Journal of Frailty & Aging最新文献

Background: Older adults with frailty have high risk for poor postoperative outcomes.

Objective: To evaluate the feasibility of a multimodal prehabilitation program in older adults with frailty awaiting hip or knee replacement.

Design: Parallel two-arm randomized controlled pilot trial.

Participants and setting: Community-dwelling older adults with frailty awaiting joint replacement aged ≥60 years recruited from the Musculoskeletal Central Intake and Assessment Centre (MSK CIAC), Ontario.

Intervention: Exercise, protein and vitamin D supplements, and medication review.

Measurement: Feasibility was assessed based on predefined progression criteria for recruitment, retention, data completion and adherence to intervention components. Clinical outcomes including Oxford Knee and Hip Scores, frailty index, Short Physical Performance Battery and health-related quality of life were collected at baseline, 1-week preoperative, 6-weeks and 6-months postoperative and were evaluated using generalized linear mixed models for repeated measures.

Results: A total of 69 participants were enrolled. Recruitment rate was 35 %. Participants' mean age was 74 (standard deviation (SD): 7.5); 51 % were prefrail and 36 % were frail. Participant retention was 81 %, and data completion was ≥80 %. Mean adherence to strength exercises was 4 days (95 % confidence interval (CI): 3-5 days/week), balance 3 days (95 % CI: 2-4 days/week), and flexibility 3 days (95 % CI: 3-4 days/week). Adherence to vitamin D intake was 82 % (95 % CI: 73-92 %), and medication review consultation completion was 86 % (95 % CI: 68-95 %). These outcomes met the target values for feasibility success. The Oxford Knee Score at 6-months postoperative 8.78 (95 % CI: 0.40-17.16) showed a clinically meaningful and statistically significant difference between treatment groups. There were also indications of clinically relevant changes for frailty and quality of life post-surgery.

Conclusion: This trial provides strong evidence of feasibility and indications of improvements in postoperative clinical outcomes. Challenges to implementation and adherence were identified that can inform modifications to study design for future trials.

Trial registration: ClinicalTrials.gov NCT02885337. Registered August 31, 2016. https://classic.

Clinicaltrials: gov/ct2/show/NCT02885337.

Background: Electronic health record (EHR) has been in place in many parts of the world. This fits in very well to the frailty index calculation proposed by Rockwood and thus a frailty index can potentially be generated automatically from an EHR database. Therefore, the Hong Kong Hospital Authority (HA) attempted to develop an electronic frailty index (HK eFI), by employing thirty-eight health variables from her own EHR database.

Methods: Five cohorts of patients aged 60 years or above ever attended any services provided by the Hong Kong HA in the year 2015, 2016, 2017, 2018 and 2019, were included. The HK eFI trajectory with ageing, generated by the five cohorts, were compared to the one described by Rockwood's group. Following the UK eFI method, 4 levels of frailty were categorized, and they were examined whether they were related to mortality, readmission rate and hospitalization patient days.

Results: Each successive cohort consisted of increasing number of patients aged 60 years or above. (2015, 1.14 million; 2016, 1.19 million; 2017,1.25 million; 2018, 1.31 million; 2019, 1.38 million). The gradients of the five trajectories ranged from 0.035 to 0.037, representing an increase in FI approximately 3.6 % annually. The intercept of the curves converged at 0.1, representing the FI at age 60 years was 0.1. Compared to the fit group, the adjusted hazard ratios of mortality of the mild, moderate and severe frail group were 1.77, 3.31 and 6.65 respectively and they were all statistically higher than the fit group. (p < 0.005) Likewise, there was a stepwise increase in readmission rate and hospital patient days utilization with increasing frailty levels.

Conclusion: It is feasible to develop an eFI and a biological age trajectory from a large EHR database with local adaptation.

Background: The older population is increasingly reliant on social care, especially those who are frail. However, an estimated 1.5 million people over 65 in England have unmet care needs. The relationship between receiving care, or receiving insufficient care, and changes in frailty status remains unclear.

Objectives: To investigate the associations between care receipt (paid or unpaid), unmet care needs, frailty status, and mortality.

Design: We used multistate models to estimate the risk of increasing or decreasing levels of frailty, using English Longitudinal Study of Ageing (ELSA) data. Covariates included age, gender, wealth, area deprivation, education, and marital status. Care status was assessed through received care and self-reported unmet care needs, while frailty status was determined using a frailty index.

Participants: 15,003 individuals aged 50+, using data collected over 18 years (2002-2019).

