Journal of Frailty & Aging最新文献

Background: Infectious diseases contribute substantially to morbidity and mortality among aging populations, yet the impact of biological aging on severe infection risk remains unclear.

Methods: Cox proportional hazards models estimated hazard ratios (HRs) and 95 % confidence intervals (CIs) for associations of accelerated biological aging (measured by KDM-BA and PhenoAge) and frailty index (FI) with overall and type-specific severe infections. Life expectancy differences by biological aging status were assessed. Bivariate response surface models evaluated combined effects of FI and two biological age acceleration indicators on severe infections.

Results: KDM-BA acceleration (HR: 1.18; 95 % CI: 1.16 to 1.19) and PhenoAge acceleration (HR: 1.27; 95 % CI: 1.25 to 1.29) were associated with increased severe infection risk. Higher FI levels showed progressively greater risk, with HRs (95 % CIs) of 1.40 (1.38 to 1.43), 2.01 (1.96 to 2.06), 2.64 (2.53 to 2.76) and 3.37 (2.96 to 3.83) for FI categories 0.1 -< 0.2, 0.2 -< 0.3, 0.3 -< 0.4, and ≥ 0.4 versus FI < 0.1. Associations varied by infection type: KDM-BA acceleration and PhenoAge acceleration showed the strongest associations with respiratory infections, whereas the frailty index was most associated with digestive infections. Significant combined effects of FI and biological age accelerations further increased risk. Biologically younger individuals had longer life expectancy: +1.59 years (95 % CI: 1.40 to 1.77) for KDM-BA acceleration and +2.2 years (95 % CI: 2.00 to 2.40) for PhenoAge acceleration.

Conclusion: Accelerated biological aging and frailty were significantly associated with increased risks of overall and type-specific severe infections. These findings suggest that integrating biological aging assessments into routine healthcare could improve infection risk stratification and guide targeted prevention strategies.

Background: Frailty is a geriatric syndrome leading to adverse health outcomes, but can be managed through targeted interventions and potentially reversed. Primary care settings play a pivotal role in identifying and addressing frailty. This review aims to assess the effective primary care interventions and strategies to manage frailty.

Methods: This review mapped evidence to evaluate systematic reviews of randomized controlled trials in older adults (≥60 years) on primary care-based interventions for managing frailty. Data were extracted from databases including MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane CENTRAL, covering publications up to September 11, 2024. Interventions in primary care, community-based, or home-based settings were included, excluding hospitalized or bedridden individuals. The AMSTAR 2 tool assessed review quality, and interventions were categorized by type, setting, and effectiveness.

Results: From the 3152 studies extracted, 17 systematic reviews met the inclusion criteria. Interventions were classified into physical, nutritional, pharmacological, e-health/telemedicine, and multicomponent approaches. Multicomponent interventions, combining physical, nutritional, and cognitive strategies, demonstrated effectiveness, with significant benefits reported in 15 reviews. Community and home-based settings dominated, emphasizing accessibility. However, the quality of evidence varied, with seven reviews rated as critically low and six as high. Most studies were conducted in high-income countries, limiting their generalizability to LMICs.

Conclusion: Multicomponent interventions delivered in community settings show significant promise for managing frailty in older adults. However, evidence gaps suggest the need for context-specific research to adapt these interventions into primary care, which can improve the health status and quality of life for ageing populations globally.

Background: Spousal caregivers of ill older adults face increasing risks of deteriorating mental health and burden. "Socio-Geriatric Evaluation" (ESOGER) is home-based care and health services for ill older adults. This study aimed to examine changes in anxiety, quality of life and burden over a 3-month period in spousal caregivers of ill older adults who benefits from ESOGER home health care and support services.

Methods/design: A randomized controlled trial (RCT) with two parallel arms enrolled 42 spousal caregivers distributed equally between the intervention group and the control group. The intervention consisted of ESOGER, a telehealth-based home care program that evaluates older adults' health and social needs and provides personalized recommendations and referrals to health and community services to ill spouses, implemented through the Canadian Red Cross. Spousal caregivers were assessed at baseline (M0) and at three months (M3). Anxiety was evaluated using a visual analogue scale (VAS) ranging from 0 (no anxiety) to 10 (severe anxiety) and the EuroQol-5D assessed quality of life using. Burden was measured using the 4-item Zarit scale.

Results: Anxiety (P < 0.001) and burden (P = 0.003) increased significantly, and the quality of life decreased (P = 0.018) in the control group at M3 compared to M0. In the intervention group anxiety decreased significantly (P < 0.001) over the 3-months follow-up. Only burden was significantly lower in the intervention group compared to the control group (P = 0.022) at M3. The changes in scores of the 4-item Zarit scale between M0 and M3 (P = 0.011) and of the EQ-5D visual analogue scale (P = 0.024) were significantly different between groups, showing an improvement in the intervention group.

Conclusion: This study highlights the positive impact of ESOGER home-based care on spousal caregivers, showing reduced anxiety and burden while improving quality of life. These findings underscore the importance of structured home care services in supporting caregivers' well-being and sustaining home-based care for older adults.

