Journal of Frailty & Aging最新文献

Background: Intrinsic capacity (IC) is a composite indicator of physical and mental capacities that are critical for healthy aging. IC comprises five domains, with "vitality" gaining most attention due to its potential impact on functional and physiological reserves with increasing age. The World Health Organization 2022 framework redefined vitality as an underlying physiological determinant of IC. However, the concept and measurement of vitality and its empirical validation are not well defined.

Objectives: This scoping review aims to: (1) map the conceptual frameworks underpinning vitality within the IC domain and (2) identify existing measures used to assess vitality.

Methods: A systematic search of MEDLINE, PubMed, Embase, Web of Science, and WHO databases (2003-2023) using Arksey and O'Malley's framework and PRISMA-ScR guidelines. Studies involving adults ≥50 years old that addressed vitality in IC were included. We extracted data on conceptual frameworks, measurement tools, and construct validity.

Results: Eighty-one studies met the inclusion criteria. Initial frameworks of vitality focused on nutritional indicators, while recent concepts include neuromuscular function, metabolism, and immune-stress responses. However, operationalization of these concepts remains inconsistent, with most studies relying on anthropometry, appetite, weight loss, and handgrip strength, while immune and stress response-related biomarkers were rarely assessed. Only 10.5 % of studies evaluated construct validity of vitality, and limited studies validated the potential roles of vitality underpinning the other expressed capacities.

Conclusions: Currently, vitality within IC varies in definitions and measurement approaches, with a predominant focus on nutrition and muscle strength. Empirical validation of vitality's role as a foundational IC domain remains limited. Expanding the scope of vitality to include metabolic and immune markers, and deeper examination of the interactions between vitality with other IC domains may enhance understanding and improve assessment frameworks for healthy aging.

Background: Intrinsic capacity (IC) is a recent key concept proposed by the World Health Organization (WHO) based on aspects of functional ability (both physical and mental) rather than the presence or absence of diseases, with a potential to predict several health outcomes.

Objective: To explore associations between IC and cognitive function (prospectively), and between IC and plasma p-tau181 (cross-sectionally and prospectively) among community-dwelling older adults.

Methods: Observational study with 491 subjects ≥70 years (67.4 % female, mean 75.3 years, SD=4.4), participants from the Multidomain Alzheimer Preventive Trial (MAPT). IC domains (locomotion, cognition, psychological, vitality) were combined into a 0-100 score. Alternative classification was based on the number of domains' abnormalities. Plasma p-tau181 was measured at baseline and 36 months of follow-up. A composite cognitive score (CCS) based on four tests was determined at baseline, 6, 12, 24, 36, 48 and 60 months.

Results: Inverse cross-sectional associations were observed between baseline IC score and p-tau181 (unadjusted model: β=-0.08, 95 %CI -0.13 to -0.03; p = 0.0025). A significant mean difference in p-tau181 3-year changes was observed between participants with low and normal IC (based on IC score) (adjusted model: 1.71, 95 %CI 0.01 to 3.40; p = 0.0483). Prospective 5-year associations between IC and CCS were only observed in unadjusted analysis according to the alternative IC classification (-0.21, 95 %CI -0.38 to -0.04; p = 0.0156).

Conclusion: IC was associated with plasma p-tau181 and cognitive function, but findings varied according to the method of IC classification. Further research may help settle the role of IC as a predictor of neurodegenerative diseases such as AD. In this regard, multidomain interventions have potential to protect IC over the aging process and prevent cognitive impairment, and should also be encouraged.

Objective: To compare the association of glaucoma and glaucoma suspect diagnoses with frailty, quantified via an electronic frailty index (eFI), and to evaluate whether a glaucoma diagnosis moderates the association between frailty and the cumulative risk of acute healthcare encounters for incident falls or fractures.

Design: Retrospective study of electronic health record (EHR) data.

Subjects, participants, and/or controls: Adults ≥65 years old with an ICD-10 diagnosis code for glaucoma or glaucoma suspect who had a calculable eFI score as of 10/1/2017.

Methods: Ordinal logistic regression was used to examine the cross-sectional association between glaucoma (predictor) and frailty status (outcome) based on the eFI. The relationship of glaucoma and frailty with the cumulative incidence of hospital or emergency room visits for injurious falls or fractures over time was modeled using cause-specific recurrent event survival models that account for censoring and the competing risk of death.

