Journal of Frailty & Aging最新文献

Background: There is a need to identify vascular and geroscience-relevant markers and mediators that can physiologically link ageing to vascular disease. There is evidence of specific T cell subsets, all influenced by age, that exert positive and negative effects on vascular health. CD31+, termed angiogenic T cells, have been linked to vascular repair whereas CD28null, termed senescent T cells, display pro-inflammatory and cytotoxic effector functions.

Objective: This study sought to determine the combined influence of increasing age and frailty status on these circulating CD31+ and CD28null T cell subsets.

Methods: This cross-sectional study recruited four different cohorts of men and women; young (20-30 years, n=22), older (65-75 years, n=17), robust non-frail (76+ years, n=17), and frail (76+ years, n=15) adults. Frailty was determined using the Fried Frailty method. T cell subsets were determined by whole blood flow cytometry based on the expression of CD3, CD4, CD8, CD31 and CD28. Cognitive impairment (CI) was measured via the Montreal Cognitive Assessment test.

Results: Whether expressed as circulating counts or as a % of total T cells, there was a progressive decrease (p<0.05) in CD31+ T cells with increasing age but paradoxically higher values (p<0.05) in the frail compared to the robust non-frail group. These changes were similar in the CD4+ and CD8+ fractions. CD28null T cells were considerably higher (p<0.05) in the frail compared to the robust non-frail group, including in the CD8+ (47% vs 29%, p<0.05) and CD4+ (4% vs 1%, p<0.05) fractions. CD28null T cell percentage was also higher (p<0.05) in those with moderate CI compared to mild CI and normal function.

Conclusion: CD8+CD28null T cells are considerably elevated in frailty and with cognitive impairment and may serve as a useful target for intervention. Currently, the utility of CD31+ T cells as an ageing biomarker may be confined to healthy ageing cohorts.

The impact of depression on functional recovery in older adults following hip fracture is unclear. We aimed to examine the association between depression and 4-month functional recovery of older inpatients with hip fracture. We conducted a longitudinal cohort study on older hip fracture patients admitted to an Orthogeriatric Unit between January 2021 and February 2022 within the multicenter "Gruppo Italiano di Ortogeriatria" network. Depression was assessed retrospectively from patient medical history. Poor functional status was a Cumulated Ambulation Score ≤4 after 4 months. The sample included 154 patients (72.1% females, mean age 81.9). A history of depression was reported in 25.3% of participants. Depression was independently associated with higher odds of poor functional outcome (OR = 2.94, 95%CI: 1.15 - 7.85). Depression predicts a poorer functional recovery after hip fracture. The identification and treatment of depression might promote better physical recovery in orthogeriatric patients.

Background: In 2015, the World Health Organization (WHO) introduced the concept of intrinsic capacity (IC) to define healthy aging based on functional capacity. In this scoping review, we summarized available evidence on the development and validation of IC index scores, the association of IC with health-related factors, and its biological basis. The review specifically focused on identifying current research gaps, proposed strategies to leverage biobank datasets, and opportunities to study the genetic mechanisms and gene-environment interactions underlying IC.

Methods: The literature search was conducted across six databases, including PubMed, CINAHL, Web of Science, Scopus, AgeLine, and PsycINFO, using keywords related to IC.

Results: This review included 84 articles, and most of them (n=38) adopted the 5-domains approach to operationalize IC, utilizing correlated five factors or bifactor structures. Intrinsic capacity has consistently shown significant associations with socio-demographic and health-related outcomes, including age, sex, wealth index, nutrition, exercise, smoking, alcohol use, ADL, IADL, frailty, multimorbidity, and mortality. While studies on the biological basis of the composite IC are limited, with only one study finding a significant association with the ApoE gene variants, studies on specific IC domains - locomotor, vitality, cognitive, psychological, and sensory suggest a heritability of 20-85% of IC and several genetic variants associated with these subdomains have been identified. However, evidence on how genetic and environmental factors influence IC is still lacking, with no available study to date.

Conclusion: Our review found that there was inconsistency in the use of standardized IC measurement tools and indicators, but the IC indices had shown good construct and predictive validity. Research into the genetic and gene-to-environment interactions underlying IC is still lacking, which calls for the use of resources from large biobank datasets in the future.

Background: Older patients in hemodialysis have high prevalence of malnutrition that is often associated with rapid weight loss till cachexia.

Objectives: We aimed to investigate whether in older patients undergoing hemodialysis the association between poor nutritional status and mortality may be independent of comorbidities and other risk factors.

Design: Retrospective longitudinal study.

Setting: Unit of Nephrology, Dialysis and Kidney Transplantation of the Policlinic Hospital of Milan, Milan, Italy.

Participants: A total of 107 prevalent patients undergoing hemodialysis for at least three months.

Measurements: Sociodemographic, clinical, and biological data were recorded. Unintentional weight loss (UWL) was defined as loss of body weight > 5% in 3 months or > 10% in 6 months. We computed a 21-item Frailty Index that included clinical conditions associated with malnutrition and mortality in this population. Unadjusted and adjusted Cox proportional hazard models were performed to test the association of UWL, albumin and transferrin levels with death. Survival analyses based on Kaplan-Meier estimates were performed.

Results: Patients' age was 79 (±7.7) years; 38 (35%) were women. Thirty-one patients (29%) died during follow-up. Eighteen (16.8%) patients experienced UWL during the follow-up period. UWL was positively associated with death in the unadjusted model and even after the progressive inclusion of potential confounders. Low albumin levels were positively associated with death only in the unadjusted and partially adjusted models while low transferrin levels were not associated with death in none of the models. Mortality was significantly higher in those patients experiencing both UWL and albumin levels below 3.5 mg/dL.

