Journal of Frailty & Aging最新文献

Background: Physical activity (PA) and good nutrition are key to maintaining independence and reversing frailty among older adults.

Objective: To evaluate the feasibility and acceptability of training volunteers to deliver a remote multimodal intervention to older people with frailty after hospital discharge.

Design: Quasi-experimental mixed-methods feasibility study.

Setting, and participants: Twenty-seven older adults (mean age 80 years, 15 female) with frailty (Clinical Frailty Status ≥5) were enrolled from a National Health Service South England hospital, UK.

Intervention: Volunteers were trained to deliver a 3-month intervention, comprising exercise, behaviour change, and nutrition guidance in a group, or one-to-one, using telephone or online platforms.

Measurements: Feasibility was assessed by determining the number of volunteers recruited, trained, and retained; participant recruitment; and intervention adherence. Interviews were conducted with 16 older adults, 1 carer, and 5 volunteers to explore intervention acceptability, and were analysed using reflexive thematic analysis. Secondary health outcomes, such as physical activity and appetite, were compared at baseline, post-intervention, and follow-up (3-months).

Results: The intervention was safe and acceptable to volunteers, and older adults with frailty. Five volunteers (mean age 16 years, 3 female) completed training, and 60 % (n = 3) were retained. Seventeen participants completed the intervention (8 online; 9 telephone). Participants attended 75 % (IQR 38-92) online sessions, and 80 % (IQR 68.5-94.5) telephone support. Volunteers provided emotional support to older people with frailty and encouraged health behaviour change. Older people learnt from each other's shared experiences in the online group, and telephone calls provided them with reassurance and monitoring. Key components to success were volunteers received comprehensive training and support from a health practitioner, while key barriers were that participants lacked social support and experienced exercise discomfort.

Conclusion: With appropriate training and support, volunteers can safely deliver a remote multimodal intervention for older adults with frailty following discharge from hospital.

Purpose: Frailty increases with age and is associated with negative health outcomes as falls, hospitalization, and mortality. Socio-economic situation (SES) in childhood and adulthood are associated with frailty. It is unclear how the interaction of childhood hardship and adulthood SES effects frailty.

Methods: A register-based study using data from national registers and from the Lolland-Falster Health Study, involving individuals aged 50 and above. Frailty status was assessed using a modified version of Fried's phenotype. Logistic regression models with multiple adjustments were used to analyze the odds of frailty. Causal interactions between economic hardship in adulthood, perception of childhood, self-reported stressful events in childhood, and self-reported educational level were assessed by estimating the relative excess risk due to interaction (RERI).

Results: The study included 10,163 individuals. The percentage of individuals fulfilling 2-5 frailty criteria varied between 17 % in the 50-65 age group and 44.9 % in the 85+ age group. Women had a higher proportion of fulfilling 2-5 frailty criteria (21.5 %) compared to men (17.2 %). Socio-economic factors associated with frailty status included perception of childhood, stressful childhood events, educational attainment, and economic hardship in adulthood. A significant causal additive effect on the percentage of individuals fulfilling 2-5 frailty criteria was demonstrated for two composite outcomes: perception of childhood + educational attainment and stressful events in childhood + economic hardship in adulthood.

Conclusion: The study showed that joint exposure to adverse socio-economic factors in childhood and adulthood, potentiated the odds of frailty in older adults. Our findings corroborate the theory of cumulative dis/advantage.

Background: Frailty is an important and increasing clinical and public health problem. Within the United Kingdom (UK). Most data relating to the occurrence of frailty is derived from Caucasian groups. This study aimed to determine the influence of ethnicity on the occurrence of frailty in a large UK urban conurbation. We also looked at frailty-related risk of severe illness related to COVID-19 infection.

Methods: Using data from the Greater Manchester Health Record (GMCR), we analysed primary care electronic medical records of 534,367 men and women aged 60 years and over who were alive on 1st January 2020. We assessed frailty using an electronic frailty index (eFI) and categorised subjects as fit, mild, moderate, and severe frailty. We used logistic regressions to examine the association between moderate and severe frailty (eFI ≥ 0.25) and ethnicity adjusted with age, sex and area deprivation (as measured using Townsend Index). We also looked among those with a first positive COVID test, the influence of frailty on subsequent admission to the hospital within 28 days.

Results: The majority of subjects were White (84 %), with 4.7 % describing themselves as Asian or Asian British, and 1.3 % Black or Black British. The unadjusted prevalence of moderate to severe frailty (eFI ≥ 0.25) was 22.1 %. Compared to the prevalence of frailty in Whites (22.5 %), the prevalence was higher in those of Asian or Asian British ethnicity (28.1 %) and lower in those of Black/Black British descent (18.7 %). After adjustment for age, gender, and deprivation, the risk of frailty remained higher in Asians (Odds Ratio = 1.61; 95 % Confidence Intervals = 1.56-1.66) and lower in Black British (OR = 0.73; 95 % CI 0.68-0.78) compared to White British. Among those with a positive COVID-19 test, those with frailty were more likely to require admission to the hospital within 28 days (OR = 1.61; 95 % CI = 1.53, 1.69).