Main outcome measures: Frailty status based on the eFI and cumulative incidence of falls or fractures.

Results: Glaucoma patients were significantly more likely to be frail compared to glaucoma suspects (adjusted odds ratio=1.36, 95 % CI(1.16, 1.60)). Both pre-frailty and frailty were associated with an increased risk of incident falls/fractures in older adults: prefrail (hazard ratio=2.07, 95 % CI (1.40, 3.06)), frail (hazard ratio=3.35, 95 % CI (2.24, 5.03)), but there was no interaction of frailty with glaucoma status on falls/fractures risk. Also, the risk of incident falls/fractures did not significantly differ between glaucoma versus glaucoma suspects.

Conclusions: Glaucoma patients were more likely to be frail or pre-frail based on an EHR-derived index than glaucoma suspects. Both pre-frailty and frailty were associated with increased cumulative risk of injurious falls or fractures but there was no interaction of frailty with glaucoma. Frailty based on the eFI was better at discriminating who is at risk of acute healthcare utilization for falls/fractures than a glaucoma diagnosis.

Background: Electronic handgrip dynamometry and accelerometry enables novel opportunities to collect additional attributes of muscle function beyond just maximal strength, but some muscle function attributes may already be related, which may warrant discerning these attributes into a short muscle function battery (SMFB).

Objectives: We sought to determine the multivariate relationships between maximal strength, asymmetry, submaximal control, rate of force development, bimanual coordination, fatigability, and contractile steadiness in older adults.

Design: A cross-sectional design was used for this investigation.

Setting: Laboratory.

Participants: The analytic sample included 121 generally healthy older adults aged 70.7 ± 4.7 years.

Measurements: Electronic handgrip dynamometry and accelerometry measured strength, asymmetry, submaximal control, rate of force development, bimanual coordination, fatigability, and contractile steadiness. The handgrip variables were standardized before they were included in a factor analysis. Factors with eigenvalues >1.0 were kept. Items within a factor with a loading |>0.30| were similarly retained.

Results: There were 3 factors retained with eigenvalues of 1.88, 1.56, and 1.10. The first factor (functional strength), which explained 39.9 % of the variance, included strength, submaximal control, and rate of force development. Factor 2 (lateral function), which explained 35.8 % of the variance, included asymmetry and bimanual coordination. The third factor (muscle endurance), which explained 24.3 % of the variance, included fatigability and contractile steadiness.

Conclusions: Our findings suggest the surfacing of themes in the additional muscle function measures, thereby providing framework for a SMFB. More research is needed for electronic handgrip dynamometry and accelerometry derived muscle function on health before consideration of implementation in clinical practice.

Background: CT measurements of psoas muscle density (PMD) and area (PMA) (with or without indexing to height-squared or body-surface-area) are used interchangeably as sarcopenia measures - it is unknown which best correlates with surgical risk.

Objectives: 1.Determine the correlation between psoas muscle density, area, and indexed area; 2.Identify which psoas measures most strongly associated with surgical outcomes DESIGN: The University Hospital Geelong Colorectal database included all patients who underwent elective colorectal surgery from 2007 to 2014 (minimum five-years follow-up). Pre-operative CT scans were reviewed, psoas measures correlated with each other and with outcomes.

Setting: University Hospital Geelong is a regional referral hospital in Victoria, Australia.

Participants: This database listed 552 patients, 120 were excluded as pre-operative CT-films were not accessible, leaving 432 patients included.

Exposure: Psoas muscle density, area, and area indexed by height-squared and body-surface-area.

Measurements: Pearson correlations investigated correlations between psoas muscle measures. Logistic regression and ROC-analysis investigated each psoas measures association with peri‑operative morbidity. Kaplan-Meier survival-analysis investigated the association of each psoas measure with long-term survival.