Conclusions: In older patients undergoing chronic hemodialysis UWL is associated with mortality independently of comorbidities and other risk factors. Patients presenting both UWL and low albumin levels were those experiencing the worst outcomes in terms of mortality.

Background: The decision regarding the use of antibiotics in hospice care, whether to initiate, defer, or discontinue therapy, presents challenges. This study aims to explore the characteristics of terminally ill patients associated with antimicrobial use in hospice.

Methods: Data are from a registry study enrolling patients admitted to hospice after discharge from a hospital. Three-hundred-sixty-six persons aged 18 and older were considered for the present analysis. Collected data encompassed demographic information, medical history, and outcomes assessed through a comprehensive geriatric assessment.

Results: Among the patients admitted to the hospice, 242 individuals did not receive antibiotics (Group A), and 91 (24.6%) were already undergoing antibiotic therapy at admission. Of these, 59 (65.6%) patients (Group B) continued the treatment, while 32 (35.6%; Group C) discontinued it. Additionally, 33 patients (Group D) initiated an antibiotic treatment during their hospice stay. Patients undergoing antibiotic therapy (Group D) presented higher residual functions than the other groups, especially compared to Group C (p<0.001). The four groups also differed in mortality risk. In particular, Cox proportional hazard models indicated that Group D presented a lower risk of death than Group A, even after adjustment for age, sex, estimated poor prognosis and two different performance status (PS ECOG, Karnofsky PS).

Conclusion: A relatively high number of persons admitted to the hospice receive antibiotic therapy without apparent benefit. The decision to prescribe antibiotics in hospice care appears to be based on the patient's functional performance and estimated prognosis.

Background: While physical activity (PA) can reduce physical frailty, the specific intensity and duration of PA required to prevent frailty are yet to be defined.

Objectives: This study aimed to investigate the relationship between objectively measured PA or sedentary behavior (SB) and physical frailty and to explore the theoretical effect of replacing SB with different intensities of PA on the risk of frailty.

Design: Cross-sectional study.

Setting: Community-based assessments.

Participants: Independently living adults aged 85-89 years participating in the Kawasaki Aging and Wellbeing Project.

Measurements: PA was measured using a triaxial accelerometer for a minimum of 10 h per day over a minimum of 3 days. Physical frailty was measured using the revised Japanese version of the Cardiovascular Health Study criteria. Physical frailty was classified as non-frail, pre-frail, and frail. The relationship between PA and frailty was assessed using analysis of covariance. The effect of replacing SB with light-intensity PA (LPA) or moderate-to-vigorous-intensity PA (MVPA) on the risk of frailty was estimated using multinomial logistic regression and an isotemporal substitution model.

Results: The analysis included 1004 participants (503 men and 501 women) of whom 242 were classified as frail. The mean step count, MVPA, and LPA were lower, and SB was higher in the frail group than in the non-frail group. SB replacement with MVPA for 10 min/day was associated with a significantly lower odds of frailty (odds ratio [95% confidence interval]: pre-frail men, 0.86 [0.77, 0.96]; frail men, 0.70 [0.60, 0.83]; pre-frail women, 0.77 [0.66, 0.90], frail women, 0.59 [0.47, 0.75]). SB replacement with LPA was not significantly associated with frailty odds in men or women.

Conclusions: Replacing 10 min of SB with MVPA was associated with lower risk of frailty in adults aged 85-89 years. These findings require confirmation in longitudinal and intervention studies.

Background: Falls are a leading cause of disability, institutionalization and mortality for older adults. More effective strategies to prevent falls are essential and may help at-risk older adults continue to live independently. While exercise programs with in-person supervision reduce fall risk, there are numerous barriers associated with older adults' participation in such programs. Digitally delivered exercise interventions utilizing wearable technology may be an alternative fall prevention strategy for many vulnerable older adults.

Objectives: To evaluate the feasibility of a scalable, multicomponent, remotely delivered, digital fall prevention exercise intervention for community-dwelling older adults with elevated fall risk.

Design: This single arm intervention trial enrolled older adults who reported ≥ 2 falls, or ≥ 1 injurious fall in the past year, or fear of falling.

Study setting and participants: Community-dwelling adults aged ≥ 65 years were recruited from the greater Boston region, MA, USA.

Intervention: The 12-week multicomponent intervention was delivered via tablet and wearable sensors and consisted of a program of progressive moderate-intensity strength, power and balance training, adaptive aerobic walking exercise, regular coaching calls and digital motivational messaging.

Measurements: Intervention adherence and measures of intervention feasibility, acceptability, and appropriateness were evaluated. Intervention effects on measures of fall risk, physical and cognitive performance, and other measures of well-being were also examined.

Results: Twenty-three participants enrolled in the study and 20 completed the intervention (mean age: 76.3±5.5 yrs; BMI: 26.9±4.6 kg/m2; short physical performance battery score: 8.8±2.2; 70% female). Overall adherence rates were 84.4±14.6% with no serious adverse events. Significant reductions in fear of falling and improvements in cognition and technology readiness were elicited (p≤0.04).

Conclusion: This study has demonstrated the feasibility of a multicomponent digital fall prevention exercise intervention for at-risk older adults. Additional studies are warranted to establish the efficacy of this highly scalable fall prevention strategy.