Differences in frailty in older men and women

Longevity Science and Women's Health and Wellbeing

In most areas of the world women comprise the majority of older persons (especially at the most advanced ages), but the additional longevity (globally it is 4.8 years) women have often comes with poorer health status compared to age-matched men. This article draws attention to four distinct ways an applied gerontological intervention designed to increase the human healthspan via "rate (of ageing) control" could positively impact the health and wellbeing of women in today's ageing world. The four benefits examined are: (1) improving women's health in late life; (2) increasing reproductive longevity and improving maternal health, (3) reducing the financial vulnerability many women experience at advanced ages (especially in the developing world); and (4) reducing the caring burdens which typically fall, at least disproportionately, on daughters to care for their ageing parents. Highlighting these factors is important as is helps focus geroscience advocacy not only on the potential health dividend age retardation could confer on those in late life, but also the distributional effects on health throughout the lifespan (e.g. improving maternal health) and on helping to ameliorate other important inequalities (e.g. reducing the financial vulnerabilities of late life and easing the burdens on the care givers for ageing parents). By making vivid the benefits "rate (of ageing) control" could confer on women, especially in the developing world, the goal of retarding biological ageing can be rightly construed as a pressing public health priority for the 21st century.

5-Hydroxymethylfurfural induces mice frailty through cell senescence-associated sarcopenia caused by chronic inflammation

Objective

5-Hydroxymethylfurfural (5-HMF) is an important component of air pollution, confirmed to be a risk factor for pulmonary inflammation. However, its association with general health is unknown. This article aimed to clarify the effect and mechanism of 5-HMF in the occurrence and aggravation of frailty in mice by investigating whether exposure to 5-HMF was linked to the occurrence and aggravation of mice frailty.

Methods

Twelve male C57BL/6 mice (12-month-old, 38 ± 1 g) were randomly divided into the control group and the 5-HMF group. The 5-HMF group was treated with 5-HMF (1 mg/kg/day, respiratory exposure) for 12 months, whereas the control group was treated with equal amounts of sterile water. After the intervention, the ELISA method was used to detect the serum inflammation level of the mice, and the physical performance and frail status were evaluated using a Fried physical phenotype-based assessment tool. The differences in the body compositions were calculated from their MRI images, and the pathological changes in their gastrocnemius muscle were revealed using the H&E staining. Furthermore, the senescence of skeletal muscle cells was evaluated by measuring the expression levels of senescence-related proteins by the western blotting.

Results

In the 5-HMF group, serum inflammatory factors IL-6, TNF-α, and CRP levels were significantly raised (p < 0.01). Mice in this group had higher frailty scores and significantly reduced grip strength (p < 0.001), slower weight gains, less WVgastrocnemius muscle masses, and lower sarcopenia indices (SI). In addition, the cross-sectional areas of their skeletal muscles were reduced, and the levels of their cell senescence-related proteins (p53, p21, p16, SOD1, SOD2, SIRT1, SIRT3) were considerably altered (p < 0.01).

Conclusion

5-HMF may induce chronic and systemic inflammation, which in turn accelerates the progression of the frailty of mice through cell senescence.

The frailty index based on laboratory test data as a tool to investigate the impact of frailty on health outcomes: a systematic review and meta-analysis

The frailty index (FI) quantifies frailty as deficit accumulation. It has been adapted to employ laboratory test data (FI-Lab). Our objective was to systematically review and meta-analyse the FI-Lab's ability to predict mortality. Secondary objectives were to review the FI-Lab's association with adverse health outcomes and whether FI-Lab scores differed between the sexes. A systematic literature search was carried out using six online databases to identify studies that measured the FI-Lab in humans. Hazard ratios (HRs) were combined in a meta-analysis to create a pooled risk estimate for mortality. Of the 1,201 papers identified, spanning January 2010 until 11 July 2022, 38 were included. FI-Lab scores per 0.01 unit increase predicted mortality overall (HR = 1.04; 95% confidence interval (CI) = 1.03-1.05) and for studies with a mean age of 81+ years (HR = 1.04; 95% CI = 1.03-1.05). The quality of evidence for these meta-analyses are moderate and high, respectively. Further, higher FI-Lab scores were associated with more frequent adverse health outcomes. Sex differences in FI-Lab scores varied, with no consistent indication of a sex effect. The FI-Lab is associated with mortality and with a variety of adverse health outcomes. No consistent sex differences in FI-Lab scores were observed, with several studies in disagreement. Notably, these conclusions were most relevant to older (65+ years old) individuals; further evidence in younger people is needed in both clinical and population representative studies.

Sex differences in frailty manifestations in patients with coronary artery disease

Aim. To analyze the differences in detection rate of prefrailty and frailty syndrome (FS) in male and female patients with multivessel coronary artery disease (CAD) undergoing elective coronary artery bypass grafting (CABG).

Material and methods. The study included 387 patients admitted for elective primary CABG. Screening for prefrailty and FS in patients before surgery was performed using the questionnaire "Age is not a drawback".

Results. In the age group of 45 to 59 years, 25% of females and only 6% of males had signs of FS, while 25% of women and 34% of men did not present with signs of frailty and prefrailty. Half of middle-aged women and 60% of middle-aged men had prefrailty. Between the ages of 60 and 74, only 14% of women and 24% of men were not frail. Elderly women are more likely than elderly men to present with signs of FS (p=0,040). The symptoms of prefrailty in elderly patients were detected at equal rate in men and women (59% and 60%, respectively). All senile-aged patients presented with the signs of prefrailty or FS.

Conclusion. Patients with multivessel CAD present with manifestation of frailty in senile, elderly, and middle age. At the same time, middle-aged and elderly women with the higher rates of comorbid disorders require special attention.

Depressive Symptoms Partially Mediate the Association of Frailty Phenotype Symptoms and Cognition for Females but Not Males

OBJECTIVES

We aimed to evaluate whether depressive symptoms mediated the relationship between frailty phenotype and cognitive function by sex.

METHODS

Data came from the Health and Retirement Study from 2012-2016. The outcome was measured by Fried's frailty criteria, our outcome was continuous global cognition, and mediator was depressive symptoms. We used mediation analysis, stratified by sex, to estimate the direct and indirect effects of frailty symptoms on cognition mediated by depressive symptoms.

RESULTS

Males had a larger total effect (β= -0.43; 95% CI: -0.66, -0.02) for lower cognitive score for each increase in frailty symptom compared to females (β= -0.28; 95% CI: -0.47, -0.08). A significant indirect effect from frailty phenotype to cognition was found through depressive symptoms for females but not males.

CONCLUSION

These results highlight the importance of identifying individuals with frailty and depressive symptoms to monitor and provide interventions to preserve cognitive function.

Measurements of damage and repair of binary health attributes in aging mice and humans reveal that robustness and resilience decrease with age, operate over broad timescales, and are affected differently by interventions

As an organism ages, its health-state is determined by a balance between the processes of damage and repair. Measuring these processes requires longitudinal data. We extract damage and repair transition rates from repeated observations of binary health attributes in mice and humans to explore robustness and resilience, which respectively represent resisting or recovering from damage. We assess differences in robustness and resilience using changes in damage rates and repair rates of binary health attributes. We find a conserved decline with age in robustness and resilience in mice and humans, implying that both contribute to worsening aging health - as assessed by the frailty index (FI). A decline in robustness, however, has a greater effect than a decline in resilience on the accelerated increase of the FI with age, and a greater association with reduced survival. We also find that deficits are damaged and repaired over a wide range of timescales ranging from the shortest measurement scales toward organismal lifetime timescales. We explore the effect of systemic interventions that have been shown to improve health, including the angiotensin-converting enzyme inhibitor enalapril and voluntary exercise for mice. We have also explored the correlations with household wealth for humans. We find that these interventions and factors affect both damage and repair rates, and hence robustness and resilience, in age and sex-dependent manners.

