Associations between frailty trajectories and frailty status and adverse outcomes in community-dwelling older adults

Frailty: a global health challenge in need of local action

Frailty is a complex, age-related clinical condition that involves multiple contributing factors and raises the risk of adverse outcomes in older people. Given global population ageing trends, the growing prevalence and incidence of frailty pose significant challenges to health and social care systems in both high-income and lower-income countries. In this review, we highlight the disproportionate representation of research on frailty screening and management from high-income countries, despite how lower-income countries are projected to have a larger share of older people aged ≥60. However, more frailty research has been emerging from lower-income countries in recent years, paving the way for more context-specific guidelines and studies that validate frailty assessment tools and evaluate frailty interventions in the population. We then present further considerations for contextualising frailty in research and practice in lower-income countries. First, the heterogeneous manifestations of frailty call for research that reflects different geographies, populations, health systems, community settings and policy priorities; this can be driven by supportive collaborative systems between high-income and lower-income countries. Second, the global narrative around frailty and ageing needs re-evaluation, given the negative connotations linked with frailty and the introduction of intrinsic capacity by the World Health Organization as a measure of functional reserves throughout the life course. Finally, the social determinants of health as possible risk factors for frailty in lower-income countries and global majority populations, and potential socioeconomic threats of frailty to national economies warrant proactive frailty screening in these populations.

Progression of frailty and cardiovascular outcomes among Medicare beneficiaries

BACKGROUND

Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent influence of frailty progression on cardiovascular outcomes remains uncertain.

METHODS

To determine whether frailty progression is associated with adverse cardiovascular outcomes, independent of baseline frailty and age, we evaluated all Medicare Fee-for-Service beneficiaries ≥65 years at cohort inception with continuous enrollment from 2003 to 2015. Linear mixed effects models, adjusted for baseline frailty and age, were used to estimate change in a validated claims-based frailty index (CFI) over a 5-year period. Survival analysis was used to examine frailty progression and risk of adverse health outcomes.

RESULTS

There were 8.9 million unique patients identified, mean age 77.3 ± 7.2 years, 58.7% female, 10.9% non-White race. In total, 60% had frailty progression and 40% frailty regression over median follow-up of 2.4 years. Compared to those with frailty regression, when adjusting for age and baseline CFI, those with frailty progression had a significantly greater risk of incident major adverse cardiovascular and cerebrovascular events (MACCE) (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.31-1.31), all-cause mortality (HR 1.34, 95% CI 1.34-1.34), acute myocardial infarction (HR 1.08, 95% CI 1.07-1.09), heart failure exacerbation (HR 1.30, 95% CI 1.29-1.30), ischemic stroke (HR 1.14, 95% CI 1.14-1.15). There was also a graded increase in risk of each outcome with more rapid progression, as well as significantly fewer days alive at home (DAH) with more rapid progression compared to the slowest progression group (270.4 ± 112.3 vs. 308.6 ± 93.0 days, rate ratio 0.88, 95% CI 0.87-0.88, p < 0.001).

CONCLUSIONS

In this large, nationwide sample of older Medicare beneficiaries, frailty progression, independent of age and baseline frailty, was associated with fewer DAH and a graded risk of MACCE, all-cause mortality, myocardial infarction, heart failure, and ischemic stroke compared to those with frailty regression.

Relationship between tooth loss and progression of frailty: Findings from the English longitudinal study of aging

OBJECTIVE

The objective of the present study was to investigate the relationship between indicators of oral health status (number of teeth; denture use) and the progression of frailty amongst adults in England.

METHODS

The subjects were participants of the English Longitudinal Study of Aging [ELSA] aged 50 years and older. We used panel data from three waves of the study (Waves 7-9). Indicators of oral health comprised the number of teeth (≥20; 10-19; 1-9; 0) and combination of removable denture usage and the number of teeth. Frailty was assessed by the 32-item Frailty Index (FI). Covariates were age, sex, education, marital status, smoking, alcohol, and physical activity. The longitudinal relationship between oral health indicators and change in FI were investigated using linear mixed-effect models considering frailty as a time-varying variable.

