Journal of Frailty & Aging最新文献

Sarcopenia and sarcopenic obesity may increase surgical complications and impact recovery and function after total joint arthroplasty (TJA). We assessed the feasibility of identifying these conditions in an orthopedic practice setting using published consensus criteria. Patients in a lower extremity TJA clinic were assessed for sarcopenia and sarcopenic obesity using EWGSOP2 and ESPEN/EASO diagnostic frameworks, respectively. Low strength testing involved maximal handgrip strength (HGS) and number of chair sit-to-stands in 30 seconds (CSTS). Same day dual-energy x-ray absorptiometry (DXA) testing was used to assess for low muscle mass (i.e. appendicular lean soft tissue) in patients with low strength. One hundred-one of a possible 128 patients were assessed in clinic (93% male, mean age 69.6±8.9 years and BMI 31.7±7.9 kg/m²). HGS was completed in 99% of screened patients; only 44.5% completed CSTS due to joint pain and balance limitations. Thirty-nine patients had low strength and were recommended for DXA. In 16 patients who completed DXA, 3 had sarcopenia and 5 had sarcopenic obesity. Screening for sarcopenia and sarcopenic obesity was challenging to complete in all patients during routine clinic flow with dedicated personnel. Despite our pragmatic approach and limited screening completion in all patients, we identified sarcopenic and sarcopenic obesity in 6.25% of patients. This is likely a lower bound for the true prevalence but suggests an opportunity to assess and intervene for these conditions before surgery to improve total joint arthroplasty outcomes.

Objectives: Social frailty (SF) has gained increasing attention in recent years. While several studies have examined SF among older adults living in the community, most have been conducted in specific countries, primarily in Asia, with limited research in Latin America. The main objective of this study was to identify the relationship between SF and demographic, health, and functional conditions among older adults in Colombia.

Methods: This study is a secondary analysis of the SABE Colombia study. Social frailty (SF) was assessed using the adapted HALFE Social Frailty Index. The main independent variables included demographic factors and health status indicators such as self-rated health, chronic conditions, depression, ADL/IADL dependence, mobility disability, and life-space assessment. Bivariate analysis and logistic regression in multivariate models were applied.

Results: The overall prevalence of SF was 66.3%, increasing with advancing age. Compared to individuals without SF, those with SF were more likely to have a low level of education (<6 years), mobility disability, dependence on IADLs, restricted life space (<55.5), be female, and report poor or very poor self-rated health. In multivariate logistic regression analyses, SF was associated with higher odds of years of education (<6), dependence for IADL, restricted life-space, being female, mobility disability, and bad and very bad self-rated health. In contrast, depressive symptoms, rural areas, and marital status lose significance.

Conclusion: SF is prevalent among Colombian elderly individuals, affecting nearly seven in ten community-dwelling older adults. It is also significantly associated with demographic, health, and functional conditions. Additionally, social issues such as economic status, social isolation, loneliness, and social participation are increasingly prominent among older adults. Thus, SF resulting from social issues requires greater attention, particularly in non-developed countries. Consequently, to promote healthy aging, it is imperative to implement measures aimed at preventing and mitigating SF among older adults in light of these findings.

Background: The Frailty Index (FI) is a well-established predictor of accelerated biological aging and a reliable tool for estimating all-cause and cardiovascular disease (CVD) mortality in older adults in the United States. However, its predictive value remains unclear in other U.S. population subgroups. This study aimed to examine the association between FI levels and both all-cause and CVD mortality among patients diagnosed with Cardiovascular-Kidney-Metabolic Syndrome (CKM syndrome).

Methods: This study utilized the data from the National Health and Nutrition Examination Survey (NHANES 2011-2018), which included 7049 participants with complete information for CKM staging (stages 0-4). We employed multivariate Cox proportional hazards models in conjunction with restricted cubic splines (RCS) to account for potential non-linear relationships in the data. Additionally, segmented Cox proportional hazards models were used to examine the association between FI levels and both all-cause and CVD mortality in the CKM syndrome population. Subgroup analyses stratified by demographic and clinical factors, along with interaction tests, were performed to evaluate the consistency of these associations.