Differences in Sex and the Incidence and In-Hospital Mortality among People Admitted for Infective Endocarditis in Spain, 2016-2020

(1) Background: A description of the trends and outcomes during hospitalization for infective endocarditis (IE) according to sex. (2) Methods: Using Spanish national hospital discharge data (2016−2020), we built Poisson regression models to compare the age-adjusted time trends for the incidence rate. We used propensity score matching (PSM) to compare the clinical characteristics and the in-hospital mortality (IHM) between men and women hospitalized with IE. (3) Results: We identified 10,459 hospitalizations for IE (33.26% women). The incidence of IE remained stable during this five-year period. The age-adjusted incidence of IE was two-fold higher among men vs. women (IRR = 2.08; 95%CI 2.0−2.17). Before PSM, women with IE were significantly older than men (70.25 vs. 66.24 years; p < 0.001) and had lower comorbidity according to the Charlson comorbidity index (mean 1.38 vs. 1.43; p = 0.019). After PSM, the IHM among women admitted for IE remained >3 points higher than that among men (19.52% vs. 15.98%; p < 0.001). (4) Conclusions: The incidence of IE was two-fold higher among men than among women. IHM was significantly higher among women after accounting for the potential confounders.

Prevalence of Frailty and Its Association with Depressive Symptoms among European Older Adults from 17 Countries: A 5-Year Longitudinal Study

BACKGROUND

This study aimed to examine the association between frailty and depressive symptoms.

METHODS

Cross-sectional and five-year longitudinal study. Data were from the population-based Survey of Health, Aging, and Retirement in Europe (SHARE) waves six (2015) and eight (2020). Frailty was assessed using the SHARE-Frailty Instrument. Fatigue, appetite, walking difficulties, and physical activity were self-reported, and grip strength was measured using a handgrip dynamometer. The EURO-D 12-item scale was used to measure depressive symptoms.

RESULTS

The sample comprised 25,771 older adults (56.2% female) with a mean age of 66.5 (95% CI 66.4, 66.6) years. The prevalence of frailty was 4.2% (95% CI 3.9, 4.4) in 2015 and 6.7% (95% CI 13.5, 14.3) in 2020. Among frail participants, 72.5% and 69.6% had depression in 2015 and 2020, respectively. Frailty was associated with depression over the 5 years. Those with pre-frailty and those with frailty in 2015 had 1.86 (95% CI 1.71, 2.01) and 2.46 (95% CI 2.14, 2.83) greater odds of having depressive symptoms in 2020.

CONCLUSIONS

Frailty is a predictor of depression in older adults, and frail participants had greater odds of presenting depressive symptoms.

A multidimensional approach to the resilience in older adults despite COVID-19

Researchers have mainly focused on aging risk factors and COVID-19 consequences. However, older adults have proved their ability to overcome adversities along their life. Resilience is a protective variable that dampens the impact of stress. Based on MacLeod’s et al. (2016) approach, we aimed to analyze the relationship between older adults’ resilience and COVID-19 related-stressors as well as their physical, mental, and social characteristics. Eight hundred eighty-nine people aged 60 and over participated in this study. Older participants, women, having better perceived health and not losing a loved one because of the virus were associated with more resilience. Moreover, higher levels of gratitude, personal growth, life purpose and lower levels of depression were associated with greater scores in resilience. This study offers a change of perspective in which aging is perceived from a positive viewpoint by focusing on easily accessible resources that may help older adults to cope with adverse situations.

Sex-specific interventions to prevent and manage frailty

There is growing interest in interventions that delay, slow, and even reverse frailty. In this narrative review, we explore the evidence on exercise, nutrition, medication optimisation and social support interventions for frailty and consider how these relate to underlying frailty pathophysiology. We also consider pathophysiological mechanisms underpinning sex differences in frailty before evaluating the limited evidence for sex-specific frailty interventions that is currently available. Through this review of the literature, we generate a list of potential sex-specific interventions for frailty. While individual-level recommendations are certainly important, future work should turn the focus towards population-level interventions that take into account sex differences in frailty, including changes to healthcare and socioeconomic systems, as well as changes to the built environment to promote healthy behaviours.

Sensory and motor correlates of frailty: dissociation between frailty phenotype and frailty index

Background

Frailty has been associated with a decline in sensory and motor function. However, given that different frailty measures were shown to overlap but also differ in their diagnostic properties, sensory and motor correlates of frailty might be different depending on the operationalization of frailty. Our objective was to identify sensory and motor determinants of frailty and compare the results between frailty phenotype (FP) and frailty index (FI).

Methods

Data from 44 pre-frail and frail subjects aged 65 and above were used. Frailty was measured using the FP and the FI. Sensory function in the visual, auditory, and tactile domain was assessed using visual acuity, absolute hearing threshold and mechanical detection threshold. Upper extremity motor performance was evaluated by the Purdue Pegboard Test and the Short Physical Performance Battery was used to assess lower extremity motor function. Multiple logistic regression models were employed to determine associations of sensory and motor function with frailty vs. pre-frailty for both frailty measures.

Results

The frailty measures were moderately correlated (0.497, p ≤ 0.01) and had a Kappa agreement of 0.467 (p = 0.002). Using the FP, frailty was significantly associated with reduced upper extremity motor function only (OR = 0.50, 95% CI 0.29–0.87, p = 0.014). Frailty as assessed by the FI was significantly related to higher hearing thresholds (OR = 1.21, 95% CI 1.02–1.43, p = 0.027) and reduced lower extremity performance (OR = 0.32, 95% CI 0.13–0.77, p = 0.012).

Conclusion

Frailty is related to reduced performance in measures of sensory and motor function. However, traditional measures of frailty might be differentially sensitive to capture sensory and motor decline, possibly contributing to the much-observed discordance between the diagnostic instruments. This should be taken into account by researchers and clinicians when planning and evaluating therapeutic interventions for frailty.

Trial registration

ClinicalTrials.gov NCT03666039. Registered 11 September 2018 – Retrospectively registered.

Expecting the best or fearing the worst: Discrepancies between self-rated health and frailty in an ageing Irish population

OBJECTIVES

Ageing populations have the propensity to rate their health status more inaccurately than their younger counterparts. As a result, we (1) devised a metric which categorized older adults into groups based on the discrepancy between their self-rated health (SRH) and Frailty Index (FI) scores, and (2) investigated which factors predict group membership.

DESIGN

A cross-sectional design was employed using data from The Irish Longitudinal Study of Ageing (TILDA).

METHODS

A health asymmetry metric was derived: this categorized 6907 participants (aged 50+ years) into three groups: 'health pessimistic' where participants underestimated their healthiness, 'health realistic' where participants accurately assessed their health, and 'health optimistic' where participants overestimated their healthiness. A multinomial logistic regression modelled the ability of a set of sociodemographic, psychosocial, and health behaviour variables in predicting membership of these categories.

RESULTS

A significant proportion of the study population were categorized as 'health realistic' (~69%). The prevalence rates of health optimistic individuals increased in older age groups, and conversely, health pessimistic rates decreased in older age groups. Most notably, psychosocial factors significantly predicted being health pessimistic: such as anxiety (OR = 1.03), loneliness (OR = 1.04), and decreased social connectedness (OR = 0.87). However, less clear sociodemographic, psychosocial, and health behaviour associations were found for being health optimistic.

CONCLUSION

Health asymmetry is a useful method of identifying at-risk individuals for inaccurate SRH. The ability of this metric to predict clinical mental health outcomes should be investigated.

An Easy-to-Implement Clinical-Trial Frailty Index Based on Accumulation of Deficits: Validation in Zoster Vaccine Clinical Trials

Purpose

Despite being among those most in need of protection, frail older adults are often not well represented in clinical trials. Although frailty likely influences responses to treatments and vaccines, frailty may not be explicitly considered in trials even when frail participants are enrolled due to the perception that frailty is difficult to measure effectively and efficiently without adding to participant or data collection burden. We developed an easy-to-implement frailty index, the Clinical Trial-Frailty Index (CT-FI), based on baseline medical history and standard patient-reported outcomes using data from clinical trials of recombinant Zoster vaccine (the ZOE-50 and ZOE-70 studies). Our objective was to demonstrate that the CT-FI is a robust measure that may be used retrospectively or prospectively in clinical trials where sufficient patient data have been collected.