Conclusion: There is variation in the occurrence of frailty across Greater Manchester across ethnic groups, with higher frequency among those of Asian or Asian British descent and lower frequency among those of Black or Black British descent. This study has added to our understanding of the way that frailty prevalence maps across communities, in this case in a large European conurbation. Further research is required to understand the causes of ethnic variation in frailty and whether ethnicity influences frailty outcomes.

Background: Recent expert guidelines recommend that frailty assessments (FAs) encompass physical, functional, cognitive, social, and mental health domains. This systematic review examines FAs administered globally between 2015 to 2022 in geriatric participants (65 years and older) to characterize the parameters used to assess frailty.

Methods: Following PRISMA guidelines, we screened 3,859 articles and included 202 in the final analysis. FA parameters were coded into 45 health-related categories defined by the authors to evaluate the domains most frequently used.

Results: Across 39 countries, 291 FAs were identified, with an average number of 17.36 parameters per instrument. Of the 4,995 total parameters analyzed, 22.32 % assessed functional health or physical performance. Cognitive, mental, and social health were assessed by only 6.09 %, 6.35 %, and 5.01 % of parameters, respectively.

Conclusions: FAs overwhelmingly measure functional and physical health parameters with limited attention to cognitive, mental, and social domains. This imbalance suggests that instruments may fall short of capturing the multidimensional nature of frailty as recommended by recent guidelines. By cataloging current FAs, their components, and the degree to which they reflect comprehensive frailty definitions, this review highlights the need for further research and refinement of FAs to ensure accurate, holistic assessment across diverse clinical settings.

Gait is a complex, multifaceted process involving multiple organ systems. Both gait and transfer activities are key requirements for independent living. As individuals age, gait undergoes characteristic changes, including reduced walking speed, altered stride length, and increased variability. These changes are closely linked to the frailty syndromes of immobility, instability, cognitive impairment, incontinence, and iatrogenic harm. Alterations in gait and transfer activities can serve as early predictors of falls, increased dependency, cognitive decline, and depression. Urinary incontinence and nocturia are associated with reduced mobility, a higher risk of falls, and fractures. Notably, the urge to void itself can influence gait patterns. Medications, particularly anticholinergics and polypharmacy, further contribute to gait disturbances, compounding falls risk. Given its strong association with cognitive and functional decline, gait analysis is a crucial component of comprehensive geriatric evaluation. Recognising and addressing gait abnormalities can enhance patient outcomes by mitigating the broader impact on geriatric frailty syndromes.

Background: Community-based programs play a critical role in providing frail older adults with a safe environment to engage in physical activity. Satisfaction is a key indicator of such programs' acceptability while also playing a significant role in older adults' long-term participation in physical activity. Moreover, program leaders' satisfaction with training and confidence in program delivery are essential for ensuring the effectiveness and sustainability of community-based programs. The Walk On! program is a 12-week structured community-based program consisting of 24 sessions each lasting 60 min, designed for older adults with mobility challenges. Evaluating older adults' satisfaction with the Walk On program and program leaders' satisfaction with the training is crucial for informing strategies to facilitate broader dissemination and sustained implementation.

Objectives: To evaluate older adults' (1) satisfaction with the Walk On! program, (2) perceived benefits on walking ability and overall well-being, and (3) program leaders' satisfaction with the Walk On! training.

Design: Pilot implementation trial.

Setting: Four community organization sites located in North Carolina, USA.

Participants: 42 older adult participants (mean age 79 years old; 87% female) and 9 all-female program leaders.

Measurements: Older adult participants' survey was completed at the end of the 12-week program cycle. Program leaders' survey was completed at the end of the training workshops.

Results: Older adult participants reported high satisfaction with the Walk On! program (n = 42, 100%), and perceived improvements across multiple domains: including strength and endurance, social support and enjoyment, walking confidence, self-efficacy and goal setting, and balance after program participation. All program leaders (n = 9) rated the training as either excellent (67%) or good (33%) and reported that the training was relevant and provided adequate preparation to lead the Walk On!

Program:

Conclusion: The Walk On! program was acceptable and perceived as impactful among older adult participants, and program leaders were highly satisfied with the Walk On! training. Together, these positive findings support the scaling and expansion of Walk On! into additional community settings.

Background: The progression of sarcopenia with aging may be related to mitochondrial dysfunction due in part to altered mitochondrial dynamics (fusion, fission, mitophagy, and biogenesis). Previous work has identified altered expression of proteins associated with these processes in with aging, but whether further changes occur in sarcopenia remains unclear.