Results: Individuals who receive care are more susceptible to frailty and are less likely to recover from frailty to a less frail state. The hazard ratio of males receiving care transitioning from prefrailty to frailty was 2.1 [95 % CI: 1.7-2.6] and for females 1.8 [1.5-2.0]. Wealth is an equally influential predictor of changes in frailty status: individuals in the lowest wealth quintile who do not receive care are as likely to become frail as those in the highest wealth quintile who do receive care. As individuals receiving care (including unpaid care) are likely to be in poorer health than those who do not receive care, this highlights stark inequalities in the risk of frailty between the richest and poorest individuals. Unmet care needs were associated with transitioning from prefrailty to frailty for males (hazard ratio: 1.7 [1.2-2.4]) but not for females.

Conclusions: Individuals starting to receive care (paid or unpaid) and people in the poorest wealth quintile are target groups for interventions aimed at delaying the onset of frailty.

Frailty, a biologic syndrome of decreased reserve and resistance to stressors, affects 5 % to 17 % of older adults and is linked to factors like low BMI, female sex, and low exercise levels. With India's older population expected to double by 2050, frailty presents major public health and economic challenges. This study summarizes the prevalence of frailty among community-dwelling Indians. This systematic review and meta-analysis followed PRISMA guidelines to determine the prevalence of frailty among adults in India. We conducted a comprehensive search across multiple databases, including PubMed, Scopus, EMBASE, and Web of Science, up to January 16, 2024, excluding hospital-based studies and reviews. Data were analyzed using STATA software with a random-effects model, and quality was assessed using the JBI Critical Appraisal Checklist. The meta-analysis revealed a pooled frailty prevalence of 36 % (95 % CI: 29 % to 44 %) among 330,007 community-dwelling adults in India, with significant heterogeneity across studies (I² = 99.95 %). Frailty prevalence varied by assessment method, with 48 % using the frailty index and 31 % using the Fried phenotype. Subgroup analyses indicated significant variability in frailty prevalence by gender, data source, and assessment tool, with no significant publication bias detected. This meta-analysis found a pooled frailty prevalence of 36 % and pre-frailty prevalence of 48 % among adults in India, with higher frailty in women (45 %) than men (35 %) and variation across assessment tools. Future research should focus on longitudinal studies and developing tailored frailty assessment tools.

Background: Age-related morbidity, including frailty and cardiometabolic disease has become increasingly prevalent among people living with HIV (PWH), and each frailty characteristic may, independently and synergistically, play a role in cardiometabolic disease.

Objective: To evaluate the prevalence of unique frailty clusters and the prevalence ratios of cardiometabolic diseases within frailty clusters among a large diverse cohort of PWH in clinical care.

Design: Cross-sectional analyses within longitudinal clinical cohort.

Setting: The Center for AIDS Research Network of Integrated Clinical Systems (CNICS) from 8 Clinics PARTICIPANTS: 4,856 PWH, mean age 61 years. 16 % frail, 45 % pre-frail, 40 % robust.

Measurements: The validated, modified Fried Phenotype from patient-reported outcomes and clustering (15 clusters) of the frailty characteristics and cardiometabolic diseases (7 diseases and multimorbidity) within each cluster.

Results: Among 4856 PWH (age: 61 ± 6 years), the prevalence of frail, pre-frail, and robust was 16 %, 45 %, and 40 %, respectively. The most prevalent cardiometabolic disease among frail PWH was hypertension (62.6 %), followed by dyslipidemia (58.8 %) and diabetes (31.4 %). Among pre-frail PWH, the most prevalent cardiometabolic diseases were dyslipidemia (65.8 %), hypertension (61.8 %), and obesity (30.5 %). The prevalence of cardiometabolic disease among frailty clusters varied. For example, PWH in the "fatigue + poor mobility" cluster had a greater prevalence of cerebrovascular disease (PR: 2.23; 95 % CI: 1.01-4.91), diabetes (1.76; 95 % CI: 1.41-2.21), and obesity (1.66; 95 % CI: 1.35-2.05) when compared with robust PWH. Individuals in the "poor mobility" cluster had a higher prevalence of diabetes (1.37; 95 % CI: 1.15-1.64), hypertension (1.12; 95 % CI: 1.04 - 1.22), and obesity (1.38; 95 % CI: 1.17-1.61) compared with robust PWH.

Conclusions: The frailty components, independently and synergistically, were associated with an increased prevalence of cardiometabolic disease. This study identified distinct frailty clusters that may be associated with increased prevalence of cardiometabolic disease among PWH.

Background: The experience of homelessness has been associated with premature ageing and an earlier onset of geriatric syndromes. Identification of frailty and appropriate intervention, may help improve health outcomes for people experiencing homelessness (PEH). This review aimed to identify prevalence, use of screening tools and risk factors for frailty in PEH.

Method: A systematic review, conducted and reported following the PRISMA checklist, was undertaken investigating the prevalence and risk factors of frailty among PEH. Searches were conducted in Ovid MEDLINE, PsycInfo, Web of Science and CINAHL from inception to July 2024. A meta-analysis examining prevalence of frailty and pre-frailty was completed with a narrative synthesis of related risk factors.