RESULTS

Among the 7,557 participants, compared to those people with 20 or more teeth, change in frailty over time was significantly higher among those with less than 20 teeth: 10-19 teeth (β: 0.249, 95 %CI: 0.116 to 0.382), and 1-9 teeth (β: 0.238, 95 %CI: 0.053 to 0.423) and being edentate (β: 0.286, 95 %CI: 0.106 to 0.465) when adjusting for co-variates. The rise in frailty over time was significantly higher among those with fewer teeth (<20 teeth), including those using dentures.

CONCLUSIONS AND IMPLICATIONS

This longitudinal analysis suggests that tooth loss is associated with accelerated progression of frailty and utilizing dentures did not reduce the trend in frailty. Thus, maintaining a functional natural dentition is important in healthy ageing.

A dynamic online nomogram for predicting the heterogeneity trajectories of frailty among elderly gastric cancer survivors

BACKGROUND

Frailty is very common among older people with gastric cancer and seriously affects their prognosis. The development of frailty is continuous and dynamic, increasing the difficulty and burden of care.

OBJECTIVES

The aims of this study were to delineate the developmental trajectory of frailty in older people with gastric cancer 1 year after surgery, identify heterogeneous frailty trajectories, and further explore their predictors to construct a nomogram for prediction.

DESIGN

We conducted a prospective longitudinal observation study. Clinical evaluation and data collection were performed at discharge, and at 1, 3, 6, and 12 months.

SETTING AND PARTICIPANTS

This study was conducted in a tertiary hospital and 381 gastric cancer patients over 60 years who underwent radical gastrectomy completed the 1-year follow-up.

METHODS

A growth mixture model (GMM) was used to delineate the frailty trajectories, and identify heterogeneous trajectories. A regression model was performed to determine their predictors and further construct a nomogram based on the predictors. Bootstrap with 1000 resamples was used for internal validation of nomogram, a receiver operating characteristic (ROC) curve to evaluate discrimination, calibration curves to evaluate calibration and decision curve analysis (DCA) to evaluate the clinical value.

RESULTS

GMM identified three classes of frailty trajectories: "frailty improving", "frailty persisting" and "frailty deteriorating". The latter two were referred to as heterogeneous frailty trajectories. Regression analysis showed 8 independent predictors of heterogeneous frailty trajectories and a nomogram was constructed based on these predictors. The area under ROC curve (AUC) of the nomogram was 0.731 (95 % CI = 0.679-0.781), the calibration curves demonstrated that probabilities predicted by the nomogram agreed well with the actual observation with a mean absolute error of 0.025, and the DCA of nomogram indicated that the net benefits were higher than that of the other eight single factors.

CONCLUSIONS

Older gastric cancer patients have heterogeneous frailty trajectories of poor prognosis during one-year postoperative survival. Therefore, early assessment to predict the occurrence of heterogeneous frailty trajectories is essential to improve the outcomes of elderly gastric cancer patients. Scientific and effective frailty interventions should be further explored in the future to improve the prognosis of older gastric cancer patients.

CONTRIBUTION OF THE PAPER STATEMENTS

This study constructed a static and dynamic online nomogram with good discrimination and calibration, which can help to screen high-risk patients, implement preoperative risk stratification easily and promote the rational allocation of medical resources greatly.

REGISTRATION

ClinicalTrials.gov (Number: NCT05982899).

TWEETABLE ABSTRACT

Our findings identified three frailty trajectories and constructed a nomogram to implement preoperative risk stratification and improve patient outcomes.

Association of depression and sleep quality with frailty: a cross-sectional study in China

Background

With the rapid growth of global aging, frailty has become a serious public health burden, affecting the life quality of older adults. Depressive symptoms (depression hereafter) and sleep quality are associated with frailty, but the pathways in which sleep quality and depression affect frailty remain unclear.

Method

This cross-sectional study included 1866 community-dwelling older adults. Demographic characteristics and health-related data of them was collected, and we also assessed frailty, depression, and sleep quality. Descriptive statistics were carried out and ordinal logistic regression analysis was used to identify the factors correlated with frailty. Spearman correlation analysis and mediation analysis were employed to assess associations between sleep quality, depression and frailty. Two-sided p < 0.05 was considered as significant.

