Journal of Frailty & Aging最新文献

Background: Veterans of the first Gulf War (1990-1991) are reaching middle and older adulthood in differing degrees of health and biological age. Many Gulf War veterans report myriad negative symptoms classified as Gulf War illness (GWI), a chronic multi-symptom illness.

Objectives: To describe and analyze deficit accumulation, among veterans with Severe GWI (SGWI+) and those without Severe GWI (SGWI-), to assess the association between a medically unexplained illness and aging.

Design: This study uses a retrospective cohort design with quasi-longitudinal data.

Setting: The recruitment sample included 10,042 Gulf War era veterans across all four US Census regions.

Participants: The analytic sample included 1,054 participants of the GWECB for whom SGWI case status could be determined and who had valid responses for at least 90% of the deficits included in the deficit accumulation index.

Measurements: Chronic health conditions were retroactively reported, including year of diagnosis, enabling us to create a longitudinal measure of deficit accumulation. This deficit accumulation index (DAI) ranged from 0-1 for each respondent in each year between 1991-2013. We compare veterans with SGWI+ to those with SGWI- using the CDC case definition.

Results: Most veterans in our sample could expect to spend more years with moderate or substantial deficits than without deficits. SGWI+ was associated with spending more years with substantial deficits than those with SGWI-. Veterans in middle age (age 35-65) experienced more years with substantial deficits than younger veterans. Individuals with SGWI+ had 13 times the hazard of accumulating substantial deficits than those without.

Conclusions: This study demonstrated that veterans with SGWI+, even those in midlife, experienced aging as measured by accumulating deficits. Practitioners should consider patients with multi-symptom illnesses as at risk of accelerated aging, tailoring treatments to address patients' holistic needs.

Background: With the significant increase in the number of long-lived elderly people living at home, the development of effective physical exercise interventions at home becomes essential to preserve their independence and delay institutionalization and hospitalizations.

Objective: to map and describe home exercise programs for elderly people aged 80 or over with physical frailty.

Methods: The scoping review allowed the inclusion of several methodologies and varied perspectives, maintaining rigor in accordance with the methodological steps of the Joanna Briggs Institute (JBI). The systematic search covered studies available until May 2023 in five databases and gray literature. Frailty was assessed according to the criteria of Fried et al. (2001), physical performance scale (SPPB), such as gait and mobility, and the authors' assessment of reduced physical function were considered. The study followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines and is publicly available in the Open Science Framework (OSF) repository.

Results: Twenty studies were identified that met the inclusion criteria. The total number of elderly people investigated in the study was 1,796. The most important physical interventions were muscular strength training, mainly of the lower limbs, together with flexibility, balance, aerobic and functional training. These home interventions have demonstrated potential, safety and effectiveness in preventing and alleviating physical frailty. These home interventions demonstrated potential, safety and effectiveness in preventing and alleviating physical frailty, adherence in most studies varied between 72% and 89%.

Conclusion: This study will allow us to design home-based exercise interventions, potentially providing practical solutions and assisting healthcare professionals in home-based interventions to reduce and mitigate physical frailty in the growing population of older adults. It will also help fill the existing knowledge gap and provide recommendations for future research.

Frailty is a state of increased vulnerability that can lead to premature death. While various clinical tools effectively measure frailty in individual care, their applicability at the population-level is limited. However, in the era of big-data, administrative databases serve as valuable sources for medication-based research and population surveillance. This narrative scoping review synthesizes the literature on tools used within administrative databases to detect frailty in community-dwelling older adults. The 17 identified publications explore four tools that meet the criteria of the Rockwood and Mitnitski frailty index model. Despite variations in the deficits they incorporate, all tools appear to be valuable for identifying frailty and predicting the risk of adverse events. Using those tools within administrative databases can be useful for research and surveillance purposes.