Background: Frailty is recognized as a dynamic and potentially reversible process, but comprehensive studies on its progression/regression are rare.

Objective: To investigate the frequency and characteristics of frailty transitions over time in a representative sample of older Italians.

Design and participants: As secondary analysis of the Italian Longitudinal Study on Aging (ILSA) population-based cohort, we studied all participants (n = 1339; women 47.5 %, age 72.7 ± 5.1) with complete information on changes in frailty status (or death) between consecutive ILSA surveys (T0, T1, T2).

Measurements: Frailty was operationalized according to Fried phenotype, analysing transitions between frailty, or death, during T0-T1, T1-T2 (4-, 5-year length). Transition probability at 1, 3, 5 years was estimated through non-hidden continuous-time Markov models, with death as absorbing state. Factors influencing transitions were evaluated with Cox proportional Hazard Ratios (HR).

Results: We observed 1931 transitions between frailty states and 241 to death. The estimated probability of: maintaining a stable frailty status (∼80 % within 1 year) halved at 5 years; worsening increased steeply over time and was always greater among women; improvement/remission was twice higher at medium (about 20 % among Frail->preFrail women, preFrail->nonFrail men) than short term. Depressive symptoms were the strongest predictor of worsening [nonFrail->Frail: women HR 3.63 (95 %CI 1.45-9.10), men HR 3.78 (95 %CI 2.0-7.13)]. Not having a spouse/partner was associated with a 30 % reduced probability of pre-frailty remission in both sexes.

Conclusions: Our findings confirm the fluctuating nature of frailty with an ample chance of remission/improvement, highlighting the importance of a prompt, multidimensional preventive approach, including psycho-social dimensions.

Introduction: As Singapore's population rapidly ages, there is a growing need to proactively address frailty and intrinsic capacity (IC) decline to delay disability and preserve independence. This study aims to a) determine prevalence of IC decline in frail older patients referred to the geriatric service hub (GSH), stratified by age and frailty status and b) determine its association with activity of daily living (ADL).

Methodology: A cross-sectional study was conducted from July 2019 to March 2022. Community-dwelling older adults (≥65 years) identified as pre-frail or frail in selected primary care clinics and eldercare centers were referred to the GSH for further evaluation. All participants received a comprehensive geriatric assessment, which included Clinical Frailty Scale (CFS) scoring and evaluation of six IC domains: locomotion, vitality, cognition, sensory (vision and hearing), psychological, and continence. Functional status was assessed using the Modified Barthel Index and self-reported ADL and instrumental ADL (IADL).

Results: Among 372 participants, 52.2 % were aged 65-79 (old) and 47.8 % were ≥ 80 years (old-old). Approximately two-thirds were classified as CFS 4 or 5. IC decline was significantly more prevalent in the "old-old" group, especially in locomotion (94.4 %), vitality (94.5 %), cognition (68.4 %), vision (78.7 %), and hearing (33.1 %). Despite IC decline, up to two-thirds of participants remained independent or only mildly dependent in ADL. IC impairment increased progressively with advancing frailty and age. In multivariate logistic regression, moderate to severe ADL dependency was independently associated with impaired locomotion (aOR 5.105; 95 % CI 1.023-25.477) and vision impairment (aOR 2.607; 95 % CI 1.234-5.508).

Conclusion: IC screening in primary care is a feasible and effective approach that may contribute to detection of early functional decline. The high burden of multidomain IC impairment, particularly among the oldest and most frail, supports the need for upstream, integrated, and age-inclusive screening and intervention strategies in community settings.

Objective: to investigate the association of diabetes and its duration with frailty and evaluate the moderating effect of sex on that association in older adults.

Methods: This cross-sectional study used data from the third visit (2017-2019) of the Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil), a multicentre cohort of Brazilian civil servants. The data included were from 4886 participants aged ≥ 60 years. Diabetes was identified on the basis of self-reported diagnosis or laboratory test values. Frailty was evaluated on frailty phenotype criteria. Associations were estimated by way of multinomial regression models.

Results: Adjusted final models showed that older adults classified as having diabetes were 116% more likely to show frailty, and 27% more likely to show pre-frailty, than persons without diabetes. Individuals with a diagnosis before baseline and those with that diagnosis at baseline or during follow-up until visit 3 were, respectively, 145% and 92% more likely to be classified as frail, and 35% and 21% more likely to be classified as pre-frail, than individuals without diabetes. No modification by a multiplier effect of sex was observed in the final models.

Conclusions/interpretation: Older adults with diabetes returned greater odds of pre-frailty and frailty, and the odds were even greater in those with longer times since the diagnosis of diabetes, but sex did not modify those associations. These findings endorse the need for more frequent screening of older adults with diabetes with a view to early prevention and/or intervention.

Background: Psoriasis is a chronic inflammatory skin disease often accompanied by various comorbidities, but its relationship with frailty remains understudied. The Frailty Index (FI), calculated based on 49 health deficits across multiple systems (e.g., cognition, function, comorbidities, laboratory values) was used as a continuous measure.