Results

The results showed that 4.1% older adults were frail and 31.0% were pre-frail. Ordinal logistic regression showed that age, consumptions of vegetables, exercise, sleep quality, depression, number of chronic diseases, chronic pain, and self-rated health were correlated with frailty. Spearman correlation analysis revealed that frailty was associated with depression and sleep quality. There was a mediation effect that sleep quality was a significant and positive predictor of frailty (total effect = 0.0545, 95% boot CI = 0.0449-0.0641), and depression was a mediator between sleep quality and frailty (mediation effect = 60.4%).

Conclusion

Depression and poor sleep quality may be early indicators of frailty in older adults. Improving the sleep quality and psychological state of older adults can improve frailty, which is beneficial for healthy aging.

A Mixed Methods Feasibility Study of Machine-Based Resistance Training With Prefrail Older Adults in Residential Care: The Keeping Active in Residential Elderly Trial II

Physical activity is an effective, proactive intervention to reduce or reverse frailty and functional decline. However, uncertainty exists about the feasibility and impact of resistance training on multidimensional health in prefrail older adults in residential care. This mixed methods feasibility study assessed practicability with limited efficacy testing on health and functional outcomes. Eleven prefrail older adults participated in a 6-week progressive resistance training protocol three times per week. The intervention and measures were found to be appropriate and acceptable by those who completed the trial, with participants self-reporting improved well-being, mood, and function. Analysis identified several barriers to recruitment, including prior commitments, seasonal impact, and session timing, and offered potential solutions with further recommendations for program refinement prior to a definitive randomized controlled trial. These findings add to our understanding of prefrail older adults' preferences regarding participation in physical activity research and the perceived benefits of resistance training. This trial was registered with ClinicalTrials.gov: NCT03141879.

Intrinsic capacity trajectories, predictors and associations with care dependence in community-dwelling older adults: A social determinant of health perspective

AIMS

To identify intrinsic capacity trajectories, predictors of intrinsic capacity trajectories and associations between intrinsic capacity trajectories and care dependence in community-dwelling older adults in China.

METHODS

A retrospective longitudinal study was conducted, and the data were obtained from a five-year national longitudinal cohort study of older adults in China between 2011 and 2015. The social determinants of health framework informed the data analysis and interpretation.

RESULTS

A total of 3893 older adults met the selection criteria and were included in the study. Three intrinsic capacity trajectories were identified: high trajectory (15.7 %), stable trajectory (52.7 %) and declining trajectory (31.6 %). Social determinants contribute to intrinsic capacity decline in older adults. Decreased cognitive function, psychological status, and locomotion at baseline were associated with care dependence.

CONCLUSION

Approximately thirty percent of the older adults in this cohort study experienced a decline in intrinsic capacity within a 5-year period. Social determinants contributed to this decline in older adults.

Progression of Frailty and Cardiovascular Outcomes Among Medicare Beneficiaries

Background

Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent influence of frailty progression remains uncertain.

Methods

Medicare Fee-for-service beneficiaries ≥ 65 years at cohort inception with continuous enrollment from 2003-2015 were included. Frailty trajectory was measured by annualized change in a validated claims-based frailty index (CFI) over a 5-year period. Linear mixed effects models, adjusting for baseline frailty, were used to estimate CFI change over a 5-year period. Survival analysis was used to evaluate associations of frailty progression and future health outcomes (major adverse cardiovascular and cerebrovascular events [MACCE], all-cause death, heart failure, myocardial infarction, ischemic stroke, and days alive at home [DAH] within the following calendar year).

Results

26.4 million unique beneficiaries were included (mean age 75.4 ± 7.0 years, 57% female, 13% non-White). In total, 20% had frailty progression, 66% had no change in frailty, and 14% frailty regression over median follow-up of 2.4 years. Compared to those without a change in CFI, when adjusting for baseline frailty, those with frailty progression had significantly greater risk of incident MACCE (hazard ratio [HR] 2.30, 95% confidence interval [CI] 2.30-2.31), all-cause mortality (HR 1.59, 95% CI 1.58-1.59), acute myocardial infarction (HR 1.78, 95% CI 1.77-1.79), heart failure (HR 2.78, 95% CI 2.77-2.79), and stroke (HR 1.78, 95% CI 1.77-1.79). There was also a graded increase in risk of each outcome with more rapid progression and significantly fewer DAH with the most rapid vs. the slowest progression group (270.4 ± 112.3 vs. 308.6 ± 93.0 days, rate ratio 0.88, 95% CI 0.87-0.88, p < 0.001).

