Journal of Frailty & Aging最新文献

Background: Frailty is a geriatric syndrome characterized by increased individual vulnerability with an increase in both dependence and mortality when exposed to external stressors. The use of Frailty Indices in routine clinical practice is limited by several factors, such as the cognitive status of the patient, times of consultation, or lack of prior information from the patient.

Objectives: In this study, we propose the generation of an objective measure of frailty, based on the signal from hand grip strength (HGS).

Design and measurements: This signal was recorded with a modified Deyard dynamometer and processed using machine learning strategies based on supervised learning methods to train classifiers. A database was generated from a cohort of 138 older adults in a transverse pilot study that combined classical geriatric questionnaires with physiological data.

Participants: Participants were patients selected by geriatricians of medical services provided by collaborating entities.

Setting and results: To process the generated information 20 selected significant features of the HGS dataset were filtered, cleaned, and extracted. A technique based on a combination of the Synthetic Minority Oversampling Technique (SMOTE) to generate new samples from the smallest group and ENN (technique based on K-nearest neighbors) to remove noisy samples provided the best results as a well-balanced distribution of data.

Conclusion: A Random Forest Classifier was trained to predict the frailty label with 92.9% of accuracy, achieving sensitivities higher than 90%.

Background: Sarcopenia contributes to increased hospitalizations, cognitive impairment, falls, and all-cause mortality. Current diagnostic methods, like body Magnetic Resonance Imaging and dual-energy X-ray absorptiometry, are costly and impractical. Notably, there is no standardized approach for assessing sarcopenia in dementia clinics. We studied the association of temporal muscle thickness (TMT) with key prognostic factors in people with Alzheimer's disease (AD) and Lewy body dementia (DLB).

Methods: We utilized data from the DemVest, a longitudinal cohort study, and included participants clinically diagnosed with mild AD or DLB. TMT was measured using baseline MRI scans. The main outcome measures were cognition, functional performance, malnutrition, and mortality. Various demographic and clinical factors were considered as potential confounders.

Results: The AD sample was mainly composed by females(76.9%), age 75.5(SD 6.95). The DLB sample was mostly composed by men(63.6%), age 75.8(SD 6.85). At baseline TMT showed significant association with cognitive performance in the DLB group (Est.=0.593, p-value=0.049). The longitudinal analysis revealed significant associations between TMT and functional decline in DLB (Est.=-0.123, p-value 0.007) and increased mortality in the whole sample(HR=0.815, p-value 0.002), the AD group (HR=0.834 p-value=0.031), and the DLB group (HR=0.767 p-value=0.019) respectively. These associations remained significant after adjusting for confounders.

Conclusions: The TMT measurement was associated with mortality in both dementia groups as well as with cognition and function in DLB. TMT emerges as a cost-efficient measure of muscle mass indicating clinical relevance and utility in healthcare settings. Implementing TMT assessment could improve patient care and aid in identifying individuals at risk of adverse outcomes in mild dementia.

Whether anti-inflammatory medications such as aspirin can lower the risk of frailty is an active area of investigation. In previous studies, we reported that regular aspirin use started in midlife was associated with a lower risk of frailty at older age. We therefore sought to further examine the relationship between inflammatory biomarkers, frailty and aspirin use in a pilot nested case-control study of 300 participants aged ≥60 years with available data to calculate a frailty index from the Physicians' Health Study, a completed randomized trial of aspirin that began in 1982. We selected 150 individuals who were frail (frailty index >0.2) and 150 who were not frail (frailty index <0.1). We then matched 29 low users of aspirin (≤60 days/year) 3:1 to 87 regular users of aspirin (>60 days/year). After matching on age, smoking status, history of diabetes and CVD, there was no significant association between aspirin use and level of frailty among those with elevated inflammatory biomarkers (all p>0.05). In this pilot study we did not find evidence of a mediation effect of CRP, TNFR-2 or IL-6 on the association between aspirin and frailty. Additional work is needed to elucidate the potential mechanistic pathways through which medications such as aspirin may be linked with frailty.