Methods

The CT-FI was based on baseline medical history and Quality of Life questionnaires (SF-36 and EQ-5D). Items meeting criteria for inclusion were scored from 0 to 1, then summed for each participant and divided by the total number of deficits considered. Validation analyses included descriptive verification of distribution and age- and sex-associations in relation to usual patterns of the frailty index, regressions in relation to outcomes hypothesized to be related to frailty, and resampling methods within the index.

Results

The CT-FI distribution was well represented by a gamma distribution with a range of 0–0.70. Deficit accumulation increased with chronological age and was higher for females. Multivariate Cox regression survival analysis showed that the CT-FI, age, and sex were significant predictors of mortality. Jackknife and Bootstrap resampling methods highlighted the robustness of the CT-FI, which was not sensitive to inclusion/exclusion of specific individual or groups of variables.

Conclusion

We have developed a reliable, robust and easy-to-implement CT-FI with potential retrospective or prospective application in other clinical trials.

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Psychological impact of COVID-19: Assessing the COVID-19-related anxiety, individual’s resilience and conspiracy beliefs on attitudes to COVID-19 vaccination

It has been 2 years since the first outbreak of the COVID-19 virus, and continuous efforts and measures have been exerted and implemented to halt its spread, such as the introduction of vaccination programs. However, as with the consumption of other products and services, some people hold different beliefs, consequently affecting their attitudes toward COVID-19 vaccination. Thus, vaccine unwillingness and hesitancy remain an enormous concern for many countries. This paper explores the effects of anxiety, individual resilience, and conspiracy beliefs on attitudes toward COVID-19 vaccines among the population of Malaysia—with a focus on Muslim individuals. We used survey data from 438 respondents (205 male, 233 female) to assess the research model. To conduct the multi-group analysis, we used partial least square structural equation modeling in SmartPLS 3. The results suggest that anxiety is positively associated with COVID-19 vaccination attitudes, whereas conspiracy beliefs have an inverse effect on vaccination attitudes, while an individual’s resilience is also positively associated with vaccination attitudes. Furthermore, it is found that the relationship between conspiracy beliefs and vaccination attitudes is weakened for an individual with a higher level of resilience. The findings also reveal the differences and similarities between males and females. To the best of our knowledge, this study is the first to simultaneously explore and demonstrate the effects of COVID-19-related anxiety, conspiracy beliefs and resilience with people’s attitudes toward COVID-19 vaccines and to examine the homogeneity of both males and females—especially among Malaysia’s Muslim population—thereby offering a valuable contribution to the literature.

Age at menopause is negatively associated with frailty: A systematic review and meta-analysis

Menopause and related changes may be associated with frailty and contribute to higher frailty risk. This systematic review of the literature on the association between menopause and frailty combines the findings from studies of community-dwelling women. PubMed was systematically searched in March 2021 with a time frame from 2000 to March 2021 without language restriction. Potentially eligible studies were those that provided cross-sectional or prospective observational data on associations between menopause and frailty in community-dwelling women. Reference lists of relevant articles and the included studies were reviewed for additional studies. The same effect sizes were combined using a meta-analysis using the generic inverse variance method. From 131 studies identified, cross-sectional data on age at menopause from 3 studies and longitudinal data on surgical menopause from 2 studies were used for meta-analysis. Each one-year increase in age at menopause was significantly associated with a 2 % decreased risk of prevalent frailty (pooled odds ratio = 0.98, 95%CI (confidence interval) = 0.96-0.99, p < 0.001). Surgical menopause did not predict incident frailty (pooled OR = 1.02, 95%CI = 0.82-1.28, p = 0.23). This systematic review and meta-analysis showed that later age at menopause was significantly associated with a lower risk of prevalent frailty. In a clinical setting, age at menopause can be useful information to help clinicians to evaluate and stratify frailty risk in postmenopausal women. Hormonal changes after menopause may be related to the link between age at menopause and frailty and thus warrant further investigation.

Validation of the Clinical Frailty Scale version 2.0 in Turkish older patients

AIM

Frailty is a syndrome that affects certain older adults more than others, and it has physical, cognitive, psychological, social and environmental aspects. The aim of our study was to determine the validity and reliability of the Clinical Frailty Scale (CFS) version 2.0 in Turkish. In total, 204 older adults aged ≥65 years took part in this study.

METHODS

The necessary permissions were obtained from Rockwood et al. The Turkish version of CFS version 2.0 had been appropriately translated through translation to the back-translation process. A questionnaire was used to investigate certain descriptive features, as well as the newly edited Turkish translation of CFS version 2.0, the Turkish version of the FRAIL Scale and the Turkish version of the Edmonton Frail Scale.

RESULTS

The age range was 65-95 years. In a Pearson correlation analysis, a positive link was discovered between FRAIL and CFS (r = 0.761 and P = 0.000) as well as CFS and Edmonton (r = 0.895 and P = 0.000).

CONCLUSION

The Turkish translation of CFS version 2.0 has been determined to be suitable, valid and reliable for use in frailty screening in outpatient clinics. Geriatr Gerontol Int 2022; 22: 730-735.

Protective effects of milk thistle (Sylibum marianum) seed oil and α-tocopherol against 7β-hydroxycholesterol-induced peroxisomal alterations in murine C2C12 myoblasts: Nutritional insights associated with the concept of pexotherapy

Peroxisomes play an important role in regulating cell metabolism and RedOx homeostasis. Peroxisomal dysfunctions favor oxidative stress and cell death. The ability of 7β-hydroxycholesterol (7β-OHC; 50 μM, 24 h), known to be increased in patients with age-related diseases such as sarcopenia, to trigger oxidative stress, mitochondrial and peroxisomal dysfunction was studied in murine C2C12 myoblasts. The capacity of milk thistle seed oil (MTSO, 100 μg/mL) as well as α-tocopherol (400 µM; reference cytoprotective agent) to counteract the toxic effects of 7β-OHC, mainly at the peroxisomal level were evaluated. The impacts of 7β-OHC, in the presence or absence of MTSO or α-tocopherol, were studied with complementary methods: measurement of cell density and viability, quantification of reactive oxygen species (ROS) production and transmembrane mitochondrial potential (ΔΨm), evaluation of peroxisomal mass as well as topographic, morphologic and functional peroxisomal changes. Our results indicate that 7β-OHC induces a loss of cell viability and a decrease of cell adhesion associated with ROS overproduction, alterations of mitochondrial ultrastructure, a drop of ΔΨm, and several peroxisomal modifications. In the presence of 7β-OHC, comparatively to untreated cells, important quantitative and qualitative peroxisomal modifications were also identified: a) a reduced number of peroxisomes with abnormal sizes and shapes, mainly localized in cytoplasmic vacuoles, were observed; b) the peroxisomal mass was decreased as indicated by lower protein and mRNA levels of the peroxisomal ABCD3 transporter; c) lower mRNA level of Pex5 involved in peroxisomal biogenesis as well as higher mRNA levels of Pex13 and Pex14, involved in peroxisomal biogenesis and/or pexophagy, was found; d) lower levels of ACOX1 and MFP2 enzymes, implicated in peroxisomal β-oxidation, were detected; e) higher levels of very-long-chain fatty acids, which are substrates of peroxisomal β-oxidation, were found. These different cytotoxic effects were strongly attenuated by MTSO, in the same range of order as with α-tocopherol. These findings underline the interest of MTSO and α-tocopherol in the prevention of peroxisomal damages (pexotherapy).

Low physical activity is the strongest factor associated with frailty phenotype and frailty index: data from baseline phase of Birjand Longitudinal Aging Study (BLAS)

Background

Frailty is the most complicated expression of aging that is related to disability or multi-morbidity. The aim of the present study was to estimate the prevalence of frailty and its associated factors among community-dwelling aged population.

Methods

A total of 1529 eligible community- dwelling older adults (≥ 60 years) were enrolled in the baseline phase of Birjand Longitudinal Aging Study (BLAS) from 2019 to 2020. Their frailty status was assessed using the Fried’s frailty phenotype and frailty index. Sociodemographic factors, including sex, age, marital status, and education level, were collected. Health status assessment included the history of hypertension, diabetes mellitus, cardiovascular disease, Alzheimer’s diseases and dementia, and other health conditions. Furthermore, functional assessment (ADL, IADL) and anthropometric measurements including height, weight, waist, calf, and mid-arm circumference were made and the body mass index was calculated. The nutrition status and polypharmacy (use 3 or more medication) were also evaluated.