Conclusions

In this large, nationwide sample of Medicare beneficiaries, frailty progression, independent of baseline frailty, was associated with fewer DAH and a graded risk of MACCE, all-cause mortality, myocardial infarction, heart failure, and stroke compared to those without progression.

Lung function and the risk of frailty in the European population: a mendelian randomization study

BACKGROUND

Epidemiological evidence has suggested a relationship between lung function and frailty, but the precise nature of the causality remains unclear. In this study, we applied a two-sample Mendelian randomization (MR) analysis to determine the causal effects of lung function on frailty.

METHODS

Single nucleotide polymorphisms (SNPs) independently related (P ≤ 5E-08) to lung function, as identified by genome-wide association study (GWAS), were applied as instrumental variables (IV). The association with frailty index (FI) was investigated using summary-level data from the latest GWAS on FI (n = 175,226). Different statistical methods were employed to evaluate the causal estimates between lung function and FI. The pleiotropy, heterogeneity, and leave-one-out analysis were applied to confirm the stability of the MR estimates.

RESULTS

Using the random-effect inverse-variance weighted approach, genetically proxied forced expiratory volume in the first second (FEV1), ratio of FEV1 on forced vital capacity (FVC) [FEV1/FVC], and peak expiratory flow (PEF) were significantly and inversely associated with FI (FEV1, β = -0.08, P = 2.03E-05; FEV1/FVC, β = -0.06, P = 9.51E-06; PEF, β = -0.07, P = 4.09E-04) with good statistical power (99.7-100%). However, no significant association was observed between FVC and FI (β = -0.01, P = 0.681). Leave-one-out analysis showed that there was no single SNP driving the bias of the estimates. There was potential heterogeneity, but no obvious pleiotropy was founded in this MR study.

CONCLUSIONS

Our findings indicate that impaired pulmonary function is closely related to the risk of frailty. Enhancing lung function in the elderly population may contribute to the prevention of frailty to a certain extent.

Exploration of frailty trajectories and their associations with health outcomes in older gastric cancer survivors undergoing radical gastrectomy: A prospective longitudinal observation study

BACKGROUND

Frailty is commom among gastric cancer survivors and increases the burden of care.

AIMS

Our aims were to identify the frailty trajectories and investigate their associations with health outcomes in older gastric cancer survivors.

METHODS

We finally recruited 381 patients aged ≧60 who underwent radical gastrectomy and recorded frailty at discharge from the hospital, 1, 3, 6, and 12 months after surgery. Growth mixture modeling was used to investigate the frailty trajectories and linear regression models were used to examine their associations with health outcomes.

RESULTS

Three classes of frailty trajectories were identified: the "improving frailty", "maintaining frailty" and "deteriorating frailty". Compared with class 1, patients who followed class 2 and class 3 frailty trajectories were more likely to have more severe disability (β = -14.22, 95 % CI: -17.92, -10.61, P < 0.001; β = -48.34, 95 % CI: -52.25, -44.42, P < 0.001), worse quality of life (β = 10.89, 95 % CI: 7.71,14.08, P < 0.001; β = 34.82, 95 % CI: 31.46, 38.19, P < 0.001), and more frequency readmission within 1 year (β = 1.02, 95 % CI: 0.98, 1.06, P < 0.001; β = 2.10, 95 % CI: 2.01, 2.14, P < 0.001) after controlling potential confounders. However, class 2 and class 3 have no significant difference from class 1 in the total hospitalization costs (β = 1672.12, 95 % CI: -7145.95, 10496.19, P = 0.709; β = 7651.60, 95 % CI: -1670.28, 16793.47, P = 0.107).

CONCLUSIONS

Our study suggested the significant prognostic heterogeneity in frailty trajectories, and what we need to do is to identify patients with heterogeneous trajectory and intervene in them to reduce adverse outcomes, promote rational use of resources, and reduce the burden of care.

