Journal of Frailty & Aging最新文献

Purpose: Concerns about falling (CaF) are common in older adults. They are associated with increased risk of falls, activity restriction, social isolation, and physical deconditioning. This systematic review assessed if frailty is a risk factor for CaF.

Methods: Searches of cross-sectional and prospective studies exploring associations between frailty and CaF were conducted across five databases (Medline, CINAHL, Embase, Psychinfo and Scopus). The Risk of Bias in Non-randomised Studies of Exposure (ROBINS-E) was used to determine risk of bias.

Results: The search identified 2492 articles, 12 were included for data extraction: 8 cross-sectional and 4 prospective studies. Participants' mean ages across the different studies ranged from 67.5 - 81.7 years. All adjusted analyses reported a significant association between increasing frailty and CaF, except for one cross-sectional paper. Significant adjusted Odd Ratios (ORs) ranged from 1.79 (CI = 1.18-2.71) to 144.78 (CI = 13.86 - 1512.60) for cross-sectional studies, and from 1.33 (CI = 1.04-1.69) to 12.4 (CI = 7.6-20.1) for prospective studies. Three studies (one cross-sectional and two prospective) explored the association between frailty and concern-related activity restriction: A significant association was reported in two prospective studies (adjusted OR = 1.58 (CI=1.09-2.30) and adjusted RRR = 3.91 (2.61-5.85)), but not the cross-sectional study (adjusted OR = 1.31 (CI=0.62-2.78)).

Conclusion: This review identifies strong associations between increasing frailty and both CaF and associated activity restriction. This expands previous work describing the opposite association (that CaF can lead to frailty), suggesting a bi-directional relationship. Clinicians working with pre-frail and frail older adults should consider screening for CaF.

Prospero: CRD42023371899.

Background: Frailty is a syndrome associated with age-related impairments in multiple organ systems, of which the autonomic nervous system plays a fundamental role. Measurement of heart rate variability (HRV) is a non-invasive method to evaluate the autonomic activity and gain insights into cardiovascular health and potentially, frailty. A few small studies have explored the relationship between HRV and frailty, with promising but conflicting results.

Objective: To investigate the relationship between HRV and frailty among adult patients with cardiovascular disease.

Design: A cross-sectional study was conducted using clinical data.

Setting: Data were collected from an ambulatory cardiology clinic.

Participants: The cohort comprised 155 patients with a mean age of 67 years (44 % female).

Measurements: HRV was assessed seated at rest for 2.5 min using a finger-based photoplethysmography (PPG) device. Frailty was assessed using the Clinical Frailty Scale (CFS), with a score ≥5 considered frail. Associations between HRV and frailty were examined using a Spearman correlation matrix and multivariable ordinal regression model. The LF/HF ratio (a frequency-domain measure reflecting imbalances between sympathetic and parasympathetic activity) was the primary HRV measure analyzed.

Results: The prevalence of frailty was 15 %. Among all HRV measures, the LF/HF ratio was most closely correlated with frailty (p < 0.001). In the multivariable model, each 1 standard deviation decrease in LF/HF ratio was associated with a 1.1-point increase in CFS (95 % CI 0.7-1.6, p < 0.001). The optimal ROC cutoff at which the LF/HF ratio was associated with frailty is ≤ 0.37.

Conclusions: The LF/HF ratio is inversely correlated with the CFS and independently associated with frailty. Measurement of HRV is a promising technique to enrich existing frailty scales and assist in frailty assessments in an ambulatory cardiology clinic.

Background: Metabolic acidosis caused by acidogenic diets increases muscle catabolism. High acidogenic diets can increase muscle loss in older adults; however, their association with functional outcomes remains unclear.

Objectives: To investigate whether high acidogenic diets increase the incidence of disability.

Design: Longitudinal study.

Setting: Community-based.

Participants: We included 1,704 community-dwelling Japanese individuals aged ≥ 75 years without disabilities at baseline (52.2 % females).

Measurements: Baseline dietary acid load was assessed using potential renal acid load (PRAL) values, which reflect urinary acidity-with higher values indicating more acidogenic diets. The outcome measure was the one-year incidence of disability, defined as needing for long-term care or support based on certification by the Japanese long-term care insurance system. As the effects of PRAL are reportedly sex-specific, separate analyses were conducted for males and females. The participants were categorized into tertiles (T1-T3, with T1 as the reference) based on their PRAL values. Odds ratios (ORs) and 95 % confidence intervals (CIs) for outcome were calculated using multiple logistic regression analysis after adjusting for age, body mass index, living status, smoking status, hypertension, diabetes, dyslipidemia, energy intake, and alcohol intake.

