Journal of Frailty & Aging最新文献

Background: Walking is a fundamental daily activity representing health status and physical condition. The number of steps taken in a given time period is widely used in research areas such as aging, geriatrics, gerontology, public health, and preventive medicine. However, the underlying mechanisms of step counts are not well understood.

Objectives: To investigate daily step counts associated with temperature, transportation, and marital status.

Design: Time series analysis of daily steps using built-in healthcare applications on smartphones.

Setting: Government-designated, well-developed urban cities in Japan: Fukuoka, Kawasaki, Kobe, Kyoto, and Saitama.

Participants: Respondents totaled 622 40- to 79-year-olds, comprising 370 males and 252 females.

Measurements: The mean period of our retrospective data was 2,344 days.

Results: Seasonal-trend decomposition using loess was applied to time series steps. With the high coefficient of determination R²: 0.798, an absolute value function was fitted between temperature and the mean daily steps of the seasonal component. Furthermore, ordinary train usage in Saitama, Kawasaki, and Fukuoka was significantly greater than that in Kobe and Kyoto by 14.1 points (p=0.001). Moreover, married and divorced or bereaved males' mean daily step counts were significantly larger than those of females' by 1,832 (p=0.001) and 2,480 (p=0.001), respectively. By contrast, the difference in the mean daily step counts for unmarried males and females was only 100.

Conclusions: This study presents significant associations between mean daily steps and the factors of temperature, transportation, and marital status. These associations can alleviate biases in step research by area and season to facilitate better step count comparisons in many research fields.

Background and objectives: The present study examined the associations between sarcopenia, operationalized through muscle strength or muscle power, and health parameters in Italian community-dwelling older adults.

Design: Cross-sectional study.

Setting: Unconventional settings across Italy.

Participants: Italian older adults (65+ years) who provided a written informed consent.

Measurements: Physical function was evaluated according to isometric handgrip strength (IHG) and 5-time sit-to-stand (5STS) performances. Muscle power parameters were estimated based on 5STS values. Sarcopenia was operationalized according to the presence of low physical function (i.e., IHG or 5STS), or low muscle power, plus low appendicular skeletal muscle mass. Health parameters included the capacity to perform the 400 m test, adherence to the Mediterranean (MED) diet, practice of physical activity (PA), blood pressure (BP) values, blood concentration of total cholesterol and glucose, verbal fluency, sleep quality, and self-reported health status.

Results: Results indicated that sarcopenic indexes had a poor-to-moderate level of agreement. Moreover, results indicated that operationalizing sarcopenia using muscle power measures provided exclusive or stronger associations with health parameters. Specifically, older adults classified as sarcopenic based on muscle power values were less likely to complete the 400-meter walk test, more likely to engage in PA, reported poorer self-rated health, and showed lower adherence to the MED diet.

Conclusions: Findings of the present study indicated that sarcopenia indexes based on muscle strength or muscle power capture different aspects of older adults' health. Specifically, operationalizing sarcopenia using muscle power measures provided exclusive or stronger associations with health parameters.

Background: Background: Frailty significantly impacts healthy aging, yet lifestyle interventions may reduce its prevalence. This study investigated the association between a comprehensive lifestyle score, comprising eight modifiable factors (diet, physical activity, smoking, sleep, body mass index [BMI], non-HDL cholesterol, blood glucose, and blood pressure), and frailty risk in older adults, identifying key components for targeted interventions.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES, 2005-2018), we analyzed 10,065 adults aged ≥60 years (mean age: 69.61, 54.97 % female). Each lifestyle factor was scored from 0 to 100, and frailty was defined using a 49-item index (>0.21). Weighted logistic regression assessed individual associations, restricted cubic spline (RCS) analysis explored dose-response relationships, and quantile g-computation evaluated joint effects.

Results: Higher scores for dietary score (OR=0.69, 95 % CI: 0.52-0.90, score 100 vs. 0), non-smoking (OR=0.62, 95 % CI: 0.51-0.75), sleep (OR=0.29, 95 % CI: 0.17-0.49), blood glucose (OR=0.27, 95 % CI: 0.17-0.44), and blood pressure (OR=0.43, 95 % CI: 0.30-0.61, score 25 vs. 0) were associated with lower frailty risk (all P < .05). Diet and non-HDL cholesterol showed no linear association; smoking, BMI, blood glucose, and blood pressure exhibited non-linear patterns (P<.05). A simultaneous one-level increase in all lifestyle factors reduced frailty risk by 94 % (95 % CI: 92-95 %), with physical activity, blood glucose, and sleep as primary contributors.

Conclusion: These findings highlighted the association between specific lifestyle factors and reduced frailty risk, underscoring the need for prospective studies to prioritize interventions for frailty prevention.

Frailty is a clinical syndrome characterized by diminished physiological reserves and increased vulnerability to stressors. While frailty has been largely studied in Alzheimer's disease, few study focused on Lewy body dementia (LBD). Beyond frailty, the World Health Organization recently highlights the concept of intrinsic capacity (IC), offering a promising framework for the early identification and intervention to mitigate the risk of frailty and disability in older adults. IC refers to an individual's physical and mental abilities (including five dimensions: sensory, psychology, locomotion, vitality and cognition), which support the maintenance of functional capacity and promote healthy aging. In this review, we aimed to describe the prevalence of IC decline in LBD and its potential consequences. While few studies focused specifically on this question, we found evidence in the literature of a higher prevalence of IC decline in LBD, compared to cognitively unimpaired older adults and to Alzheimer's disease patients. If future studies are needed to confirm these results, we assume that IC assessment and monitoring in LBD may be a further step towards a better integrated and personalized care for patients. This may open the avenue to develop specific tailored interventions, to decrease disability and increase quality of life and "healthy ageing" of patients despite the presence of LBD.