Objectives: We investigated the association between psoriasis and the Frailty Index (FI), providing evidence to support the implementation of frailty screening and potential interventions in patients with psoriasis.

Design and setting: This cross-sectional study used data from the 2003-2006 U.S. National Health and Nutrition Examination Survey (NHANES) including 6532 participants.

Measurements: We analyzed the psoriasis-FI relationship using weighted nested regression, supplemented by subgroup analyses and restricted cubic spline regression to test for nonlinear relationships.

Results: The FI was significantly higher in patients with psoriasis (n = 162) than in those without (n = 6370; P < 0.001). Weighted nested regression analysis showed a significant positive association between FI and psoriasis (OR 2.22; 95% CI 1.14-4.35; P = 0.02). The association was stronger for male patients, those with normal body mass index, hypertension, and diabetes. Nonlinear relationships were observed between FI and psoriasis.

Conclusions: The present study validates the association between psoriasis and frailty using a nationally representative sample and provides empirical support for integrating frailty evaluations into psoriasis care. Our findings are consistent with the hypothesis that chronic inflammatory pathways may underlie the association between psoriasis and frailty.

Background: Anabolic interventions, including physical exercise, proteins and omega-3 polyunsaturated fatty acids (PUFAs) supplementation, have shown effectiveness in improving sarcopenia outcomes. However, data on their combined effects in older adults with sarcopenia remain limited.

Objectives: To assess feasibility, acceptability, and preliminary effects of a multicomponent intervention combining individualized home-based exercise, proteins, and/or omega-3 supplementation.

Design: Parallel five-armed randomized assessor-blinded controlled feasibility trial with triple-blinded supplementation.

Participants and setting: Community-dwelling older adults (≥65 years) diagnosed with sarcopenia (EWGSOP2-criteria) from the Exercise and Nutrition for Healthy Ageing (ENHANce) study. The ENHANce study was registered on ClinicalTrials.gov (NCT03649698).

Intervention: Participants were randomized into 5 groups: 1) Exercise, 2) Proteins, 3) Exercise+Protein, 4) Exercise+Protein+Omega-3, and 5) Control group.

Measurements: Feasibility was assessed via eligibility, recruitment, retention, and data completion rates. Acceptability was evaluated through participants' feedback, adherence, and safety. Effects were measured by changes in sarcopenia outcomes after 12 weeks.

Results: Fifty-eight participants (76.2±6.6years,♀:65.5%) were included (Exercise,n=9;Protein,n=12; Exercise+Protein,n=13;Exercise+Protein+Omega-3;n=12;Control,n=12). Feasibility was low, with a recruitment rate of 2%. Acceptability was moderate, with most participants completing the planned assessments and reporting positive experiences such as feeling stronger and more aware of the importance of physical activity and nutrition. However, many found the study procedures demanding, and many experienced difficulties with the protein supplements. Adherence varied widely across interventions. Safety was high, with no significant adverse effects reported. The interventions showed potential to improve chair stand test (CST), Short Physical Performance Battery (SPPB), muscle mass and quadriceps strength.

Conclusion: A multicomponent intervention to treat sarcopenia showed low feasibility, moderate acceptability, and high safety. Preliminary efficacy results showed that exercise with protein supplementation may improve physical function. Adding omega-3 PUFA might offer further benefits for muscle strength and mass, but should be confirmed in larger studies. The insights and the practical challenges in the ENHANce study inform future sarcopenia intervention designs.

Frailty is prevalent among older nursing home residents, although there is limited evidence regarding frailty screening and management in this setting.

Objective: To evaluate the measurement properties of the Frail Index based on the Comprehensive Geriatric Assessment (Frail-VIG).

Design: Prospective observational longitudinal study of 571 residents from 3 nursing homes. Frail-VIG scores were calculated at baseline and at 6 and 12 months. Sociodemographic variables were studied. Feasibility was assessed based on simplicity of application and requirements for score calculation. Reliability was evaluated through inter-rater agreement and test-retest assessments. Construct and content validity were examined by comparing it with other frailty indexes. Predictive validity was evaluated using log-rank tests and AUC-ROC curves for mortality prediction.

Results: Mean (SD) resident age was 88.2 (6.5) years, and 80.6 % were women. The mortality rate was 11.4 % at 6 months and 20 % at 12 months. Calculating Frail-VIG scores required 5.15 min and no additional space or equipment, and there was low risk of missing data. The inter-rater consistency and score stability over time indicate strong reliability. The Frail-VIG maintains the characteristics of other established frailty indexes and shows strong convergent validity with the FRAIL-NH and CFS scales. Baseline scores have an AUC-ROC curve (confidence interval) of 0.69 (95 % CI, 0.63-0.76) at 6 months and 0.65 (95 % CI, 0.6-0.71) at 12 months.

Conclusions: The measurement properties of the Frail-VIG in older nursing home residents validate its use in this population and setting. Its predictive ability for mortality suggests important implications for advanced care planning.