Journal of Frailty & Aging最新文献

Background: Major joint surgery is one of the largest components of Medicare spending in the US and the most frequent major procedure performed in older adults. Increasing age is associated with increasing prevalence of frailty, but the influence of frailty on healthcare expenditures following arthroplasty has yet to be adequately explored.

Objective: To explore the association between frailty and healthcare expenditures in the year following total hip and knee arthroplasties.

Design: Retrospective cohort study SETTING: United States population PARTICIPANTS: Medicare beneficiaries 65 and older undergoing total knee or hip arthroplasty (n = 1,152,872) from 2017 through 2018.

Measurements: Claims-based frailty index (exposure), total 1-year Medicare expenditures broken down by category (primary outcome), in-hospital complications, length of stay, discharge destination, readmission and mortality (secondary outcomes).

Results: Among 435,496 patients who underwent hip (37.8 %) and 717,376 patients who underwent knee arthroplasty (62.2 %), the mean age was 73.7 years and 19.2 % were classified as frail. Median total expenditures in US dollars at one year were higher in those with frailty ($247,503; IQR [$169,400-$391,176]) relative to the prefrail ($179,379 [$127,396-$265,039]) and robust ($130,314 [$85,438-$199,605]) groups. Total expenditures included the index surgical admission, rehospitalization, skilled nursing care, and outpatient care, all of which were higher with increasing frailty. However, the surgical procedure accounted for less than a third of the total 1-year healthcare costs and was the category with the lowest degree of variation between patients. Frailty was also associated with longer lengths of stay, higher risks of complications, readmission, and mortality and lower likelihood of being discharged home after the procedure.

Conclusions: Among older adults undergoing total hip and knee arthroplasty, frailty is associated with higher healthcare expenditures, predominantly driven by longitudinal care during the year following the procedure. More research is needed to test interventions to improve outcomes and reduce cost in this high-risk population.

Background: Among community dwelling older adults, social vulnerability increases with age. Advanced age alone does not fully explain how or why older adults become more socially vulnerable; frailty may offer a better explanation.

Objective: We aimed to understand how change in frailty relates to change in social vulnerability over time.

Design: Retrospective cohort study.

Setting and participants: We analyzed older adults aged 65 years and older from the province of Nova Scotia who accessed publicly funded home care in 2005 and 2008 followed for up to ten years.

Measurements: We measured social vulnerability and frailty using indices. Controlling for time constant covariates, multi-level growth modelling was used to evaluate whether within-person changes in frailty were associated with within person changes in social vulnerability, after accounting for between-person differences.

Results: There were 2,791 older adults in the 2005 cohort and 2,741 older adults in the 2008 cohort. Mean age, frailty index and social vulnerability index were 80.6 years (SD 7.5), 0.23 (SD 0.10), 0.22 (SD 0.07) and 80.4 (SD 7.6), 0.23 (SD 0.10), and 0.23 (SD 0.07) for each cohort respectively. After accounting for age, sex and baseline frailty, a 0.1 point increase in change of FI from baseline was associated with a 0.017 (CI 0.016 - 0.019, p < 0.001) increase in SVI in the 2005 cohort and a 0.014 (CI 0.013 - 0.016, p < 0.001) increase in SVI in the 2008 cohort.

Conclusions: Although social vulnerability tends to remain constant in the absence of increases in frailty, changes in frailty are closely associated with changes in social vulnerability. Incorporating within-person changes in health into quantitative models of late-life social vulnerability may further improve our understanding of how and why some individuals are able to stay in the community despite their vulnerabilities.

Background: Older adults with frailty have high risk for poor postoperative outcomes.

Objective: To evaluate the feasibility of a multimodal prehabilitation program in older adults with frailty awaiting hip or knee replacement.

Design: Parallel two-arm randomized controlled pilot trial.

Participants and setting: Community-dwelling older adults with frailty awaiting joint replacement aged ≥60 years recruited from the Musculoskeletal Central Intake and Assessment Centre (MSK CIAC), Ontario.

Intervention: Exercise, protein and vitamin D supplements, and medication review.

Measurement: Feasibility was assessed based on predefined progression criteria for recruitment, retention, data completion and adherence to intervention components. Clinical outcomes including Oxford Knee and Hip Scores, frailty index, Short Physical Performance Battery and health-related quality of life were collected at baseline, 1-week preoperative, 6-weeks and 6-months postoperative and were evaluated using generalized linear mixed models for repeated measures.