Background: People live longer, and frailty has become an important problem in the acute hospital setting. Increasingly the association between frailty and hospital-acquired complications has been reported. However, the overall burden of frailty in this setting has not been described. Therefore, we undertook this study to describe the association between frailty and the risk of hospital-acquired complications among older adults across our five acute hospitals and to estimate the overall burden of frailty attributable to these complications.

Methods: Consecutive admissions among women and men aged ≥ 65 years across our local health district's five acute hospitals, between January 2010 and December 2020, were included to investigate the association between the number of cumulative frailty deficit items and hospital-acquired complications and infections. The numbers of cumulative frailty deficits are presented in four groups (0-1 item, 2 items, 3 items, and 4-13 items). Individual events such as falls, delirium, pressure injuries, thromboembolism, malnutrition, and multiple types of infections are also presented. The overall burden of frailty was estimated using a population-attributable-risk approach.

Results: During the study period there were 4,428 hospital-acquired complications, among 120,567 older adults (52% women). The risk of any hospital-acquired complication (HAC) or any hospital-acquired infection (HAI) increased as the cumulative number of frailty deficits increased. For the 0-1 deficit item group versus the 4-13 items group, the risk of any HAC increased from 5.5/1000 admissions to 80.0/1000 admissions, and for any HAI these rates were 6.2/1000 versus 58.2/1000, respectively (both p-values < 0.001). The 22% (27,144/120,567) of patients with 3 or more frailty deficit items accounted for 63% (2,774/4,428) of the combined hospital-acquired complications and infections. We estimated that the population-attributable risks of any hospital-acquired complication or infection were 0.54 and 0.47, respectively.

Conclusion: We found that an increasing number of cumulative frailty deficit items among older patients are associated with a higher risk of hospital-acquired complications or infections. Importantly, frail older adults account for most of these adverse events.

Background: Frailty is an indicator of individual vulnerability and differentiates health status among people of the same chronological age.

Objectives: This study aimed to determine whether baseline frailty index (FI) was associated with systemic anticancer therapy treatment outcomes in older adults with solid cancers.

Design: Retrospective cohort study.

Setting: Major metropolitan outpatient oncology service.

Participants: Adults aged over 65 years with a solid malignancy who had been referred for consideration of systemic therapy, and had completed a baseline frailty assessment between January 2019 and July 2021.

Measurements: Frailty had been prospectively assessed with a 58-item FI derived from a geriatric oncology nurse assessment prior to initial oncologist appointments. Primary outcome was treatment completion, and secondary outcomes included incidence of high-grade treatment-related toxicity or unplanned hospital admissions, and survival outcomes. Univariate and multivariable regression analyses were conducted to test the association between treatment outcomes and baseline FI. Co-variates included age, sex, performance status, treatment intent, and stage. Kaplan-Meier and cox proportional hazard analysis were conducted for survival analysis.

Results: The median FI (IQR) was 0.24 (0.15-0.31) and 43% were frail (FI>0.25). FI was positively correlated with ECOG, however 28% of ECOG 0-1 were frail. In multivariable regression analyses, each 0.10 increase in FI was associated with an increased likelihood of not completing or not receiving treatment (OR 1.37, 95% CI 1.02-1.84; p=.04), treatment-related toxicity (OR 1.60, 95% CI 1.14-2.23; p<.01) and unplanned hospital admissions (OR 1.61; 95% CI 1.16-2.25; p<.01). Frail patients had increased mortality (adjusted HR 2.81, 95% CI 1.42-5.56; p<.01). Age did not predict treatment completion, toxicities, or survival.

Conclusion: Baseline FI is a granular measure that can help to identify frailer older patients who are more likely to require tailored therapy and support, and less frail older patients who are more likely to tolerate treatment.

Background: There is currently no standardized protocol for the measurement of gait speed in older adults, particularly regarding the choice between static versus dynamic start.

Objectives: This study aimed to assess the impact of removing the initial phase on gait speed measurement and compare the correlation of different measurement methods with other physical performance metrics.

Design: A cross-sectional study.

Setting: A geriatric clinic in a tertiary hospital in Seoul, Korea.

Participants: Adults aged 65 years or older who underwent physical performance examinations during comprehensive geriatric assessments (n = 511).