Machine Learning Models to Predict Future Frailty in Community-Dwelling Middle-Aged and Older Adults: The ELSA Cohort Study

BACKGROUND

Machine learning (ML) models can be used to predict future frailty in the community setting. However, outcome variables for epidemiologic data sets such as frailty usually have an imbalance between categories, that is, there are far fewer individuals classified as frail than as nonfrail, adversely affecting the performance of ML models when predicting the syndrome.

METHODS

A retrospective cohort study with participants (50 years or older) from the English Longitudinal Study of Ageing who were nonfrail at baseline (2008-2009) and reassessed for the frailty phenotype at 4-year follow-up (2012-2013). Social, clinical, and psychosocial baseline predictors were selected to predict frailty at follow-up in ML models (Logistic Regression, Random Forest [RF], Support Vector Machine, Neural Network, K-nearest neighbor, and Naive Bayes classifier).

RESULTS

Of all the 4 378 nonfrail participants at baseline, 347 became frail at follow-up. The proposed combined oversampling and undersampling method to adjust imbalanced data improved the performance of the models, and RF had the best performance, with areas under the receiver-operating characteristic curve and the precision-recall curve of 0.92 and 0.97, respectively, specificity of 0.83, sensitivity of 0.88, and balanced accuracy of 85.5% for balanced data. Age, chair-rise test, household wealth, balance problems, and self-rated health were the most important frailty predictors in most of the models trained with balanced data.

CONCLUSIONS

ML proved useful in identifying individuals who became frail over time, and this result was made possible by balancing the data set. This study highlighted factors that may be useful in the early detection of frailty.

Association of triglyceride-glucose index trajectory and frailty in urban older residents: evidence from the 10-year follow-up in a cohort study

BACKGROUND

Frailty is an age-related geriatric syndrome that leads to a series of clinically negative events. A better understanding of the factors associated with frailty assists in preventing its progression. The triglyceride-glucose (TyG) index, a simple alternative index of insulin resistance, has not yet been proven to be associated with frailty. The present study aimed to investigate the association between the TyG index and its trajectory with frailty from a cross-sectional, retrospective and prospective level based on an ongoing cohort.

METHODS

This longitudinal study included 1,866 older residents from the "Fujian prospective aging cohort" (ChiCTR 2,000,032,949). The TyG index was calculated as ln [fasting triglyceride (mg/dL) ╳ fasting plasma glucose (mg/dL)/2] and group-based trajectory model (GBTM) was applied to identify the trajectory of TyG index. The association between different trajectory groups of TyG index with frailty risk were estimated using multinomial logistic regression analysis.

RESULTS

In the cross-sectional analysis, the highest quartile of the TyG index was associated with an increased risk of frailty (TyG index Q4 vs. Q1, OR = 1.50, 95% CI 1.00-2.25, P = 0.048). Restricted cubic splines demonstrated an increasing trend for TyG index and frailty risk. During a follow-up of ten years, three distinct trajectories of the TyG index were identified: low-stable (n = 697, 38.3%), moderate-stable (n = 910, 50.0%) and high-stable (n = 214, 11.7%). Compared with those in the stable-low group of TyG index trajectory, the ORs (95% CI) of prefrailty and frailty risk were 1.79 (95% CI 1.11-2.88) and 2.17 (95% CI 1.01-3.88) for the high-stable group, respectively (P = 0.017 and P = 0.038). In the subgroup analysis, the association of the high-stable trajectory of TyG and frailty status were only observed in subjects with BMI ≥ 24 kg/m2. Prospectively, the highest quartile of the TyG index was associated with a 2.09-fold significantly increased risk of one-year ADL/IADL decline (P = 0.045).

CONCLUSIONS

The present study suggests a potential role for a high and sustainable level of TyG index in the risk of frailty. The trajectories of the TyG index can help to identify older individuals at a higher risk of frailty who deserve primitive preventive and therapeutic approaches.

Associations between transitions of intrinsic capacity and frailty status, and 3-year disability

BACKGROUND

The trajectory of frailty and intrinsic capacity (IC) often overlap in older adults. Longitudinal analyses of transitions of frailty and IC, and their associations with incident functional decline are limited. The present study aimed to identify transitions of frailty status and IC, and explore associations between transitions of frailty and IC, and future disability among community-dwelling older adults.