Results: A total of 1672 articles were screened for eligibility and 11 studies were included, containing 1017 participants from seven countries. Six different screening tools were employed to detect frailty in the included studies. The range of frailty prevalence was 16-70 % and pre-frailty prevalence was 18-60 %. The pooled frailty prevalence from studies employing the Fried Criteria was 39 % (95 % CI 15-66); the Clinical Frailty Scale: 37 % (95 % CI 24-51); the Edmonton Frailty Scale: 53 % (95 % CI 44-63); and the Tilburg Fraily Indicator: 31 % (95 % CI 8-60). High heterogeneity was observed between the studies. Identified risk factors for developing frailty in PEH included being female, increased years spent homeless, and drug addiction.

Conclusion: This study highlights a high prevalence of frailty and pre-frailty in PEH. The identified risk factors illustrate potential areas to target interventions to reverse frailty. Future research should focus on the role of screening for frailty in PEH and developing appropriate frailty detection tools in this group.

Background: Muscle mass is associated with physical and functional performance across adulthood. Its reduction plays a crucial role in the development of age-related conditions such as frailty and sarcopenia. Genetic variations potentially impact muscle health, particularly in an aged population.

Objectives: For this reason, we aimed to evaluate the association between genetic biomarkers and appendicular lean mass index (ALMI), a marker of muscle health, to identify possible risk factors for age-related sarcopenia in a population-based study.

Materials and methods: We cross-sectionally analyzed data collected in 2015 from the São Paulo Epidemiologic Sleep Study (EPISONO). Participants underwent bioelectrical impedance and genetic evaluations.

Results: After adjusting the data for age and sex, 12 single nucleotide polymorphisms (SNP) were significantly associated with ALMI. Among them, rs9928094 (beta = -0.031 p = 0.029) and rs9930333 (beta = -0.030 p = 0.035) are located in the FTO gene, which is related to obesity and fat gain and, rs16839632 (beta = 0.038 p = 0.029) located in the FMN2 gene, responsible for actin cytoskeleton and cell polarity.

Conclusions: Poor muscle health is a multifactorial condition and genetic biomarkers can support the stratification of the risk for adverse body composition states affecting muscle and physical performance across adulthood.

The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force convened in March 2024 to address patient-reported outcomes measures (PROMs) in the field of sarcopenia. PROMs are crucial to enhance healthcare services at both individual and societal levels. PROMs complement objective outcome measures by capturing insights that patients are best suited to judge. In recent years, there has been an increase in the recognition of PROMs' importance within clinical trials by pharmaceutical industries and regulatory agencies. Consequently, it has become imperative to develop valid and reliable tools tailored to capture various aspects of patient's experience and health status. This report aims to present the state-of-the-art available and validated PROMs for sarcopenia that can be used within clinical settings by various stakeholders, and to highlight several research gaps and barriers that need to be addressed to expedite and improve the use of these outcome measures within the context of clinical trials.

Background: Skin tactile perception may indicate frailty in older adults. Although gait performance is crucial for diagnosing frailty, its association with skin tactile perception has not yet been explored.

Objectives: To examine the association between skin tactile perception and changes in step length, cadence, and gait speed in middle-aged and older adults.

Design: A longitudinal study (mean follow-up: 10.8 years) SETTING: Community-based survey PARTICIPANTS: A total of 1,403 middle-aged and older adults (aged 40-79 years, 53.6 % men) from the National Institute for Longevity Sciences-Longitudinal Study of Aging were included in this study. These participants completed the baseline survey (1997-2000) and at least two follow-up surveys (2000-2012), had no history of cerebrovascular disease, rheumatoid arthritis, or Parkinson's disease, and had complete data with no outliers in skin tactile perception measurements.

Measurements: Skin tactile perception was assessed using a two-point discrimination test. Step length (cm), cadence (steps/min), and gait speed (m/min) were evaluated on an 11-m walkway at a usual speed.

Results: The mean age of participants was 56.4 years. After full adjustment, mixed-effects models with splines revealed that the association between skin tactile perception and gait parameters varied with age. In adults aged 60 and above, we observed non-linear relationships between skin tactile perception and gait parameters. A consistent inflection point around 10 mm in tactile perception was identified across different age groups and gait parameters.

Conclusions: Among community-dwelling middle-aged and older Japanese adults, skin tactile perception was associated with changes in gait parameters, particularly in those aged 60 and above. The 10-mm threshold in tactile perception may serve as a critical indicator for predicting changes in gait performance. Skin tactile perception tests may prove clinically useful for screening patients at elevated risk of impaired gait performance.