Background: There is urgency to manage frailty due to its increasing prevalence. The Geriatric Service Hub (GSH) is a novel programme in Singapore, which aims to manage frailty amongst community-dwelling older adults.

Objectives: We aimed to (1) assess the effectiveness of the GSH through patient-outcomes including patient activation, functional status, and quality-of-life (QoL), and (2) assess impact on patient-outcomes through different levels of frailty using the Clinical Frailty Scale (CFS) scores.

Design: Single-arm pre-post design.

Setting: Community-based health and social care provider PARTICIPANTS: 218 GSH patients, aged≥65, with CFS4 to CFS7.

Intervention: Patients received comprehensive geriatric assessments in community-based settings and had individualised care plans formed by a multi-disciplinary care team. Patients were then referred to health and social services located in the community based on identified needs.

Measurements: Functional status (Barthel Index), Patient activation (Patient Activation Measure), health-related QoL (EuroQoL 5-dimension 5-level tool) and the emotional-related QoL (Control, Autonomy, Self-realisation, and Pleasure tool). Measurements administered at baseline, 3- and 6-months post-enrolment. Analysis included unadjusted t-tests and multi-level mixed-effects linear regression.

Results: We studied 191 (87.6 %) participants who completed all 3-timepoints. Compared to baseline, functional status was maintained at 3-months (M_diff=-0.2, 95 % CI [-1.8;1.3]) and 6-months (M_diff=-0.5, 95 % CI[-2.2;1.2]). Patient activation increased slightly at 3-months (M_diff=3.0, 95 % CI [0.1;5.9]) but not at 6-months (M_diff=1.5, 95 % CI [-1.2;4.1]). There were significant increases for health-related QoL a t 3-months (M_diff=0.068, 95 %CI [0.041;0.095]) and 6-months (M_diff=0.045, 95 % CI [0.016;0.074]), and for emotional-related QoL at 3-months (M_diff=2.3, 95 % CI [1.2;3.3]) and 6-months (M_diff=1.5, 95 % CI [0.4;2.7]). For sub-group analyses, there were significant increases for patient activation and both QoL measurements for patients categorised as CFS4 and CFS5, and no significant changes for patient-outcomes for CFS6-7.

Conclusions: Overall, results suggest maintenance in patient activation and functional status, with improvements in QoL. Sub-group analyses suggest that GSH is beneficial for patients categorised as CFS4 and CFS5, but the programme played a largely maintenance role for patients with CFS6-7.

Background: Longitudinal trajectories of healthcare utilization, medication prescription, and clinical outcomes among older adults with disabilities receiving home healthcare (HHC) holds significance but remains elusive.

Methods: People aged≥65 years who newly received Taiwan's National Health Insurance funded HHC program from January 2005 to December 2013 were identified. Healthcare utilization, life-sustaining treatment, medication prescriptions (polypharmacy, psychotropics, anticholinergic burden and antibiotics), health status (Charlson's comorbidity index, CCI), and mortality were assessed over a 10-year period spanning 5 years before and after initiating HHC.

Results: Overall, 187,547 patients (80.6 ± 7.7 years, 51.2 % females, CCI 3+: 51.2 %) with a high prevalence of dementia (34.0 %), stroke (38.7 %), and pneumonia (49.5 %), and usage of life-sustaining treatment (urinary catheters: 82.8 % and nasogastric feeding: 78.7 %) were obtained. A sudden peak of admission rate at 1 year (91.7 %) before HHC, followed by the 70 % and 60 % admission rate in the first and second year after receiving HHC were found. Quarterly changes of using life-sustaining treatment showed significant increases from as early as 1 year prior to HHC. Gradual increases of polypharmacy, use of psychotropics, and antibiotic (4.5-fold and 3-fold) after HHC further demonstrated the complex needs (both p < 0.01). The 5-year cumulative mortality rate was 81 % (40 % in the first year with an annual rate of 25 %).

Interpretation: HHC recipients embody a confluence of complex care needs and high mortality risk, whereby various interventions aim to alleviate symptoms and sustain life. Engaging in proactive advanced care planning and end-of-life care should be prioritized when home healthcare is being contemplated.

Background: Frailty increases vulnerability for adverse outcomes in older adults. Characterizing the prevalence and distribution of frailty can help guide healthcare service decision-making and policy.

Objectives: This study evaluated the association between frailty and healthcare utilization and interactions by demographic characteristics.

Design: Using electronic health records (2018-2022), we conducted a retrospective cohort study with 355,266 patients ≥65 years of age who had ≥2 ambulatory office visits in separate years in the 4-year baseline period (2018-2021). The Gilbert Frailty Index (GFI) was calculated (low vs. intermediate vs. high) using ICD-10 codes. One-year utilization outcomes in 2022 included high outpatient clinic utilizations (OCU), inpatient (IP), emergency department (ED), and nursing home (NH) admissions. Fully adjusted log-binomial regression models were calculated overall and by race (White vs. Black), age groups, and gender.

Results: The sample was 74.5(±7.5) years of age, 57.7 % female, 89.2 % White, and 13.5 % categorized as GFI high. After adjustment for covariates, GFI high had the highest risk for all outcomes (RR=3.31 for IP; 2.77 for ED; 4.26 for NH; 1.60 for high OCU). We observed significant interactions by race, gender, and age for some outcomes. Effects of GFI high vs. low were larger for White (IP, ED, & high OCU), female patients (ED & high OCU), and younger patients (IP). Conversely, the effects of GFI high vs. low were strongest in older patients for ED, IP and high OCU.

Conclusions: Monitoring frailty and paying attention to patient's demographic characteristics is needed to best estimate associations between frailty and healthcare utilization.