Results: A total of 69 participants were enrolled. Recruitment rate was 35 %. Participants' mean age was 74 (standard deviation (SD): 7.5); 51 % were prefrail and 36 % were frail. Participant retention was 81 %, and data completion was ≥80 %. Mean adherence to strength exercises was 4 days (95 % confidence interval (CI): 3-5 days/week), balance 3 days (95 % CI: 2-4 days/week), and flexibility 3 days (95 % CI: 3-4 days/week). Adherence to vitamin D intake was 82 % (95 % CI: 73-92 %), and medication review consultation completion was 86 % (95 % CI: 68-95 %). These outcomes met the target values for feasibility success. The Oxford Knee Score at 6-months postoperative 8.78 (95 % CI: 0.40-17.16) showed a clinically meaningful and statistically significant difference between treatment groups. There were also indications of clinically relevant changes for frailty and quality of life post-surgery.

Conclusion: This trial provides strong evidence of feasibility and indications of improvements in postoperative clinical outcomes. Challenges to implementation and adherence were identified that can inform modifications to study design for future trials.

Trial registration: ClinicalTrials.gov NCT02885337. Registered August 31, 2016. https://classic.

Clinicaltrials: gov/ct2/show/NCT02885337.

Background: The experience of homelessness has been associated with premature ageing and an earlier onset of geriatric syndromes. Identification of frailty and appropriate intervention, may help improve health outcomes for people experiencing homelessness (PEH). This review aimed to identify prevalence, use of screening tools and risk factors for frailty in PEH.

Method: A systematic review, conducted and reported following the PRISMA checklist, was undertaken investigating the prevalence and risk factors of frailty among PEH. Searches were conducted in Ovid MEDLINE, PsycInfo, Web of Science and CINAHL from inception to July 2024. A meta-analysis examining prevalence of frailty and pre-frailty was completed with a narrative synthesis of related risk factors.

Results: A total of 1672 articles were screened for eligibility and 11 studies were included, containing 1017 participants from seven countries. Six different screening tools were employed to detect frailty in the included studies. The range of frailty prevalence was 16-70 % and pre-frailty prevalence was 18-60 %. The pooled frailty prevalence from studies employing the Fried Criteria was 39 % (95 % CI 15-66); the Clinical Frailty Scale: 37 % (95 % CI 24-51); the Edmonton Frailty Scale: 53 % (95 % CI 44-63); and the Tilburg Fraily Indicator: 31 % (95 % CI 8-60). High heterogeneity was observed between the studies. Identified risk factors for developing frailty in PEH included being female, increased years spent homeless, and drug addiction.

Conclusion: This study highlights a high prevalence of frailty and pre-frailty in PEH. The identified risk factors illustrate potential areas to target interventions to reverse frailty. Future research should focus on the role of screening for frailty in PEH and developing appropriate frailty detection tools in this group.

The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force convened in March 2024 to address patient-reported outcomes measures (PROMs) in the field of sarcopenia. PROMs are crucial to enhance healthcare services at both individual and societal levels. PROMs complement objective outcome measures by capturing insights that patients are best suited to judge. In recent years, there has been an increase in the recognition of PROMs' importance within clinical trials by pharmaceutical industries and regulatory agencies. Consequently, it has become imperative to develop valid and reliable tools tailored to capture various aspects of patient's experience and health status. This report aims to present the state-of-the-art available and validated PROMs for sarcopenia that can be used within clinical settings by various stakeholders, and to highlight several research gaps and barriers that need to be addressed to expedite and improve the use of these outcome measures within the context of clinical trials.

Background: Skin tactile perception may indicate frailty in older adults. Although gait performance is crucial for diagnosing frailty, its association with skin tactile perception has not yet been explored.

Objectives: To examine the association between skin tactile perception and changes in step length, cadence, and gait speed in middle-aged and older adults.

Design: A longitudinal study (mean follow-up: 10.8 years) SETTING: Community-based survey PARTICIPANTS: A total of 1,403 middle-aged and older adults (aged 40-79 years, 53.6 % men) from the National Institute for Longevity Sciences-Longitudinal Study of Aging were included in this study. These participants completed the baseline survey (1997-2000) and at least two follow-up surveys (2000-2012), had no history of cerebrovascular disease, rheumatoid arthritis, or Parkinson's disease, and had complete data with no outliers in skin tactile perception measurements.

Measurements: Skin tactile perception was assessed using a two-point discrimination test. Step length (cm), cadence (steps/min), and gait speed (m/min) were evaluated on an 11-m walkway at a usual speed.

Results: The mean age of participants was 56.4 years. After full adjustment, mixed-effects models with splines revealed that the association between skin tactile perception and gait parameters varied with age. In adults aged 60 and above, we observed non-linear relationships between skin tactile perception and gait parameters. A consistent inflection point around 10 mm in tactile perception was identified across different age groups and gait parameters.

Conclusions: Among community-dwelling middle-aged and older Japanese adults, skin tactile perception was associated with changes in gait parameters, particularly in those aged 60 and above. The 10-mm threshold in tactile perception may serve as a critical indicator for predicting changes in gait performance. Skin tactile perception tests may prove clinically useful for screening patients at elevated risk of impaired gait performance.

