Journal of Frailty & Aging最新文献

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.

Background: Fatigue negatively impacts health outcomes but its association with physical function across the adulthood remains unclear.

Objectives: This study described self-reported fatigue levels across age and sex categories, investigated the associations between fatigue and physical functions, and examined whether age and sex moderated their associations.

Design: Cross-sectional design.

Setting: Community.

Participants: Nine hundred sixteen participants aged 20-100 years in the observational INSPIRE-T cohort study.

Measurements: Participants were classified into four age categories. Fatigue was assessed using the Patient-Reported Outcomes Measurement Information System (Short Form v1.0 - Fatigue 8a) and physical function was assessed by handgrip strength (HGS, Kg), usual gait speed (UGS, m/s), both 5-repetition (5CR, s) and 30-sec chair rise tests (30sCR, times), isokinetic knee extension strength (IKES, N m), and maximum oxygen consumption (V̇O2 max, ml/kg/min). Multiple linear regressions were performed to examine the associations between fatigue and the physical function outcomes (all square-root-transformed). Interactions of fatigue with age and sex were considered.

Results: Fatigue levels were the highest in people 75+ years. Women had a higher fatigue level than men. Fatigue was significantly associated with decreasing performance in UGS, HGS, 5CR, and 30sCR but not in IKES and V̇O2 max. Interaction analyses revealed that fatigue was associated with reduced UGS as people age (Fatigue × age: B = -0.002, 95% confidence interval = -0.003, -0.001). Sex did not moderate the association between fatigue and physical function.

Conclusions: Our study indicated that fatigue was negatively associated with several components of physical function. Although sex did not moderate the relationship between fatigue and physical function, the association between fatigue and low UGS was more pronounced with increasing age.

Background: Postural instability and gait difficulties (PIGD) are a significant cause of mobility loss and lower quality of life in Parkinson's disease (PD). When PD progresses, patients may experience falls and freezing of gait (FoG) resulting in fear of falling and increasing sedentariness. Sedentary behavior results in sarcopenia associated with other changes in body composition, especially in older patients becoming frail. Previous studies have shown gender-specific changes in body composition with aging as well as gender disparities in symptoms and progression of PD, yet the association between gender-specific body composition and PIGD symptoms such as FoG along with falls, remains unexplored.

Obective: This study aimed to investigate the association between gender-specific changes in body composition, FoG and falls assessment.

Methods: 136 PD subjects underwent detailed clinical test batteries and had whole-body composition assessed using dual-energy X-ray absorptiometry (DXA). Multivariate logistic forward stepwise regression was performed to define body composition associations for FoG and falls.

Results: Multivariate regression analysis revealed that in males with PD, lower leg lean mass was significantly associated with the presence of FoG (OR, 0.429; 95% CI, 0.219-0.839; p=0.013) but not with falls. In females with PD, higher leg adipose mass was significantly associated with falls (OR, 4.780; 95% CI, 1.506-15.174; p=0.008) but not with FoG.

Conclusion: These observations suggest gender specific associations between body composition and FoG vs. falls in PD. Future research should explore the impact of interventions on body composition in individuals with PD by paying specific attention to gender differences.

Digital technologies hold promise to modernize healthcare. Such opportunity should be leveraged also to address the needs of rapidly ageing populations. Against this backdrop, this paper examines the use of wearable devices for promoting healthy ageing. Previous work has assessed the prospects of digital technologies for health promotion and disease prevention in older adults. However, to our knowledge, ours is one of the first attempts to specifically address the use of wearables for healthy ageing, and to offer ethical insights for assessing the prospects of leveraging wearable devices in this context. We provide an analysis of the considerable opportunities associated with the use of wearables for healthy ageing, with a focus on the five domains of intrinsic capacity: locomotion, sensory functions, psychological aspects, cognition, and vitality. We then highlight current limitations and ethical challenges of such approach to healthy ageing, including issues related to access, inclusion, privacy, surveillance, autonomy, and regulation. We conclude by discussing the implications of our analysis in light of current debates on the ethics of digital health, and suggest measures to address the identified challenges.

Background: Physical resilience is an emerging concept that describes an individual's capacity to recover from stressors. However, few instruments are currently available for assessing physical resilience.

Objective: To develop a scale to assess physical resilience in older adults.

Design: Development of a clinical scale.

Setting and participants: A total of 172 hospitalized older adults were recruited.

Measurements: This study comprised two stages. First, a pool of physical resilience scale items was created through a literature review, and the Delphi method was used to establish an initial scale. Second, the initial physical resilience scale was tested on hospitalized older adults.