Results

The prevalence of frailty was 21.69% according to the frailty phenotype and 23.97% according to the frailty index. A multiple logistic regression model showed a strong association between low physical activity and frailty phenotype (OR = 36.31, CI = 16.99–77.56, P < 0.01), and frailty index (OR = 15.46, CI = 5.65–42.34, P < 0.01). Other factors like old age (≥80), female sex, malnutrition, polypharmacy, obesity, and arthritis were also associated with frailty. The Kappa coefficient of the agreement between these two instruments was 0.18.

Conclusion

It seems that low physical activity is the most important determinant of frailty. Low physical activity and some other factors may be preventable or modifiable and thus serve as clinically relevant targets for intervention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03135-y.

Finding good alternatives to hospitalisation: a data register study in five municipal acute wards in Norway

BACKGROUND

In Norway, municipal acute wards (MAWs) have been implemented in primary healthcare since 2012. The MAWs were intended to offer decentralised acute medical care 24/7 for patients who otherwise would be admitted to hospital. The aim of this study was to assess whether the MAW represents the alternative to hospitalisation as intended, through 1) describing the characteristics of patients intended as candidates for MAWs by primary care physicians, 2) exploring the need for extended diagnostics prior to admission in MAWs, and 3) exploring factors associated with patients being transferred from the MAWs to hospital.

METHODS

The study was based on register data from five MAWs in Norway in the period 2014-2020.

RESULTS

In total, 16 786 admissions were included. The median age of the patients was 78 years, 60% were women, and the median length of stay was three days. Receiving oral medication (OR 1.23, 95% CI 1.09-1.40), and the MAW being located nearby the hospital (OR 2.29, 95% CI 1.92-2.72) were factors associated with patients admitted to MAW after extended diagnostics. Patients needing advanced treatment, such as oxygen therapy (OR 2.13, 95% CI 1.81-2.51), intravenous medication (OR 1.60, 95% CI 1.45-1.81), intravenous fluid therapy (OR 1.32, 95% CI 1.19-1.47) and MAWs with long travel distance from the MAW to the hospital (OR 1.46, 95% CI 1.22-1.74) had an increased odds for being transferred to hospital.

CONCLUSIONS

Our findings indicate that MAWs do not represent the alternative to hospitalisation as intended. The results show that patients receiving extended diagnostics before admission to MAW got basic treatment, while patients in need of advanced medical treatment were transferred to hospital from a MAW. This indicates that there is still a potential to develop MAWs in order to fulfil the intended health service level.

Earlier menopause is associated with higher risk of incident frailty in community-dwelling older women in England

BACKGROUND

Although it is well known that women have higher risk of frailty, mechanisms are not clear. Reproductive history may be related to the sex difference in frailty.

METHODS

A total of 1249 community-dwelling women aged ≥60 in England were examined for associations between age at menopause and risk of developing frailty. Frailty defined by the frailty phenotype was measured at baseline and 4 years later. Age at menopause was used as a continuous variable and categorical groups: premature/early (10-45 years), normal (46-55 years), and late (56 years or older). Men with comparable conditions from the same cohort were also used as a comparison.

RESULTS

Earlier age at menopause was significantly associated with higher risk of incident frailty. One year later menopause age was associated with a 3% decrease in incident frailty risk (Odds ratio [OR] = 0.97, 95%CI = 0.95-1.00, p = 0.02). Women with premature or early menopause had a significantly higher risk of developing frailty compared with those with normal menopause (OR = 1.90, 95%CI = 1.28-2.81, p = 0.001), while those with late menopause did not. In a supplementary analysis with older men, older women with premature or early menopause were more likely to develop frailty compared with older men (OR = 2.29, 95%CI = 151-3.48, p < 0.001), however, there was no significant difference between women with normal or late menopause.

CONCLUSIONS

Earlier menopause was significantly associated with higher risk of developing frailty. Our findings suggest that menopause or its related factors, such as decline in estrogen after menopause, potentially play an important role in the sex difference in frailty.

Frailty indices based on self-report, blood-based biomarkers and examination-based data in the Canadian Longitudinal Study on Aging

BACKGROUND

Frailty can be operationalised using the deficit accumulation approach, which considers health deficits across multiple domains. We aimed to develop, validate and compare three different frailty indices (FI) constructed from self-reported health measures (FI-Self Report), blood-based biomarkers (FI-Blood) and examination-based assessments (FI-Examination).

METHODS

Up to 30,027 participants aged 45-85 years from the baseline (2011-2015) comprehensive cohort of the Canadian Longitudinal Study on Aging were included in the analyses. Following standard criteria, three FIs were created: a 48-item FI-Self Report, a 23-item FI-Blood and a 47-item FI-Examination. In addition a 118-item FI-Combined was constructed. Mortality status was ascertained in July 2019.

RESULTS

FI-Blood and FI-Examination demonstrated broader distributions than FI-Self Report. FI-Self Report and FI-Blood scores were higher in females, whereas FI-Examination scores were higher in males. All FI scores increased nonlinearly with age and were highest at lower education levels. In sex and age-adjusted models, a 0.01 increase in FI score was associated with a 1.08 [95% confidence interval (CI): 1.07,1.10], 1.05 (1.04,1.06), 1.07 (1.05,1.08) and a 1.13 (1.11,1.16) increased odds of mortality for FI-Self Report, FI-Blood, FI-Examination and FI-Combined, respectively. Inclusion of the three distinct FI types in a single model yielded the best prognostic accuracy and model fit, even compared to the FI-Combined, with all FIs remaining independently associated with mortality.

CONCLUSION

Characteristics of all FIs were largely consistent with previously established FIs. To adequately capture frailty levels and to improve our understanding of the heterogeneity of ageing, FIs should consider multiple types of deficits including self-reported, blood and examination-based measures.

Gender differences in frailty transition and its prediction in community-dwelling old adults

Frailty is very common in old age and often associated with adverse events. Transitioning between frailty states is possible in both directions (improvement and worsening) offering targets for interventions. Frailty is more prevalent in women, but little is known about the impact of gender on frailty transition. The aim of this study is to identify gender differences for frailty transition in older adults and to develop gender-stratified prognostic prediction models for frailty transition. We performed a longitudinal analyses of the Berlin Initiative (cohort) Study with a frailty follow-up of 2.1 years. Description of frailty transition using the frailty phenotype and development of prognostic prediction models using multivariable logistic regressions for transition (improvement or worsening) stratified by gender following the TRIPOD statement were performed. In total, the study population consisted of 1158 community-dwelling adults with a mean age of 84.4 years and of whom 55% were women. Out of 1158 participants 225 (19%) were robust, 532 (46%) prefrail and 401 (35%) frail. After 2.1 (IQR 2.0–2.3) years, half of the participants had transitioned between frailty states. Men worsened more often and those who were already frail died more often than women. Gender-stratified prediction models for frailty transition demonstrated that some predictors (age, self-rated health, cognitive impairment, baseline frailty status) were included in all models. While stroke, diabetes mellitus, smoking and glomerular filtration rate were unique predictors in the models for females, osteoarthritis, hospitalization and education were predictors in the models for males. There are gender differences in frailty transition rates, patterns and prediction. This supports the importance of considering gender when addressing frailty and targeting interventions in old age.

Motivational Factors Are Varying across Age Groups and Gender

The aim of the current study was to explore differences in passion for achievement, grit, and mindset across age and gender, by using a cross-sectional design. The sample consisted of 1548 participants including 931 females and 617 males aged from 13 to 77 years (Mage 26.53 years, SD = 11.77). The eight-item Passion for Achievement Scale was used to assess general passion and the Grit-S scale was used to assess grit. Mindset was assessed using the eight-item Theories of Intelligence Scale (TIS). The results indicated significant differences between the three factors related to age, age groups, and gender. For the total sample, there was a significant gender difference in passion, where males score higher, and growth mindset, where females score higher. With age, passion decreases until the age of 50–59, and slightly increases for the remaining age groups. After a decrease in grit between the first (13–19 years) and the second (20–29 years) age group, grit increases with age. Mindset scores decline strongly after the age of 40–49. Generally, the patterns show that mindset and passion decrease across the life-span, while grit increases. Indeed, these attributes seems to be different from each other, and how they change varies across age groups.