Background: Pre-frailty is highly prevalent and multimodal lifestyle interventions are effective for preventing transition to frailty. However, little is known about the potential for medical group visits (MGV) to prevent frailty progression.

Objectives: To assess the feasibility and acceptability of the MGV Age Self Care-Resilience.

Design: Single-arm mixed methods pilot clinical trial.

Setting: Virtual MGV delivered in an ambulatory setting at a U.S. academic medical center.

Participants: Community-dwelling older adults (n = 11; age 65+) with pre- to mild frailty.

Intervention: Age Self Care-Resilience, an 8-week virtual MGV (90-minute sessions once per week) with sessions focused on physical activity, nutrition, social engagement, mind-body practice, and home environment modification.

Measurements: Primary outcomes were feasibility of recruitment, attendance, satisfaction, and feasibility of study measurements, collected via quantitative and qualitative approaches. Exploratory outcomes included frailty, psychosocial health, and physical function.

Results: A priori feasibility criteria were met for recruitment, with 15 (48 %) of those screened (31) meeting eligibility criteria, 11 (35 %) enrolling (mean age 74.5 yrs), and recruitment completed in less than one month. The nine participants who completed the study attended a mean of 7.2 of 8 sessions and completed 100 % of baseline and follow-up study measures; participants completed 58 % of the home practice log. Themes from participant interviews included: (1) mixed reactions to the recruitment term "pre-frailty;" (2) finding group participation as meaningful and empowering; and (3) perception that the program positively changed attitudes and lifestyle behaviors.

Conclusions: Age Self Care-Resilience is feasible and acceptable to pre- to mildly frail older adults. Next steps include evaluating the efficacy of Age Self Care-Resilience for preventing frailty progression with a fully powered randomized controlled trial.

Background: Body mass index (BMI) determines general corpulence and health, whatever age, sex or clinical background. Normal BMI (18.5-24.9 kgm²) is defined as healthy, normal, weight leading to a false impression that no intervention is needed.

Objectives: Assess the prevalence of body impairments in the presence of normal BMI.

Design: Cross-sectional design. Bivariate and a multivariate regression analysis assessed the association of body composition with clinical parameters in the presence of normal BMI.

Setting: Community dwelling older adults attending the Toulouse Frailty Clinic at the University Hospital, Toulouse.

Participants: 876 community dwelling, autonomous older adults, 70 years and over.

Measurements: Dual X-ray Absorptiometry (DXA) assessment, and cognitive, physical, nutritional, and demographic evaluations were included in the present analysis.

Results: Of the initial sample, 347 (39.61 %) patients had normal BMI, and among them, 152 (43.80 %) had low lean mass, 144 (41.49 %) were osteoporotic and 2 (0.58 %) increased fat mass. A poor nutritional status (Mini-Nutritional Assessment score, MNA-score, <24) was the only independent variable associated with body impairments in the presence of normal BMI (Odd Ratio 2.83; 95 % Confidence Interval 1.64-4.89).

Conclusion: Nearly 70 % of the adults with normal BMI had at least one impairment in body composition (low lean mass, osteoporosis, or obesity). In the light of the present study, older adults with normal BMI and an MNA-score under 24 should be assessed with DXA to identify the age-associated impairments in body composition in order to lead to specific interventions.

Objectives: The aim of this pilot study is to assess the feasibility of using the mobile photographic method (m-health) of teledentistry for oral screening and triaging of older patients living in aged care homes.

Methods: The study took place in 2023 in four aged care facilities in Egypt. Three trained dentists performed clinical oral examinations of the participants and filled in the World Health Organization (WHO) oral health assessment form. Afterwards, five intraoral photographs were taken for each participant and independently examined by three calibrated dentists for caries detection and decision on intervention urgency for proper dental referral. Agreement between the testing modalities was analyzed using Cohen's kappa coefficient, and the significance level was set at p < 0.05 within all tests.

Results: The results indicated that teledentistry had higher specificity than sensitivity in caries detection compared to clinical examination. The level of agreement between the teledentistry examination and the clinical oral examination for caries assessment ranged from (k = 0.36) to (k = 0.58) showing fair to moderate agreement. Also, all teledentistry examiners showed almost perfect statistically significant intra-rater and inter-rater agreement for caries detection (K ≥ 0.82, p < 0.001). Moreover, intervention urgency scoring showed moderate to substantial agreement between the testing modalities with kappa values ranging from (k = 0.48) to (k = 0.65).

Conclusions: The mobile photographic method of teledentistry offers a feasible model that helps in oral examination and triaging dental treatment of older patients living in aged care facilities. However, larger studies with proper sample size are required which will allow better generalizability of the results.