Results: Five primary and 19 secondary items were identified after reviewing the literature. After two rounds of expert consultations, three primary and 16 secondary items were determined. The overall Cronbach's alpha for the scale was 0.760. Except for items N2, N4, N5, N8, and N14, Pearson's correlation between the scores of the remaining items and the total score ranged from 0.407 to 0.672. Except for items N2, N4, and N5, the corrected item-total correlation results ranged from 0.301 to 0.580, indicating good consistency between each item and the overall scale. Factor analysis showed that except for N7, the factor loadings of the remaining items were between 0.584 and 0.844. After expert discussions, items N2, N4, N7, and N14 were included in the scale, and items N5 and N8 were removed.

Conclusion: A 14-item physical resilience scale, CHEES, was developed to assess physical resilience levels in older adults.

Background: Screening tools such as calf circumference (CC) and Yubi-wakka (finger-ring) test have been recognized as effective tools by Asian Working Group for Sarcopenia 2019 (AWGS'19) for sarcopenia screening but their comparative agreement, diagnostic performance and validity are unclear.

Objectives: This study aims to determine: (i)agreement between calf and finger-ring circumference, (ii)diagnostic performance for low muscle mass and AWGS'19 sarcopenia diagnosis, (iii)correlation with muscle mass, strength, and physical performance, and (iv)association with frailty, life space mobility and physical activity.

Methods: We studied 187 healthy community-dwelling older adults (mean age=66.8+7.0years) from the GERILABS-2 study. CC was measured via (i) both calves in sitting and standing positions, and (ii) Yubi-wakka test by encircling the thickest part of the non-dominant calf with index fingers and thumbs of both hands. We performed Cohen's kappa to check for agreement, area under receiver operating characteristic curve (AUC) to compare diagnostic performance, partial correlations adjusted for age and gender to compare convergent validity, and logistic regression to determine predictive validity for outcome measures.

Results: Sarcopenia prevalence was 24.0% (AWGS'19). Yubi-wakka identified 16.6% of participants as screen-positive ("smaller"), showing moderate agreement only with non-dominant sitting CC measurements (k=0.421,p<0.001) and having lower diagnostic performance in determining low muscle mass (AUC=0.591 vs 0.855-0.870,p<0.001; sensitivity=57.1% vs 75.5-90.8%; specificity=58.4% vs 70.8-80.9%) and sarcopenia diagnosis (AUC=0.581 vs 0.788-0.818,p<0.001; sensitivity=55.6% vs 57.5-71.8%; specificity=74.4% vs 75.6-88.9%) compared to CC measurements. Yubi-wakka correlated significantly with muscle mass, grip strength and knee extension but not physical performance. When adjusted for age, gender and hypertension, Yubi-wakka was significantly associated with frailty (OR=3.96,95%CI:1.09-14.38), life space mobility (OR=2.38,95%CI:1.08-5.24) and physical activity (OR=2.50,95%CI:1.07-5.86).

Discussion and conclusions: Yubi-wakka provides a self-administered, low-cost and practicable community screening tool for sarcopenia. Our study affirmed the convergent and predictive validity of Yubi-wakka, albeit with lower sensitivity and specificity in diagnostic performance compared to CC measurements.

Despite evidence linking the gut microbiome to neuropathic pain (NP), it is not known if altering gut microbiota can alleviate NP via the microbiome-gut-brain axis. This study examined if healthy gut microbiota of sham male rats (Sham+V) and dysbiotic gut microbiota of NP rats (spinal nerve ligation: NP, SNL+V) can be disrupted and restored, respectively, via fecal microbiota transplant (FMT) from the opposite group [Sham+(SNL-FMT) and SNL+(Sham-FMT), respectively]. All groups received FMT daily for two weeks, followed by three weeks without FMT. SNL rats showed higher mechanical hypersensitivity [SNL+V vs. Sham+V] throughout the study. After two weeks, the FMT of healthy gut microbiota decreased mechanical hypersensitivity in SNL rats [SNL+(Sham-FMT) vs. SNL+V]. A temporal shift in microbiome profiles after 2-week FMT treatment was observed in Sham+(SNL-FMT) and SNL+(Sham-FMT) groups, while the microbiome profile shifted back a certain extent after FMT ceased. At the end of study, the Sham+(SNL-FMT) group acquired low abundance of UCG-001, Odoribacter, and Peptococcaceae, and high abundance of UBA1819 and Victivallis. The SNL+(Sham-FMT) group maintained high abundance of Butyricimonas and Escherichia-Shigella. The SNL+(Sham-FMT) group had altered glial and macrophage activation/inflammation markers in the brain/colon than the SNL+V group. Relative to the SNL+V group, the SNL+(Sham-FMT) group had significantly lower gene expressions of GFAP (hypothalamus), IBA-1 (colon), and NF-κB (amygdala/colon), but higher gene expressions of complex I (amygdala/hypothalamus) and claudin-3 (amygdala/hypothalamus/colon). In conclusion, FMT containing healthy microbiota given to SNL rats attenuates mechanical hypersensitivity, modulates microbiota composition, and mitigates downstream glial activation/inflammation markers in a NP model.