Results: The PRAL ranges in groups T1, T2, and T3 were: -64.51 to 0.21, 0.27 to 11.34, and 11.41 to 61.00, respectively, in males, and -61.22 to -3.84, -3.75 to 5.89, and 5.90 to 38.68, respectively, in females. Disabilities occurred in 44 (5.7 %) males and 71 (8.7 %) females. ORs (95 % CIs) for disability in T2 and T3 were 0.79 (0.35-1.76) and 0.81 (0.37-1.79), respectively, in males and 1.10 (0.57-2.13) and 1.96 (1.06-3.61), respectively, in females.

Conclusions: A high dietary acid load increased the incidence of disability in older females. Therefore, managing an acidogenic diet may help maintain daily living functions in older females. Future studies should investigate whether sex is an effect modifier.

Background: Frailty is a major health concern among older adults, and its association with oral health-related quality of life (OHRQoL) remains underexplored in longitudinal studies.

Objective: To investigate the association between baseline OHRQoL and physical frailty incidence at a 2-year follow-up in community-dwelling older adults.

Design: Prospective longitudinal study.

Setting: The study was conducted within the Tosa Longitudinal Aging Study framework in Japan.

Participants: This study included 144 community-dwelling older adults (50 men and 94 women; median age, 81.0 years) with complete data who participated in the Tosa Longitudinal Aging Study in 2016 and 2018 and were not categorized as physical frailty in 2016.

Measurements: Baseline assessment included OHRQoL, which was evaluated using the General Oral Health Assessment Index (GOHAI; range 12-60), with higher scores indicating better OHRQoL, oral function, and general health status. The incidence of physical frailty was defined using the revised Japanese version of the Cardiovascular Health Study criteria. The association between the GOHAI score and physical frailty was assessed using logistic regression analysis.

Results: The median baseline GOHAI score was 58. The incidence of frailty after a 2-year follow-up was 13.9 % among the participants (18.0 and 11.7 % for men and women, respectively). Each point of the GOHAI score was associated with an 11 % reduction in frailty risk over 2 years after adjusting by age, sex, number of teeth, Food Diversity Score, Geriatric Depression Scale score, eating alone, smoking, and more than five medications (adjusted odds ratio: 0.893; 95 % confidence interval: 0.810-0.984).

Conclusions: This longitudinal study showed that a higher baseline OHRQoL, based on the GOHAI score, was linked to a lower incidence of physical frailty among community-dwelling older adults after 2 years.

Background and objective: This study examined the relationship between body mass index (BMI) and sarcopenia with oral function decline in older patients as well as whether a combination of underweight BMI and sarcopenia was associated with decreased oral function in individuals with conservative restorative and prosthetic treatment for masticatory disorders.

Design, setting, and participants: This cross-sectional study included 290 older Japanese patients who regularly attended a general dental clinic. A detailed examination of oral function, sarcopenia, and BMI according to the Asian Working Group for Sarcopenia 2019 criteria was conducted for patients aged 65 years. This study used odds ratios as an epidemiological measure in the cross-sectional survey.

Results: Multinomial logistic regression analysis showed that the number of remaining teeth and tongue pressure was associated with both ideal and overweight BMI in individuals with sarcopenia when compared to healthy individuals. The underweight BMI plus sarcopenia group was associated with tongue and lip motor function [ka] sound test, swallowing function, and the presence of oral hypofunction.

Discussion: Our findings indicated that various aspects of oral function were impaired in community-dwelling older adult Japanese patients with sarcopenia and underweight BMI. Notably, among older adults with sarcopenia, both obese and thin patients exist, suggesting that distinct pathophysiological mechanisms influence oral function.

Conclusion: The above findings support the hypothesis that the coexistence of sarcopenia and underweight BMI is associated with poor oral function. Regular oral function assessments and weight measurements in general dental practice can aid the prompt identification of sarcopenia and reduced swallowing function and can facilitate early intervention. The presence of sarcopenia and impaired swallowing function should be considered in patients with underweight BMI, reduced [ka] sound, and low tongue pressure following a thorough oral function examination.

Background: Several indexes based on clinical and laboratory tests to identify frailty and to predict mortality have been produced. Only two studies, mixing clinical and laboratory parameters were made about a frailty index made of laboratory tests (FI-Lab) and mortality in older patients hospitalized for COVID-19. The aim of this study was to explore the accuracy and precision of an FI-Lab constructed with some common bio-humoral tests and mortality in a cohort of patients hospitalized for COVID-19.

Methods: The FI-Lab was constructed using 40 different bio-humoral tests during the first four days of hospitalization, with a score from 0 to 1. The association between FI-Lab and mortality was assessed using a multivariate Cox's regression analysis, reported as hazard ratios (HRs) and 95% confidence intervals (CIs). The accuracy of the FI-Lab was reported as area under the curve (AUC) and the precision with the C-Index.

