Journal of Frailty & Aging最新文献

Objectives: To assess the awareness and training of primary care physicians on nutrition in older patients.

Design: Observational, real-world data survey.

Setting: Primary Care.

Participants: One hundred sixty-two physicians, generalists and specialists, working in primary care.

Measurements: Participants received an online questionnaire with 18 questions concerning the importance of nutrition, degree of knowledge, needs, and training in nutrition. The results were evaluated using univariate descriptive analysis, with a percentage for each chosen answer. Logistic regression models were used to evaluate if answers were related to training in nutrition and professional experience.

Results: 43.2% of participants reported that nutrition is very important in individuals over 65 years old, and 90% were aware of the importance of nutrition in healthy aging. Nutritional problems affect 30 to 50% of patients, according to 44.7% of participants. 89.2% agree about the need for nutritional assessment in older patients; however, the professionals believe they should be better prepared. Two out of three respondents consider the training received in nutrition during their undergraduate course or continuing medical education as deficient. Time of professional practice was mainly associated with conceptual facts, while continuing medical education did with practical issues, mainly the use of screening and diagnostic tools [FRAIL (OR: 3.16; 95%IC: 1.55-6.46), MNA-SF (OR: 6.455; 95%IC: 2.980-13.981) and SARC-F (OR: 3.063; 95%IC: 1.284-7.309)].

Conclusion: Although primary care professionals are aware of the importance of nutrition in older patients, there are still gaps in daily practice that could be improved by developing educational strategies.

The primary objective of this study was to analyze the moderating effect of body mass index (BMI) on the association between lower body strength, agility, and dynamic balance, considering the mediating influence of lower body flexibility and aerobic endurance in community-dwelling older adults. This study included a sample of 607 community-dwelling older adults (female = 443; male = 164) aged between 60 and 79 years (M = 69.24; SD = 5.12). Participants had a mean body mass index of 28.33kg/m2 (SD = 4.45). In the mediation-moderation model, positive associations were found between lower body strength and lower body flexibility, aerobic endurance, and agility and dynamic balance (p < 0.05). As for the moderation effects and interactions, BMI was found to have a significant interaction with lower body strength on agility and dynamic balance (β = -.04, [-.06, -.03]), representing an R2-change of 0.04 (p < .001). Conditional direct effects were estimated at BMI scores of 23.9 (β = -.09, [-.15, -.03]), 27.7 (β = -.19, [-.24, -.14]), and 32.7 (β = -.33, [-.40, -.26]) kg/m2. Older adults with high levels of muscular strength tended to have shorter timed up-and-go test times, regardless of BMI. Also, individuals with lower levels of lower body strength were found to have longer timed up-and-go test times, and this relationship became more pronounced with increasing BMI.

Background: High blood pressure variability (BPV) is a predictor of cardiovascular events and all-cause mortality in people with end-stage kidney disease (ESKD) and a marker of aging in geriatric populations. Nevertheless, the relationship between BPV and geriatric syndromes, such as frailty, in people with ESKD is not well understood.

Objective: To examine the association between very short-term BPV and frailty in people with ESKD and receiving hemodialysis.

Design: Cross-sectional study.

Setting: Three dialysis units in the United Kingdom.

Participants: Sixty-nine people receiving hemodialysis (median age=62.0 years, interquartile range [IQR]=19.0; 52.2% male; median dialysis vintage=1.1 years, IQR=2.4).

Measurements: Systolic and diastolic BPV were recorded using continuous, non-invasive BP monitoring (Task Force Monitor). The very low, low, and high frequency components of BPV (VLF-BPV, LF-BPV, and HF-BPV), as well as the power spectral density (PSD-BPV) and low frequency/high frequency ratio of BPV (LF/HF-BPV) were analyzed. Frailty was evaluated using the Fried frailty phenotype.