METHODS

In the West China and Aging Trend Study, 808 participants aged ≥ 60 years completed baseline and three years follow-up (frailty, IC and disability assessments). Physical frailty was measured based on Fried phenotype. IC was evaluated by five domains (cognition, locomotion, sensory, psychological, and vitality). Disability was defined as a need for assistance in any items in activity of daily living (ADL) or the instrumental activity of daily living (IADL). Logistic regressions were performed to examine their relationships.

RESULTS

Four transitions of IC status (kept well: 27.4%, improved: 8.4%, worsened: 35.4%, and kept poor: 28.8%), and two transitions of frailty status (kept not-frail/improved: 93.2%, kept frail/worsened: 6.8%) were identified. Impaired locomotion and vitality at baseline were significantly associated with kept frail or worsened frail. However, impaired sensory and vitality at baseline not frailty status was significantly associated with transitions of IC. Adjusted for covariates and transitions of frailty, kept poor IC was associated with ADL (OR = 2.26, 95%CI = 1.17,4.34) and IADL disability (OR = 3.74, 95%CI = 1.79, 7.82).

CONCLUSIONS

Transitions of IC, but not frailty were associated with higher risk of incident disability. Baseline locomotion and vitality impairment were associated with worsened or kept frail. Our findings support the WHO's notion of monitoring and optimizing IC to delay deterioration of IC and preventing frailty and disability.

CLINICAL TRIAL NUMBER

ChiCTR1800018895.

Utility of SCORE2 risk algorithm for predicting life course accelerated frailty and physical function decline

BACKGROUND

Frailty is a dynamic process that increases with ageing, while it remains unclear whether cardiovascular disease (CVD) risk algorithm could predict life course dynamic frailty trajectories, for example, the longitudinal patterns of how frailty evolves with time. We intended to examine the predictive utility of the Systemic Coronary Risk Estimation 2 (SCORE2) algorithm for life course accelerated frailty and physical function decline, in comparison with the precedent SCORE algorithm.

METHODS

Longitudinal data regarding accumulation of deficits frailty index (FI) and physical function (grip strength, gait speed, peak expiratory flow and timed chair rises) were drawn from the English Longitudinal Study of Ageing (ELSA) and Health and Retirement Study (HRS), two nationally representative cohorts with community-dwelling adults aged ≥50 years. SCORE and SCORE2 were calculated at baselines following European Society of Cardiology guidelines. A group-based trajectory modelling approach was used for identifying potential life course frailty trajectories, based on 14- and 12-year FI data in the ELSA and HRS. Modified Poisson regression and linear mixed model were applied for analysing associations between SCORE2 with accelerated frailty trajectory and physical function decline, respectively. Receiver operating characteristic curve (ROC) analysis was conducted to evaluate predictive utility for accelerated frailty increase trajectory of SCORE and SCORE2, with the area under the curve (AUC) compared using the paired DeLong's test.

RESULTS

A total of 4834 participants from the ELSA and 7815 participants from the HRS were included (mean age: 64.0 ± 9.2 and 65.4 ± 9.9 years; men: 44.3% and 41.4%, respectively). Three frailty trajectories were consistently identified in both cohorts: (1) stable frailty increase (n = 3026 in ELSA and 4004 in HRS); (2) moderate frailty increase (n = 1325 in ELSA and 2955 in HRS); (3) accelerated frailty increase (n = 483 in ELSA and 856 in HRS). Each 10% increment in SCORE2 risk was associated with the higher risk of accelerated frailty increase (risk ratio [RR]: 3.58, 95% confidence interval [CI] [3.22, 3.98], P < 0.001 in ELSA; RR: 1.61, 95% CI [1.56, 1.67], P < 0.001 in HRS) and faster declines in all physical function measurements. SCORE2 algorithm showed good accuracy for predicting accelerated frailty increase (area under the curve [AUC] in ELSA: 0.759; HRS: 0.744), with better performance than the SCORE (AUC in ELSA: 0.729; HRS: 0.700) in both cohorts (P < 0.001 for comparison).

CONCLUSIONS

SCORE2 algorithm could serve good utility for predicting life course accelerated frailty increase and physical function decline among community-dwelling non-frail adults aged ≥50 years.

