Journal of Frailty & Aging最新文献

Background: Pre-frailty is highly prevalent and multimodal lifestyle interventions are effective for preventing transition to frailty. However, little is known about the potential for medical group visits (MGV) to prevent frailty progression.

Objectives: To assess the feasibility and acceptability of the MGV Age Self Care-Resilience.

Design: Single-arm mixed methods pilot clinical trial.

Setting: Virtual MGV delivered in an ambulatory setting at a U.S. academic medical center.

Participants: Community-dwelling older adults (n = 11; age 65+) with pre- to mild frailty.

Intervention: Age Self Care-Resilience, an 8-week virtual MGV (90-minute sessions once per week) with sessions focused on physical activity, nutrition, social engagement, mind-body practice, and home environment modification.

Measurements: Primary outcomes were feasibility of recruitment, attendance, satisfaction, and feasibility of study measurements, collected via quantitative and qualitative approaches. Exploratory outcomes included frailty, psychosocial health, and physical function.

Results: A priori feasibility criteria were met for recruitment, with 15 (48 %) of those screened (31) meeting eligibility criteria, 11 (35 %) enrolling (mean age 74.5 yrs), and recruitment completed in less than one month. The nine participants who completed the study attended a mean of 7.2 of 8 sessions and completed 100 % of baseline and follow-up study measures; participants completed 58 % of the home practice log. Themes from participant interviews included: (1) mixed reactions to the recruitment term "pre-frailty;" (2) finding group participation as meaningful and empowering; and (3) perception that the program positively changed attitudes and lifestyle behaviors.

Conclusions: Age Self Care-Resilience is feasible and acceptable to pre- to mildly frail older adults. Next steps include evaluating the efficacy of Age Self Care-Resilience for preventing frailty progression with a fully powered randomized controlled trial.

Background: Body mass index (BMI) determines general corpulence and health, whatever age, sex or clinical background. Normal BMI (18.5-24.9 kgm²) is defined as healthy, normal, weight leading to a false impression that no intervention is needed.

Objectives: Assess the prevalence of body impairments in the presence of normal BMI.

Design: Cross-sectional design. Bivariate and a multivariate regression analysis assessed the association of body composition with clinical parameters in the presence of normal BMI.

Setting: Community dwelling older adults attending the Toulouse Frailty Clinic at the University Hospital, Toulouse.

Participants: 876 community dwelling, autonomous older adults, 70 years and over.

Measurements: Dual X-ray Absorptiometry (DXA) assessment, and cognitive, physical, nutritional, and demographic evaluations were included in the present analysis.

Results: Of the initial sample, 347 (39.61 %) patients had normal BMI, and among them, 152 (43.80 %) had low lean mass, 144 (41.49 %) were osteoporotic and 2 (0.58 %) increased fat mass. A poor nutritional status (Mini-Nutritional Assessment score, MNA-score, <24) was the only independent variable associated with body impairments in the presence of normal BMI (Odd Ratio 2.83; 95 % Confidence Interval 1.64-4.89).

Conclusion: Nearly 70 % of the adults with normal BMI had at least one impairment in body composition (low lean mass, osteoporosis, or obesity). In the light of the present study, older adults with normal BMI and an MNA-score under 24 should be assessed with DXA to identify the age-associated impairments in body composition in order to lead to specific interventions.

Objectives: The aim of this pilot study is to assess the feasibility of using the mobile photographic method (m-health) of teledentistry for oral screening and triaging of older patients living in aged care homes.

Methods: The study took place in 2023 in four aged care facilities in Egypt. Three trained dentists performed clinical oral examinations of the participants and filled in the World Health Organization (WHO) oral health assessment form. Afterwards, five intraoral photographs were taken for each participant and independently examined by three calibrated dentists for caries detection and decision on intervention urgency for proper dental referral. Agreement between the testing modalities was analyzed using Cohen's kappa coefficient, and the significance level was set at p < 0.05 within all tests.

Results: The results indicated that teledentistry had higher specificity than sensitivity in caries detection compared to clinical examination. The level of agreement between the teledentistry examination and the clinical oral examination for caries assessment ranged from (k = 0.36) to (k = 0.58) showing fair to moderate agreement. Also, all teledentistry examiners showed almost perfect statistically significant intra-rater and inter-rater agreement for caries detection (K ≥ 0.82, p < 0.001). Moreover, intervention urgency scoring showed moderate to substantial agreement between the testing modalities with kappa values ranging from (k = 0.48) to (k = 0.65).

Conclusions: The mobile photographic method of teledentistry offers a feasible model that helps in oral examination and triaging dental treatment of older patients living in aged care facilities. However, larger studies with proper sample size are required which will allow better generalizability of the results.

Purpose: Concerns about falling (CaF) are common in older adults. They are associated with increased risk of falls, activity restriction, social isolation, and physical deconditioning. This systematic review assessed if frailty is a risk factor for CaF.

