stay, within hospital mortality, and discharge.

RESULTS

The study included 271 patients with a mean age of 81.1±7 years, and mainly women (81.2%). The median hospital stay was 9 days (interquartile range 5 to 14 days). The ability to walk independently decreased after PF from 72.3% to 3.6%. Severe disability cases increased in activities of daily living from 7.9% to 79.5%. Within hospital mortality was 2.2%. As regards medical follow-up consultations, the mean length of stay was significantly reduced compared to the assessment consultations (10.0±7.8 vs 16.1±12.0 days, P<.001) CONCLUSION: PF patients evaluated by the Geriatrics Department were mainly women, with advanced age, and a severe functional impairment secondary to PF. The intervention of a geriatrician could contribute to optimise hospital resources.