Results: After adjusting for potential confounding variables, a nonlinear association was observed between the FI and CKM syndrome. Multivariable Cox regression analysis based on nationally representative data demonstrated that higher FI levels were significantly associated with increased risks of both all-cause and CVD mortality among patients with CKM syndrome. Multivariable analysis indicated a robust association between higher FI levels and the presence of CKM syndrome. Among patients diagnosed with CKM syndrome, each 10-unit increase in the FI was associated with a 54% higher risk of CVD mortality (HR = 1.54, 95% CI: 1.24-1.91; P < 0.001) and a 55% higher risk of all-cause mortality (HR = 1.55; 95% CI: 1.38-1.73, P < 0.0001). Stratified analyses revealed no significant interaction effects between the FI and demographic or clinical factors on mortality outcomes.

Conclusion: The results highlight a robust and statistically significant association between FI and increased risk of both all-cause and CVD mortality among individuals with KM syndrome. Notably, FI may serve as a valuable marker for CKM stage stratification and for identifying high-risk patients.

By 2030, one in six people globally will be over 60, potentially increasing the burden of frailty, a condition characterized by reduced physiological resilience and poor clinical outcomes. Although frailty affects up to 49 % of hospitalized patients, it is frequently under-recognized. Tools like the Clinical Frailty Scale (CFS) and the FI-Lab aim to assess frailty, though each has limitations. This retrospective cohort study evaluated the predictive value of CFS and FI-Lab, separately and in combination, for in-hospital and three-month post-discharge mortality in older adults. The study included 410 hospitalized patients (median age 87) admitted to two geriatric units between 2023 and 2025. Frailty was assessed using the CFS and a 22-item FI-Lab derived from blood tests within 48 h of admission. In-hospital and post-discharge mortality rates were 12.6 % and 24.7 %, respectively. Both FI-Lab and CFS were independently associated with increased mortality risk. A weak correlation between the two tools (r = 0.19, p < 0.001) suggests they capture distinct but complementary aspects of frailty. These findings support the combined use of FI-Lab and CFS for more accurate risk stratification in acutely ill older adults. FI-Lab may reflect acute physiological stress not captured by clinical measures alone, aiding early identification of vulnerable patients. Despite limitations, including modest sample size and lack of adjustment for multimorbidity, this study highlights the potential utility of integrating lab-based frailty assessments into routine hospital care for personalized geriatric management.

Objectives: Midlife women often experience concurrent declines in intrinsic capacity (IC) and increasing caregiving responsibilities. This study evaluated the effectiveness of an educational intervention designed to enhance knowledge of IC preservation, self-care efficacy, and caregiving competencies among midlife women.

Methods: The Pursuit of Wellness Program was developed and evaluated through a multicentre mixed methods study. This program comprised nine modules addressing IC domains (cognitive, vitality, psychological) and six modules focused on priority midlife conditions (e.g., urinary incontinence). Each module integrated health education, self care practices, and caregiving training. Program's effectiveness was assessed using a mixed methods evaluation. Outcomes included pre- and post-changes in domain- or condition-specific knowledge (summative score range: 0-3) and self-care efficacy (visual analogue scale: 0-10), post-intervention caregiving confidence (Likert scale: 1-5), and qualitative feedback from program coordinators.

Results: A total of 690 women aged 50-64 years were assessed. Pre-tests revealed knowledge gaps in pain management, bladder health, and dementia care, with mean health knowledge scores ranging from 1.3-1.6. Post-intervention improvements were most significant for bladder health (+69.0%, p<0.001), followed by nutrition for muscle & bone health (+56.3%, p<0.001). Self efficacy increased significantly across all IC domains and midlife conditions (ps<0.01), while caregiving confidence reached from 68.7 to 89.3% agreement, highest for skin and bathing care (89.3%) and dementia support (86.3%). Qualitative findings from program coordinators (n=18) confirmed high participant engagement with nutrition strategies and stress management techniques, corroborating quantitative outcomes.