Methods: Searches of cross-sectional and prospective studies exploring associations between frailty and CaF were conducted across five databases (Medline, CINAHL, Embase, Psychinfo and Scopus). The Risk of Bias in Non-randomised Studies of Exposure (ROBINS-E) was used to determine risk of bias.

Results: The search identified 2492 articles, 12 were included for data extraction: 8 cross-sectional and 4 prospective studies. Participants' mean ages across the different studies ranged from 67.5 - 81.7 years. All adjusted analyses reported a significant association between increasing frailty and CaF, except for one cross-sectional paper. Significant adjusted Odd Ratios (ORs) ranged from 1.79 (CI = 1.18-2.71) to 144.78 (CI = 13.86 - 1512.60) for cross-sectional studies, and from 1.33 (CI = 1.04-1.69) to 12.4 (CI = 7.6-20.1) for prospective studies. Three studies (one cross-sectional and two prospective) explored the association between frailty and concern-related activity restriction: A significant association was reported in two prospective studies (adjusted OR = 1.58 (CI=1.09-2.30) and adjusted RRR = 3.91 (2.61-5.85)), but not the cross-sectional study (adjusted OR = 1.31 (CI=0.62-2.78)).

Conclusion: This review identifies strong associations between increasing frailty and both CaF and associated activity restriction. This expands previous work describing the opposite association (that CaF can lead to frailty), suggesting a bi-directional relationship. Clinicians working with pre-frail and frail older adults should consider screening for CaF.

Prospero: CRD42023371899.

Background: Frailty is a syndrome associated with age-related impairments in multiple organ systems, of which the autonomic nervous system plays a fundamental role. Measurement of heart rate variability (HRV) is a non-invasive method to evaluate the autonomic activity and gain insights into cardiovascular health and potentially, frailty. A few small studies have explored the relationship between HRV and frailty, with promising but conflicting results.

Objective: To investigate the relationship between HRV and frailty among adult patients with cardiovascular disease.

Design: A cross-sectional study was conducted using clinical data.

Setting: Data were collected from an ambulatory cardiology clinic.

Participants: The cohort comprised 155 patients with a mean age of 67 years (44 % female).

Measurements: HRV was assessed seated at rest for 2.5 min using a finger-based photoplethysmography (PPG) device. Frailty was assessed using the Clinical Frailty Scale (CFS), with a score ≥5 considered frail. Associations between HRV and frailty were examined using a Spearman correlation matrix and multivariable ordinal regression model. The LF/HF ratio (a frequency-domain measure reflecting imbalances between sympathetic and parasympathetic activity) was the primary HRV measure analyzed.

Results: The prevalence of frailty was 15 %. Among all HRV measures, the LF/HF ratio was most closely correlated with frailty (p < 0.001). In the multivariable model, each 1 standard deviation decrease in LF/HF ratio was associated with a 1.1-point increase in CFS (95 % CI 0.7-1.6, p < 0.001). The optimal ROC cutoff at which the LF/HF ratio was associated with frailty is ≤ 0.37.

Conclusions: The LF/HF ratio is inversely correlated with the CFS and independently associated with frailty. Measurement of HRV is a promising technique to enrich existing frailty scales and assist in frailty assessments in an ambulatory cardiology clinic.

Background: Metabolic acidosis caused by acidogenic diets increases muscle catabolism. High acidogenic diets can increase muscle loss in older adults; however, their association with functional outcomes remains unclear.

Objectives: To investigate whether high acidogenic diets increase the incidence of disability.

Design: Longitudinal study.

Setting: Community-based.

Participants: We included 1,704 community-dwelling Japanese individuals aged ≥ 75 years without disabilities at baseline (52.2 % females).

Measurements: Baseline dietary acid load was assessed using potential renal acid load (PRAL) values, which reflect urinary acidity-with higher values indicating more acidogenic diets. The outcome measure was the one-year incidence of disability, defined as needing for long-term care or support based on certification by the Japanese long-term care insurance system. As the effects of PRAL are reportedly sex-specific, separate analyses were conducted for males and females. The participants were categorized into tertiles (T1-T3, with T1 as the reference) based on their PRAL values. Odds ratios (ORs) and 95 % confidence intervals (CIs) for outcome were calculated using multiple logistic regression analysis after adjusting for age, body mass index, living status, smoking status, hypertension, diabetes, dyslipidemia, energy intake, and alcohol intake.

Results: The PRAL ranges in groups T1, T2, and T3 were: -64.51 to 0.21, 0.27 to 11.34, and 11.41 to 61.00, respectively, in males, and -61.22 to -3.84, -3.75 to 5.89, and 5.90 to 38.68, respectively, in females. Disabilities occurred in 44 (5.7 %) males and 71 (8.7 %) females. ORs (95 % CIs) for disability in T2 and T3 were 0.79 (0.35-1.76) and 0.81 (0.37-1.79), respectively, in males and 1.10 (0.57-2.13) and 1.96 (1.06-3.61), respectively, in females.