Measurements: A one-dimensional light detection and ranging device was used to obtain real-time gait signal data and measure the participants' gait speed. Descriptive statistics were obtained for the acceleration phase. Various lengths of the initial phase were removed to determine the point at which gait speed plateaued. Correlations between four-meter gait speeds, with different initial phase lengths, and chair stand and balance test results were examined.

Results: The mean ± standard deviation of the acceleration phase (m) was 0.92 ± 0.51. The removal of various initial phase lengths showed that 2 m gait speed based on dynamic start (0.5 m) significantly differed from static start (0.7 m/s versus 1.05 m/s, p<0.001). Gait speed showed an increase with the removal of longer initial phases but plateaued after removing 1 meter. This change lacked clinical significance after removing 0.5 meters. Dynamic start gait speed exhibited superior discriminative ability in chair stand and balance tests compared to static start gait speed.

Conclusion: Static start underestimates gait speed, while dynamic start aligns better with other physical performance results. An acceleration phase of 0.5 to 1 meter appears sufficient, but further studies are needed to optimize gait measurement methods.

Background: The World Health Organization (WHO) introduced the Integrated Care for Older People (ICOPE) approach to assist communities in evaluating the intrinsic capacities of older adults and proposing strategies to prevent, mitigate, or reverse declines. This study represents the inaugural attempt to assess intrinsic capacities among older adults in Singapore, aligning with the nation's Healthier Singapore (Healthier SG) initiative aimed at enhancing quality of life.

Objectives: This study aims to investigate the feasibility of implementing Step 1 screening of the ICOPE framework, which assesses cognition, locomotion, vitality, psychological state, visual and auditory functions, within the Singapore context.

Design, setting, and participants: Using a mixed-method approach, this cross-sectional study established a baseline understanding of the levels of intrinsic capacity in 367 community-dwelling older adults in Singapore (mean age 71.8 years), elucidated the experiences of administering the ICOPE Step 1 screening tool and the formulation of personalized care plans from the perspective of 25 assessors.

Measurements: Participants completed ICOPE Step 1 screening, providing basic demographic and health profiles, while assessors engaged in focus group discussions.

Results: Among older participants, 284 exhibited signs of decline in intrinsic capacity. The primary areas of decline were visual impairment (42.0%), hearing loss (33.5%), and cognitive deterioration (31.3%), followed by limited mobility (24.3%), malnutrition (16.1%), and depressive symptoms (16.1%). Assessors found the ICOPE screening tool user-friendly and appreciated its person-centred approach, noting its integration with care plans, which many other tools lacked. They were confident in Singapore's capacity to adopt the ICOPE approach, citing existing practices in assessing intrinsic capacity domains and integrated care models.

Conclusion: Critical steps for successful implementation of the ICOPE framework include follow-up interventions like self-management strategies for declining intrinsic capacity, diagnostic assessments, and routine monitoring. Coordination between healthcare clusters and community care networks is essential for its success.

Background: Population aging is occurring worldwide. As a result, frailty and disability are in the full interest of practice, policy, and science. An increase in healthcare utilization is an adverse outcome of frailty and disability.

Objective: The aim of the present study was the prediction of six indicators of healthcare utilization by frailty and disability measures. The six indicators of healthcare utilization of interest were: use of informal care, number of visits to a general practitioner, hospital admission, receiving nursing care, receiving personal care, and contacts with (health)care professionals.

Methods: We used a sample of 484 people that was randomly drawn from the municipality of Roosendaal (the Netherlands), a municipality with 78,000 inhabitants. A subset of people who completed the Tilburg Frailty Indicator (TFI) at baseline and the Groningen Activity Restriction Scale (GARS) questionnaires was used with a nine-year followup. We used generalized estimation equations (GEE) to predict the six indicators with the frailty measures (physical, psychological, and social scores) and disability measures (ADL and IADL scores). We also performed GEE analyses adjusted for age, gender, and multimorbidity from part A of the TFI at baseline.