Conclusions: The program significantly enhanced knowledge related to IC preservation and management of midlife conditions, self-care practices, and caregiving competencies among midlife women. It addresses a critical gap by concurrently promoting IC preservation and caregiving proficiency during the midlife transition.

Background: Frailty is a dynamic, age-related condition marked by progressive loss of resilience. Its risk factors include socioeconomic status and physiological stress burden, such as allostatic load score (ALS), remain unclear. This study aims to examine the role of depression in the association between ALS and frailty trajectories.

Methods: We analyzed data from 5885 LEAD cohort participants aged 25-82 years at baseline and from 3564 participants with follow-up data. Frailty status (robust, pre-frail, frail) was defined using the Fried phenotype, and transitions between visits were assessed. ALS was calculated from 14 parameters spanning cardiovascular, metabolic, and body composition measures. Associations of ALS with frailty status at baseline and with frailty transitions at follow-up were examined, and depressive symptoms were tested as a mediator.

Results: At baseline, 62.3% of participants were robust, 36.2% pre-frail, and 1.5% frail. Between visits, 16.3% transitioned to a worse frailty stage, while 17.7% improved. Higher ALS was linked to increased odds of being pre-frail/frail at baseline (OR 1.11; 95% CI: 1.08-1.15), and to a higher risk of transitioning from robust to pre-frail/frail (RRR 1.06; 95% CI: 1.02-1.09). Depressive symptoms mediated 35% (95% CI: 25-47%) of the cross-sectional and 17% (95% CI: 6.6-43%) of the longitudinal association between ALS and frailty.

Conclusions: Socioeconomic factors influenced frailty onset but not its progression, whereas depressive symptoms mediated approximately 17% of the effect of ALS on frailty development over time. These findings highlight the importance of exploring the effect of interventions for depression on frailty progression.

Background: Ketone bodies are metabolites produced during fasting or on a ketogenic diet that have pleiotropic effects on the inflammatory and metabolic aging pathways underpinning frailty in vivo models. Ketone esters (KEs) are compounds that induce hyperketonemia without dietary changes and that may impact physical and cognitive function in young adults. The functional effects of KEs have not been studied in older adults.

Objectives: Our long-term goal is to examine if KEs modulate aging biology mechanisms and clinical outcomes relevant to frailty in older adults. Here, we report the exploratory functional and quality-of-life outcome measures collected during a 12-week safety and tolerability study of KE (NCT05585762).

Design: Randomized, placebo-controlled, double-blinded, parallel-group, pilot trial of 12-weeks of daily KE ingestion.

Setting: The Clinical Research Unit at the Buck Institute for Research on Aging, California.

Participants: Community-dwelling older adults (≥65 years), independent in activities of daily living, with no unstable acute medical conditions (n = 30).

Intervention: Participants were randomly allocated (1:1) to consume 25 g daily of either KE (bis-octanoyl (R)-1,3-butanediol) or a taste, appearance, and calorie-matched placebo (PLA) containing canola oil.

Measurements: Longitudinal change in physical function, cognitive function and quality of life were assessed as exploratory outcomes in n = 23 completers (n = 11 PLA, n = 12 KE). A composite functional outcome intended for interventional frailty trials was derived and calculated. Heart rate and activity was measured throughout the study using digital wearables.

Results: There were no statistically significant longitudinal differences between groups in exploratory functional, activity-based or quality of life outcomes.

Conclusion: Daily ingestion of 25 g of KE did not affect exploratory functional or quality-of-life end points in this pilot cohort of healthy older adults. Future work will address these endpoints as primary and secondary outcomes in a larger trial of pre-frail older adults.

Background: In Japan's super-aged society, frailty prevention is a critical public health issue. While social media use is increasing among older adults, its impact on well-being is complex and not fully understood beyond a simple active-passive dichotomy. This study aims to explore the relationship between specific social media usage patterns, users' psychosocial backgrounds, and frailty risk.