Results: Twenty-six (37.7%) participants were classified as frail and 43 (62.3%) as non-frail. Frail participants had higher median systolic (2.1, IQR=5.2 mmHg2 vs. 1.1, IQR=1.6 mmHg2, p=0.002) and diastolic HF-BPV (0.9, IQR=2.3 mmHg2 vs. 0.5, IQR=1.0 mmHg2, p=0.048) compared to their non-frail counterparts. In addition, frail participants had higher median systolic VLF-BPV (3.2, IQR=12.5 mmHg2 vs. 2.0, IQR=2.4 mmHg2, p=0.012), LF-BPV (2.0, IQR=3.8 mmHg2 vs. 1.1, IQR=2.0 mmHg2, p=0.016), and PSD-BPV (6.6, IQR=27.6 mmHg2 vs. 4.5, IQR=5.9 mmHg2, p=0.005) compared to the non-frail participants. In age- and sex-adjusted logistic regression analyses, only systolic VLF-BPV (odds ratio [OR]=1.13, 95% confidence interval [CI]:1.01-1.26, p=0.035), HF-BPV (OR=1.26, 95%CI:1.01-1.57, p=0.044), and PSD-BPV (OR=1.06, 95%CI:1.01-1.12, p=0.029) were associated with increased odds of being frail.

Conclusion: Higher systolic BPV is associated with frailty in people receiving hemodialysis. Beat-to-beat assessments of BPV through continuous, non-invasive BP monitoring may be useful in evaluating frailty in ESKD populations.

Objective: Reciprocal connections exist between mental health and physical health, and conditions of cellular senescence/advanced biological age have been observed in association with certain psychiatric diseases. However, the construct of frailty has only preliminarily been explored in young adults and in relation to psychopathology so far. In the present study we aimed at further elucidating the relationships linking psychopathological phenomena with physical diseases in a sample of young adults.

Methods: The sample was made of 527 Italian young adults (age range: 18-34). Participants were assessed on clinical/socio-demographic information as well as on the following measures: an ad hoc designed Frailty Index (FI), the Brief Symptroms Inventory (BSI), the Relationship Questionnaire (RQ), and the Childhood Trauma Questionnaire (CTQ).

Results: Individuals with clinically-relevant psychopathological symptoms (based on established BSI cut-off scores) showed significantly higher FI values than individuals without clinically-relevant psychopathological symptoms (p<0.001). Higher levels of childhood traumatic experiences and higher levels of insecure forms of attachment were significantly associated with higher FI scores. The severity of preoccupied attachment style was significantly independently associated with higher FI scores also when multiple confounding variables were controlled for.

Discussion: Our findings provide novel pieces of insight on the complex relationship of frailty, conceptualized as a measure of deficit accumulation and an indicator of functional status and biological age, with psychopathology, childhood traumas and insecure attachment, with potential implications for the clinical management of young individuals.

Although the association of type 2 diabetes (T2D) with an increased risk of poor physical function and frailty in older adults is widely documented, the underlying pathophysiological pathways linking these two entities are not fully understood. Accordingly, we conducted a cross-sectional observational study aiming to investigate the association of T2D and its microvascular complications retinopathy, nephropathy, and neuropathy, with gait speed (GS), a common surrogate marker of functional decline, adjusting for age, sex, and cognitive function, in the cohort of older adults of the DIALCAT project (Catalonia, Spain). From the initial 335 participants, 84 were excluded because of missing or incorrect GS assessment. The remaining 251 individuals showed a mean (SD) age of 76.5 (5.8) years, of which 50.4% were women, and 69.4% had T2D. Participants were functionally independent (Barthel Index = 95.9 ± 7.3) but showed low physical performance (GS = 0.7 ± 0.3 m/s). Univariate analysis revealed a significant association between GS and sex, body mass index, Barthel index, Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS) scores, retinopathy, and nephropathy, and a non-significant association between GS and presence/absence of T2D. In multivariate analysis, T2D complications was independently associated with slower GS (β=-0.12 (-0.23, -0.01), p=0.029, with absence of T2D as reference group; and -0.13; (-0.23, -0.04); p=0.007, with T2D without complications as reference group). Further adjustment for MMSE and GDS, which remained significantly associated with GS, attenuated the association of GS with T2D complications. In conclusion, the presence of diabetes complications, encompassing renal, visual, peripheral, and potentially central nervous system levels, was associated with a reduction in gait speed, a relevant marker of physical function and frailty.