Results: The significant predictors were different for each indicator. However, the physical frailty score, the ADL score, and the IADL score often emerged as significant predictors. These three variables predicted several indicators of healthcare utilization: use of informal care, number of visits to a general practitioner, hospital admission, receiving nursing care, receiving personal care, and contacts with (health)care professionals. The social score was found to be significant for the indicator use of disciplines.

Conclusions: In conclusion, our study showed that in particular physical frailty, and ADL and IADL disability predicted healthcare utilization in community-dwelling people aged 75 years or older. It is important that care and welfare professionals pay attention to physical frailty and both ADL and IADL disability aiming to diminish frailty and disability and preventing intensive healthcare utilization and related costs. Future research will have to focus on more representative Dutch municipalities in order to get a more reliable and accurate picture of the disciplines used by people with frailty and disability.

Objectives: To compare the discriminative capabilities for the manifestation of sarcopenia or physical frailty between serum creatinine- and cystatin C-derived indices among community-dwelling older adults.

Design: Cross-sectional study.

Setting: Primary Care and Community.

Participants: We utilized a subset of data from the Frail Elderly in the Sasayama-Tamba Area (FESTA) study, which was initiated in 2015 to gather comprehensive information on various health-related parameters among community-dwelling older individuals (age ≥65 years).

Measurements: Five serum creatinine-cystatin C based indices including the Sarcopenia Index, the serum creatinine/cystatin C ratio, the disparity between serum cystatin-C-based and creatinine-based estimated GFR, the total body muscle mass index (TBMM), and the prediction equation for skeletal muscle mass index (pSMI) were employed. Sarcopenia and physical frailty were identified based on the Asian Working Group for Sarcopenia criteria and the revised Japanese version of the Cardiovascular Health Study criteria, respectively. The receiver operating characteristic (ROC) and logistic regression analyses were performed to assess the discriminative abilities of these tools.

Results: In the analysis of 954 participants, 52 (5.5%) were identified with sarcopenia and 35 (3.7%) with physical frailty. Regarding sarcopenia discrimination, TBMM and pSMI both exhibited area under the curve (AUC) values exceeding 0.8 for both men and women. Concerning the identification of physical frailty, AUC values ranged from 0.61 to 0.77 for males and 0.50 to 0.69 for females. In the multivariate logistic regression analyses, only TBMM and pSMI consistently displayed associations with sarcopenia, irrespective of sex (P<0.001, respectively). On the other hand, no consistent associations were observed between the indices and physical frailty.

Conclusions: This study provides a robust association of a serum creatinine- and cystatin C-derived indices, especially TBMM and pSMI, with sarcopenia among community-dwelling older adults. Conversely, the application of these indices for the screening of physical frailty has its constraints, necessitating further investigation.

Background: The study investigates the correlation between muscle mass and physical activity level measured objectively and subjectively in older adults who fall or are at high risk of falling.

Methods: FITNESS (Fall Interest to Target Newly Sarcopenic Society) is a multi-center (French university hospitals of Angers, Lille, Limoges and Orléans), cross-sectional, observational study of routine care within a French multidisciplinary hospital consultation. Inclusion criteria were ≥ 75 years old, living at home and consulting for fall or gait disorder. A standardized geriatric assessment, muscle mass evaluation by impedancemetry, physical activity by continuous actimetry (5 days) and Incidental and Planned Exercise Questionnaire (IPEQ) were performed at patient inclusion.

Results: 170 people aged 75 and over were included in the FITNESS study (mean age 82.9 ±4.7 years, women 72.9%). Muscle mass (whole body and lower limbs) correlated with active energy expenditure (AEE, ρ whole body = 0.32, p-value < 0.001; ρ lower limbs = 0.25, p-value = 0.003), but not with number of daily steps, nor with IPEQ score. Multivariate analysis of whole-body muscle mass showed a positive and significant association with AEE and albumin levels and for lower limb muscle mass, a positive association with AEE and Charlson.

Conclusion: This study suggests that in the particular population of older adults who fall and/or are at high risk of falling, loss of muscle mass correlates with reduced physical activity. So subjects who fall or at high risk of falling constitute a special group for whom the fight against sedentary lifestyles and the maintenance of physical activity should be a dual priority.