Results: 376 patients (mean age: 65 years; 53.7% males) were initially included. During the follow-up period, 41 deceased. After adjusting for five different factors, an FI-Lab value >0.54, the median value of our cohort, was associated with a relative risk about five times greater than lower values. Modeling FI-LAB as a continous variable, each increase in 0.01 points was associated with an increased risk in mortality of 8.4% (HR=1.084; 95%CI: 1.039-2.044). The FI-Lab was highly accurate (AUC=0.91; 95%CI: 0.87-0.95) and precise (C-Index=0.81) in predicting death.

Conclusions: A simple index based on common laboratory tests can be used to predict mortality among older people hospitalized for COVID-19.

Background: Exercise is efficacious in older adults, including those with multi-morbidity. However, the optimum mode is not known and there are conflicting findings as regards the types of exercises to recommend. It is postulated that multi-component exercise interventions better meet the needs of older adults who experience multi-morbidity as they more holistically address the range of functional problems they may experience. To date, no review has explored and described in detail what multi-component exercise interventions have been tested in older adults with multi-morbidity.

Objectives: To explore the number and types of exercises included within multi-component exercise interventions that have been tested in older adults with multi-morbidity. Secondary objectives were to explore the rationale for selecting particular exercise components within the intervention design and to describe the characteristics of the exercise program.

Design: Systematic review and narrative synthesis.

Results: Database searches yielded 51,001 articles; following screening 138 unique interventions were retained for analysis. Across studies, 22 different multi-component combinations were identified, and there was marked variation in frequency, intensity and duration. Few studies describe characteristics that are in line with the preferences or needs of older adults with multi-morbidity. Exercise design decisions were most frequently judged to be based on practitioner intuition/local practice.

Conclusion: There is substantial heterogeneity within multi-component exercise interventions; which has significant implications for meta-analysis of effects. Interventions do not frequently appear to consider the abilities or needs of those with multi-morbidity, nor do they seem to be attuned to the participation barriers they experience.

Objectives: Flavonoids are of particular interest for their antioxidant property and anti-inflammatory, and a therapeutic potential for age-related diseases has been suggested. Frailty is becoming a global public health concern due to an increasingly aging population. We aimed to evaluate the association between dietary flavonoid intake and the likelihood of frailty in middle-aged and older adults.

Design: A US nationally representative cross-sectional study.

Setting: National Health and Nutrition Examination Surveys database.

Participants: Of the 8159 adults aged 50 years and older.

Measurements: This study used data from NHANES (2007-2010 and 2017-2018). Dietary flavonoid intake data were obtained from a 24-h recall interview. Frailty was measured using a 53-item frailty index (FI) and diagnosed as FI > 0.21. We used survey-weighted logistic regression models to assess the association between flavonoid intake and odds of having frailty. The dose-response association between flavonoid intake and frailty was estimated using a survey-weighted restricted cubic spline (RCS) model.

Results: Among the 8159 adults (63.42 ± 0.20 years), 2551 (31.3%) had frailty. The RCS depicted a U-shaped association between total flavonoid intake and frailty. Compared with those in the lowest quintile (≤14.55 mg/day), participants in the fourth total flavonoid intake quintile (84.13-313.51 mg/day) had the lowest likelihood of frailty with an OR (95% CI) of 0.65 (0.51-0.84). The likelihood of frailty decreased until 220 mg/day, with 2% (0.8%-4.1%) lower odds of frailty per 10 mg higher total flavonoid intake, which increased thereafter. Similarly, the U-shaped relation with frailty was observed for five flavonoid subclasses (flavan-3-ols, flavanones, flavones, flavonols, isoflavones), while a roughly negative linear relation was observed for the other flavonoid subclass (anthocyanidins).

Conclusion: U-shaped associations with frailty for dietary intake of total flavonoids and flavonoid subclasses (flavan-3-ols, flavanones, flavones, flavonols, and isoflavones) were observed in middle-aged and older US adults.

Objective: This study aims to investigate the correlation between leisure-time physical activity (LTPA) and cognitive function in older adults.

Methods: We conducted an analysis of 2,657 participants (aged ≥60 years) from the cross-sectional National Health and Nutrition Examination Survey (NHANES) spanning 2011-2014. Multiple logistic regression and linear regression analyses were employed to explore the associations between leisure-time physical activity and cognitive function.

Results: Significant correlations were observed between LTPA duration and frequency with Animal Fluency Test (AF) and Digit Symbol Substitution Test (DSST) scores. Engaging in leisure-time physical activity 1-4 times per week was associated with a 33%((OR) 0.67, (CI) 0.48-0.92) reduced risk of memory decline compared to non-active individuals. An inverted U-shaped relationship was observed between LTPA duration and AF/DSST and a U-shaped relationship between LTPA frequency and the risk of memory decline.

Conclusion: Encouraging older adults to participate in leisure activities 3-4 times per week may help protect cognitive function.