Methods: We conducted a cross-sectional online survey of 950 community-dwelling older adults in Japan. Frailty was assessed using the Kihon Checklist. A two-stage analysis was performed: 1) K-means cluster analysis was used to classify participants based on eight SOCIAL MEDIA use behavior variables, followed by a Kruskal-Wallis test to compare psychosocial characteristics across clusters; 2) Ordinal logistic regression analysis was used to identify specific behaviors associated with frailty after adjusting for covariates.

Results: Three distinct user clusters were identified: "Balanced, reality-oriented communicators" (n = 333), "Low-engagement, passive users" (n = 419), and "Active, multi-purpose users" (n = 198). The "Low-engagement" group reported the highest levels of loneliness and unhappiness, despite high real-world social participation. Regression analysis revealed that the specific behavior of "using social media to keep a record of my own activities" (self-documentation) was independently associated with an increased risk of frailty (β = 0.105, p < .05). Conversely, high exercise self-efficacy (p < .001), sleep satisfaction (p < .01), and satisfaction with face-to-face communication (p < .001) were protective factors.

Conclusion: Social media usage patterns reflect underlying psychosocial states, but are not direct predictors of frailty. The motivation-driven behavior of self-documentation, rather than general activity, is a risk factor. These findings suggest that interventions should focus on the quality and function of social media use, promoting digital literacy that enhances well-being in older adults.

Purpose: The purpose of this research is to determine if balance can be improved in older adults from exercising at home using a novel piece of exercise equipment called the "Balance T".

Method: Fifty older adults (77.9 ± 6.7 years old) participated in a four-week home exercise, open-label clinical pilot study investigating ability to improve balance using the Balance T device. Pre- and post-intervention assessments included the Activities-specific Balance Confidence (ABC) Scale, Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), Clinical Test of the Sensory Interaction on Balance (CTSIB), Balance T Change Score (BTCS), and a user-opinion survey. Statistical analyses comprised parametric and non-parametric tests for pre-post exercise comparisons as well as evaluated balance differences across frailty status using established frailty-defining criteria.

Results: Frail participants at-risk for falls exhibited greater improvement in balance confidence compared to robust participants, with a mean change of 5.28 ± 12.9 (p < 0.001). In addition, each performance variable of balance showed clinically significant and meaningful changes after completing the Balance T exercise program. Participants reported the Balance T device as easy and safe to use with benefits gained at improving their balance.

Conclusion: The Balance T device proved feasible for home use, showing preliminary evidence of improved balance performance and confidence, particularly among frail adults.

Background: The prevalence of Parkinson's disease rises with age and so patients may also be living with multimorbidity, two or more long-term conditions, and frailty, a loss of physiological reserve. However, these individuals are typically under-represented in clinical research. The aim was to describe the prevalence and interrelationship of frailty, multimorbidity, disability, sarcopenia and polypharmacy in a representative sample of people with parkinsonism recruited to the PRIME-UK cross-sectional study.

Methods: In this single-centre cross-sectional study of people with parkinsonism, we supported the inclusion of typically under-represented groups including those with impaired capacity to consent to the research. Participants, or their representative, completed questionnaires including self-reported comorbidities, medications, a sarcopenia screening tool and measures of frailty and disability. Venn diagrams were used to show the overlap between these domains and a hierarchical cluster analysis was performed to explore clustering.

Results: Only 78 (16.8 %) were categorised as neither frail nor multimorbid nor disabled. Almost all patients living with frailty were additionally living with disability and/or multimorbidity. It was uncommon to have multimorbidity and frailty without disability. Only 6 (1.3 %) had frailty without probable sarcopenia. Individuals clustered into three groups based on co-occurrence of some or all of these five domains.

Conclusions: Amongst a representative sample of people with parkinsonism, there was a high frequency and co-occurrence of pre-frailty/frailty, sarcopenia, multimorbidity, polypharmacy and disability. This has implications for the structuring of health services for people with parkinsonism. There may also be opportunities to intervene to stop or slow the trajectory towards disability.