Intrinsic capacity(IC) is a measure of physical, cognitive, vitality, psychological, and sensory abilities which determines functional ability. Decline in IC has been shown to accelerate the trajectory of frailty. We aim to show the impact of exercise (Ex) and cognitive stimulation therapy (CST) on (i) IC domains and composite score (ii) frailty and functional ability in pre-frail older adults. Secondary analysis of data from a pre-post intervention study of pre-frail older adults ≥ 65 years attending primary care clinic. Control (CON) and 2 intervention groups ((i) Ex 6 months (ii) CST 3 months with Ex 6 months (Ex+CST)) were recruited. Pre-frailty was determined using the FRAIL scale. Questionnaires (on demographics, functional ability, and depression) were administered and physical function assessment (gait speed (GS), short physical performance battery (SPPB) test, handgrip strength, five times sit-to-stand (5x-STS)) was conducted at 0, 3, 6 and 12 months. Four domains of IC were evaluated: locomotion (GS and 5x-STS), vitality (nutrition and muscle mass), cognition (MoCA and subjective cognitive decline) and psychological (depression and anxiety). Each domain was scored from 0 to 2 (no decline) with total IC score ranging from 0 to 8. 187 participants completed baseline and 3 months assessments, 109 (58.3%) were allocated to CON, 37 (19.8%) to Ex and 41 (21.9%) to Ex + CST groups. At 3 months, both Ex and Ex +CST showed improvement in IC composite scores, locomotion, and psychological domain scores but improvement in cognition domain only in Ex + CST group. At 6 months, there were improvements in total IC score, locomotion, vitality, and psychological domain in both Ex and Ex + CST groups. At 12 months, significant improvement was evident in total IC score for Ex and Ex+CST groups, vitality when fatigue (in addition to muscle mass and nutrition) was added and instrumental activities of daily living. Multidomain intervention incorporating exercise and CST resulted in significant improvement in IC composite scores, locomotion, vitality, cognition, and psychological domains.

Objectives: To assess the awareness and training of primary care physicians on nutrition in older patients.

Design: Observational, real-world data survey.

Setting: Primary Care.

Participants: One hundred sixty-two physicians, generalists and specialists, working in primary care.

Measurements: Participants received an online questionnaire with 18 questions concerning the importance of nutrition, degree of knowledge, needs, and training in nutrition. The results were evaluated using univariate descriptive analysis, with a percentage for each chosen answer. Logistic regression models were used to evaluate if answers were related to training in nutrition and professional experience.

Results: 43.2% of participants reported that nutrition is very important in individuals over 65 years old, and 90% were aware of the importance of nutrition in healthy aging. Nutritional problems affect 30 to 50% of patients, according to 44.7% of participants. 89.2% agree about the need for nutritional assessment in older patients; however, the professionals believe they should be better prepared. Two out of three respondents consider the training received in nutrition during their undergraduate course or continuing medical education as deficient. Time of professional practice was mainly associated with conceptual facts, while continuing medical education did with practical issues, mainly the use of screening and diagnostic tools [FRAIL (OR: 3.16; 95%IC: 1.55-6.46), MNA-SF (OR: 6.455; 95%IC: 2.980-13.981) and SARC-F (OR: 3.063; 95%IC: 1.284-7.309)].

Conclusion: Although primary care professionals are aware of the importance of nutrition in older patients, there are still gaps in daily practice that could be improved by developing educational strategies.

The primary objective of this study was to analyze the moderating effect of body mass index (BMI) on the association between lower body strength, agility, and dynamic balance, considering the mediating influence of lower body flexibility and aerobic endurance in community-dwelling older adults. This study included a sample of 607 community-dwelling older adults (female = 443; male = 164) aged between 60 and 79 years (M = 69.24; SD = 5.12). Participants had a mean body mass index of 28.33kg/m2 (SD = 4.45). In the mediation-moderation model, positive associations were found between lower body strength and lower body flexibility, aerobic endurance, and agility and dynamic balance (p < 0.05). As for the moderation effects and interactions, BMI was found to have a significant interaction with lower body strength on agility and dynamic balance (β = -.04, [-.06, -.03]), representing an R2-change of 0.04 (p < .001). Conditional direct effects were estimated at BMI scores of 23.9 (β = -.09, [-.15, -.03]), 27.7 (β = -.19, [-.24, -.14]), and 32.7 (β = -.33, [-.40, -.26]) kg/m2. Older adults with high levels of muscular strength tended to have shorter timed up-and-go test times, regardless of BMI. Also, individuals with lower levels of lower body strength were found to have longer timed up-and-go test times, and this relationship became more pronounced with increasing BMI.

Background: High blood pressure variability (BPV) is a predictor of cardiovascular events and all-cause mortality in people with end-stage kidney disease (ESKD) and a marker of aging in geriatric populations. Nevertheless, the relationship between BPV and geriatric syndromes, such as frailty, in people with ESKD is not well understood.

Objective: To examine the association between very short-term BPV and frailty in people with ESKD and receiving hemodialysis.

Design: Cross-sectional study.

Setting: Three dialysis units in the United Kingdom.

Participants: Sixty-nine people receiving hemodialysis (median age=62.0 years, interquartile range [IQR]=19.0; 52.2% male; median dialysis vintage=1.1 years, IQR=2.4).