Is Frailty Index a better predictor than pre-stroke modified Rankin Scale for neurocognitive outcomes 3-months post-stroke?

Background

The prognostic value of frailty measures for post-stroke neurocognitive disorder (NCD) remains to be evaluated.

Aims

The aim of this study was to compare the predictive value of pre-stroke FI with pre-stroke modified Rankin Scale (mRS) for post-stroke cognitive impairment. Further, we explored the added value of including FI in prediction models for cognitive prognosis post-stroke.

Methods

We generated a 36-item Frailty Index (FI), based on the Rockwood FI, to measure frailty based on pre-stroke medical conditions recorded in the Nor-COAST multicentre prospective study baseline assessments. Consecutive participants with a FI score and completed cognitive test battery at three months were included. We generated Odds Ratio (OR) with NCD as the dependent variable. The predictors of primary interest were pre-stroke frailty and mRS. We also measured the predictive values of mRS and FI by the area (AUC) under the receiver operating characteristic curve.

Results

598 participants (43.0% women, mean/SD age = 71.6/11.9, mean/SD education = 12.5/3.8, mean/SD pre-stroke mRS = 0.8/1.0, mean/SD GDS pre-stroke = 1.4/0.8, mean/SD NIHSS day 1 3/4), had a FI mean/SD score = 0.14/0.10. The logistic regression analyses showed that FI (OR 3.09), as well as the mRS (OR 2.21), were strong predictors of major NCD. When FI and mRS were entered as predictors simultaneously, the OR for mRS decreased relatively more than that for FI. AUC for NCD post-stroke was higher for FI than for mRS, both for major NCD (0.762 vs 0.677) and for any NCD (0.681 vs 0.638).

Conclusions

FI is a stronger predictor of post-stroke NCD than pre-stroke mRS and could be a part of the prediction models for cognitive prognosis post-stroke.

Trial Registration

ClinicalTrials.gov Identifier: NCT02650531.

Is Sex as a Biological Variable Still Being Ignored in Preclinical Aging Research?

Five years ago, the National Institute of Health (NIH) introduced a mandate to revolutionize the way sex as a biological variable (SABV) is considered in NIH-funded preclinical research. Given the known effects of sex on aging physiology, pathology, treatment response, and the effectiveness of interventions it is particularly important that SABV be considered in basic biology of aging research. Five years after this mandate, a significant amount of published work funded by the National Institute on Aging (NIA) is still not including mice of both sexes and/or not considering sex differences or comparisons in preclinical studies. Here we review a cross-section of recently published NIA-funded research to determine adherence to this mandate. We discuss the state of the preclinical aging field in terms of SABV and suggest strategies for improving adherence to the NIH mandate. It is imperative that we consider SABV and include males and females in all aspects of aging biology research to improve health outcomes for all.

Roadmap for Sex-Responsive Influenza and COVID-19 Vaccine Research in Older Adults

Sex differences in the immune system are dynamic throughout the lifespan and contribute to heterogeneity in the risk of infectious diseases and the response to vaccination in older adults. The importance of the intersection between sex and age in immunity to viral respiratory diseases is clearly demonstrated by the increased prevalence and severity of influenza and COVID-19 in older males compared to older females. Despite sex and age biases in the epidemiology and clinical manifestations of disease, these host factors are often ignored in vaccine research. Here, we review sex differences in the immunogenicity, effectiveness, and safety of the influenza and COVID-19 vaccines in older adults and the impact of sex-specific effects of age-related factors, including chronological age, frailty, and the presence of comorbidities. While a female bias in immunity to influenza vaccines has been consistently reported, understanding of sex differences in the response to COVID-19 vaccines in older adults is incomplete due to small sample sizes and failure to disaggregate clinical trial data by both sex and age. For both vaccines, a major gap in the literature is apparent, whereby very few studies investigate sex-specific effects of aging, frailty, or multimorbidity. By providing a roadmap for sex-responsive vaccine research, beyond influenza and COVID-19, we can leverage the heterogeneity in immunity among older adults to provide better protection against vaccine-preventable diseases.

Sex-specific aging in animals: Perspective and future directions

Sex differences in aging occur in many animal species, and they include sex differences in lifespan, in the onset and progression of age-associated decline, and in physiological and molecular markers of aging. Sex differences in aging vary greatly across the animal kingdom. For example, there are species with longer-lived females, species where males live longer, and species lacking sex differences in lifespan. The underlying causes of sex differences in aging remain mostly unknown. Currently, we do not understand the molecular drivers of sex differences in aging, or whether they are related to the accepted hallmarks or pillars of aging or linked to other well-characterized processes. In particular, understanding the role of sex-determination mechanisms and sex differences in aging is relatively understudied. Here, we take a comparative, interdisciplinary approach to explore various hypotheses about how sex differences in aging arise. We discuss genomic, morphological, and environmental differences between the sexes and how these relate to sex differences in aging. Finally, we present some suggestions for future research in this area and provide recommendations for promising experimental designs.

Preclinical frailty assessments: Phenotype and frailty index identify frailty in different mice and are variably affected by chronic medications

Use of different objective frailty assessment tools may improve understanding of the biology of frailty and allow evaluation of effects of interventions on frailty. Polypharmacy is associated with increased risk of frailty in epidemiologic studies, regardless of frailty definition, but the pathophysiology of the association is not well understood. This study aims to (1) assess and compare the prevalence of frailty from middle to old age following control, chronic polypharmacy or monotherapy treatment, when measured using the clinical frailty index assessment and the mouse frailty phenotype tools; and (2) to evaluate and compare the effects of chronic polypharmacy regimens with zero, low and high Drug Burden Index (DBI) and monotherapies from middle to old age on the rate of deficit accumulation on the frailty index, mean number of phenotype criteria, odds of being frail assessed by the frailty index or phenotype, and the time to onset of frailty assessed by the frailty index or phenotype. In a longitudinal study, middle-aged (12 months) male C57BL/6J(B6) mice were administered non medicated control feed and water, or therapeutic doses of different polypharmacy combinations or monotherapies in feed and/or water. Frailty assessments were performed at 12, 15, 18, 21 and 24 months. There was limited overlap between animals identified as frail using different frailty assessments. Polypharmacy has measurable and different effects on each frailty assessment. Long-term chronic administration of some polypharmacy and monotherapy therapeutic drug regimens increased the number of frailty deficits (clinical frailty index: low DBI polypharmacy (15 and 21 months), high DBI polypharmacy (15-21 months), oxycodone (15-18 months), oxybutynin (15-18 months), citalopram (15-21 months) and metoprolol monotherapy (15 months) and modified frailty phenotype assessment (over the whole duration of treatment, low DBI polypharmacy (adjusted Risk Ratio(aRR) = 1.97, 95% confidence interval (CI) 1.43-2.72), high DBI polypharmacy (aRR = 1.88; 95% CI 1.36-2.60), oxybutynin (aRR = 1.48; 95% CI 1.01-2.16) and citalopram monotherapy (aRR = 1.96; 95% CI 1.41-2.74), p < 0.05) . The odds of developing frailty measured with the clinical frailty index increased with high DBI polypharmacy (adjusted odds ratio (aOR) = 3.13; 95% CI 1.01-9.66) and when measured with the frailty phenotype assessment increased with low DBI polypharmacy (aOR = 4.38, 95% CI 1.40-13.74), high DBI polypharmacy (aOR = 3.43; 95% CI 1.12-10.50) and citalopram monotherapy (aOR = 4.63; 95% CI 1.39-15.54)). No treatment affected time to frailty using either frailty assessment. Analysis of the number of deficits on the frailty index or number of positive criteria on the frailty phenotype allows analysis of rate of change and provides greater sensitivity, while the odds of being frail analysis provided a clinically relevant indicator of whether mice had greater chance of reaching a cut-off for becoming frail with medication exposure than without. Our results are consistent with clinical studies, demonstrating that certain polypharmacy regimens induce frailty, with different relationships observed when using different frailty assessments and analyses.