Role of sarcopenia in the frailty transitions in older adults: a population-based cohort study

BACKGROUND

Frailty and sarcopenia are age-associated syndromes that have been associated with the risk of several adverse events, mainly functional decline and death, that usually coexist. However, the potential role of one of them (sarcopenia) in modulating some of those adverse events associated to the other one (frailty) has not been explored. The aim of this work is to assess the role of sarcopenia within the frailty transitions and mortality in older people.

METHODS

Data from the Toledo Study of Healthy Aging (TSHA) were used. TSHA is a cohort of community-dwelling older adults ≥65. Frailty was assessed according with the Frailty Phenotype (FP) and the Frailty Trait Scale-5 (FTS5) at baseline and at follow-up. Basal sarcopenia status was measured with the standardized Foundation for the National Institutes of Health criteria. Fisher's exact test and logistic regression model were used to determine if sarcopenia modified the transition of frailty states (median follow-up of 2.99 years) and Cox proportional hazard model was used for assessing mortality.

RESULTS

There were 1538 participants (74.73 ± 5.73; 45.51% men) included. Transitions from robustness to prefrailty and frailty according to FP were more frequent in sarcopenic than in non-sarcopenic participants (32.37% vs. 15.18%, P ≤ 0.001; 5.76% vs. 1.12%; P ≤ 0.001, respectively) and from prefrailty-to-frailty (12.68% vs. 4.27%; P = 0.0026). Improvement from prefrail-to-robust and remaining robust was more frequent in non-sarcopenic participants (52.56% vs. 33.80%, P ≤ 0.001; 80.18% vs 61.15%, P ≤ 0.001, respectively). When classified by FTS5, this was also the case for the transition from non-frail-to-frail (25.91% vs. 4.47%, P ≤ 0.001) and for remaining stable as non-frail (91.25% vs. 70.98%, P ≤ 0.001). Sarcopenia was associated with an increased risk of progression from robustness-to-prefrailty [odds ratio (OR) 2.34 (95% confidence interval, CI) (1.51, 3.63); P ≤ 0.001], from prefrailty-to-frailty [OR(95% CI) 2.50 (1.08, 5.79); P = 0.033] (FP), and from non-frail-to-frail [OR(95% CI) 4.73 (2.94, 7.62); P-value ≤ 0.001]. Sarcopenia does not seem to modify the risk of death associated with a poor frailty status (hazard ratios (HR, 95%) P > 0.05).

CONCLUSIONS

Transitions within frailty status, but not the risk of death associated to frailty, are modulated by the presence of sarcopenia.

Effects of Multicomponent Training Followed by a Detraining Period on Frailty Level and Functional Capacity of Older Adults with or at Risk of Frailty: Results of 10-Month Quasi-Experimental Study

This study aimed: To analyze the effects of 6-month multicomponent training (MCT) and 4-month detraining on functional capacity and frailty among older adults with/at risk of frailty and to analyze the influence of frailty status on training and detraining adaptations. A total of 106 older adults (80.5 ± 6.0 years) were divided into a control (CON) or training group (TRAIN). The TRAIN performed a 6-month MCT (Eelder-fit), while CON continued their usual lifestyle. Functional capacity was assessed by the Short Physical Performance Battery (SPPB), while frailty was evaluated through Fried (FP) and the short version of the Frailty Trait Scale (FTS-5). Linear mixed models were performed to analyze group effects and to compare differences in changes within and between groups. TRAIN showed improvements in SPPB (3.2 ± 2.4), FP (-0.7 ± 1.3), and FTS-5 (-5.9 ± 5.8), whereas CON improved in SPPB (0.7 ± 2.9) and deteriorated in FTS-5 (2.8 ± 7.6) (all p < 0.05). Group effects favorable to TRAIN were found for all scales during this period (all p < 0.05). After detraining, TRAIN worsened in SPPB (-1.2 ± 2.7) and FTS-5 (4.1 ± 6.1) (both p < 0.05). No relevant differences were observed, accounting for frailty status between TRAIN subgroups. Eelder-fit improved the functional capacity and frailty of this population, whereas 4-months of detraining caused a drop of these variables except in FP.

Healthcare cost expenditures associated to frailty and sarcopenia

Objectives

Frailty and sarcopenia have been related with adverse events, including hospitalization. However, its combined effect with hospitalization-related outcomes, including costs, has not been previously investigated. Our purpose was to explore how frailty, sarcopenia and its interaction could impact on healthcare expenditures.