Results: Mean age was 70.4 years, 41 % were female. Psoas muscle density correlated poorly with area (R²=0.15). Unindexed psoas muscle area correlated well with area indexed by height-squared (R²=0.950) and body-surface-area (R²=0.938). Long-term survival was associated with psoas muscle density (HR1.515(95 %CI 1.062-2.161)) and area (HR1.886(95 %CI 1.322-2.692)). Increasing psoas muscle density (reduced sarcopenia) was associated with decreased major-complications (OR0.963(95 %CI 0.938-0.989)) and peri‑operative mortality (OR0.903(95 %CI 0.847-0.962)), with ROC-curve AUC=0.829 indicating an accurate test. There was no association between psoas muscle area and major-complications (OR1.000(95 %CI 1.000-1.000)), nor peri‑operative mortality (OR1.000(95 %CI 0.999-1.001)), with ROC-curves AUC=0.507-0.521. Indexed area measures were not associated with outcomes.

Conclusions: Psoas muscle density and area did not correlate. Both were associated with long-term survival, but only density was associated major-complications and mortality. Indexing removed the correlation of area with long-term survival.

Ethical and procedural requirements make research in care homes challenging. With people living longer globally, it is essential that older people are included in research, including within the care home setting. We conducted a randomised controlled trial (AFRI-c) in 91 care homes across England, aiming to make the study available to every eligible resident. Facilitators included flexible models for receiving consent; commitment from care home staff, residents and families; tailored and specific training for care home staff; and support from national research infrastructure to engage care homes in research. To facilitate inclusive care home research, we recommend consulting with care homes about their research priorities; continuing investment in national research infrastructure for care homes; using advance directives for research planning for care home residents; embedding research nurses in care home environments; and more guidance for researchers and ethics committees on applying legal frameworks regarding capacity to research settings.

A frailty index (FI) is a frailty assessment tool calculated as the proportion of the number of health-related deficits an individual has to the total number of variables in the index. Routinely collected clinical and administrative data can be used as sources of deficits to automatically calculate FIs. This scoping review aimed to evaluate the current research landscape on routine data-based FIs. We searched seven databases to find literature published in 2013-2023. Main inclusion criteria were original research articles on FIs constructed from routine data, with deficits in at least two of the following categories: "symptoms/signs", "laboratory values", "diseases", "disabilities", and "others". From 7526 publications screened, 218 were included. Studies were primarily from North America (47.7 %), conducted in the community (35.3 %), and used routine data-based FIs for risk stratification (51.4 %). FIs were calculated using various routine data sources; however, most were initially developed and validated using hospital records. We noted geographical differences in study settings and routine data sources. We identified 611 unique deficits comprising these FIs. Most were either "diseases" (34.4 %) or "symptoms/signs" (32.1 %). Routine data-based FIs are feasible and valid risk stratification tools, but research is confined to high-income countries, their routine adoption is slow, and deficits comprising these FIs emphasise a reactive and overtly medical approach in addressing frailty. Future directions include exploring the feasibility and applicability of using routine databases for frailty assessment in lower- and middle-income countries, and leveraging non-clinical routine data through data linkages to proactively identify and manage frailty.

Background and objectives: Sarcopenia, characterized by a progressive decline in muscle mass and strength, is a significant concern among older individuals, impacting their functionality and overall quality of life (QOL). The relationship between sarcopenia and QOL among Filipino older adults remains underexplored. Thus, the study aims to determine the prevalence of sarcopenia and its association with the QOL of community-dwelling older adults in selected Philippine cities.

Design: This cross-sectional study used convenience sampling in the selection of the cities. Participants were randomly selected from the list provided by each local city government.

Setting and participants: 536 apparently healthy community-dwelling Filipino older adults from three major islands in the Philippines.

Methods: Sarcopenia was determined using the 2019 Asian Working Group for Sarcopenia criteria which is the presence of low muscle mass, plus low muscle strength, and/or low physical performance. Quality of life was assessed using the culturally-validated WHO-QOL short form questionnaire. Mixed Model logistic regression adjusted for covariates was performed to study the association of sarcopenia indicators to quality of life.

Results: 24.3 % of older Filipinos were found to have sarcopenia. Sarcopenic community-dwelling older adults had significantly decreased odds of attaining higher score in the physical domain (OR 0.63; 0.40-0.98), psychological domain (OR 0.55; CI 0.35-0.84), and overall quality of life (OR 0.57; CI 0.37-0.89) than the non-sarcopenic group.

Conclusion: One in four community-dwelling Filipino older adults met the sarcopenia criteria. Sarcopenia is associated with decreased QOL scores, particularly in the physical health and psychological health domains. Sarcopenia needs to be considered in the context of public health to come up with targeted nutrition and health interventions for improved QOL.