Aerobic Exercise Attenuates Frailty in Aging Male and Female C57Bl/6 Mice and Effects Systemic Cytokines Differentially by Sex

Aerobic exercise is a promising intervention to attenuate frailty, but preclinical studies have used only male animals. We investigated the impact of voluntary aerobic exercise on frailty, biological age (FRailty Inferred Geriatric Health Timeline [FRIGHT] clock), predicted life expectancy (Analysis of FRAIlty and Death [AFRAID] clock), and mortality in both sexes and determined whether exercise was associated with changes in inflammation. Older (21-23 months) male (n = 12) and female (n = 22) C57Bl/6 mice matched for baseline frailty scores were randomized into exercise (running wheel) and sedentary (no wheel) groups. Frailty index scores were measured biweekly (13 weeks), and 23 serum cytokines were measured at midpoint and end point. Exercise levels varied between mice but not between the sexes. Exercise had no effect on mortality, but it attenuated the development of frailty in both sexes (female = 0.32 ± 0.04 vs 0.21 ± 0.01; p = .005; male = 0.30 ± 0.02 vs 0.22 ± 0.02; p = .042) and reduced frailty in older females after 10 weeks. FRIGHT scores were unaffected by exercise but increased with time in sedentary males indicating increased biological age. Exercise prevented the age-associated decline in AFRAID scores in older females such that exercised females had a longer life expectancy. We investigated whether aerobic exercise was associated with changes in systemic inflammation. Cytokine levels were not affected by exercise in males, but levels of pro-inflammatory cytokines were positively correlated with the frequency of exercise in females. Despite increases in systemic inflammation, exercise reduced frailty and increased life span in older females. Thus, voluntary aerobic exercise, even late in life, has beneficial effects on health in both sexes but may be especially helpful in older females.

Frailty-aware care: giving value to frailty assessment across different healthcare settings

Healthcare systems need to adapt to better serve an aging population with complex presentations. Frailty assessments are a potential means to address this heterogeneity in aging to identify individuals at increased risk for adverse health outcomes. Furthermore, frailty assessments offer an opportunity to optimize patient care in various healthcare settings. While the vast number of frailty assessment tools available can be a source of confusion for clinicians, each tool has features adaptable to the constraints and goals of different healthcare settings. This review discusses and compares barriers, facilitators, and the application of frailty assessments in primary care, the emergency department/intensive care unit and surgical care to cover a breadth of settings with different frailty assessment considerations. The implementation of frailty-aware care across healthcare settings potentiates better healthcare outcomes for older adults.

Exploring Early Detection of Frailty Syndrome in Older Adults: Evaluation of Oxi-Immune Markers, Clinical Parameters and Modifiable Risk Factors

Ageing is accompanied with a decline in several physiological systems. Frailty is an age-related syndrome correlated to the loss of homeostasis and increased vulnerability to stressors, which is associated with increase in the risk of disability, comorbidity, hospitalisation, and death in older adults. The aim of this study was to understand the relationship between frailty syndrome, immune activation, and oxidative stress. Serum concentrations of vitamins A and E were also evaluated, as well as inflammatory biomarkers (CRP and IL-6) and oxidative DNA levels. A group of Portuguese older adults (≥65 years old) was engaged in this study and classified according to Fried’s frailty phenotype. Significant increases in the inflammatory mediators (CRP and IL-6), neopterin levels, kynurenine to tryptophan ratio (Kyn/Trp), and phenylalanine to tyrosine ratio (Phe/Tyr), and significant decreases in Trp and Tyr concentrations were observed in the presence of frailty. IL-6, neopterin, and Kyn/Trp showed potential as predictable biomarkers of frailty syndrome. Several clinical parameters such as nutrition, dependency scales, and polypharmacy were related to frailty and, consequently, may influence the associations observed. Results obtained show a progressive immune activation and production of pro-inflammatory molecules in the presence of frailty, agreeing with the inflammageing model. Future research should include different dimensions of frailty, including psychological, social, biological, and environmental factors.

Frailty in Indigenous Populations: A Scoping Review

Background: Indigenous populations experience high rates of age-related illness when compared to their non-Indigenous counterparts. Frailty is a challenging expression of aging and an important public health priority. The purpose of this review was to map what the existing literature reports around frailty in Indigenous populations and to highlight the current gaps in frailty research within the Indigenous landscape.

Method: Scoping review of English language original research articles focusing on frailty within Indigenous adult populations in settler colonial countries (Australia, Canada, New Zealand and USA). Ten electronic databases and eight relevant institutional websites were searched from inception to October 2020.

Results: Nine articles met our inclusion criteria, finding this population having a higher prevalence of frailty and frailty occurring at younger ages when compared to their non-Indigenous counterparts, but two did not use a formal frailty tool. Females presented with higher levels of frailty. No culturally specific frailty tool was identified, and the included articles did not assess strategies or interventions to manage or prevent frailty in Indigenous peoples.

Conclusions: There was little definitive evidence of the true frailty prevalence, approaches to frailty screening and of potential points of intervention to manage or prevent the onset of frailty. Improvements in the quality of evidence are urgently needed, along with further research to determine the factors contributing to higher rates of frailty within Indigenous populations. Incorporation of Indigenous views of frailty, and instruments and programs that are led and designed by Indigenous communities, are crucial to address this public health priority.

Sex-Specific Association Between Socioeconomic Status, Lifestyle, and the Risk of Frailty Among the Elderly in China

Background: Lifestyle contributors to frailty among the elderly were previously reported in the developed Western countries, while evidence from the less developed East Asian regions was still lacking. Due to the well-acknowledged sex-based disparity of frailty and sex-difference of socioeconomic status and lifestyle, it is worth investigating the sex-specific association between the social and behavioral contributors and the risk of frailty among the East Asian longevous population. Methods: The present study was an observational study based on the four waves of interviews of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. The participants aged ≥65 years and without frailty at baseline were included. Fried criteria (exhaustion, shrink, weakness, low mobility, and inactivity) were adopted to identify the incidence of frailty (≥3 domains) and pre-frailty (1-2 domains) during the follow-up. The sex-specific association between lifestyle (smoke status, drinking status, food intake, sleep, exercise, and physical activity) and the risk of incident pre-frailty and frailty was analyzed using the multinomial logistic regression models. Results: Altogether, 3,327 participants aged 81.2 ± 10.3 (range 65-116) years were included. In total, 964 (29.0%) and 1,249 (37.5%) participants were recognized as having incident pre-frailty and frailty, respectively. Older women were disproportionately uneducated, frequently did housework and labor work, but seldom did exercise. Men had diverse dietary and recreational activities but were frequently exposed to tobacco and alcohol. The protective effects of higher income, exercise, doing housework, and daily intake of fresh fruits/vegetables were found in both the sexes (P < 0.05). Sleep disorders (odds ratio [OR] = 2.16, 95% CI: 1.28-3.62) and labor work (OR = 2.18, 95% CI: 1.42-3.33) were associated with the increased risk of frailty among women. For men, diverse dietary (four types of food added: OR = 0.21, 95% CI: 0.09-0.50) showed a protective effect on the risk of frailty, but daily intake of pickled vegetables showed the opposite effect (OR = 1.86, 95% CI: 1.12-3.07). Conclusion: Socioeconomic status, lifestyle, and the association with the risk of frailty showed substantial difference between the sexes among the longevous population in China. To establish the individualized strategy of behavioral improvement for the frailty prevention should consider the sex disparity.

Is slowness a better discriminator of disability than frailty in older adults?

BACKGROUND

The trajectory of incident disability that occurs simultaneously with changes in frailty status, as well as how much each frailty component contributes to this process in the different sexes, are unknown. The objective of this study is to analyse the trajectory of the incidence of disability on basic and instrumental activities of daily living (BADL and IADL) as a function of the frailty changes and their components by sex over time.

METHODS

Longitudinal analyses of 1522 and 1548 of the English Longitudinal Study of Ageing study participants without BADL and IADL disability, respectively, and without frailty at baseline. BADL and IADL were assessed using the Katz and Lawton Scales and frailty by phenotype at 4, 8, and 12 years of follow-up. Generalized mixed linear models were calculated for the incidence of BADL and IADL disability, as an outcome, using changes in the state of frailty and its components, as the exposure, by sex in models fully adjusted for sociodemographic, behavioural, biochemical, and clinical characteristics.