Methods

1358 community-dwelling older adults from the Toledo Study of Healthy Ageing (TSHA) were included. Sarcopenia was measured using the Foundation for the National Institutes of Health criteria fitted to our cohort. Frailty was defined according to Frailty Trait Scale 5 (FTS5) and the Frailty Index fitted to the cut-off points of TSHA population. Hospitalization costs were taken from hospital records and costs were attributed according to Diagnostic-Related Groups, using as the cost base year 2015. Two-part regression models were used to analyze the relationship between frailty and sarcopenia and hospital admission, number of hospitalizations, length of stay and hospitalization costs.

Results

Sarcopenia was associated only with the probability of being admitted to hospital. Frailty was also associated with higher hospital use, regardless of the frailty tool used, but in addition increased hospital admission costs at follow-up by 23.72% per year and by 19.73% in the full model compared with non-frail individuals. The presence of sarcopenia did not increase the costs of frailty but, by opposite, frailty significantly increased the costs in people with sarcopenia, reaching by 46–56%/patient/year at follow-up. Older adults with frailty and sarcopenia had a higher risk of hospitalization, disregarding the tool used to assess frailty, and higher hospitalization costs (FTS5) in the full model, at the cross-sectional and at the follow-up level.

Conclusions

Frailty is associated with increased hospitalization costs and accounts for the potential effects of sarcopenia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03439-z.

The Usefulness of Radiomics Methodology for Developing Descriptive and Prognostic Image-Based Phenotyping in the Aging Population: Results From a Small Feasibility Study

Background: Radiomics is an emerging field that translates medical images into quantitative data to enable phenotypic profiling of human disease. In this retrospective study, we asked whether it is possible to use image-based phenotyping to describe and determine prognostic factors in the aging population.

Methods: A radiomic frailty cohort with 101 patients was included in the analysis (65 ± 15 years, 55 men). A total of 44 texture features were extracted from the segmented muscle area of the ultrasound images of the anterior thigh. Univariate and multivariate analyses were performed to assess the image data sets and clinical data.

Results: Our results showed that the heterogeneity of muscle was associated with an increased incidence of hearing impairment, stroke, myocardial infarction, dementia/memory loss, and falls in the following two years. Regression analysis revealed a muscle radiomic model with 87.1% correct predictive value with good sensitivity and moderate specificity (p = 0.001).

Conclusion: It is possible to develop and identify image-based phenotypes in the elderly population. The muscle radiomic model needs to further be validated. Future studies correlated with biological data (genomics, transcriptomics, metabolomics, etc.) will give further insights into the biological basis and molecular processes of the developed radiomic model.

Mediating Effect of Physical Activity in the Association between Low 25-Hydroxyvitamin D and Frailty Trajectories: The English Longitudinal Study of Ageing

BACKGROUND: Frailty is associated with adverse health outcomes, and vitamin D (VD) deficiency may be a risk factor. We aimed to identify frailty trajectories and examine the mediating effect of physical activity (PA) on the association between VD deficiency and frailty trajectories. METHODS: We included 2997 participants aged 60 to 85 years from ELSA. VD was measured using serum 25-hydroxyvitamin D [25(OH)D] (sufficient: >50; insufficient: 30−50; deficient: <30 nmol/L). Frailty was assessed by a 60-item frailty index, and PA was measured on the basis of total energy expenditure. Frailty trajectories were identified using group-based trajectory modeling, and the mediation effect of PA was tested using causal mediation analysis. RESULTS: Three distinct frailty trajectories emerged: “Non-frail” (66.48%), “Pre-frail to frail” (25.67%) and “Frail to severely frail” (7.85%). VD deficiency was associated with the “Pre-frail to frail” (OR = 1.51, 95% CI: 1.14, 1.98) and “Frail to severely frail” trajectories (OR = 2.29, 95% CI: 1.45, 3.62). PA only mediated 48.4% (95% CI: 17.1%−270.8%) of the association between VD deficiency and the “Pre-frail to frail” trajectory. CONCLUSIONS: Vitamin D deficiency is associated with the onset and worsening of frailty in older adults, and reduced PA may mediate its impact on the transition from pre-frailty to frailty.