Objectives: The purpose of this study was to assess protein expression of markers of mitochondrial fusion (Mfn2, Opa1), fission (Drp1, Fis1), mitophagy (Parkin), biogenesis (PGC-1α), and content (Complex IV: CIV) in sarcopenic and non-sarcopenic older adults. We also determined whether resistance training affected skeletal muscle mitochondrial content and expression of mitochondrial quality control proteins in sarcopenic older adults.

Design: Longitudinal exercise training study, with cross-sectional baseline comparison.

Setting and participants: Ten older adults with mild-moderate sarcopenia, plus ten non-sarcopenic, matched older adults from Maryland, USA.

Intervention: Twelve-week resistance training.

Measurements: Strength, sarcopenic index (ALM/BMI: appendicular lean mass divided by body mass index), body composition, and mitochondrial morphology and protein expression in vastus lateralis muscle.

Results: No differences in protein expression were observed between sarcopenic and non-sarcopenic participants at baseline; however, ALM/BMI was inversely related to CIV expression (r = -0.55, P = 0.013) across all subjects. Similarly, lean body mass and ALM correlated inversely with expression of the fusion protein Opa1-S (r = -0.55 - -0.51, P ≤ 0.022). Resistance training increased strength in sarcopenic older adults by 13 % (P = 0.02), but this group's expression of mitochondrial quality control proteins was mostly unaltered.

Conclusions: The presence of sarcopenia identified by ALM/BMI was not associated with changes in protein expression that are consistent with impaired mitochondrial dynamics beyond those changes that might occur with aging alone. While short-term resistance training increased strength in older adults with sarcopenia, this was not accompanied by changes in protein expression, with the possible exception of fusion protein Mfn2.

Background: There has been success in implementing frailty education for healthcare professionals, but there remains a need to improve the knowledge and skills of researchers and healthcare professionals to develop, implement and evaluate frailty-focused research.

Objectives: This paper describes how the Australian Frailty Network developed and evaluated a virtual community of practice (VCOP), a proven model for fostering knowledge mobilisation, to support researchers and healthcare professionals in advancing frailty research and practice in Australia.

Design: Mixed methods.

Setting: Australian research and healthcare workplaces.

Participants: Researchers and healthcare professionals.

Measurements: A survey of prospective members sought to define the VCOP's purpose, membership and structure. An evaluation was undertaken 18 months post-commencement, guided by the RE-AIM framework to assess reach, effectiveness, adoption, implementation and maintenance.

Results: Fifty-five prospective members completed the initial survey. There was wide agreement from respondents to be inclusive in defining membership. The preferred purposes of the group included networking, opportunities to gain feedback, review frailty research, and knowledge and skill acquisition. In response, Frailty Nexus was launched, with three core components ('Learning Link-Up', online learning events; 'Nexus News', newsletter sharing learning and research opportunities; 'Nexus Nook', a library of shared resources). Membership totalled 618 from 81 organisations. Ninety-six percent of surveyed members expressed satisfaction with Frailty Nexus.

Conclusions: Frailty Nexus is contributing to capacity building in multidisciplinary and translational frailty research. This VCOP could serve as a model that can be adapted by others to improve research outcomes and policy implementation.

Physical activity is protective against osteoarthritic development and is among the best approaches to manage frailty, which can be characterized as the presence of health deficits. It is unclear whether overall health of a person influences the relation between physical activity and knee-joint health.

Objective: Test the hypothesis that physical activity is associated with knee osteoarthritis symptoms and investigate frailty as a moderator.

Design: This cohort observational study included participants (n = 1351; 728 females) from the Osteoarthritis Initiative, aged 45-79 (60±9) years. Hip-worn accelerometers were used to quantify free-living stationary time, light (LPA) and moderate-to-vigorous-physical-activity (MVPA). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) defined symptom progression. Baseline frailty was determined via a 31-item Frailty Index and participants grouped into Non-Frail (0-0.09), Very-Mild Frailty (0.1-0.19), and Mild Frailty+ (>0.2). Accelerometry and WOMAC were determined at 72-month follow-up.

Results: MVPA (18±19mins/day) was negatively related to WOMAC outcomes (β<-0.0155, p < 0.0022), while LPA (274±79mins/day) was not (β<0.0005, p > 0.3061). Stationary time (606±88mins/day) was positively associated with WOMAC stiffness (β=0.0009, p = 0.0147). Frailty (0.134±0.077) did not moderate LPA and WOMAC relations (p > 0.308). A stronger negative relation between MVPA and WOMAC pain (β=-0.0092, p = 0.041) was observed in the Mild Frailty+ group compared to the Very-Mild Frailty and Non-Frail groups. A stronger positive relation between Stationary time and WOMAC stiffness (β=0.0013, p = 0.012) was observed in the Mild Frailty+ groups compared to the Very-Mild Frailty and Non-Frail groups.

Conclusion: Engaging in MVPA and limiting stationary time may be more beneficial on knee osteoarthritis pain and stiffness among frailer older adults.