RESULTS

The mean age, at baseline, of the 1522 eligible individuals free of BADL and free of frailty was 68.1 ± 6.2 years (52.1% women) and of the 1548 individuals free IADL and free frailty was 68.1 ± 6.1 years (50.6% women). Women who became pre-frail had a higher risk of incidence of disability for BADL and IADL when compared with those who remained non-frail (P < 0.05). Men and women who became frail had a higher risk of incidence of disability regarding BADL and IADL when compared with those who remained non-frail (P < 0.05). Slowness was the only component capable of discriminating the incidence of disability regarding BADL and IADL when compared with those who remained without slowness (P < 0.05). Weakness and low physical activity level in men and exhaustion in women also discriminated the incidence of disability (P < 0.05).

CONCLUSIONS

Slowness is the main warning sign of functional decline in older adults. As its evaluation is easy, fast, and accessible, screening for this frailty component should be prioritized in different clinical contexts so that rehabilitation strategies can be developed to avoid the onset of disability.

Protein Nutritional Status and Frailty: A Mendelian Randomization Study

BACKGROUND

Observational studies have suggested that better protein nutritional status may contribute to prevention of frailty.

OBJECTIVE

We sought to examine this hypothesis using a Mendelian randomization (MR) analysis.

METHODS

We conducted a two-sample MR study using GWAS summary statistics data of the UK Biobank. We applied genetically predicted serum albumin as a primary exposure measure and serum total protein as a secondary exposure measure. The outcome measure was the Rockwood frailty index (FI) based on 49 deficits from 356,432 individuals (53.3% of them were women, with a mean ± SD age of 56.7 ± 8.0 y. The association between serum protein measures and FI was mainly analyzed by use of the inverse variance weighted method.

RESULTS

A genetically predicted serum albumin concentration was not statistically significantly associated with FI in the full sample. However, in women, we observed a preventive association between genetically predicted serum albumin and FI (β = -0.172 per g/L; 95% CI: -0.336, -0.007; P = 0.041). In the full sample, genetically predicted serum total protein was inversely associated with FI (β: -0.153 per g/L; 95% CI: -0.251, -0.056; P = 0.002). In both women and men, higher serum total protein was significantly inversely associated with FI; regression coefficients were -0.148 per g/L (95% CI: -0.287, -0.009; P = 0.037) for women, -0.154 per g/L (95% CI: -0.290, -0.018; P = 0.027) for men.

CONCLUSIONS

The present MR study implies that better protein nutritional status modestly contributes to reducing the risk of frailty.

Frailty in ethnic minority women

In majority populations in high- and middle-income countries, women live longer yet experience higher levels of frailty than men of the same age. It is unclear whether this 'sex-frailty paradox' is present in ethnic minority populations. In this narrative review, we explore biological, behavioural and social factors associated with mortality, morbidity and frailty in women, particularly ethnic minority women. We ascertain that natural menopause occurs earlier in women of particular ethnicities. Ethnic minority women (living in high-income countries) have more children and higher rates of chronic disease and disability, all of which are associated with frailty. In some ethnic minorities, women are less likely to engage in deleterious health behaviours such as smoking and alcohol consumption. However, in others the reverse is true. Women from migrant ethnic minorities tend to have lower levels of physical activity. With time, they can also adopt adverse behavioural patterns of the majority population. Although the evidence is sparse, sex differences in health reporting and social assets, as well as gender roles, are likely to contribute to sex differences in frailty in ethnic minorities. Overall, ethnic minority women are a particularly vulnerable group, but the majority of risk factors for frailty appear to be mutable rather than fixed. Future research may examine interventions that target frailty in different races and ethnicities at individual, population and global levels.

Cell and Cell-Free Therapies to Counteract Human Premature and Physiological Aging: MSCs Come to Light

The progressive loss of the regenerative potential of tissues is one of the most obvious consequences of aging, driven by altered intercellular communication, cell senescence and niche-specific stem cell exhaustion, among other drivers. Mesenchymal tissues, such as bone, cartilage and fat, which originate from mesenchymal stem cell (MSC) differentiation, are especially affected by aging. Senescent MSCs show limited proliferative capacity and impairment in key defining features: their multipotent differentiation and secretory abilities, leading to diminished function and deleterious consequences for tissue homeostasis. In the past few years, several interventions to improve human healthspan by counteracting the cellular and molecular consequences of aging have moved closer to the clinic. Taking into account the MSC exhaustion occurring in aging, advanced therapies based on the potential use of young allogeneic MSCs and derivatives, such as extracellular vesicles (EVs), are gaining attention. Based on encouraging pre-clinical and clinical data, this review assesses the strong potential of MSC-based (cell and cell-free) therapies to counteract age-related consequences in both physiological and premature aging scenarios. We also discuss the mechanisms of action of these therapies and the possibility of enhancing their clinical potential by exposing MSCs to niche-relevant signals.

The Science of Frailty: Sex Differences

Frailty is an important clinical syndrome of age-related decline in physiologic reserve and increased vulnerability. In older adults, frailty leads to progressive multisystem decline and increased adverse clinical outcomes. The pathophysiology of frailty is hypothesized to be driven by dysregulation of neuroendocrine, inflammatory, and metabolic pathways. Sex-specific differences in the prevalence of frailty have been observed. Treatment interventions of geriatric care can be applied to the care of frail older women with these differences in mind. As additional evidence regarding sex-specific differences in frailty emerges, research efforts should encompass the development of screening tools and therapeutic interventions that optimize outcomes.

Surgical Management of Facial Fractures in Geriatric Patients

ABSTRACT

Facial fractures comprise a substantial part of traumatology. Due to aging of the population, over the last 20 years, there has been a pattern of redistribution of these fractures with a higher incidence at an older age. The aim of this study was to retrospectively analyze the epidemiology, pattern, and surgical management of facial fractures in geriatric patients presenting at a single tertiary trauma center.This study included patients aged ≥70 years who presented with facial bone fractures between 2008 and 2017 and were treated with surgical interventions. Parameters such as age, sex, American Society of Anesthesiologists classification, Glasgow Coma Scale score, fracture type, fracture mechanism, concomitant injuries, duration of hospitalization, and postoperative complications were evaluated.A total of 300 patients were included: 118 men (39.3%) and 182 women (60.7%). The mean age was 78.8 years. An orbital floor fracture was the most common injury (35.1%). The most common cause of fracture was a fall at home (67%). A total of 113 patients (37.7%) had 162 concomitant injuries, 35 patients (11.7%) suffered from polytrauma, and 7 patients developed postoperative complications. The average length of stay was 1.67 days in the intensive care unit and 5.50 days in the standard ward. Polytrauma, pre-existing medical conditions, and oral anticoagulation had a significant impact on the duration of hospitalization.Facial fractures are common in combination with other injuries. Women are more often affected than men, and falling at home is the most common cause of facial injuries. Postoperative complications are rare.

Frailty Status Among the Elderly of Different Genders and the Death Risk: A Follow-Up Study

Background: Frailty in the elderly population is currently a frontier and focus in the field of health and aging. The goal of this study was to explore the frailty status among the elderly of different genders and its influence on the risk of death during 11 years.

Methods: Frailty index (FI) was used to evaluate the frailty status in the elderly based on the baseline data conducted in 2009; and death as outcome variables collected in 2020 were analyzed. The difference of the frailty level and mortality of different genders was compared. Cox regression and Kaplan–Meier curves were applied to evaluate the influence on the risk of death and the 11-year survival of the elderly at different level of frailty, respectively.