Measurements: Systolic and diastolic BPV were recorded using continuous, non-invasive BP monitoring (Task Force Monitor). The very low, low, and high frequency components of BPV (VLF-BPV, LF-BPV, and HF-BPV), as well as the power spectral density (PSD-BPV) and low frequency/high frequency ratio of BPV (LF/HF-BPV) were analyzed. Frailty was evaluated using the Fried frailty phenotype.

Results: Twenty-six (37.7%) participants were classified as frail and 43 (62.3%) as non-frail. Frail participants had higher median systolic (2.1, IQR=5.2 mmHg2 vs. 1.1, IQR=1.6 mmHg2, p=0.002) and diastolic HF-BPV (0.9, IQR=2.3 mmHg2 vs. 0.5, IQR=1.0 mmHg2, p=0.048) compared to their non-frail counterparts. In addition, frail participants had higher median systolic VLF-BPV (3.2, IQR=12.5 mmHg2 vs. 2.0, IQR=2.4 mmHg2, p=0.012), LF-BPV (2.0, IQR=3.8 mmHg2 vs. 1.1, IQR=2.0 mmHg2, p=0.016), and PSD-BPV (6.6, IQR=27.6 mmHg2 vs. 4.5, IQR=5.9 mmHg2, p=0.005) compared to the non-frail participants. In age- and sex-adjusted logistic regression analyses, only systolic VLF-BPV (odds ratio [OR]=1.13, 95% confidence interval [CI]:1.01-1.26, p=0.035), HF-BPV (OR=1.26, 95%CI:1.01-1.57, p=0.044), and PSD-BPV (OR=1.06, 95%CI:1.01-1.12, p=0.029) were associated with increased odds of being frail.

Conclusion: Higher systolic BPV is associated with frailty in people receiving hemodialysis. Beat-to-beat assessments of BPV through continuous, non-invasive BP monitoring may be useful in evaluating frailty in ESKD populations.

Objective: Reciprocal connections exist between mental health and physical health, and conditions of cellular senescence/advanced biological age have been observed in association with certain psychiatric diseases. However, the construct of frailty has only preliminarily been explored in young adults and in relation to psychopathology so far. In the present study we aimed at further elucidating the relationships linking psychopathological phenomena with physical diseases in a sample of young adults.

Methods: The sample was made of 527 Italian young adults (age range: 18-34). Participants were assessed on clinical/socio-demographic information as well as on the following measures: an ad hoc designed Frailty Index (FI), the Brief Symptroms Inventory (BSI), the Relationship Questionnaire (RQ), and the Childhood Trauma Questionnaire (CTQ).

Results: Individuals with clinically-relevant psychopathological symptoms (based on established BSI cut-off scores) showed significantly higher FI values than individuals without clinically-relevant psychopathological symptoms (p<0.001). Higher levels of childhood traumatic experiences and higher levels of insecure forms of attachment were significantly associated with higher FI scores. The severity of preoccupied attachment style was significantly independently associated with higher FI scores also when multiple confounding variables were controlled for.

Discussion: Our findings provide novel pieces of insight on the complex relationship of frailty, conceptualized as a measure of deficit accumulation and an indicator of functional status and biological age, with psychopathology, childhood traumas and insecure attachment, with potential implications for the clinical management of young individuals.

Although the association of type 2 diabetes (T2D) with an increased risk of poor physical function and frailty in older adults is widely documented, the underlying pathophysiological pathways linking these two entities are not fully understood. Accordingly, we conducted a cross-sectional observational study aiming to investigate the association of T2D and its microvascular complications retinopathy, nephropathy, and neuropathy, with gait speed (GS), a common surrogate marker of functional decline, adjusting for age, sex, and cognitive function, in the cohort of older adults of the DIALCAT project (Catalonia, Spain). From the initial 335 participants, 84 were excluded because of missing or incorrect GS assessment. The remaining 251 individuals showed a mean (SD) age of 76.5 (5.8) years, of which 50.4% were women, and 69.4% had T2D. Participants were functionally independent (Barthel Index = 95.9 ± 7.3) but showed low physical performance (GS = 0.7 ± 0.3 m/s). Univariate analysis revealed a significant association between GS and sex, body mass index, Barthel index, Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS) scores, retinopathy, and nephropathy, and a non-significant association between GS and presence/absence of T2D. In multivariate analysis, T2D complications was independently associated with slower GS (β=-0.12 (-0.23, -0.01), p=0.029, with absence of T2D as reference group; and -0.13; (-0.23, -0.04); p=0.007, with T2D without complications as reference group). Further adjustment for MMSE and GDS, which remained significantly associated with GS, attenuated the association of GS with T2D complications. In conclusion, the presence of diabetes complications, encompassing renal, visual, peripheral, and potentially central nervous system levels, was associated with a reduction in gait speed, a relevant marker of physical function and frailty.