Conclusions: A high dietary acid load increased the incidence of disability in older females. Therefore, managing an acidogenic diet may help maintain daily living functions in older females. Future studies should investigate whether sex is an effect modifier.

Background: Frailty is a major health concern among older adults, and its association with oral health-related quality of life (OHRQoL) remains underexplored in longitudinal studies.

Objective: To investigate the association between baseline OHRQoL and physical frailty incidence at a 2-year follow-up in community-dwelling older adults.

Design: Prospective longitudinal study.

Setting: The study was conducted within the Tosa Longitudinal Aging Study framework in Japan.

Participants: This study included 144 community-dwelling older adults (50 men and 94 women; median age, 81.0 years) with complete data who participated in the Tosa Longitudinal Aging Study in 2016 and 2018 and were not categorized as physical frailty in 2016.

Measurements: Baseline assessment included OHRQoL, which was evaluated using the General Oral Health Assessment Index (GOHAI; range 12-60), with higher scores indicating better OHRQoL, oral function, and general health status. The incidence of physical frailty was defined using the revised Japanese version of the Cardiovascular Health Study criteria. The association between the GOHAI score and physical frailty was assessed using logistic regression analysis.

Results: The median baseline GOHAI score was 58. The incidence of frailty after a 2-year follow-up was 13.9 % among the participants (18.0 and 11.7 % for men and women, respectively). Each point of the GOHAI score was associated with an 11 % reduction in frailty risk over 2 years after adjusting by age, sex, number of teeth, Food Diversity Score, Geriatric Depression Scale score, eating alone, smoking, and more than five medications (adjusted odds ratio: 0.893; 95 % confidence interval: 0.810-0.984).

Conclusions: This longitudinal study showed that a higher baseline OHRQoL, based on the GOHAI score, was linked to a lower incidence of physical frailty among community-dwelling older adults after 2 years.

Background and objective: This study examined the relationship between body mass index (BMI) and sarcopenia with oral function decline in older patients as well as whether a combination of underweight BMI and sarcopenia was associated with decreased oral function in individuals with conservative restorative and prosthetic treatment for masticatory disorders.

Design, setting, and participants: This cross-sectional study included 290 older Japanese patients who regularly attended a general dental clinic. A detailed examination of oral function, sarcopenia, and BMI according to the Asian Working Group for Sarcopenia 2019 criteria was conducted for patients aged 65 years. This study used odds ratios as an epidemiological measure in the cross-sectional survey.

Results: Multinomial logistic regression analysis showed that the number of remaining teeth and tongue pressure was associated with both ideal and overweight BMI in individuals with sarcopenia when compared to healthy individuals. The underweight BMI plus sarcopenia group was associated with tongue and lip motor function [ka] sound test, swallowing function, and the presence of oral hypofunction.

Discussion: Our findings indicated that various aspects of oral function were impaired in community-dwelling older adult Japanese patients with sarcopenia and underweight BMI. Notably, among older adults with sarcopenia, both obese and thin patients exist, suggesting that distinct pathophysiological mechanisms influence oral function.

Conclusion: The above findings support the hypothesis that the coexistence of sarcopenia and underweight BMI is associated with poor oral function. Regular oral function assessments and weight measurements in general dental practice can aid the prompt identification of sarcopenia and reduced swallowing function and can facilitate early intervention. The presence of sarcopenia and impaired swallowing function should be considered in patients with underweight BMI, reduced [ka] sound, and low tongue pressure following a thorough oral function examination.

Background: Several indexes based on clinical and laboratory tests to identify frailty and to predict mortality have been produced. Only two studies, mixing clinical and laboratory parameters were made about a frailty index made of laboratory tests (FI-Lab) and mortality in older patients hospitalized for COVID-19. The aim of this study was to explore the accuracy and precision of an FI-Lab constructed with some common bio-humoral tests and mortality in a cohort of patients hospitalized for COVID-19.

Methods: The FI-Lab was constructed using 40 different bio-humoral tests during the first four days of hospitalization, with a score from 0 to 1. The association between FI-Lab and mortality was assessed using a multivariate Cox's regression analysis, reported as hazard ratios (HRs) and 95% confidence intervals (CIs). The accuracy of the FI-Lab was reported as area under the curve (AUC) and the precision with the C-Index.

Results: 376 patients (mean age: 65 years; 53.7% males) were initially included. During the follow-up period, 41 deceased. After adjusting for five different factors, an FI-Lab value >0.54, the median value of our cohort, was associated with a relative risk about five times greater than lower values. Modeling FI-LAB as a continous variable, each increase in 0.01 points was associated with an increased risk in mortality of 8.4% (HR=1.084; 95%CI: 1.039-2.044). The FI-Lab was highly accurate (AUC=0.91; 95%CI: 0.87-0.95) and precise (C-Index=0.81) in predicting death.

Conclusions: A simple index based on common laboratory tests can be used to predict mortality among older people hospitalized for COVID-19.