Results: Totally, 1,246 elderly people were recruited. The mortality in men (43.7%, 227/519) was statistically higher than that in women (34.3%, 249/727) (x² = 11.546, P = 0.001). Deficits accumulated exponentially with age, and at all ages, women accumulated more deficits than do men on average (B = 0.030 vs. 0.028, t = 4.137, P = 0.023). For any given level of frailty, the mortality rate is higher in men than in women, and the difference in mortality between genders reached the peak when FI value was 0.26. Cox regression analysis showed that FI value had a greater impact on the risk of death in older men (HR = 1.171, 95%CI: 1.139~1.249)than that in older women (HR = 1.119, 95%CI: 1.039~1.137). Survival analysis showed that the median 11-year survival time in women was longer than that in men (95.26 vs. 89.52 months, Log rank = 9.249, P = 0.002). Kaplan–Meier curves showed that the survival rate decreased with the increase of frailty, and at the same level of frailty, survival time in older women was longer than that in older men, except for severe frailty (FI ≥ 0.5).

Conclusion: The frailty status and its influence on mortality are different among the older people of different genders; therefore, specific interventions for frailty should be conducted in the elderly population of different genders, as well as of different degrees of frailty.

Gender Issues in the Care of Elderly: A Narrative Review

Aging is an inevitable physiological process. A significant increase has been noted in the elderly population over the years. Aging population face challenges with physical health conditions, but also mental health problems. Care of the elderly is influenced by health conditions, health services, as well socio cultural factors. Gender plays an important role in the aging process with significant differences noted in the aging process, variations in health conditions as well care received. The current review addresses the role of gender in the aging process and its influence in the prevalence, clinical presentation and course of various mental and physical health conditions in the elderly. The review identifies gaps in understanding the gender perspectives related to long-term elderly care, legal and financial issues. The review emphasizes the necessity to address the gender perspective in aging to adequately meet the health demands of the elderly.

Age- and Gender-Specific Prevalence of Frailty and Its Outcomes in the Longevous Population: The Chinese Longitudinal Healthy Longevity Study

Background: Frailty is an epidemic age-related syndrome addressing heavy burden to the healthcare system. Subject to the rarity, age-, and gender-specific prevalence of frailty and its prognosis among the longevous population remains under-investigated.

Methods: Based on the Chinese Longitudinal Healthy Longevity Study (CLHLS, 2008–2018), individuals aged ≥ 65 years having complete data of frailty were recruited. Modified Fried criteria (exhaustion, shrink, weakness, low mobility, and inactivity) were adopted to define pre-frailty (1–2 domains) and frailty (≥3 domains), respectively. The association between pre-frailty/frailty and adverse outcomes (frequent hospitalization, limited physical performance, cognitive decline, multimorbidity, and dependence) was analyzed using logistic regression models. The association between pre-frailty/frailty and mortality was analyzed using Cox proportional hazards models. Age- and gender-stratified analyses were performed.

Results: Totally, 13,859 participants aged 85.8 ± 11.1 years, including 2,056 centenarians, were recruited. The overall prevalence of pre-frailty and frailty were 54.1 and 26.3%, respectively. Only 5.0% of centenarians were non-frailty whereas 59.9% of the young-old (65–79 years) showed pre-frailty. Both pre-frailty and frailty were associated with the increased risk of multiple adverse outcomes, such as incident limited physical performance, cognitive decline and dependence, respectively (P < 0.05). Frail males were more vulnerable to the risk of mortality (hazard ratio [HR] = 2.3, 95% confidence interval [CI], 2.1–2.6) compared with frail females (HR = 1.9, 95%CI, 1.7–2.1). The strongest association between frailty and mortality was observed among the young-old (HR = 3.6, 95%CI, 2.8–4.5). Exhaustion was the most common domain among patients with pre-frailty (74.8%) or frailty (83.2%), followed by shrink (32.3%) in pre-frailty and low mobility (83.0%) in frailty. Inactivity among females aged 65–79 years showed the strongest association with the risk of mortality (HR = 3.50, 95%CI, 2.52–4.87).

Conclusion: A huge gap exists between longer life and healthy aging in China. According to the age- and gender-specific prevalence and prognosis of frailty, the strategy of frailty prevention and intervention should be further individualized.

The degree of frailty as a translational measure of health in aging

Frailty is a multiply determined, age-related state of increased risk for adverse health outcomes. We review how the degree of frailty conditions the development of late-life diseases and modifies their expression. The risks for frailty range from subcellular damage to social determinants. These risks are often synergistic-circumstances that favor damage also make repair less likely. We explore how age-related damage and decline in repair result in cellular and molecular deficits that scale up to tissue, organ and system levels, where they are jointly expressed as frailty. The degree of frailty can help to explain the distinction between carrying damage and expressing its usual clinical manifestations. Studying people-and animals-who live with frailty, including them in clinical trials and measuring the impact of the degree of frailty are ways to better understand the diseases of old age and to establish best practices for the care of older adults.

Sex differences in frailty: Comparisons between humans and preclinical models

Frailty can be viewed as a state of physiological decline that increases susceptibility to adverse health outcomes. This loss of physiological reserve means that even small stressors can lead to disability and death in frail individuals. Frailty can be measured with various clinical tools; the two most popular are the frailty index and the frailty phenotype. Clinical studies have used these tools to show that women are frailer than men even though they have longer lifespans. Still, factors responsible for this frailty-mortality paradox are not well understood. This review highlights evidence for male-female differences in frailty from both the clinical literature and in animal models of frailty. We review evidence for higher frailty levels in female animals as seen in many preclinical models. Mechanisms that may contribute to sex differences in frailty are highlighted. In addition, we review work that suggests frailty may play a role in susceptibility to chronic diseases of aging in a sex-specific fashion. Additional mechanistic studies in preclinical models are needed to understand factors involved in male-female differences in frailty in late life.

FRAGILIDADE EM PESSOAS IDOSAS RESIDENTES NO DOMICÍLIO INSCRITAS NUMA UNIDADE DE SAÚDE DO NORTE DE PORTUGAL

Introdução: Com o aumento da longevidade e declínio da função física, psicológica e social dos idosos é essencial perceber as condições sociodemográficas e de saúde que concorrem para a fragilidade. Objetivos: Analisar o perfil de fragilidade dos idosos de uma unidade de saúde do norte de Portugal. Metodologia: Estudo descritivo, transversal com 173 idosos a residir no domicílio e inscritos numa Unidade de Saúde. Como instrumento de recolha de dados usou-se um inquérito, realizado por telefone, contendo dados sociodemográficos, de saúde e o Índice de fragilidade de Tilburg (TFI). Resultados: Amostra predominantemente feminina com idade média de 81,11 anos, maioritariamente casados, com diversas comorbilidades e polimedicados. A representação da fragilidade foi de 60,7%, estando essa condição significativamente associada ao género, estado civil, número de doenças crónicas, polimedicação e autoperceção da saúde. Para a maioria dos idosos (83,8%), a condição de fragilidade é influenciada cumulativamente pelas dimensões físicas, psicológicas e sociais. Conclusão: A fragilidade é uma condição prevalente e o perfil está associado a um conjunto de caraterísticas nas quais é possível intervir retardando a progressão da fragilidade que ocorre com o envelhecimento.

Housing and Care for Older Women in Australia

Background: Housing is essential for healthy ageing, being a source of shelter, purpose, and identity. As people age, and with diminishing physical and mental capacity, they become increasingly dependent on external supports from others and from their environment. In this paper we look at changes in housing across later life, with a focus on the relationship between housing and women's care needs.

Methods: Data from 12,432 women in the 1921–26 cohort of the Australian Longitudinal Study on Women's Health were used to examine the interaction between housing and aged care service use across later life.

Results: We found that there were no differences in access to home and community care according to housing type, but women living in an apartment and those in a retirement village/hostel were more likely to have an aged care assessment and had a faster rate of admission to institutional residential aged care than women living in a house. The odds of having an aged care assessment were also higher if women were older at baseline, required help with daily activities, reported a fall, were admitted to hospital in the last 12 months, had been diagnosed or treated for a stroke in the last 3 years, or had multiple comorbidities. On average, women received few services in the 24 months prior to admission to institutional residential aged care, indicating a potential need to improve the reach of these services.

Discussion: We find that coincident with changes in functional capacities and abilities, women make changes to their housing, sometimes moving from a house to an apartment, or to a village. For some, increasing needs in later life are associated with the need to move from the community into institutional residential aged care. However, before moving into care, many women will use community services and these may in turn delay the need to leave their homes and move to an institutional setting. We identify a need to increase the use of community services to delay the admission to institutional residential aged care.